CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Adolescence is a transitional phase of human growth and development between childhood and adulthood. It is the time when individuals begin to be independent, build new relationships, develop social skills and learn behaviours that will last the rest of their lives and remains one of the most challenging periods in the growth and development of the individual [1]. Adolescents are prone to early unwanted pregnancies, septic abortions, sexual abuse, Sexually Transmitted Infections (STIs) including Human Immunodeficiency Virus (HIV), alcohol and substance use and abuse and vulnerability to early and adventurous sexual activity and child marriage, yet face limited access to family planning services [2]. Adolescent pregnancy remains a major contributor to maternal and child mortality, and to intergenerational cycles of ill-health and poverty [3]. Pregnancy and childbirth complications are the leading causes of death among 15 to 19 years old girls globally, with low and middle –income countries accounting for 99% of global maternal deaths of women ages 15 to 49 years [4].

            Contraceptive prevalence and the unmet need for family planning are key indicators for measuring improvement in access to reproductive health as essential in the 2030 Agenda for Sustainable Development Goals under the target 3.7; ensuring universal access to sexual and reproductive health [5].  Although important progress has been made in increasing family planning coverage with modern contraceptives methods worldwide, there is still a large gap in relation to effectively meet the educational needs on contraception and family planning (FP) goals of adolescents [6].

Among the 1.9 billion women of reproductive age (15-49 years) living in the world in 2019, 1.1 billion have a need for family planning, that is, they are either current users of contraceptives—842 million use modern methods of contraception and 80 million use traditional methods—or have an unmet need for family planning—190 million women want to avoid pregnancy and do not use any contraceptive method.

 In developing countries, one in three women give birth before the age of 20 and pregnancy-related death during childbirth is two times higher compared to women older than 20 years [7]. About 16 million girls aged 15-19 years give birth annually while 2.5 million girls under 16 years give birth each year in developing regions and many of them are unplanned pregnancies [7, 8, 9].  It has been reported that the proportion of adolescent girls presenting with unintended pregnancy and unmet need for contraception remains high in developing countries [10]. According to Ahmed (2012), prevalence rate of modern contraceptive use in sub Saharan Africa only witnessed a slight increase from 23.9% to 28.5% between 2012 and 2017, at less than 1% point annually [11, 12].

Cameroon has a large youth population, with more than 60% of the population under the age of 25. Fertility is falling but remains at a high level, especially among the poor, rural and under educated women, in part because of inadequate access to contraception [13]. According to World Bank collection of development indicators, the contraceptive prevalence rate for married women of childbearing age (15 – 49 years) in Cameroon was reported at 19%% in 2018, year of the latest survey data available [14]. In addition, fertility rates for women aged 15 to 19 years increases from 4% for 15 years to 49% for 19 years with 32% in the rural and 17% in urban setting. Fertility rate also decreases inversely to the level of education, from 48% for those with no education, 22% for those with secondary education level, to 1% for those with a higher level of education. Among adolescents of 15 to 19 years, 18% of girls and 6% of boys already have their first sexual intercourse before the age of 15 years. 3% of these girls have already given birth to their first child and no boy has given birth to a child before the age of 15 years [14]. 

Millions of sexually active girls worldwide want to postpone childbearing until they finish school, gain employment and plan for a family [15].  But sources of information and contraceptive advice are rarely available and accessible to them [16]. It is evident that unprotected sexual intercourse exposes adolescents to not only unplanned pregnancies but also the risk of sexually transmitted infections, including HIV, which currently contributes to the overall disease burden among adolescents in Sub-Saharan Africa including Cameroon [17]. In order to ward off the unintended pregnancies and the possible consequences, contraceptive use has been prioritized as a key intervention [18]. Among the key indicators to track progress towards sustainable development goal 3 are the proportion of women in reproductive age who have their need for family planning satisfied with modern methods, and adolescent birth rate [19].  Therefore the effective use of contraceptive methods would potentially prevent 90% of abortions, 20% pregnancy-related morbidity and a third (32%) of maternal deaths worldwide [20].

The sexual and reproductive health care services in Cameroon are still fragile and insufficient with old technical installations which are sometimes in appalling conditions, inadequate infrastructure, mostly unequally distributed territorially, deficient medical staff coverage of the population, particularly as far as reproductive health services are concerned. Policy makers and program designers must ensure that girls have a healthy transition into motherhood, and this requires the provision of accessible, appropriate, and targeted reproductive health care services that have components tailored to young, first-time mothers [21]. Although contraceptive usage among adolescents in Cameroon is low, little is known and reported about the educational needs of these adolescents regarding knowledge on the types and effectiveness of contraceptives, proper time to use contraceptives, the advantages of using contraceptives and the consequences of not using contraceptives. To develop more responsive interventions that address the problem of low use of contraception among adolescents, it is crucial to understand adolescents’ perceptions and the challenges they face. In addition, it is important to compare the effects of education and service provision on contraceptive use among adolescents.

1.2 STATEMENT OF THE PROBLEM

Projections indicate the number of adolescent pregnancies will increase globally by   2030, with the greatest proportional increase in the West and Central Africa [22, 23]. In Cameroon, out of every 5 adolescent girls, 1 is exposed to the risk of pregnancy [24] and complications during childbirth are the leading cause of death for 15 to 19 year-old globally [25]. In Cameroon, 91.1% of adolescents aged 15 to 19 years have heard of contraception while 47% are using at least a method and 58% have their contraceptives needs satisfied. Reasons accounted for the low utilization rate are low level of education, lack of discussion of contraceptive use with partners, lack of information on contraceptive sources and side effects of contraceptives [14]. Little is known about adolescents’ educational needs on contraception in Mamfe health district and nearly half of adolescents have had essential knowledge about reproductive health [26]. Adolescents’ contraceptives utilization rate in Mamfe health district is presumably low and this is due to inappropriate information sources interwoven with other socio-demographic, socio-cultural, socio-economic and religious factors. Therefore, it is essential to assess the educational needs on contraceptives use among these adolescents.

1.3 JUSTIFICATION OF STUDY

Reproductive health activities have been implemented in Mamfe health district as in other parts of Cameroon, but the utilization rate of contraceptives is presumed low [37]. The results of this study may reveal a high utilization rate of contraceptives among adolescents, which will help the reproductive health unit and the district health team to understand the challenges of the existing interventions of contraception. On the other hand, if the results reveal that the utilization rate is low, benefits of contraception interventions will be justified.

Findings of this study will help reveal the educational needs on contraceptives usage among adolescents of Mamfe health district. It will also determine appropriate strategies and policies that can help the district in planning.

This study will also add to the existing literature and further serve as the base for other studies to be conducted in other areas.

More importantly, the study’s recommendations will go a long way to strengthen institutions and guide policies towards increasing the overall utilization rate of contraceptives in Cameroon.

1.4 RESEARCH GOAL

The study sought to determine the Knowledge, practice and barriers of modern contraceptives among women of reproductive age.

RESEARCH HYPOTHESES

1. Contraceptives utilization rate among adolescents of Mamfe health district is low.
2. Adolescents of Mamfe health district have inadequate knowledge on contraception
3. The contraception challenges among adolescents of Mamfe health district are not known
4. The educational strategies for appropriate contraceptive use are insufficient

1.6 RESEARCH QUESTIONS

1. What is the contraceptives utilization rate among adolescents of Mamfe Health District?
2. What knowledge do adolescents of Mamfe health district have on contraception?
3. What contraception challenges do adolescents face in Mamfe health district?
4. What educational strategies are appropriate to improve on contraceptives usage among adolescents of Mamfe health district?

1.7 RESEARCH OBJECTIVES

1.7.1 General objective

The main aim of this study was to Knowledge,practice and barriers of modern contraceptives among women of reproductive age.

1.7.2           Specific objectives

1. To determine the contraceptive utilization rate among adolescents of Mamfe health district
2. To assess the level of knowledge on contraception among adolescents of Mamfe health district
3. To identify the challenges that influence contraceptive use among adolescents of Mamfe health district
4. To determine appropriate strategies to improve on contraceptives usage among adolescents of Mamfe health district