A RESEARCH STUDY ON SEXUALITY AND CONTRACEPTIVE USE AMONG RURAL YOUTHS IN SOUTH WESTERN NIGERIA

BACKGROUND

The youths in the areas of developing nations such as Nigeria have been found to exhibit varying degrees of vulnerability towards sexually transmitted infections (STIs). Most cases of human immunodeficiency virus infection, other STIs and unintended pregnancy occur through unprotected sex. This study, therefore, sought to determine the risky sexual practices and the use of contraceptives among rural youths in two communities in Southwest Nigeria.

Materials and Methods

A cross-sectional study design was used; a semi-structured questionnaire was administered to 640 youths (320 in two separate communities) in 2013. Risky sexual behaviour was measured using five items, namely age at first sexual experience, the use of condom at first sexual intercourse, consistent condom use among youths who had sexual intercourse in the 3 months preceding the study, the number of sex partners 3 months preceding the study and the history of transactional sex. Systematic random sampling technique was used to select one respondent per house. Chi-square at P < 0.05 was used to demonstrate the association between categorical variables. Multivariate logistic regression was used to identify the predictors of risky sexual behaviour and contraceptive use.

Results The mean age was 19.51 ± 2.62 years, whereas the mean age at first sex was 17.33 ± 2.56 years. About 10% of the respondents had engaged in transactional sex. Among respondents who had previously used condom, 31.2% used it at first sexual act, and this was significantly common (P = 0.032) among the males (55.8%) compared to the females (39.7%). About half of the sexually active respondents used condom consistently, and about a quarter (28.6%) had multiple sexual partners. The most popular modern contraceptive methods were male condoms (49.8%) followed by injectables (46.0%) and the pill (30.1%). Male respondents (90.0%) were more likely to know where to procure family planning services (P = 0.001). All sexually active respondents using contraceptives used the male condom, and <5% used hormonal contraceptive namely the pill. Only 22.1% of the sexually active respondents expressed willingness to use contraceptives; within this group, females (29.5%) outscored the males (15.7%) (P = 0.005). More than a quarter (27.9%) reported a past incidence of unintended pregnancy.

Conclusion: A high proportion of respondents were observed to engage in risky sexual behaviour. There is an urgent need for community-based sexuality education and contraceptive use to promote behaviour change and a qualitative study to explore reasons why youths are not using contraceptives.

 INTRODUCTION

According to the World Health Organization African region report for 2008, an estimated 93 million cases of curable sexually transmitted infections (STIs), namely gonorrhoea, chlamydia, syphilis and trichomoniasis, occurred in the region.^[1] Unsafe sexual practices have been implicated in the transmission of STIs. Most cases of STIs are asymptomatic but could lead to complications, which include infertility, cervical cancer and congenital malformations. Because of the fact that the age at sexual debut has been decreasing over the years, young people are now acquiring the infection, which has far reaching implications on their future and health^[1],[2]

At the end of 2015; almost 2% of the global adult population were affected with human immunodeficiency virus (HIV). More than 70% of the people infected lived in sub-Saharan Africa,^[3] with the high burden of the disease further compounding the poverty in the region. Some STIs, especially syphilis and genital ulcer disease, have been implicated as co-factors in the transmission of HIV.^[1] Most cases of HIV infection and STI occur through unprotected sex. Condoms when used correctly and consistently have been shown to be effective against the transmission of HIV, STIs and unintended pregnancy.^[4] It is, therefore, one of the key behavioural components of the HIV prevention strategy.

The world population could increase by as much as six times by 2100 if fertility does not decline, which will aggravate the existing poverty.^[5] Nigeria, one of the countries listed by the United Nations as a developing country, has a high population growth rate of about 3% and an estimated population of about 190 million in 2016.^[6] Like other less developed regions that have at least 18% of their population as young persons within the 15–24 years age group, a high proportion of the country’s population is young. In 2014, the adolescent fertility rate in Nigeria was 112/1000 for the 15–19 years age group.^[7] This presents a challenge and limits the ability of affected young people to complete their education and achieve full economic potential.^[8]

Globally, over a period of 20 years (1990–2010), contraceptive prevalence increased by almost 10% from 54.8 to 63.3%.^[9] In Nigeria, during the same period of time, the national average increased from 7.2 to 14.4% even though it was higher in urban areas.^[9] Unmet need for family planning is highest in developing countries and among disadvantaged individuals who are also more likely to suffer from adverse consequences of unprotected sex. A study conducted among in-school adolescents in Lagos state, Nigeria showed that less than a third of those who were sexually active reported previous use of contraceptives.^[10]

Studies conducted in Africa have demonstrated a link between the education of the girl child and the health outcomes in later years. Early sexual activity and low contraceptive prevalence in Africa increase the volume of unplanned pregnancy and its effects on the health of women and children leading to high maternal and child mortalities.^[11] The gender parity index for sub-Saharan Africa was 0.77 for adults and 0.86 for youths in 2014, and this is an indication that substantial gender gaps exist with respect to literacy rates in this region.^[12] A study conducted in Kenya showed that girls who stayed in school were more likely to postpone their sexual debut than those who drop out of school.^[13]

In Nigeria, basic deprivation such as food deprivation is more common among people who live in the slums and rural areas compared to their urban counterparts. This form of deprivation influences the sexual behaviour of out-of-school youths including involvement in multiple sexual partnerships.^[14],[15] Out-of-school youths are considered to be a disadvantaged group at risk of not having access to sexuality education programmes including the life skill education, which has been shown to be effective in improving contraceptive knowledge and use as well as the practice of safe sex among young people.^[16],[17] This cross-sectional descriptive study was conducted to assess risky sexual practices and the use of family planning methods among youths who can be considered as living in a severely disadvantaged position because they are out of school and live in rural communities. It is hoped that the result of this survey will be useful as evidence to solicit sexual and reproductive health services targeted at out-of-school youths living in rural areas in Nigeria.

Two communities with similar characteristics classified as rural by the appropriate authorities in southwest geopolitical zone of Nigeria were selected for the study: Ajara Vetho in Badagry Local Government Area of Lagos state and Ward Three in Ifo Local Government Area in an adjoining state (Ogun state). According to the 2006 census, Badagry had a population of 241,093 (121,232 males and 119,861 females), whereas Ifo had a population of 524,837 (267,587 males and 257,250 females). The local government secretariat estimates for the population of Ajara Vetho and Ward Three in 2013 were 33,791 and 32,673, respectively. The study population was unmarried rural youths (15–24 years). The sample size was calculated using the formula for descriptive study at P = 0.5 and z of 1.96.

There are 87 settlements in Ajara Vetho, whereas Ward Three has 49; 10 settlements were randomly selected from each region. Community mapping was conducted to ascertain the number of houses on each street, and one in two systematic random samplings was used to select houses, whereas simple random sampling was used to select households. Only one eligible respondent was interviewed per house.

Information was collected with a semi-structured questionnaire by four trained research assistants who had a 1-day training on the objectives of the study and the contents of the questionnaire. Pre-testing was conducted in another Local Government Area among 24 out-of-school youths, after which the questionnaire was further modified.

Out of the 640 questionnaires (320 in each community) that were administered, three were discarded because the respondents opted out of the study before providing all the required information. Risky sexual behaviour was measured using five items: age at first sexual experience, the use of condom at first sexual intercourse, consistent condom use among youths who had sexual intercourse in the 3 months preceding the study, the number of sex partners during the past 3 months and the history of transactional sex. Univariate analysis was presented as frequency tables (socio-demographics). For bivariate analysis, chi-square at P < 0.05 was used to demonstrate the association between categorical variables. Multivariate logistic regression was used to identify the predictors of risky sexual behaviour and contraceptive use. Epi Info statistical software version 3.5.3 (Centers for Disease Control and Prevention, Atlanta, GA) was used for data entry and IBM SPSS software version 20 computer software (Released 2011, IBM SPSS Statistics for windows, Version 20.0; IBM Corp., Armonk, NY) for data analysis.

The study was approved by the ethics and research committee of Lagos University Teaching Hospital, Lagos. Permission to conduct the study was obtained from the appropriate authorities in the two local government areas. Participation was voluntary, and written informed consent was obtained from each of the participants who were assured of confidentiality of the information provided. Personal information that could be used to trace participants was not collected or included in the questionnaires.

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