Female Adolescent Sexuality, Contraceptive Use and Reproductive Health In The Central Region of Ghana: A Case Study Of Cape Coast And Mankrong

Abstract

The study on Adolescent Sexuality, Contraceptive Use and Reproductive Health was undertaken as part of the ongoing effort at understanding some of the problems that confront adolescents in Ghana, With a general objective of examining the magnitude of reproductive health-related problems pertaining to adolescent sexuality and contraceptive use, the study used a sample of 1,828 female adolescents aged 12-24 years (1,503 from Cape Coast and 325 from Mankrong) in the Central Region of Ghana as a case study. This was with the primary purpose of comparing the situation in an urban vis-a-vis a rural area. The two study areas are far apart: Cape Coast at the coast while Mankrong is located in the interior of the Central Region. It uses simple techniques including cross-tabulations as well as multiple regression analysis to examine quantitative and qualitative data collected from structured questionnaire and focus group discussions held separately among male and female adolescents and adults in Cape Coast and Mankrong. Among other things, the study found that the proportion of adolescents ever having sex increased with higher age of the adolescent with higher proportion having sex in Mankrong compared to Cape Coast. The mean age at first sex was, however, almost the same at 16.9 years in Cape Coast and 17 years in Mankrong. Mean age at first sex also increased with higher age of adolescents, implying plausibly of a declining age at first sex at the two study areas. Furthermore, there were suggestions to indicate that females become sexually active earlier than their male counterparts on account of the fact that at first sex most females were much younger than their male partners at the time. However, it was deduced that due to the fact that first sex usually may occur with persons who may be sexually more experienced and older, it may not always be easy to determine whether or not it is the female who enters into sex earlier if one depended on responses exclusively from the male or female. Generally, the adolescents did not approve of pre-marital sex but gave the indication of the possibility to indulge in it for financial reasons. What people approve of may thus, be different from what they may practise depending on the issues at stake. Peer pressure and lack of knowledge were the main reasons that provided grounds for a large proportion of the adolescents entering into sex for the first time. Again, although most of the adolescents did not approve of abortion, the report on abortion among them showed a possibility of an underestimation, suggesting a situation of a much higher abortion rate among the sexually active adolescents than was reported. Abortion rates were found to be higher in Cape Coast relative to Mankrong. Also important was the finding that adolescents who used contraception at first sex had a higher age at pregnancy. Similarly, adolescents who practised contraception had a relatively lower number of children ever bom in contrast with those who did not practise contraception at first sex. There was also a lower number of children ever bom with higher education of the woman. Results from the multiple regression analysis confirmed most of the observations made in the cross-tabulations. These included a declining age at first sex at 100 per cent level of confidence. Besides, financial considerations were found to contribute more to the reduction of an adolescent’s age at first sexual activity. The study confirmed at 95 per cent level of confidence, four of the five hypotheses, namely, that: i) There is an inverse relationship between age at first sexual intercourse and childbearing among adolescents; ii) There is an inverse relationship between adolescent childbearing and contraceptive use at first sex; iii) There is an inverse relationship between education and childbearing among adolescent females; and iv) There is a direct relationship between contraceptive use at first sex and age at first sexual activity among adolescent females. However, the hypothesis that contraceptive use is directly related to the level of education of the adolescent could not be analysed due to the very small sample of adolescents who were reported to be contracepting at the time of the survey. It is therefore, recommended that future research should consider a much larger sample of adolescents to facilitate such an analysis. In addition, future research should probe into the educational level of adolescents as at the time of their first sexual act for incorporation into the analysis. Similarly, future research should consider collecting information on the educational aspirations of adolescents as a proxy in analysing the timing of first sex among adolescents. The study further recommends intensive and sustained public education against criminal abortion, highlighting the short and long-term health implications to the adolescents while underscoring the fact that abortion is not a family planning method. It also calls for a review of the educational policy in Ghana with a possibility of making Family Life Education (FLE) a completely separate subject from Social Studies and be taught at earlier stages of the primary school education possibly at Primary Class Four. Besides, to ensure that teachers who are well trained in FLE teach pupils, FLE should be a compulsory component of the curricula of teacher training colleges in the country. A call is also made for the establishment of District Youth Centres throughout the country to offer education and counselling on all issues pertaining to the adolescents, especially their sexual and reproductive health. The study concludes by calling on government and civil society to put adolescent sexuality and reproductive health as a national development priority and to show the maximum commitment in addressing the various dimensions of the problem principally as critical components of the efforts at addressing the HIV/AIDS epidemic in Ghana. This is borne out of the realisation that the adolescents offer a window of opportunity and hope in the fight against HIV/AIDS among the entire population of Ghana.