Most young person will become sexually active before their 20 th birthday having to battle with early and unplanned pregnancies, unsafe abortions, maternal deaths and injuries. This study examined young person’s sexual knowledge, attitudes and practices and their levels of utilization of sexual reproductive health. Our study progresses beyond current research of reporting only sexual behaviour among youth to have insight into sexual and reproductive health update drivers yielding new empirically robust results for the Ghanaian case for sexual and reproductive health service uptake. The descriptively cross sectional design was employed in sampling 170 youth (150 surveyed and 20 Interviewed) using the stratified sampling technique together with a purposive selection of one key informant. Test of significance and associations were performed with the Chisquare test. In all 45.2% (77/170) of youth (10 - 24) had had sexual experience in life time. In respect of in-school youth, 42% (63/150) had had sexual experience whiles 70% (14/20) out-of-school youth had had sexual intercourse in life time. A total of 28.8% (49/170) of all the youth had sexual intercourse in the last six months with only 40.1 (20/49) using condom for protection. Parental discussion of contraceptive methods (29.3%) and sexual and romantic relationship (28.0%) was the least sexual and reproductive health area discussed among in-school youth. Youth knowledge of the available sexual reproductive health service was statistically associated with reproductive health service utilization (X 2 = 0.00, P ≤ 0.05). A concerted effort is required from government, NGO, Civil society organizations and religious bodies to help translate youth knowledge about sexual health into responsible sexual life and protective sex.
Young people can be defined as those aged 10 - 24 years, and this group combines adolescents-aged 10 - 19 years- and youth-aged 15 - 24 years [
The UNICEF reports that concern about Youth Reproductive Health has grown following reports that sexual related activities, early pregnancies and sexually transmitted diseases rates are continuously increasing among young people in developing countries [
Many of the young people across the world have had to navigate their way through sexual maturity without the benefit of any information or services which are known to promote healthy sexual and reproductive life. Adolescence stage of the youth has been noted to represent the period with the highest frequency of negative consequences. These consequences are associated with sexual activities like sexually transmitted diseases and unwanted pregnancies [
In the study of Hock-long and others [
It has also been observed by Frost and Driscoll [
In a study by the Pathfinder [
In using multiple logistic regression analyses, Bogale & Seme [
The need for an exploration into reproductive health knowledge levels among Ghanaian youth, their sexual attitude and how it influences their reproductive health service utilization is timely. This paper has as its objective examining youth knowledge, sexual attitude and practice and reproductive health service utilization.
The study was conducted in the Kwadaso Sub-Metropolitan district of Ghana. The Kwadaso Sub-metro district is located in the western part of Kumasi, the Ashanti regional capital of Ghana and shares boundary with Atwima Nwabiagya (Nkawie) to the north, Bantama to the South Nhyiaeso to the east and the Atwima Kwawoma (Ofoase) to the west. The Sub Metro Council comprises fifteen communities which are sub-divided into nine (9) electoral areas. It has a population of 220,798 [
The study used both qualitative and quantitative methods. The study design was descriptive cross-sectional survey. The data was collected between January 2014 and May, 2014. The multi-stage sampling technique was employed in the study. The simple random sampling facilitated the selection of one school from each level of educational ladder (Junior high school, Secondary and Tertiary) within the Kwadaso Sub Metro district and designated as the primary sampling unit. Using a three stage stratified technique, the in-school youth were stratified according to the levels of their education; Junior high school, Secondary and Tertiary as the Secondary sampling Unit (SSU). The in-school secondary sampling units (PSUs) was then selected with probability proportional to size. Fifty (50) students were selected from the three schools with the Forms (Form 1, Form 2 and Form 3) serving as stratum within which students were randomly sampled. The tertiary sampling unit involved conducting face-to-face interviews for out of school youth. Verbal and written informed consent was obtained from all participants. The final response rate was 100% for the interviewees and 94% for the questionnaires.
Interviews informed the collection of qualitative data. The study area was divided into two and 20 youth interviewed with 10 youth coming from Sofo-line area as the unaffiliated youth base known for its marketing and hawking and the Kwadaso-Fie as the affiliated youth with so many apprentices shops. All youth aged 10 - 24 were considered as constituting the population of the study. A total of one hundred and Seventy (170 youth (in-school, affiliated to an apprenticeship and non-affiliated street hawking youth) were sampled using stratified random techniques. The inclusion criteria involved youth who had stayed or schooled in the study area for at least six months and was aged 10 - 24 years. Two methods were adopted in collecting data. This was through the administration of questionnaires and interviews. The questionnaires were pre-tested at Elite College; a mixed sex Secondary School and modifications were made on the questionnaire.
Variables were measured at nominal level with a “Yes” or “No” response. The Independent variable was “Knowledge of available reproductive health services” with the dependent variable being “Reproductive health services utilization”. Participants were asked to indicate whether they knew or were in the known of any available facility based youth friendly reproductive health services offered to them in the study area and whether they had accessed any reproductive health service from any reproductive health services facility in the area in their life time of schooling or staying in the district. Through the application of the triangulation approach, probing and negative case analysis, reliability and validity of data was ensured.
Data collected through the surveys were analyzed using both descriptive and inferential statistics. Results were cross-tabulated to identify patterns. The chi-square test and Pearson moment correlations were performed to find out whether there was any association between young people’s knowledge of available youth friendly reproductive health service and service utilization. The Confidence Interval was taken as ±1.96 at 95% confidence level. The qualitative data was analyzed by transcribing whiles applying the pattern matching method. The data was later categorized into appropriate themes on the basis of the study objectives. Content and thematic analysis formed the basis for the interpretation.
The study complied with the ethical requirements necessary to protect human subjects in research. Permission was sought from the headmasters/mistresses of the schools which participated in the survey. Additionally, written and verbal consent was sought from the students and the out-of-school youth before they were administered with the survey tool. Ethical issues which relate to anonymity, privacy and confidentiality were also strictly adhered to.
A total of 170 study participants constituting 150 in-school youth and 20 Out-of school youth (
The variables considered under this section were aimed at eliciting information on youth sexual relationship history, age at first sexual relationship and length of stay in the relationship. From
Characteristic | N | % |
---|---|---|
Sex | ||
Male | 63 | 42 |
Female | 87 | 58 |
Age (years) | ||
12 - 14 | 15 | 10.4 |
15 - 17 | 53 | 35.3 |
18 - 20 | 36 | 24 |
21 - 23 | 40 | 26.7 |
24 + yrs | 6 | 4.0 |
Educational Level | ||
Junior High School | 50 | 33.3 |
Secondary | 50 | 33.3 |
Tertiary | 50 | 33.4 |
Religion | ||
Christianity | 142 | 94.7 |
Moslems | 7 | 4.7 |
Traditionalist | 1 | 0.6 |
Variables | N | % |
---|---|---|
History of boyfriend/girlfriend relationship | ||
Yes | 84 | 56 |
No | 66 | 44 |
Age at first boyfriend/girlfriend | ||
12 - 14 | 17 | 20.4 |
15 - 17 | 25 | 29.7 |
18 - 20 | 31 | 36.9 |
21 - 23 | 11 | 13 |
Length of stay in current or past relationship | ||
Less than a month | 6 | 6.7 |
Two to three months | 13 | 16 |
3 - 6 months | 10 | 12 |
6 - 12 months | 4 | 4.7 |
Over a year | 18 | 21.3 |
Can’t recall | 33 | 39.3 |
The study showed that 60.71% (51/84) of the participants with history of sexual relationship were currently with their boyfriend or girlfriend. This shows a decrease of 33 youth (51/84) who make up a reduction proportion of 39.39% of the total youth who had ever had boyfriend or girlfriend. Females were much more in relationship than males at the current time of the study (31/51 vs. 20/51). Females in sexual relationship were 1.51 times higher than males. Out of the sample participants, 39.8% (20/51) of males had girlfriends, as compared to 60.2% (31/51) of females who had boyfriends. Male youth who had ever had girlfriend but at the time of the study were without girlfriend was 57.8% compared to 42.2% females of similar characteristics. Generally, the proportion of youth with sexual experience was near half. In all, 45.2% (77/170) out of the sampled study population (In- school and out of school youth) had history of sexual experience. A total of 63 representing 42% of in-school youth had engaged in pre-marital sex in their life time. Out of this, almost two thirds 69.8% (44/63) had had sex in the last six months preceding the conduct of the study. The total number of youth (All categories-both In- school and out-of-school youth) who had had sex in the last six months preceding the conduct of the study were 28.8% (49/170) comprising 44 in-school youth and five out-of-school youth.
Out of the total number of in-school youth who had ever had sexual experience in lifetime, females who had had sexual experience were higher 55.6% (35/63) compared to 44.4% males (28/63). The evidence show that sexually active out-of-school youth were smaller 25% (5/20) in proportional terms than the sexually active in- school youth, 29.3% (44/150) with sexual experience in the last six months. In respect of the twenty (20) youth who were interviewed, the study identified that only six of them had not had sexual experience. The remaining fourteen (14) with ages ranging between 14 to 24 had had sexual exposure with some having it more than once. The results are presented in
An interview with a key informant who had had working relationship with youth and pastors one of the biggest youth congregation in the study area corroborated the evidence:
Investigator: What are your views on the sexual behaviour of your churched youth?
Key Informant (KI): Sexual behaviour is a threat to youth in general of which the church youth are not exempted. This day’s youth cannot control their passion for sex. They easily engage in sex. This has eaten into church that Christian brothers and sisters before they marry they have sex.
First as Paul advised Timothy to free from youthful lust, youth of today rub into it. They take adventure to explore.
He continued when asked the extent to which the youth are engaging in risky sexual behaviour:
“Youth talk on sex on phones, Facebook, Whats App and other social media. They also engage in them through kissing and other sexual words that could lead to sexual abuse. They do not use any of the contraceptives to protect themselves. They do not check their blood groups, sickle cells, HIV Virus and other related diseases”.
A female, 18 year old youth in the unaffiliated category affirmed this by saying:
“I had several sex with my boyfriend, he was my boyfriend so once we were in love we had sex”.
Gender of Youth | Current Boyfriend/Girlfriend status of youth | Total | Percentage | ||
---|---|---|---|---|---|
Male | Yes | No | |||
20 | 14 | 34 | 40.5 | ||
Female | 31 | 19 | 50 | 59.5 | |
Total | 51 | 33 | 84 | 100 | |
Gender and youth lifetime ever sexual experience | |||||
Gender of Youth | Whether in-school Youth has had sex in life time | Total | Percentage | ||
Male | Yes | No | |||
28 | 27 | 56 | 41.7 | ||
Female | 35 | 43 | 78 | 58.3 | |
Total | 63 | 70 | 134 | 100 |
An interview with the youth in affiliated category (dressmaker, hairdressers, bakers etc) in the study area brought to the fore that, they have minimally used sexual and reproductive health services. Four hair dressers agreed on the same point by saying:
“As for us we have never been to any hospital for these services you are talking about before”.
A lady who plaits hair when asked her shared experience on service use opined:
“Reproductive health services that we know and have used before are counseling received from our church leaders on abstinence”. One young lady age 21, intimated;
“I have never used any sexual reproductive health service and have never also have sex before and I think I don’t need it. I am ok.―A 23 year lady seamstress from Asuoyeboa, Kwadaso.
When youth in the unaffiliated category were interviewed, similar results were identified. In quoting, one female youth interviewed;
“I have used female condom before and, my guy asked me to use it so I don’t get pregnant. Also I had some menstrual problem so I visited a nearby hospital down there [Name Withheld] and the nurses gave me sexual counseling on menstrual pains and pregnancy”―A 20 year Credit card seller.
Similar opinion was expressed by a male store keeper who shared his experience:
“For sexual reproductive health, the actual hospital one, I have not gone for any services there, but I have received counseling services from my church pastor on abstinence. Apart from that I haven’t gone for any services at any place. In fact, I don’t just know where to go for it. I sometimes hear about information on condom, family planning and some advert on T.V”―A 17 year male store keeper.
In contrast, a nineteen year SHS graduate opined that he had used SRHS before, he had this to say
“I have used condom before, I used it when I was young, I used to watch pornography. I was very young then, it was later on that I used condom. But for now, I don’t use it―A19 Nineteen SHS graduate―St. Peters area― Kwadaso.
The total number of youth who had been sexually active in the past six months was 49 (
Nine of the 13 youths had performed abortion only once, three had aborted three (3) pregnancies. One parti- cipants however said she had engaged in abortion more than thrice. Majority 46.1% (6/13) of respondents said their abortion was performed by a specialist at a hospital or health care center with four (4) performing their abortion through self-medication.
A key informant interviewed during the study shared his views on abortion and contraceptive usage by the youth. He had this to say:
An abortion of any form by the youth is a sin against God and must be prevented by teachings. The youth need to be taught to abstain from sex. My view is to teach the youth to abstain from sex. Safe sex is only applicable only by obeying the natural laws. I will rate the sexual abstinence to be 70%.
When further asked about his views on abortion and contraceptive use, he shared:
An abortion of any form by the youth is a sin against God and must be prevented by teachings. The youth need to be taught to abstain from sex. My view is to teach the youth to abstain from sex. Safe sex is only applicable only by obeying the natural laws. I will rate the sexual abstinence to be 70%―Key Informant.
Awareness of family planning methods and practice, knowledge of STI and HIV prevention methods and approaches have profound influence on reproductive service utilization. Safe sex practices, how to say no to sex and HIV/AIDS prevention, affirmed by (57.3%) of study participants, were the most frequent sexual and reproductive
Variables | N | % |
---|---|---|
Sexually active by youth status | ||
In school youth | 44 | 89.8 |
Out of school youth | 5 | 10.2 |
Condom use by youth in past six months sex | ||
Yes | 20 | 40.9 |
No | 29 | 59.1 |
Why youth did not use condom | ||
Shy and afraid to ask partner | 9 | 31.0 |
Condom use is not considered needful | 6 | 20.7 |
Condom use not enjoyable | 5 | 17.3 |
Irritation when condom is used | 4 | 13.8 |
Condom can get lost in vagina | 3 | 10.3 |
Condom can burst during intercourse | 2 | 6.9 |
Youth ever been pregnant (N = 170) | ||
Yes | 15 | 8.8 |
No | 155 | 91.2 |
Outcome of last pregnancy | ||
Gave birth | 2 | 13.3 |
Had abortion | 13 | 86.7 |
Frequency of abortion by female youth | ||
Once | 9 | 69.2 |
Twice | 3 | 23.1 |
Thrice or more | 1 | 7.7 |
Place of performing the abortion | ||
Self-medication/going to drug store to buy drug | 4 | 30.8 |
A specialist at a hospital/health care center | 6 | 46.2 |
Use of traditional herbs | 2 | 15.4 |
Other Method | 1 | 7.6 |
health domains that youth received much education from their parents and adult family members. Discussion on sexual and romantic relationship was very low at a percentage of 28.0% among youth. Participant’s discussion on contraceptive methods with adult family member was very low and reported among only 29.3% of In-school study participants. The majority of the youth got informed about sexual and reproductive health through radio. The school also serves as a channel to inform 44.0% of the youth studied.
Family planning services constitute a component of sexual and reproductive health services. Some of the family planning services and options are facility based, others are non-facility based whiles some are both. The family planning options ever used by the youth are therefore both facility-based (Contraceptives: Pills, IUD, Injectable, Condoms etc.) and non-facility based sexual reproductive health services (Withdrawal) and both (Abstinence, Natural method). The results as illustrated in
Variables | N | % |
---|---|---|
Sexual and Reproductive health area discussed with parents | ||
HIV/AIDS prevention | 86 | 57.3 |
How to say No to sex | 86 | 57.3 |
Safe sex practice | 86 | 57.3 |
Female menstrual cycle | 77 | 51.3 |
Sexually transmitted infections | 72 | 48.0 |
How pregnancy occurs | 68 | 45.3 |
Use of contraceptive methods | 44 | 29.3 |
Sexual and romantic relationship | 42 | 28.0 |
Sources of information on SRH, STI and HIV/AIDS (N = 150) | ||
Radio | 78 | 52.0 |
Friends | 46 | 30.7 |
Health Worker | 45 | 30.0 |
Newspaper | 38 | 25.3 |
Relatives | 20 | 13.3 |
Youth group | 20 | 13.3 |
Posters/books/pamphlet | 14 | 9.3 |
Mosque | 1 | 0.7 |
Church | 29 | 19.3 |
School | 66 | 44.0 |
Private Clinic | 18 | 12.0 |
Grocery/Pharmacy | 4 | 2.7 |
Family Planning method used by all youth (N = 170) | ||
Pill | 8 | 4.7 |
IUD | 2 | 1.1 |
Injections | 7 | 4.1 |
Condoms | 29 | 17 |
Natural Method | 5 | 2.9 |
Withdrawal | 2 | 1.1 |
Abstinence | 8 | 4.7 |
None of the FP methods | 109 | 64.1 |
Experience of STI infection in the past 12 months | ||
Syphilis | 10 | 6.7 |
Gonorrhea | 19 | 12.7 |
Genital warts | 4 | 2.7 |
Cancroid | 3 | 2.0 |
Chlamydia | 1 | 0.7 |
Herpes simplex | 1 | 0.7 |
None | 112 | 74.7 |
Disclosure of STI infection to sexual partner, N = 38 | ||
Yes | 10 | 26.4 |
No | 17 | 44.7 |
Don’t remember | 11 | 28.9 |
utilizing condoms. The rest gave answers like pill (4.7%), IUD (1.1%), injections (4.1%), natural method (2.9%), withdrawal (1.1%) and lastly abstinence (4.7%).
The study further illustrates the STIs that in-school youth has had in the past 12 months. Majority 12.6% (10/150) had acquired Gonorrhea. In the past one year, 6.7% of study participants had contracted Syphilis infection, with 2.7% and 2.0% reporting history of Genital warts Cancroid infection. Majority 44.7% (17/38) of the in-school youth who had had an STI in the last one year responded did not make their partners aware when they were diagnosed of STI’s. A little over a quarter of the youth (26.3%) informed their partners.
HI: Young people’s Knowledge of available youth friendly Reproductive health service in the district significantly influences the utilization of Reproductive Health.
Independent Variable: Knowledge of available Reproductive Health services.
Dependent: Reproductive Health Services Utilization. This results of the cross tabulation is presented in
In respect of hypothesis H1, a chi square test of significance was conducted with reproductive health service utilization as the dependent variable and Knowledge of available Reproductive Health services as the independent variable. The results showed that, Pearson coefficient at 95% confidence level had its P value for two- tailed test of significance at 0.00. The results presented demonstrate that there is an association between youth awareness or knowledge about the available sexual and reproductive health services provided to them in the area and service utilization. Thus the null hypothesis is rejected and its alternative hypothesis that youth awareness of available sexual reproductive health services in the study area significantly influences their utilization of sexual reproductive health is supported at 5% level of significance.
Whether youth has ever used reproductive health Service | Awareness of any youth friendly reproductive health services rendered to them in the area | Total | P value at 0.05 level of significance | |
---|---|---|---|---|
Yes | No | |||
Yes | 18 | 13 | 31 | |
No | 9 | 78 | 87 | 0.00 |
Total | 27 | 91 | 118 |
P value = 0.00.
The study was towards assessing youth knowledge, attitude and sexual practice and reproductive health service utilization informed by a cross sectional qualitative and quantitative design. Our finding demonstrates a positive relationship between youth awareness about the available sexual and reproductive health services in the area and service utilization. This finding is consistent with the study of Hock-long and others [
The study found out that large number of respondents entered into relationship between the ages of 18 - 20 years. This was followed by 15 - 17 years with majority affirming that they have had sex in their life time. This result corroborates the extant literature by Mitikie and others [
Females who have ever had sex in their life time exceed the number of males with females being sexually active in the past six months constituting one and half times higher than their male counterparts. This finding corroborates GDH survey [
However, the results is not consistent with similar African setting [
The finding of this study further illustrates that pre-marital sexual experience among in-school youth was high in Ghana (42%) than that of Ethiopia [
The results show that many young people thought about and take steps to obtain adequate protection only after having their first sexual intercourse [
Some youth held the view that they have been pregnant before and they attempted aborting the pregnancy [
This study represents a contribution to studies on current sexual and reproductive health update among youth from a life course perspective. A major finding of this study is the dissonance between knowledge of what is known about sexual and reproductive health and practice of what is known. Youth attitudes, norms, and perceive changes in sexual behavioral is yet to correlate with sexual decision making. Contraceptive use among sexually active young people was very low especially among those who had had sex in the last six months. Despite youth fair knowledge and in some specific reproductive health cases, excellent knowledge about sexual reproductive health, youth risky sexual behaviour does not seem to be influenced by knowledge about youth friendly sexual reproductive health. On this basis, we recommend that the youth should be given sexual and reproductive health education appropriate to their age. This should include but not limited to the provision of education on puberty before sexual debut as well as issues of menstruation and personal hygiene. Political will and stakeholder involvement in sexual and reproductive health education is required to meet the uptake of sexual and reproductive health services whiles translating knowledge into practice.
We are grateful to all the survey respondents who took time off their busy schedules to participate in the study. We also acknowledge the research assistants who assisted during data collection.
The authors did not receive funding for this study.
The authors declare that they have no competing interests.
Jonathan MensahDapaah,Seth Christopher YawAppiah,AfuaAmankwaa,Larbi RitaOhene, (2016) Knowledge about Sexual and Reproductive Health Services and Practice of What Is Known among Ghanaian Youth, a Mixed Method Approach. Advances in Sexual Medicine,06,1-13. doi: 10.4236/asm.2016.61001
SRHS, Sexual and reproductive health service