EXPLORING THE KNOWLEDGE AND PRACTICES ON THE USE OF

CONTRACEPTIVES AMONG ADOLESCENT GIRLS IN SENIOR HIGH

SCHOOL
CHAPTER ONE
INTRODUCTION
Background to the study

Contraceptive use among adolescents has received global attention in recent years.

Despite the risks associated with early pregnancies, various surveys indicate that

sexually active adolescents, who are 15-19 years old, rarely use contraceptives

(Tchokossa & Adeyemi, 2018). Globally, there are about 1.2 billion adolescents aged

between 10 to 19 years and 86% of them live in developing countries. Approximately,

23 million of them have an unmet need for modern contraception and risk getting

unintended pregnancy. Whereas half of the women aged, 15 to 19 are victims of

unintended pregnancies on a global map, 46% of them live in Africa. This is closely

associated with poor access to and utilization of contraceptive services (World

Fertility and Family Planning 2020).

Contraceptive use refers to the intentional prevention of pregnancy while using either

chemicals, devices, or natural or surgical procedures. The use of contraception among

adolescents is hinged on the desire to maintain a physical relationship free of fear of

unwanted pregnancies which allows freedom of when to have children, spacing, and

the number (Jain & Muralidhar, 2011). However, the contraceptive prevalence rate is

currently as low as 25% in Middle and Western Africa, about 43% in East Africa, and

above 70% in Europe, and America. Again, the African regions have high adolescent

birth rates at 115 per 1,000 girls compared to the global rate of 92 per 1000 births

among girls aged 15 to 19 years. Besides contraception, adolescents and youth in the
developing world still face relatively similar challenges around sexual and

reproductive health including access to these services and age-appropriate

information. The impact has been observed in socio-cultural aspects such as child

marriage, unintended teenage pregnancies, HIV transmission, and low coverage of

modern contraceptives (World Family Planning, 2017). In Kenya, contraceptive use

among adolescents was 19.6% in 2015, and during that same period, about 36% of

adolescents gave birth before reaching 19 years (Melesse, Mutua, Choudhury, Wado,

Faye, Neal, Boerma, 2020). A systematic study conducted in Sub-Saharan Africa

noted that misconceptions regarding the side effects of contraceptives, disapproval of

the male partner, and cultural norms around the use of contraceptives prohibited the

use of contraception (Kinaro, Kimani, Ikamari, Ayiemba, 2015). These factors had

earlier been mentioned in another study conducted among adolescents in selected

Senior Secondary Schools in Ghana. The study indicated that youth and adolescents

are highly exposed to unprotected sexual intercourse that may result in unintended

pregnancies (Hagan & Buxton, 2015)

Adolescent pregnancy is a pressing public health issue that carries significant risks for

both young mothers and their children. These risks include higher rates of maternal

and infant mortality, low birth weight, and long-term socio-economic disadvantages

(World Health Organization, 2014). Despite these risks, adolescent pregnancy rates

remain high in many regions, particularly in low- and middle-income countries. A

critical factor contributing to these high rates is the gap in knowledge, attitudes, and
practices (KAP) regarding contraceptives among adolescent girls. Studies have

demonstrated that adolescent girls often have limited knowledge about contraceptives,

which can lead to misuse or non-use. Research in Nigeria revealed that only 48% of

sexually active adolescent girls were aware of at least one modern contraceptive

method, and only 23% knew how to use it correctly (Adelekan et al., 2014).

Attitudes toward contraceptive use are shaped by a myriad of factors, including

cultural norms, religious beliefs, peer influence, and perceptions of parental approval.

Negative attitudes and misconceptions about contraceptives can create significant

barriers to their adoption. A study in Ghana found that many adolescent girls

associated contraceptive use with promiscuity and adverse health effects, leading to

reluctance to use them (Adjei et al., 2015). Conversely, supportive attitudes and a

positive perception of contraceptives are linked to higher usage rates. In Ethiopia,

adolescents with a favorable attitude toward contraceptives were more likely to use

them (Tesso et al., 2012).

Despite awareness and generally positive attitudes, the actual practice of

contraceptive use among adolescent girls remains low. Barriers such as limited access

to contraceptive services, fear of social stigma, and lack of confidentiality in

healthcare settings hinder consistent use. In Kenya, although a significant number of

adolescents were aware of contraceptives, only a small fraction used them regularly

due to fears of judgment and inadequate adolescent-friendly health services (Kabiru et

al., 2011). The current state of contraceptive use among adolescents varies widely,
with many regions reporting low levels of both knowledge and utilization. In Ghana,

research by Gyan (2018) highlighted that although awareness of contraceptives is

relatively high among adolescents, there are pervasive misconceptions that hinder

effective use. Similarly, Okigbo and Speizer (2015) found that in Nigeria, only a small

percentage of adolescent girls used contraceptives during their last sexual encounter,

primarily due to a lack of accurate information and access. This disparity between

knowledge and practice is not confined to low- and middle-income countries. In the

United States, despite high awareness levels, inconsistent contraceptive use remains a

problem among teenagers (Martinez et al., 2011).

Statement of the problem

Despite advancements in sexual health education, the prevalence of unintended

pregnancies and STIs among adolescents remains high. The Guttmacher Institute

(2020) reported that while comprehensive sex education is linked to delayed sexual

initiation and increased contraceptive use, significant gaps in knowledge persist

among adolescents. These gaps often lead to misconceptions about contraceptive

methods, their use, and their effectiveness, which in turn affects their sexual and

reproductive health outcomes.

Despite the progress in sexual health education, unintended pregnancies and STIs

among adolescents are still prevalent. The Guttmacher Institute (2020) noted that

comprehensive sex education is linked to delayed sexual initiation and increased

contraceptive use. However, there are still significant knowledge gaps among

adolescents, leading to misconceptions about contraceptive methods and their

effectiveness, impacting their sexual and reproductive health outcomes.

Although contraceptive methods are available, there remains a considerable gap in

knowledge and practices of contraceptive use among senior high school girls. Their

incomplete or incorrect understanding of contraceptives contributes to the inconsistent

use of these methods. For instance, a study in Ghana found that while the majority of

senior high school girls had heard about contraceptives, their detailed knowledge

about different methods and their correct usage was limited (Boakye-Yiadom et al.,

2015). Similarly, research in Nigeria indicated that despite awareness of contraceptive

options, adolescents' understanding of proper usage and potential side effects was

inadequate (Adelekan et al., 2014).

The practice of contraceptive use among senior high school girls is influenced by

various factors, including accessibility, social stigma, and cultural norms. In Kenya,

many adolescents reported being aware of contraceptives but did not use them

consistently due to fears of social judgment and the lack of adolescent-friendly health

services (Kabiru et al., 2011). This is consistent with findings from South Africa,

where adolescents cited limited access to confidential and youth-friendly

contraceptive services as a significant barrier to consistent use (Mchunu et al., 2012).

In Ghana, research by Gyan (2018) highlighted that although awareness of

contraceptives is relatively high among adolescents, there are pervasive

misconceptions that hinder effective use. This study aims to explore the knowledge

and practices regarding contraceptive use among adolescent girls in senior high
schools. By identifying the gaps in education and health systems, this research seeks

to inform more effective interventions and policies that support adolescent girls in

making informed reproductive choices. Understanding these dynamics is crucial for

improving health outcomes and empowering young girls to take control of their

reproductive health.

Research Questions

1. What is the level of knowledge about various contraceptive methods among

adolescent girls in senior high school?

2. What are the prevalent attitudes and perceptions towards the use of contraceptives?

3. What factors influence the decision to use or not use contraceptives among

adolescent girls in senior high school?

4. How accessible and available are contraceptive resources and information to

adolescent girls in senior high school, and what are the barriers they face in accessing

these resources?

Significance of the study

The significance of this study lies in its comprehensive approach to addressing crucial

aspects of adolescent health, education, and empowerment, which have the potential

to generate lasting positive impacts on individuals and society as a whole.

Understanding the knowledge and practices related to contraceptives among

adolescent girls is vital for dealing with public health concerns such as unintended

pregnancies, sexually transmitted infections (STIs), and reproductive health issues. By

identifying gaps in knowledge and misconceptions, the study could facilitate the
development of effective interventions to enhance sexual health education.

Furthermore, the findings of this study will offer valuable insights into the

effectiveness of existing sexual education programs in high schools. These insights

will highlight the strengths and weaknesses of current programs, thereby providing

guidance to policymakers and educators for necessary curriculum improvements.

Moreover, the study will empower adolescent girls by equipping them with accurate

information and practical knowledge about contraceptives, thereby enhancing their

ability to make informed decisions about their reproductive health. This autonomy can

lead to improved health outcomes, higher educational attainment, and an enhanced

quality of life.

Lastly, the results will provide guidance for the development of policies aimed at

increasing access to contraceptive resources and education. This encompass

identifying barriers to access, such as socioeconomic factors, cultural norms, and

healthcare infrastructure, and recommending actionable solutions.

CHAPTER THREE
 RESEARCH METHODS

Research Design
The study utilized a cross-sectional descriptive research design to investigate the

knowledge and behaviors related to contraceptive use among adolescent girls in

senior high school. This design was selected to capture the current state of affairs and

to evaluate different factors linked to contraceptive knowledge and behaviors at a

particular moment in time.

Study Population
The research focused on adolescent girls between the ages of 15 and 19 who were

attending senior high schools in the Assin South district. This age group was chosen

to ensure that the results would be applicable to high school students, particularly

those who could benefit from specific sexual health education initiatives.

Sample Size and Sampling Procedure

In order to ensure a representative and statistically significant sample, a total of 300

adolescent girls were targeted for the study. We employed a stratified random

sampling approach to ensure diversity across various schools, grades, and socio-

economic backgrounds. Both urban and rural schools were included in the sampling

process, encompassing a mix of public and private institutions. This method allowed

us to obtain a balanced sample that accurately reflected the diversity of the adolescent

girl population. Additionally, within each selected school, a random sample of eligible

adolescent girls aged 15-19 was chosen using a simple random sampling technique.

The sample size was determined based on the estimated prevalence of contraceptive

use knowledge and practices, with considerations for an appropriate margin of error

and confidence level.

Data Collection Methods
The data was gathered using a self-administered structured questionnaire comprising

three sections. The first section, Demographic Information, collected data on age,

grade level, socioeconomic status, and other relevant background information. The

second section, Knowledge of Contraceptives, included questions on awareness of

different contraceptive methods, sources of information, and understanding of how

each method works. The third section, Practices and Attitudes, explored the actual use

of contraceptives, reasons for use or non-use, perceived barriers, and attitudes toward

contraceptive use. Prior to implementation, the questionnaire was pre-tested with a

small group of students to ensure question clarity and reliability.

Data Collection Procedure

Data collection was conducted during school hours with the cooperation of school

administrators and teachers. Informed consent was obtained from all participants and

their parents where necessary. Participants were assured of the confidentiality and

anonymity of their responses.

Data Analysis
Quantitative data was analyzed using both descriptive and inferential statistics.

Descriptive statistics such as frequencies, percentages, means, and standard deviations

were employed to summarize demographic characteristics, levels of knowledge, and

practices. Inferential statistics, including chi-square tests and logistic regression, were

utilized to investigate the relationships between demographic variables and

knowledge and practices of contraceptives. In addition, qualitative data from open-

ended questions was thematically analyzed to uncover common themes and insights

pertaining to attitudes and barriers to contraceptive use.

Ethical Considerations
Ethical approval was obtained from the relevant institutional review board prior to the

commencement of the study. All participants were informed about the purpose of the

study, their right to withdraw at any time, and assurances of confidentiality.

Questionnaire for Research on Exploring the Knowledge and Practices of

Contraceptives Among Adolescent Girls in Senior High School

By completing this questionnaire, you agree to participate in this study voluntarily.

Your responses will be kept confidential and used only for research purposes.

Section A: Demographic Information

1. Age: _____

2. Grade Level:

- [ ] JSS 1

- [ ] JSS 2

- [ ] JSS 3

3. School Location:

- [ ] Urban

- [ ] Suburban

- [ ] Rural

4. Socioeconomic Status:

- [ ] Low

- [ ] Middle

- [ ] High

5. Religion:

- [ ] Christianity

- [ ] Islam

- [ ] Other (please specify): __________

6. Parental/Guardian Education Level:

 - [ ] No formal education

- [ ] Primary education

- [ ] Secondary education

- [ ] Tertiary education

Section B: Knowledge of Contraceptives

7. Have you ever heard of contraceptives?

- [ ] Yes

- [ ] No

8. Which of the following contraceptive methods are you aware of? (Check all that

apply)

- [ ] Condoms

- [ ] Birth control pills

- [ ] Intrauterine device (IUD)

- [ ] Implants

- [ ] Injections

- [ ] Emergency contraception

- [ ] Natural methods (e.g., calendar method)

- [ ] Other (please specify): __________

9. Where did you learn about contraceptives? (Check all that apply)

- [ ] School
 - [ ] Family

- [ ] Friends

- [ ] Internet

- [ ] Healthcare providers

- [ ] Media (TV, radio, magazines)

- [ ] Other (please specify): __________

10. How would you rate your knowledge of contraceptives?

- [ ] Very knowledgeable

- [ ] Somewhat knowledgeable

- [ ] Not knowledgeable

11. Do you know how to correctly use the contraceptive methods you are aware of?

- [ ] Yes

- [ ] No

Section C: Practices and Attitudes

12. Have you ever used any contraceptive method?

- [ ] Yes

- [ ] No

13. If yes, which contraceptive method(s) have you used? (Check all that apply)

- [ ] Condoms

- [ ] Birth control pills

- [ ] Intrauterine device (IUD)

- [ ] Implants

- [ ] Injections
 - [ ] Emergency contraception

- [ ] Natural methods (e.g., calendar method)

- [ ] Other (please specify): __________

14. What influenced your choice of contraceptive method? (Check all that apply)

- [ ] Ease of use

- [ ] Accessibility

- [ ] Affordability

- [ ] Effectiveness

- [ ] Recommendations from others

- [ ] Other (please specify): __________

15. What are your main reasons for using contraceptives? (Check all that apply)

- [ ] Prevent pregnancy

- [ ] Prevent STIs

- [ ] Regulate menstrual cycle

- [ ] Other (please specify): __________

16. If you have never used contraceptives, what are your reasons? (Check all that

apply)

- [ ] Lack of knowledge

- [ ] Fear of side effects

- [ ] Cultural or religious beliefs

- [ ] Partner’s preference

- [ ] Difficulty accessing them

- [ ] Other (please specify): __________

17. How do you feel about using contraceptives? (Select one)

- [ ] Strongly approve

- [ ] Approve

- [ ] Neutral

- [ ] Disapprove

- [ ] Strongly disapprove

18. What do you think are the main barriers to contraceptive use among adolescents?

(Check all that apply)

- [ ] Lack of information

- [ ] Stigma and judgment

- [ ] Accessibility issues

- [ ] Financial cost

- [ ] Cultural or religious restrictions

- [ ] Fear of side effects

- [ ] Other (please specify): __________

19. Do you feel comfortable discussing contraceptive use with the following? (Check

all that apply)

- [ ] Parents

- [ ] Teachers

- [ ] Healthcare providers
 - [ ] Friends

- [ ] Partner

- [ ] No one

Section D: Open-Ended Questions

20. In your opinion, what could be done to improve the knowledge and practices of

contraceptive use among adolescent girls in your school?

21. Please share any additional thoughts or experiences regarding contraceptive use.