RG556.5AS1 bite C.l G374945 THE BALME LIBRARY 3 06?2 10OO 1 1 40 O University of Ghana http://ugspace.ug.edu.gh CAUSES OF TEENAGE PREGNANCY IN SENYA BEREKU COMMUNITY OF AWUTU- EFUTU- SENYA DISTRICT BY JESSELINE ASAMOAH THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MA DEVELOPMENT STUDIES DEGREE JULY 2005 University of Ghana http://ugspace.ug.edu.gh DECLARATION I, JESSELINE ASAMOAH, do hereby declare that except for the references cited in this work, which have been duly acknowledged, this dissertation is the result o f my own work produced from research undertaken under supervision and that it has not been presented for another degree elsewhere. 0?. Jesseline Asamoah ..... DR. FELIX ASANTE University of Ghana http://ugspace.ug.edu.gh This work is dedicated to God Almighty in whom I live and have my being and to my love AMA CHIPO KHUMALO. Ama may you grow in the Grace o f God always. The work is also dedicated to all the teenage mothers who have beaten the odds to carve out a niche for themselves in the society. DEDICATION University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGMENT I ascribe thanks to Almighty God for His Grace and continual mercies in my life. I am grateful to my supervisors Prof. C. Ahiadeke and Dr. F. Asante for the help and direction given to carry out this project. I wish to thank all the staff o f ISSER for their warmness and friendliness towards me. I am so grateful to Mrs. M. Ackumey and Nash who took time o ff their busy schedule to help me shape this project. Thanks to all my friends who supported me with prayers. A shout out to all my course mates. University of Ghana http://ugspace.ug.edu.gh ABSTRACT The main objective o f the study was to investigate into factors contributing to teenage pregnancy in the Senya- Bereku community o f the Awutu-Effutu-Senya District, which has a high drop out rate o f girls in the educational facilities make recommendations to the District Health Management Team and District Assembly o f Awutu-Effutu-Senya District. The dissertation is based on data collected from the field between June 2004 and June 2005. Data on 200 adolescents o f which 82 was male, 10 teenage mothers, 5 mothers o f adolescent mothers and ten opinion leaders. Distribution o f respondents was presented in tables, pie charts, bar charts and cross tabulations. The chi-square test was used to establish the association between independent variables stated in the hypothesis and teenage pregnancy. The finding o f the study showed that coercion, career aspirations, parental control, knowledge and usage o f contraceptives and involvement in extracurricular activities were significantly related to adolescent sexuality. The median age o f sexual debut was 16 years for males and females, and there was poor usage o f conventional family planning methods despite education on teenage pregnancy and HIV/AIDS. Programmes to help reduce the incidence o f teenage pregnancy will need the combined efforts o f all stakeholders. Health services and counselling centres should be established for the youth with emphasis on reproductive behaviour and sexua lity . Early onset o f education on teenage pregnancy and coiiuavcpiiy^ms^tcuuimncnded University of Ghana http://ugspace.ug.edu.gh for the youth in the early teenage years prior to the median age o f sexual debut. Channelling o f sexual energy into asexual activity such as athletics and clubs will be helpful for the youth. Teenage mothers can be helped and supported by the community to continue their education. v University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS TITLE PAGE DECLARATION .......................................................... DEDICATION .......................................................... ACKNOWLEDGEMENT ............................................ ABSTRACT ... ... ... ... ... ■ • • TABLE OF CONTENTS ............................................ LIST OF TABLES .......................................................... LIST OF F IG U R E S .......................................................... CHAPTER ONE: INTRODUCTION.............................. 1.1 Background . . . ... ... ... ... 1.2 Problem Statement ... ... ... ... 1.3 Objectives ... ... ... ... ... ... 1.4 Significance o f Study ... ... ... ... 1.5 Limitations to the study ... ... ... ... 1.6 Outline o f dissertation ... ... ... ... CHAPTER TWO: TEENAGE FERTILITY IN GHANA 2.1 Regional f e r t i l i t y ................... ... ................. 2.2. Teenage fertility and level o f education ... ... 2.3 Teenage fertility and level o f poverty ... ... 2.4 Certain groups o f disadvantaged youth ... ... University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE: LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK ... 3.0 Introduction ... ... ■■■ 3.1 Adolescent Sexuality ... ... ...16 ...16 ... 16 3.2 Adolescent Contraceptive Use ...18 3.3 Adolescent and Marriage ... ...20 3.4 Teenage Childbearing ...21 3.5 Adolescent and Abortion ...21 3.6 Sexually Transmitted Infections ... 3.7 Focus on HIV/AIDS 3.8 Conceptual framework ...22 ...23 ...23 CHAPTER FOUR: STUDY AREA AND METHODOLOGY 4.1 Study Area ...................... ... ... ... ... 4.2 Method o f data collection ... ... ... ................. 4.2.1 Sources o f data and Sampling Frame ... ................. 4.2.2 Sampling Technique ... ... ... ... ... 4.2.3 Instruments o f data collection and analysis ... ... ...26 ...26 ...30 ...30 ...31 ...32 CHAPTER FIVE: DISCUSSION OF RESULTS 5.1 Introduction 5.2 Socio -Demographic Characteristics o f Respondents . .. 5.3 Socio-Economic Characteristics o f respondents . . . . ___ ...33 ...33 ...33 ...33 vu University of Ghana http://ugspace.ug.edu.gh 5.4 Festivals ... ... ... ■■■ ■ ••• ••• ■■■ 5.5. Menarche ... ... ... ... ■■■ ■■■ ...40 5.6 Sexual activity ... ................. ... ... ■■■ ■•■40 5.7 Contraceptive knowledge and use ... ... ... ... ...49 5.8 Education and knowledge o f teenage p regnancy .............................................51 5.9 Communication ... ... ... ... ... ... ■■■ .53 CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS................. 55 6.1 Summary and Conclusions ... ... ... ... ... --.55 6.2 Recommendations... ... ... ... ... ... ...57 REFERENCES ................................................................................................... 59 APPENDICES ................................................................................................... 61 1. Questionnaire for teenagers in school ... ... ... ... ...61 2. Guidelines for in-depth interview with opinion leaders in community .. .71 3 Guidelines for focus group discussions with never pregnant teenagers .. .72 4. Guidelines for in-depth interviews with teenage mothers ... ... ... 74 viii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 1.1 Pregnancy Records at the Senya Health Centre from 1999- 2004 ... 6 Table 2.1 Regional Teenage fertility ... ... ... ... 11 Table 4.1 Population Characteristics o f Awutu-Effutu-Senya District ... 27 Table 4.2 Distribution o f educational facilities in AESD ... ... ... 28 Table 4.3 Distribution o f educational facilities in Senya ... ... ... 29 Table 5.1 Ethnicity o f respondents ... ... ... ... ... ... 34 Table 5.2 Characteristics o f respondents by religion and religious practice... 35 Table 5.3 Distribution by Who pays School fees for Respondents ... 38 Table 5.4 Percentage distribution o f respondents by sex and sexual experience 40 Table 5.5 Sexual debut pattern by sex ... ... ... ... ... 44 Table 5.6 Cross tabulation o f age at menarche and age at sexual debut ... 46 Table 5.7 Cross tabulation o f religious practice and sexual debut ... ... 47 Table 5.8 Students Opinion for the Ideal age for Marriage o f Women ... 54 ix University of Ghana http://ugspace.ug.edu.gh Fig. 1. Relationship between Level o f Education and Teenage Fertility ... 12 Fig. 2 Relationship between Teenage Fertility and Level o f Poverty... ... 13 Fig.3 Diagrammatic Presentation o f Factors that Cause Teenage Pregnancy 25 Fig.4 Percentage distribution o f bathing facilities o f respondents ... ... 36 Fig.5: Occupation o f Father o f Respondents ... ... ... ... ... 37 Fig.6 Occupation o f Mother o f Respondents ... ... ... ... ... 38 Fig. 7 Age at first menarche o f respondents ... ... ... ... ... 40 Fig.8 Age at sexual debut ... ... ... ... ... ... ... 42 Fig.9 Situation in which the sexual debut took place ... ... ... ... 43 Fig 10 Sexual Activity o f students ... ... ... ... ... ... 44 Fig. 11 Relationship to the person you last had sexual intercourse with ... 45 Fig. 12 Expenditure distribution o f money received from sexual partner ... 48 Fig. 13. Contraceptive usage ... ... ... ... ... ... ... 50 Fig. 14. Contraceptive use in the past 6 months ... ... ... ... 50 Fig 15 Percentage distribution o f means o f education on teenage pregnancy... 51 Fig. 16 Causes o f teenage pregnancy in Senya according to students in community 52 LIST OF FIGURES University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE: INTRODUCTION 1.1 Background Adolescent and Reproductive health has become an issue o f concern to governments, demographers and planners all over the world. It is estimated that 23% o f the world’s population comprises the youth aged 10-20 years. Worldwide, pregnancy-related conditions are the leading cause o f death among women aged 15-19years. There are 2 main risks for the pregnant adolescent: pre-eclamptic toxaemia and cephalopelvic disproportions (Karim 2003). Both can present serious problems. The International Population Conference o f August 1984 in Mexico City addressed the issue o f teenage pregnancy and childbearing in four o f the 88 recommendations endorsed by delegates o f the 147 nations represented at the conference. Governments were advised to encourage delay in the commencement o f childbearing and to raise the age o f entry into marriage. Infact the year 1985 was designated by the United Nations as International Youth Year and it was an added incentive to increase the focus on dimensions and problems of adolescent fertility. In September 2000, the General Assembly o f the United Nations adopted the United Nations Millennium Declaration. The Declaration, described as a major landmark in the annals o f global development partnerships endorsed by 192 countries, was then translated into a roadmap setting out goals to be reached by the year 2015. The UN recognizes the contribution that developed countries can make through trade, development assistance, debt relief and debt sustainability, access to essential drugs and technology transfer to the global economy and global human capital development. Although Adolescent Reproductive health is not specifically mentioned I University of Ghana http://ugspace.ug.edu.gh in the MDGs per se, it is linked to four out o f the eight goals namely: promote gender equality and women empowerment; reduce child mortality; improve maternal health; combat HIV/AIDS and other diseases. Adolescent health is also to be considered if the goal o f universal primary education is to be attained especially in developing countries where the average age o f pupil may be as high as 15 years. By 2020 according to the UN medium projections, the world total of adolescents aged 10-19 will be well over 1.3 billion and o f these 1.1 billion or 86 percent will be living in the developing countries. Inspite of these figures Adolescent and Reproductive Health has not been accorded as much attention as it deserves. The society in which adolescents grow up has an important influence on their development, relationships, adjustments and problems. The expectations o f the society mold their personalities, influence their roles, and guide their future. The structure and functions o f the society help them fulfill their needs or create new problems by stimulating further tension and frustration. Because adolescents are social beings who are part o f a larger society, we need to understand this social order and some o f the ways it influences them. There are some important influences on today’s adolescent among which is computer technology (which some term the computer revolution age), the materialistic revolution, education revolution, the family, the sexual revolution and the violence revolution (Henshaw et al 1986). The success o f any adolescent reproductive health program will need to include efforts at improving the status o f women. Sadik (1995) has identified specific development goals involved with improving the status o f women as follows: • Reduction in levels of illiteracy, especially female illiteracy; 2 University of Ghana http://ugspace.ug.edu.gh • Expansion o f girl’s enrolment in schools and their retention in the school system; • Securing women’s legal and social rights to free marriage, land and ownership and paid employment; and • Increasing income-generating programs for women In Ghana 51.4 percent o f the total population o f about 18 million is less than 19 years. The medium term objective o f the Government o f Ghana is to achieve a middle income status by 2015. The state recognizes the fact that the objective can best be attained and sustained by developing and harnessing the potential o f the youth who are “the spirit o f today and the hope for the future” (Adolescent Reproductive Health Policy, 2000), through education and skills training. Teenage pregnancy unfortunately has the potential to curtail a teenager’s aspirations and promising future as well as increase gender disparity in the formal school enrolment. Once the female teenager is unable to continue with her formal education because of childbearing; she loses the opportunity to hold positions o f influence in society. In Ghana to reduce the disparity between female and male enrolment in the formal education sector, the government set up the Ministry o f Girl Child Education. The Ministry initiated the Science Club for girls to get them interested in the science subjects and science careers, an area which hitherto has been predominantly occupied by males. The Ministry o f Women and Children’s Affairs also a fairly new ministry set up in 2000 are all part o f the state efforts to empower women and to attain the gender balance in all spheres of the society in Ghana. Vocational Schools and Institutions have been set up to train many girls in employable skills. 3 University of Ghana http://ugspace.ug.edu.gh teenage pregnancy not only burdens individual teenagers and their babies but also its wide effect on the community and the nation as a whole is evidenced by the number o f street children, adolescent gangsters who indulge in armed robbery, commercial sex work and many other vices. A study by Nabila and Fayorsey (1995) showed that by 17 years o f age, 60 percent o f adolescent females and males interviewed in Kumasi and Accra had either become pregnant or impregnated a female. Most adolescent pregnancies were however outside the context o f marriage and this has negative consequences on teenage mothers who are ill equipped to raise children. The population o f Ghana can be described as youthful since the median age is 17.5 years. The proportion o f the population aged more than 15years is around 45 percent. Total fertility in Ghana has declined over the decade from 6.4 per female in 1988 to 4.6 children in 1998. There are however spatial variations in the teenage fertility in the country. Table 1.1 shows the regional differences in teenage fertility. Central region has the highest rate o f teenage fertility at 24.1 percent; the lowest rate o f teenage fertility in the nation is found in the Greater Accra region, while the national average is 14.8 percent. At the time o f the Ghana Demographic and Health Survey in 2003 the Central region had the highest percentage o f teenagers pregnant with their first child i.e. 10.5 percent. 4 University of Ghana http://ugspace.ug.edu.gh Table 1.1 Regional Teenage fertility in Ghana Name of region % of teen mothers % teen p regnan t w ith 1st child % teen who have began ch ildbearing Central region 13.7 10.5 24.1 Northern region 15.7 7.9 23.6 Volta region 14.3 2.7 17.1 Western region 10.2 4.0 14.2 Brong Ahafo region 10.7 2.9 13.6 Eastern region 9.5 3.7 13.2 Upper East region 9.1 3.5 12.6 Ashanti region 8.1 2.2 10.3 Upper West region 8.5 1.3 9.8 Greater Accra region 8.4 1.1 9.5 Total 10.8 4.0 14.8 Source: GDHS 2003 A linear relationship between age at first marriage and level o f education has been observed. Females with no formal education married at 18.5 years o f age as compared to those with a secondary or higher education who married at 23 years of age (GDHS 1998). These findings were also reflected in the 2003 GDHS shown in Figure 1. 5 University of Ghana http://ugspace.ug.edu.gh Figure 1 Relationship between Level o f Education and Teenage Fertility o f education middle/JSS 17°/ secondary+ 5% primary 35% no education 43% □ no education m primary □ m iddle/JSS □ secondary+ Source: GDHS 2003 The highest percentage o f teenage mothers were those with no education (43 percent) and the rate decreased to 5 percent as the level o f education increased to secondary Majority o f youth (60 percent) by age 17 years will have had unprotected sexual intercourse putting them at risk o f unintended pregnancy and sexually transmitted diseases and HIV/AIDS. Mass national campaigns to educate the youth on HIV through the media etc. means most teenagers have heard about the disease yet many believe they are not at risk so there has not been much change in sexual behaviour. The youth in Ghana do not use contraceptives to protect against teenage pregnancy; results from the national survey on teenage fertility show (GDHS 2003). The director o f the Ghana AIDS Commission reported this year that there has been a decrease in the use o f condoms; the most effective way o f reducing pregnancy and HIV/AIDS in sexually active people. Among those who had used a condom the last time they had plus. 6 University of Ghana http://ugspace.ug.edu.gh sex, only about half o f young women and one-quarter o f young men did so to prevent the transmission o f HIV/AIDS— indicating that preventing unintended pregnancies may be a greater concern among sexually active adolescents. The Senya Bereku community o f the Awutu Effutu Senya district in the Central Region o f Ghana has had over the years increasing dropout o f girls from the formal education sector due to teenage pregnancy. This has led to intensification o f sex education in schools and communities in the district. Certain NGOs and CBOs operating in the areas o f youth development and HIV/AIDS awareness have done a commendable job by setting up Peer Educators and Counselors in the schools within the past 3 years in the community. The formation of Virgins Club whose aim is to promote sexual abstinence among the youth and encourage sexual morality before marriage is part o f the programme to reduce teenage pregnancy. The AYA (African Youth Alliance) educates the youth on the usage o f contraceptives and has made available through its peer educators free condoms for the youth in the district. 1.2 Problem Statement Results from the World Fertility Survey published in the Population Bulletin o f the United Nations have shown a considerable mortality before age 5 o f children bom to teenage mothers, especially those under age 18, and most importantly among children bom after short birth intervals. Most adolescents when faced with an unwanted pregnancy resort to unsafe abortion because o f restrictions such as parental permission for legal procedures. Those who keep their pregnancies encounter problems associated with early childbearing such as curtailing o f education and a reduction in economic opportunities. 7 University of Ghana http://ugspace.ug.edu.gh The gap between first intercourse and first marriage leaves a window of time when adolescents are potentially at high risk o f HIV/AIDS and other Sexually Transmitted Infections (STI’s), as well as unplanned pregnancy. This is partly because this period may involve sexual experimentation, relationship instability and a lack o f access to health services. In Ghana, this window o f exposure is approximately two years for women and more than five years for men, and is a crucial period for adolescents to protect themselves from the consequences o f risky sexual behavior that could shorten or change their lives (Awubaso-Asare, 2004). Adolescent pregnancy in the Central Region has been listed as a priority for international organizations like the UNFPA as well as the District Assemblies in the region. Many programs that have been introduced in this problematic area seem not to have dealt with the problem using the teenagers themselves. So these programs have not been sustained. There has been therefore the need to go back to the drawing board and seek help from those who are the target group that is the teenagers themselves. There has been increasing school drop out o f female students due to teenage pregnancy in the study area that is Senya Bereku in the Awutu-Effutu-Senya District and this is a matter o f concern to all the authorities in the educational institutions and the society at large. Pregnancy records at the Senya Health Centre, the only health facility in the community were assessed for the first antenatal attendance. The attendees were then grouped into two: namely those aged 19 years and below; and those aged above 19 years. The percentage o f teenage pregnancy was determined from the total number o f first antenatal attendance as shown in Table 1.2 for the period o f six years from the year 1999 to the year 2004. 8 University of Ghana http://ugspace.ug.edu.gh Table 1.2 Pregnancy Records at the Senya Health Centre from 1999- 2004 Year Total No of pregnancies % teenage pregnancy 1999 878 17.2 2000 883 16.9 2001 678 21.0 2002 878 16.3 2003 923 17.6 2004 878 17.2 Source: Senya Bereku Healt'i Centre The average percentage o f teenage pregnancy for Senya Bereku was 17.7 percent for the past 6 years (taking the sum total o f teenage pregnancy for the period and finding the average) and this is greater than the national cumulative fertility average o f 8.68 percent for adolescents from ages 15-19 years ( GDHS 2003). The health centre at Senya is ill-equipped both in terms o f human resource as well as logistics to deal with delivery o f babies o f pregnant teenagers so they are referred to the district hospital to forestall any labour complication common to them such as cephalopelvic disproportion, eclampsia etc. The health centre though deals with the prenatal care and counselling o f pregnant teenagers. The study seeks to find out the causes o f teenage pregnancy in the Senya Bereku community. 1.3 Objectives General objective: To analyse the causes o f teenage pregnancy in the Senya Bereku community o f the Awutu-Effutu-Senya District. 9 University of Ghana http://ugspace.ug.edu.gh Specific objectives of the study: 1. To assess sexual experience of teenagers in the community. 2. To determine the knowledge and usage o f contraceptives among the adolescents. 3. To understand the community’s perception about teenage pregnancy. 4. To recommend strategies to address the problem o f teenage pregnancy The research seeks to address the question: Why are children having children? Do the factors such as need for financial support, peer pressure, poor knowledge and use of contraceptives, low career aspirations, contribute to the incidence of teenage pregnancy in the Senya Bereku community o f the Awutu-Effutu-Senya District? Hypothesis Null Hypothesis Ho= Coercion, Peer pressure, Poor knowledge and use o f contraceptives, Low career aspirations are not contributory factors to Teenage Pregnancy in Senya- Bereku community. Alternate Hypothesis Ha= Coercion, Peer Pressure, Poor knowledge and use o f contraceptives, Low career aspirations are contributory factors to Teenage Pregnancy in Senya- Bereku community. 1.4 Significance of Study Adolescent child bearing has potentially negative demographic and social consequences. Births that occur to teenage mothers have been found to have the 10 University of Ghana http://ugspace.ug.edu.gh highest infant and child mortality in Ghana (Ghana Statistical Service, 1994 and 1999). This may be due to the fact that teenage mothers are more likely to suffer from pregnancy and delivery complications than older mothers, resulting in higher morbidity and mortality for both themselves and their children. In addition, early childbearing may foreclose a teenager’s ability to pursue educational and job opportunities. It is estimated that 1 in every 4 teenager is sexually active globally though older teenagers from ages 15 were found to be more sexually active as compared to younger teenagers from ages 12 to 13 from a CDC National Survey o f Family Growth undertaken in 1995 in the United States. Most pregnant teenagers will attempt abortion so as to be able to continue their education. This poses a problem in Ghana where abortion is only legalized on medical grounds and should be performed by a qualified medical practitioner in a health institution. Teenage pregnancy, according to the laws of the land is no justification for a legal abortion except when medically proven that the health o f the mother is at risk should the pregnancy be allowed to reach its full term. This has given rise to lots o f unqualified doctors who attempt illegal abortions under unhygienic conditions with poorly sterilized instruments with which they tend to infect the girls who end up at the health institutions with complications such as uterine infections, severe anaemia from uterine bleeding, perforated uterus, secondary infertility, as well as loss o f life. The majority o f adolescents are sexually experienced by the time they turn 20. In the year 2002, more than 3 percent o f 15-24-year-olds were estimated to -be HIV nrtc,t,ve 11 University of Ghana http://ugspace.ug.edu.gh Women—particularly young women—are at a greater risk o f HIV/AIDS and are infected at a younger age than are men. Between 1986 and 2001, women accounted for 61 percent o f the cumulative AIDS cases in Ghana -Awubaso-Asare et al (2004). Infant mortality and literacy are indicators o f development o f any nation incorporated in the Human Development Index. The study is useful to direct future policies that direct at developing interventions that minimize adolescent fertility and reduce the potential threat o f HIV/AIDS in Senya Bereku community and the nation. 1.5 Limitations to the study The results o f the study especially on ‘ever experienced sex' were solely subjective and the respondents may not give truthful responses due to fear o f being branded ‘bad’ by others. Teenage mothers may also when asked retrospectively give different reasons for being pregnant in the first place and give a different twist to their relationship to the father of their child prior to the pregnancy. 1.6 Outline of dissertation Chapter one, the introductory chapter outlines the background to the project topic and states the problem statement as well as the justification for the study. The state o f teenage fertility in Ghana and in the study area Senya Bereku o f the Awutu-Effiitu- Senya District in the Central region is emphasized. Chapter two posits other research and demographic findings on adolescent reproductive health and sexuality through literature review. Chapter three describes the demographic features o f the study area, the economic activities of the area, educational and health 12 University of Ghana http://ugspace.ug.edu.gh facilities in the district as well as Senya Bereku community. The method o f data collection and instruments o f data collection are outlined in this chapter as well. The sample size and sampling technique are described in this chapter. The fourth chapter presents and diffuses the results o f the data analysis. Chapter five, the concluding chapter, outlines the summary, conclusion and recommendations from the survey. CHAPTER TWO: LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK 2.0 Introduction 13 University of Ghana http://ugspace.ug.edu.gh This chapter provides a theoretical background to the study/ topic. It seeks to explore materials on the factors that influence teenage pregnancy by various authors. 2.1 Adolescent Sexuality Globally from a survey by the Pregnancy Centre in Virginia (2004), it is estimated that 1 in every 5 adolescents has ever had sexual intercourse before his or her 15th birthday. The centre posits that by age 19years, 80 percent o f males and females will have had sexual intercourse. According to the centre the percentage o f high school students who have remained virgins has also risen from 45.9 percent in 1991 to 54.5 percent in 2001 in the USA. The reasons teenagers give for engaging in sexual intercourse include peer/ social pressure, pressure from partner, curiosity, rebellion, an expression o f love and a response to the need to be loved, lack o f understanding about real love, it feels good, ‘no longer a virgin’ so no big deal to engage in sexual intercourse. According to Vadies et al (1977), a majority of young males were willing to lie about love in order to have sex and that peer pressure was an important influence in their sexual activity. Hojcak et al (1988) conclude that non-sexual needs drive sexual behavior among adolescents. They argue that adolescents engage in sexual intercourse to confirm their sexual identity i.e. masculinity/ femininity; gain affection; rebel against authority o f parents and social norms; build self-esteem; alleviate anger and boredom; hurt or degrade others and express jealousy. They recommend that parents and therapists can alleviate teenage sexuality by teaching teenagers to use nonsexual techniques to satisfy sexual needs. 14 University of Ghana http://ugspace.ug.edu.gh Hanson et al (1981) conclude that females with employed mothers were more likely to have initiated sexual activity at an earlier age, were less knowledgeable about contraception and expressed a willingness to accept a higher risk o f pregnancy. In the United States the average age for initiating sexual activity is 16 years according to Crieghton- Zollar A. (1985), although in certain cities such as New York, the average age o f first sexual intercourse is 11.6 years for the African-American youth, and 12.8 years for the Hispanic youth and 14.5years for the white youth Miller et al (1986) report on a relationship between parental control and adolescent sexual experience. The highest level o f sexually permissive attitudes and experience in sexual intercourse among adolescents were associated with a lack of parental rules. Moore et al (1986) analyzed data from a survey that indicates that parental discussion with children is associated with a lower frequency of the initiation o f sexual activity only in families that held traditional family values and beliefs. Miller (1998) agrees from a review o f research synthesized findings that parental values favouring sexual abstinence as well as parental supervision are related to reduced teen pregnancy risk. Findings though were mixed about parent/child closeness and teenage pregnancy related behaviours. Miller posit that teenagers from disadvantaged neighbourhoods and who had single parents, had older sexually active siblings or were sexually abused were more likely to start having sexual intercourse at an early age. According to Awusabo-Asare et al (2004), four in 10 Ghanaian women and two in 10 men aged 15-19 have ever had sex; by age 20, 83 percent o f women and 56 percent o f men have had sex and that the median age at first intercourse is 17.4 for women and nineteen and a half years for men. They hold the view that am ausA ose who have had 15 University of Ghana http://ugspace.ug.edu.gh sex, four in 10 women and six in 10 men aged 12-24 have had more than one sexual partner. They posit that the proportion o f 15-19-year-olds who have had sex declined substantially between 1993 and 1998: from 59 percent to 38 percent among women and from 33 percent to 19 percent among men. Sexual coercion they found out is a common occurrence in Ghana: one in four sexually experienced young women say that they have ever been forced against their will to have sexual intercourse (8 percent o f sexually experienced young men report the same). Twelve percent o f women and 2 percent o f men were forced into their first sexual experience. 2.2 Adolescent Contracep tive Use Card et al (1988) hold the view that low contraceptive usage among adolescents is due to reasons that the sexual intercourse is not planned and that planning may require admission to the fact that one was becoming sexually active, especially among the young females. Awusabo-Asare et al (2004) suggests that many women do not have an accurate understanding o f conception or how to use contraceptives effectively. They posit that many females are not comfortable enough with their sexuality to plan ahead, obtain contraceptives or even talk about method use with their partners. Some adolescents actually hold the erroneous view that they could not get pregnant at the initial sexual act. Cohen and Rose (1984) argue that males contraceptive behaviour is primarily self­ oriented and that adolescent men were more inclined to use contraceptives in casual encounters than with steady girlfriends; the men also tended to view birth control as female decisions. Finkel and Finkel (1975) conclude from a research o f 421 male high 16 University of Ghana http://ugspace.ug.edu.gh school students that low birth control methods usage among them was due to the sporadic nature o f sexual activity and lateness o f sexual education. Hogan et al (1985) explore the correlation between social factors and use o f contraceptives at first sexual intercourse. They conclude that teenagers who were higher in socioeconomic status, live in higher status neighbourhoods and had parents with intact marriages were more likely than others to use contraceptives at the first sexual debut. Awusabo- Asare et al confirm that among 15-19-year-olds in Ghana, 76 percent o f women and 88 percent o f men are aware o f at least one modem family planning method. The condom is the most frequently cited method. They suggest that although about two-thirds o f 15-19 year olds (female and male) approve of family planning, most sexually active teenagers do not use contraceptives. Among sexually active adolescents in this age-group, 80 percent o f females and 63 percent o f males currently do not use any modem method. They confirm that only 10-12 percent o f 15-19 year olds who are not currently using contraceptives intend to use a method in the next 12 months. They posit that young people in Ghana do not feel confident insisting on condom use and that 27 percent o f men and 30 percent o f women say that they could not insist on using a condom if their partner did not want to use one. 2.3 Adolescent Marriage and Culture 17 University of Ghana http://ugspace.ug.edu.gh There are cultural beliefs in every society concerning teenage marriage. Asian and Middle- East cultures accept teenage marriage. In many cultural strict societies the one responsible for impregnating the teenager will be coerced to marry her. This used to be the practice in Ghana but it is gradually dying. Westney et al (1986) contend that most adolescent fathers ignore responsibility for the child and tend to be high school dropouts with no meaningful education aspirations. The longer the relationship before the pregnancy, the more supportive the young man was o f the young mother and child and the more the likelihood that the couple will marry according to Westney et al (1986). They conclude that there is no difference in marriage opportunities between an unwed teenage mother and never been pregnant teenage mother. There is a window between time o f sexual debut and marriage. This increases the risk o f the adolescent to STIs. The average time between first sexual activity and marriage is about two years for young women and more than five years for young men in Ghana according to Awusabo-Asare et al (2004). They conclude that half o f women aged 20-24 in 1998 had married by age 19.3 but in the year 1988, half had married by 18.7years. Men marry later than women in Ghana, in 1998, half o f men had married by age 24.8. 2.4 Teenage Childbearing Bearing a child tend to have negative effects on both the teenage mother and teenage father, though the negative consequences are far more outreaching for the young 18 University of Ghana http://ugspace.ug.edu.gh mothers Card et al (1978). Teenage childbearing has negative consequences for educational attainment, occupational achievement, marital stability and the ability to control subsequent fertility; children o f adolescent mothers had lower academic achievement, were more likely to live in single or stepparent families and wee a little more likely to duplicate the early fertility, early marriage pattern o f their parents. Illegitimate births are the outcomes o f first pregnancies in two thirds o f teenagers, according to Zelnick et al (1974). Awusabo-Asare et al (2004) conclude from their study that twelve percent o f women and one percent o f men aged 15-19 have ever had a child and that one in 10 births in Ghana occur among teenage mothers. Adolescent women in rural areas are more than twice as likely as those in urban areas to have a child. The Pregnant Centre in Virginia (2005) confirms that although some teens marry, the vast majority o f boy friends leave when the girlfriends have a baby, sixty seven percent o f births occurred to unmarried teenage mothers in 1989 and in the year 1994, 75 percent o f teenagers aged 15-19 are unmarried by the time the pregnancy ends. Cohen et al (2004) agree that one fifth o f all teenage girls who drop out o f school do so because they got pregnant and that less than 50 percent o f teenage mothers are able to graduate from high school. 2.5 Adolescent and Abortion 19 University of Ghana http://ugspace.ug.edu.gh Abortion is a common occurrence among adolescents. Twenty percent o f abortions in the U.S. are obtained by teenagers in a survey by CDC (1993). Forty five percent o f teenagers who become pregnant unintentionally have abortions posits Henshaw et al (1998). They found out in a study o f 439 females that 49 percent did not inform their parents before having an abortion. Whites who do not marry terminate their pregnancies through abortions seven times more frequently than blacks according to Zelnick et al (1974). Sixteen percent o f women and eleven percent o f men aged 12-24 who ever had sex reported being involved in terminating a pregnancy in Ghana according to Awusabo-Asare et al (2004) and not all abortions take place in a clinical setting: thirty percent o f women and thirty nine percent o f men aged 12-24 say that the last abortion they were involved in took place at home. They posit that young women most often cite a desire to continue their education, the lack of financial means to support a child or their male partner's denial o f paternity as the main reason for having an abortion. 2.6 Sexually Transmitted Infections From the GDHS (2003) about one in four adolescents (27 percent o f males and twenty two percent o f females) say that they know one or more people who have ever had an STI. Among adolescents who have ever had an STI, three-quarters o f young men and more than half o f young women sought treatment, most often from a drug store, hospital or clinic. After HIV/AIDS, adolescents are most likely to have heard o f gonorrhea, followed by syphilis. 20 University of Ghana http://ugspace.ug.edu.gh 2.7 Focus on HIV/AIDS General awareness o f the disease is nearly universal among 15-19-year-olds, with ninety seven percent o f both males and females reporting that they had heard o f HIV/AIDS. However, about one in five young men and women still cannot name any specific way by which HIV is transmitted, and only about one in four believe themselves to be at risk o f infection. In response to the outbreak o f the HIV/AIDS epidemic in 1986, the Ghanaian government embarked on a set o f educational programs designed to increase awareness. The mass media and the workplace are the main sources o f HIV/AIDS information for adolescents. Among those aged 15-19 who have heard o f HIV/AIDS, the reported sources o f information for females and males, respectively, are radio (66 percent and 68 percent); workplace (52 percent and fifty percent); television (49 percent and 46 percent); print (13 percent and 18 percent); friends and relatives (7 percent and 5 percent); and heal tit workers (2 percent and 3 percent) (GDHS). Six in 10 teenagers say that knowledge o f HIV/AIDS has influenced their behavior, according to one study o f 10-19 years-olds in three areas o f Ghana. National studies have also shown, however, that fewer than half o f adolescents who have heard o f HIV/AIDS have actually changed their behavior by abstaining from sex, limiting their number o f partners or using condoms as a result o f HIV/AIDS knowledge. 21 University of Ghana http://ugspace.ug.edu.gh 2.8 Conceptual framework The term teenager is o f fairly recent origin. It first appeared in the Readers’ Guide to Periodical Literature in the 1943-1945 issue but since has become a popular term to denote people aged between 13-19 years. These subjects are the focus o f this study. Adolescent refer to the period o f transition in human development from childhood to adulthood. It is characterized by rapid emotional and physical changes, and an increasing awareness o f ones sexuality and awareness o f the sexuality o f others- same and opposite sex. There are variations in definitions on the exact period o f time o f the adolescent period but most define it as a period between ages 10-19 years. In Ghana, the booklet on Adolescent Reproductive Health Policy, 2000 defines adolescence as the period between 10 to 19 years and defines youth as ages 10 to 19 years. Many factors have been thought to influence teenage pregnancy and adolescent sexuality. Some of the factors include peer pressure exhibited by a need to belong to a group, curiosity, the need to love and be loved in return, and lack of parental control among others. Socio-cultural acceptance o f early marriages in certain countries also is a major factor causing teenage pregnancy. Lack o f career aspirations and future goals will influence a teenager’s waywardness and indulgence in sexual activity. Negative media influences especially in this era o f globalization, poor knowledge o f contraceptives as well as the reproductive organs and cycle and irregular usage of contraceptives all act as determinates o f teenage pregnancy. Factors that will be explored in the study include peer pressure, need for financial support and age at menarche. Socio-cultural factors will indirectly be assessed using religion and religious practice, festival celebration and participation in the 22 University of Ghana http://ugspace.ug.edu.gh community, early marriage. Socioeconomic factors will be investigated indirectly through the variables: occupation o f the parents, living arrangements, bathing facilities, who pays the school fees. Contraceptive knowledge and usage by sexually active youth, knowledge o f HIV/AIDS and education on teenage pregnancy will help to identify reproductive knowledge o f the respondents. Figure 2. Diagrammatic Presentation of Factors that Cause Teenage Pregnancy The factors such as age at menarche, poor knowledge and usage o f contraceptives, lack o f guidance about sex, low career aspirations, socioeconomic factors, socio­ cultural factors, coercion, adventure, peer pressure and lack o f parental control in the community will be explored in the study. 23 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE: STUDY AREA AND METHODOLOGY 3.1 STUDY AREA 3.1.1 Location and Size Awutu Effutu Senya District is in the Central Region. It was carved out o f the former Gomoa-Awutu-Effutu District in 1988 to facilitate government’s decentralization and local government reform policy. It is situated between latitude 5 20’ north and longitudes 5 42’ and longitudes 0 25’ and 0 37’ west on the eastern part o f the Central Region of Ghana. It is bordered by the Greater Accra and three districts, namely Ga District Agona Gomoa. It is bordered to the north by Agona District, to the north - east by the West Akim District, to the south by the Gulf o f Guinea, to east by Gomoa District and Ga District and on the Gomoa District. The district covers an area o f approximately 417.3 sq/km . 3.1.2 Socio-Demographic Features According to the 2000 population and housing census, the population o f the district was approximately 169,972. This represents ten percent o f the population o f the central region. The district has approximately 168 settlements with Winneba as the district capital. The table 3.1 shows population characteristics o f the district. The major settlements in the district are Winneba, Senya, Kasoa, Awutu Bereku, Bontrase, Bawjiase. These settlements have 60 percent of the district population. The main ethnic group in the district are the Guans. 24 University of Ghana http://ugspace.ug.edu.gh Table 3.1 Population Characteristics of Awutu-Effutu-Senya District and Senya Bereku Community Name of locality Total population sex male female Awutu-Effutu-Senya District 169,972 80,535 89,437 Senya Bereku Community 15,908 7,100 8,808 Source: Ghana Statistical Service 2002 3.1.3 Major Economic Activities Agriculture, commerce, service, and manufacturing and processing are the main economic activities. Agriculture constitutes the main economic activity o f the district economy. It employs about 58 percent o f the district population. The farming population is 99,116, including fishermen who total 16,519. Agricultural production in the district is on two levels: subsistence level constitutes 70 percent o f the farming population while commercial farming constitutes 30 percent. Senya is basically a fishing community and this is the main economic activity in the district. Because it is along the coast however it has a potential to grow in the tourist sector especially with the construction o f hotels along the beach. 3.1.4 Income per household The average annual income per household from a survey in October 2002 (GLSS 4) was 6,944,091 cedis as against the expenditure of 12,460,618cedis. Education represented 7.1 percent o f the household expenditure. 25 University of Ghana http://ugspace.ug.edu.gh 3.1.5 Educational facilities The percentage o f girls’ enrolment in the educational facilities decreases as the level o f education increases from an average o f 53.2 percent to 46.5 percent, then increases at the Senior Secondary School (SSS) level. The increase at the SSS level may be due to the fact that some o f the girls are from outside the district since the schools have boarding facilities for students who live outside the district. According to the District Director o f Education, the drop-out o f girls from the schools is due primarily to pregnancy. Drop-out o f girls is greatest at the level o f Junior Secondary School (JSS). Table 3.2 Distribution of educational facilities in AESD Type of School Number Enrolment % of Girls Drop-out rate of girls % Nursery/ Kindergarten 101 7,220 53.2 Primary 121 25,642 47.8 5.3 JSS 60 9,804 46.5 10.1 SSS 4 3,518 48.8 0.83 Total 286 46,184 Source: District Education Office (2002) The percentage enrolment for girls at the JSS level is lower for Senya Bereku (43.8 percent) as compared to the percentage enrolment for the district at (46.5 percent). This is due to the reason that teenage pregnancy in the community o f Senya Bereku according to the District Director of education is higher than in any part of the district. 26 University of Ghana http://ugspace.ug.edu.gh is celebrated in the month o f August which coincides with the season o f fish bumper catch. 3.2 METHOD OF DATA COLLECTION 3.2.1 Sources of data and Sampling Frame The data were collected from primary and secondary sources. The secondary data includes literature from the internet, journals, statistical service reports, quarterly reports from the health centre and the district education service office as well as the district assembly. Primary sources are observations from field, in-depth interviews with opinion leaders and key informants and focus group discussions. Since the entire student population o f about 1500 in the community could not be included in the study, a representative sample o f 200 respondents was used for answering the questionnaires. These 200 teenagers ‘never been pregnant’ were selected this way: 120 students from five Junior Secondary Schools and 80 students from the only Senior Secondary School in the district. Ten teenage mothers were picked for in-depth interviews Twenty teenagers participated in 2 focus group discussions: 10 males and 10 females in each respectively Fifteen key informant interviews with the following persons were held: • The youth leader o f the Muslim community • The peer educator for AYA in the community • Three teachers • The Medical Assistant • One midwife 28 University of Ghana http://ugspace.ug.edu.gh • A public Health nurse • Five mothers o f teenage mothers for their opinions • The District Assembly Officer • The District Director o f Education 3.2.2 Sampling Technique The students from all the JSS schools in the community were used in the research. This was done to ensure equal representation o f the sampling population and to avoid any bias. The Senya Senior Secondary School being the only SSS in the community was picked by the purposive sampling method. Two hundred teenagers ‘never been pregnant’ were selected from the five Junior Secondary Schools in the community by the simple random technique. The students were made to pick ballot papers that had ‘Yes’ or ‘No’ written on them. The papers were equal in size, texture and colour and were identical. The papers were shuffled prior to being picked by respondents. The 200 who picked ‘Yes’ ballot papers were included in the research: 120 students from JSS and 80 students from the SSS. Ten teenage mothers were also picked using the snowball approach with the help o f 5 key informants. Twenty teenagers participated in 2 focus group discussions: 10 males and 10 females in each group. The focus group discussions were done with the help o f a moderator and recorded on audio tape. The recorded information was then transcribed. A research assistant was enlisted to help in the collection o f data from the students in the field. Key informants interviews were held with teachers, the youth leader o f the Muslim community, the peer educator for AY A in the community and the Medical Assistant, 29 University of Ghana http://ugspace.ug.edu.gh midwife, public health nurse at the Senya Bereku Health Centre, mothers o f five teenage mothers, the District Assembly Officer and the District Education Officer as opinion leaders. 3.2.3 Instruments of data collection and analysis The instruments used in collecting data from the field included questionnaire which was in the form o f open ended, closed-ended and semi-closed questions. All the questionnaires were self-administered. In-depth focus group discussion and in-depth interviews with opinion leaders and key informants helped to solicit views, which would otherwise not have been captured in the questionnaires. Data collected was transferred to the Statistical Programmes for Social Sciences (SPSS) after all the data cleaning had been completed. Descriptive statistical tools were used to summary statistics in forms o f frequencies and relative percentages. Bivariate analysis, T and Chi-square and Correlations were run to study relationships between variables. The results have been presented in the forms o f tables, graphs, charts and bars. 30 University of Ghana http://ugspace.ug.edu.gh Ethnicity of respondents The ethnic distribution o f the respondents reflects the socio-demographic features o f the community as the main ethnic group (77 percent) o f respondents are Akans/ Guans. The other ethnic groups refers to migrants from neighbouring countries in West Africa - most o f them Liberians which is understandable considering the proximity o f the refugee camp at Bunduburam to the community. Pattern o f ethnic background is presented in Table 4.1. Table 4.1 Ethnicity of respondents Distribution of respondents by ethnicity Ethnic group Akan/Guan Ga/Adangme Ewe Gur Hausa Other ethnic groups 77% 6% 3% 5% 5% 4% Source: Field survey Characteristic by the parent being alive, whom they stay with Data was collected about their parents being alive or not, whom they stay with to assess i f students were from broken homes and to assess the head o f household. Parents alive or not All the respondents’ mother was alive and 14 percent o f the respondents’ father was deceased. Parent respondent stays with 32 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR: RESULTS AND DISCUSSION 4.0 Introduction Information collected from the field survey is discussed in this chapter. The study variables included gender, age, age at first intercourse, age at menarche, occupation of father and mother, religion and religious practice, family composition, current living situation, condom knowledge and usage, ‘ever had sex’, HIV/AIDS knowledge, education on teenage pregnancy, communication with parents, guardians or other people when respondents have problems. 4.1 Socio -Demographic Characteristics of Respondents Sex and age of respondents The number o f male students who answered the questionnaire totaled 58 and the total number o f females ‘never been pregnant’ totaled 142. The median age o f males is 16.6 years and that o f females is 16.09 years in the survey. The median age for teenage mothers in the survey was 18 years. 31 University of Ghana http://ugspace.ug.edu.gh Majority of the ‘never pregnant’ respondents lived with their mother only (46 percent), as against 37 percent who lived with both parents; 7 percent who lived with their father only and ten percent who lived with other relatives. From the survey it was found out that majority o f the ‘never pregnant’ respondents were from homes where their parents were either divorced or separated or had polygamous marriages. One hundred percent o f the teenage mothers were from female headed households and out o f this 20 percent stayed with a female relative other than their mother. All the teenage mothers were from homes which lacked a fatherly figure. Fifty percent o f the teenage mothers were from homes where their parents were divorced or separated. Ten percent said their fathers had traveled outside the county for some years and had not been in touch. Thirty percent were from polygamous homes and father was deceased in ten percent o f cases. Table 4.2 Parent respondent stays with Description ‘Never pregnant’ teenager Teenage mothers Both parents 37% Mother only 46% 80% Father only 7% Relatives 10% 20% Total 100% 100% Family instability, need to love and express love, lack o f a proper male role model contributed to the incidence of adolescent pregnancy in their situation. Family size 33 University of Ghana http://ugspace.ug.edu.gh Family size was assessed using information gathered by the number o f siblings each respondent had. Number o f siblings in the family o f respondents ranges from 1 to 9. Majority o f respondents (27 percent) had 5 siblings. Mean number of siblings of respondents is 4.7 per family. Since family size is a reflection on the financial constraints on the household head, especially female headed households (GDHS 2003), it is reasonable to assume most o f the respondents came from large families with low income levels. 4.2 Socio-Economic Characteristics of respondents The parent’s occupation The main occupation o f father (29 percent) was found out to be civil servant from the field survey. The next main occupation o f the father was fisherman. Not specific (6 percent) was o f students whose fathers were deceased even though some o f the students stated the occupation o f their father though he was deceased. Figure 3. Occupation of Father of Respondents 34 University of Ghana http://ugspace.ug.edu.gh Psrcenl PASTOR 17% Source: Field Survey Most mothers o f respondents were found to be traders (72 percent) from the field survey. Fishmongers occupied only seven percent o f occupation o f mothers. The distribution is illustrated in Figure 4. The three percent stated as non specific is o f those respondents who did not make available the occupation o f their mothers. All the mothers o f the teenage mothers were petty traders which imply an irregular source o f income as compared to that o f civil servants. 35 University of Ghana http://ugspace.ug.edu.gh Figure 4. Occupation o f Mother of Respondents TRADER ’,'2% CIVIL SERVANT 2X SEAMSTRESS 6% HOUSEWIFE6% HEALTH PROFESSIONAL NOT SPECIFIC 3% FARMER 2% FISHMONGER Source: Field survey Payment of school fees Forty- eight percent o f the students had their fees paid by their fathers; this is less than fifty percent o f the respondents. O f concern are the students who paid their fees themselves. These were female students who also worked and received money from their sexual partners in order to pay their fees. Detailed information is outlined in Table 4.3. These female students are at risk o f getting pregnant because o f the financial support they need to continue their education. Table 4.3 Distribution by Who pays School fees for Respondents 36 University of Ghana http://ugspace.ug.edu.gh Payment of school fees % of students Father Mother Guardian Siblings Myself Both parents 48% 40% 7% 1% 2% 1% Source: Field survey Economic activities of the students Twenty five percent o f the respondents said they worked for income as well as attend school. The most common job they were involved in was petty trading o f ice-water and other items that is (94.4 percent). The rest o f the working respondents that is 4.6 percent sold cooked foodstuffs. 4.3 Career aspirations Majority o f the ‘never pregnant’ respondents had career aspirations; only 24.7 percent did not know what to do in the future. The professions chosen were civil servant (45 percent), seamstress/ tailor (14.4 percent), health professional (7.2 percent), broadcaster (4.1 percent), caterer (2.1percent), and air hostess (lpercent). 4.4 Socio-Cultural Characteristics of respondents 4.4.1 Religion and religious practice Majority o f respondents were Christians i.e. 90 percent and forty percent o f them practiced their religion daily. Only 10 percent o f the respondents were Moslems. Crosstabulation o f religion and religious practice was run to assess the differences if any between the two main religion and religious practice. Findings are in Table 4.2. Other as stated in Table 4.4 i.e. 2 percent o f respondents, for religious practice, were 37 University of Ghana http://ugspace.ug.edu.gh students who practiced their religion irregularly and sporadically. Some 4 percent reported truthfully that they did not practice their religion at all. Table 4.4 Characteristics of respondents by religion and religious practice Religion Religious practice Daily Twice weekly Weekly Fortnightly Not at all Other Christian 40% 22% 19% 5% 4% Moslem 5% 2% 1% 2% Total 45% 22% 21% 6% 4% 2% Source: Field survey 4.4.2 Living arrangements Place o f abode Sixty- eight percent o f ‘never pregnant’ respondents said they lived in a compound house as against thirty two percent who do not live in a compound house. Ninety percent o f the teenage mothers lived in a compound house and the rest 10 percent lived in a single house unit. Sleeping arrangements The sleeping arrangement reflects the income o f the family o f the respondents. Majority o f students shared rooms with either their parents (34percent) or their siblings (47 percent). Only 14 percent o f the students had a room to themselves and a few even slept on the corridor o f their homes. Prior to being pregnant, the seventy percent o f the teenage mothers shared a room with the household head or their siblings, thirty percent had a room to themselves. It is was suggested by some opinion leaders that, that might be a contributory factor to teenage pregnancy in the case of 38 University of Ghana http://ugspace.ug.edu.gh those who share rooms with their parents but this was not reflected in the survey results o f the teenage mothers since they lived in female headed housholds. Bathing facilities Since most o f the respondents live in a compound house their bathing facilities were included in the survey. Fifty- eight percent o f the students had bathing facilities within the house though some had their bath outside their house or in a neighbour’s house. Having a bath outside the house may increase the risk o f coercion to participate in a sexual act. Data has been represented in Figure 5. Figure 5. Percentage distribution of bathing facilities of respondents bathing facilities bathroom is in neighbor's house 12% Source: Field survey 4.4.3 Festivals The months for the festivals were stated as August (94.7 percent), followed by May (4.2 percent) then February and September (1 percent) each. The discrepancies may be due to the fact that not all the students are from the community so they will have 39 University of Ghana http://ugspace.ug.edu.gh different festivals in their hometown, since the question read as ‘Do you have any festival in your community?’ Fifteen percent o f respondents said they stay out late during the festival seasons and seventy one percent said they make new friends during that time. Festivals are social gatherings and in this time many parents are lax on strict rules for their children. 4.5 Menarche and Sex Experience Menarche Most common age at first menarche is 14 years (25 percent), followed by 15 years and 12years at 18 percent respectively. The least age is 11 years. Median age for menarche is 14.06 years. Age at onset o f menarche from the field survey has not reduced as expected in the community compared to global trends. Figure 6 shows the community trend. Figure 6. Age at first menarche of respondents age at f irs t m enarche 10 YEARS 16 YEARS 17% 15 YEARS 16% 14 YEARS 25% Source: Field survey 40 University of Ghana http://ugspace.ug.edu.gh ‘Ever Had Sex’ Experience Respondents were asked if they had ever engaged in sexual intercourse and 56 percent o f the respondents answered in the affirmative. To determine the gender differences for those who have ever had sexual intercourse a crosstabulation with a Chi-square test was performed. The results show that majority i.e. 82.8 percent o f the male respondents had eve had sexual intercourse whilst 45.1 percent o f the females had ever had any sexual intercourse. These results show that male students are approximately 12 times more likely to have ever had sex as compared to the female students. Table 4.5 Percentage distribution of respondents by sex and sexual experience sex no yes N Male 17.2% 82.8% 58 Female 54.9% 45.1% 112 [X2 (1 ,200) =11.869, p=0.001] Age at sexual debut Eighteen percent o f the respondents did not state the age o f first intercourse though most stated if they had ever had sexual intercourse. The eighty two who stated their age o f first intercourse are illustrated in Fig.8. Majority o f the students had sexual intercourse at age 15-16 years (50 percent) followed by age 17-18 years at 38.9 percent, with 5.6 percent having had sexual intercourse at less than ten years o f age. These were male respondents that had sexual intercourse at ages 4 years and 5 years. Many teenagers had their sexual debut in later teen years that is from 15 years onward. 41 University of Ghana http://ugspace.ug.edu.gh Figure 7. Age at sexual debut Age at f irs t sex ' • 0 13 14 15-16 17-1© A ge s Source: Field survey How the sexual debut took place Majority 58 percent o f the never pregnant teenagers stated that they were coerced in their first sexual debut. The next largest group, 26 percent said they were tricked into having sexual intercourse. Sexual debut pattern was significantly different for the males and the females as shown in Fig. 9. Many female respondents stated that they were forced or tricked. Significantly some o f the male respondents 11 percent stated that the sexual act was planned. Gender and violence plays a significant role in sexual debut. This pattern reflects in the findings from the teenage mothers, 60 percent o f who stated that they were coerced, 20 percent- they were tricked and 20 percent said it just happened. With a Chi-square o f ([X2 (3,84)=9.064, p=0.028]) the alternate hypothesis that coercion 42 University of Ghana http://ugspace.ug.edu.gh plays an important role in the cause o f teenage pregnancy is accepted . Percentage distribution for gender is represented in Figure 8. Figure 8. Situation in which the sexual debut took place Source: Field survey HOW DID THE SEXUAL INTERCOURSE HAPPEN BY GENDER 67 .50% □ MALE ■ FEMALE Present Sexual activity Only 18 percent o f the students who had ever had sexual intercourse answered questions on their present sexual activity. O f these sexual activity is as follows: daily (5.6 percent); once a week (33.3 percent); once monthly (44.4 percent); twice monthly (11.1 percent); sex just once (5.6 percent). Frequency o f sexual activity was not dependent on the gender o f the respondents. 43 University of Ghana http://ugspace.ug.edu.gh Figure 9. Sexual Activity of students sexual activity had sexjust once daily 6%6% twice mo 11°/ onoe a week 33% once a month 44% □ daily a onoe a week □ once a month □ twice monthly ■ had sexjust once Source: Field Survey Relationship to the person you last had sexual intercourse with Thirty one percent o f the respondents responded to the question o f relationship to the person they last had sexual intercourse with. There was no statistical difference for gender in the relationship to the person they last had sexual intercourse with (p=0.445). Most respondents are in consensual relationships. Figure 10 shows the diagrammatic presentation o f the gender and the various categories o f boyfriend/ girlfriend, stranger, casual acquaintance, and relative. 44 University of Ghana http://ugspace.ug.edu.gh Figure 10. Relationship to the person you last had sexual intercourse with RELATIVE CASUAL A3UAJNT7WCE STRANGER BOYFRIEND/GIRLFRIEND 0 20 40 60 80 100 120 140 160 □ male a female Source: Field survey Relationship between age at menarche and sexual debut Early age at sexual debut influences the probability that a teenager will either get pregnant or contract sexually transmitted diseases. Most young adolescents receive education on sexual education much later than their age o f sexual debut. All the respondents who had menarche at age 12 years had sexual intercourse at ages 15-16 years and they are 50 percent o f the female respondents who affirmed their age o f first sexual intercourse. None o f the respondents with earlier menarche ages made their 45 University of Ghana http://ugspace.ug.edu.gh sexual debut after the age o f 17 years, but much earlier than those who had menarche at age 16 years. There is a strong positive relationship between age at menarche and age o f sexual debut (r=0.651, p=0.042), proving that early age at menarche may contribute to early sex debut and puts these females at high risk o f getting pregnant in adolescence if protective measures are not taken. Table 4.6 Relationship between age at menarche and age at sexual debut Age at sexual debut Total 15-16 years 17-18 years Age at menarche 12 years 50% 50% 14 years 10% 10% 20% 16 years 10% 20% 30% Source: Field survey Relationship between religious practice and age of sexual debut Religious practice was assessed using categories o f daily, twice weekly, weekly, fortnightly, and not at all. Relationship between religious practice and age at sexual debut was investigated by using a cross tabulation. Table 4.7 Relationship between religious practice and age at sexual debut Age at first sexual intercourse Total Religious practice Less than lOyrs 13-14yrs 15-16yrs 17-18yrs Daily 16.7% 22.3% 38.7% Twice Weekly 16.7% 5.6% 22.3% Weekly 5.6% 16.7% 22.3% Fortnightly 5.6% 5.6% Not at all 11% 11% Total 5.6% 5.6% 50.1% 38.9% Source: Field survey 46 University of Ghana http://ugspace.ug.edu.gh There is a highly significant relationship between religious practice and age at sexual debut [X2 (12, 36)=27.735, p=0.006]. Those who practiced their religion daily made their sexual debut at a later stage in their teenage life than those who practiced their religion weekly and fortnightly for. All the teenage mothers said prior to being pregnant they had practiced their religion fortnightly. Career aspirations and ‘ever had sex’ experience There was a relationship found between specific career aspirations and sexual activity [X2(6, 194)= 14.165, p=0.028]. All the respondents who aspired to be health professionals in future had never had any sexual intercourse whereas for all the other students irrespective o f their choice o f career, majority o f them, over 50 percent had ever indulged in sexual intercourse. Aspiring health professionals may be more focused and interested more in their health and the consequences of getting pregnant. Financial exchange in relationships Many respondents said they neither receive money nor give money to their sexual partners but those who do receive money, spend the money on food (36.4 percent), clothes (36.4 percent) and school fees (22.7 percent), and other things (4.5 percent). All respondents who need financial assistance from sexual partners in order to pay or subsidize their school fees are more at risk from sexually transmitted infections and teenage pregnancy. 4.7 Contraceptive knowledge and use Contraceptive use 47 University of Ghana http://ugspace.ug.edu.gh Seventy one percent o f respondents said they were doing something to prevent pregnancy. The methods used are as follows: abstinence (56.3 percent); natural family planning (21.1 percent); conventional family planning method (16.9 percent); herbs (5.6 percent). Figure 11 shows a graphic presentation on the methods used to prevent pregnancy. Figure 11. Contraceptive usage Source: Field survey This means that the teenagers from the survey are not using conventional family planning methods but are relying on natural family planning methods and herbs; placing themselves and their partners at risk from Sexually Transmitted Infections, HIV/AIDSs as well as unplanned pregnancies. Despite education some are using herbs (5 percent) to prevent unwanted pregnancy. The efficacy o f this method cannot be vouched for. The majority of the students though are abstaining from sexual activity. 48 University of Ghana http://ugspace.ug.edu.gh Focus on Condom usage Twenty four percent o f students said they had had sexual intercourse in the past six months, out o f which only 50 percent o f them used a condom. Despite education on teenage pregnancy and HIV/AIDS, 50 percent o f the students who had sexual intercourse in the past 6 months did not use condoms for the sexual activity. Figure 12. Contraceptive use in the past 6 months Source: Field survey In the focus group discussion the general consensus was that they did not patronise condoms because as one respondent put it we do not like condoms . 49 University of Ghana http://ugspace.ug.edu.gh Most o f the students (90 percent) did know where to get condoms; with the chemist shop being the common option, though some students had knowledge about assessing condoms from peer educators in the community. Only 25 percent o f the teenage mothers interviewed used injectable contraceptive to prevent pregnancy but this failed over a period o f time because all contraceptives have failure rates. 4.8 Education and knowledge of teenage pregnancy Education on teenage pregnancy All the respondents had received education on teenage pregnancy. Method o f education was by the means o f school, media, peer education, NGO, and hospital. Education was given within the past 2 years on teenage pregnancy. Figure 13. Percentage distribution of methods of education on teenage pregnancy how respondents received education on teenage pregnancy hospital NGO 9% 18% □ school ■ media □ peer educator □ NGO ■ hospital Source: Field survey 50 University of Ghana http://ugspace.ug.edu.gh Reasons for increase in teenage pregnancy This was a multiple response question and respondents could give as many reasons as they wanted tor the cause of teenage pregnancy. The answers included need for financial support (31.5 percent), sexual promiscuity (25.6 percent), peer pressure (24.4 percent), adventure (8 percent), need to have children by certain age (8 percent), don’t know (2.5 percent). None stated coercion as the reason for teenage pregnancy, though as much as 58 percent o f respondents stated that they were coerced at the first sexual act: bringing to the fore the m isconception among most teenagers that one cannot get pregnant in the first sexual act. Figure 14 is a graphic presentation of the causes o f teenage pregnancy according to the students themselves. Figure 14 Causes o f teenage pregnancy in Senya according to students in community caLses o f teenage pregnancy by percentage Source: Field survey All respondents at the focus group discussions felt sex was an integral part o f ‘boyfriend-girlfriend relationship’ and that if someone was in a relationship with the 51 University of Ghana http://ugspace.ug.edu.gh opposite sex then the person could not refuse to have sex with the partner. Seventy- five percent o f the teenage mothers interviewed entered into their sexual relationships willingly with their partners but 25 percent of the teenage mothers did say they were coerced and got pregnant at the initial sexual act. Knowledge about teenage mother Eighty five percent o f the students knew o f a girl who had gotten pregnant in the past four years and had to drop out o f school. Eighty seven percent o f the respondents knew the situation o f the teenage mothers as at now. The following reasons were given as their assessment o f the teenage mother’s present situation: nothing idling at home -32.2 percent; petty trading -27.6 percent; formal schooling -13.8 percent; apprenticeship- 12.6 percent; cohabiting with the one who impregnated her -9.2 percent; married to the one who impregnated her -3.4 percent; cohabiting w ith someone else -1.1 percent. All the teenage mothers interviewed were not married to the one who impregnated them. W ith the exception o f one, the fathers had actually denied responsibility for the pregnancy. Seventy five percent o f the teenage were continuing their formal education with support from their families in rearing the child. Ideal age for marriage The age that the majority o f students felt was ideal for girls to get married is between the 25-30 years range. Despite the education on teenage pregnancy 2.1 percent felt the ideal age for marriage was from 15-19 years. 52 University of Ghana http://ugspace.ug.edu.gh Table 4.8 Students Opinion for the Ideal age for Marriage of Women Ideal age for marriage in a range % of students 15-19yrs 20-24yrs 25-30yrs >30yrs 2.1% 18.6% 76.3% 3.1% Source: Field survey 4.8 Communication Interpersonal relationships is very important in development during the teenage years for it helps shape their lives emotionally and psychologically so having someone to talk to when teenagers have problems is very important. The majority o f students said they talked to their mothers when they have problems. The results were mother only (39 percent), parents and friends (5.2 percent), both parents (13.1 percent), friends (1.1 percent), no one (9.1 percent), relatives (5.1 percent), pastor/church elder (3 percent), teacher (2 percent).The ‘relatives’ in the survey referred to siblings and grand parents. O f concern is the 9.1 percent who do not communicate with anyone when they have problems. They will need counseling. 4.9 The Community Perceptions about Teenage Pregnancy Results from in depth interviews held with opinion leaders, key informant persons were used to assess the perception about teenage pregnancy in the community. According to some opinion leaders, early marriage was a culturally acceptable norm in the community. In fact parents and relatives got worried if by 17 years o f age, daughters had no suitor in sight and persisted in continuing their education; ‘a woman’s place in society is to have a family o f her own and care for them as a housewife whilst the man must be the breadwinner’ - is their belief. Poverty and lack o f parental control were stated as contributory factors to teenage pregnancy in the 53 University of Ghana http://ugspace.ug.edu.gh commun i t y . Fi f ty pe r ce n t o f the mothe r s o f te enage mo the r s b emoan e d thei r lack o f par en t a l con tro l that t hey bel i eve cont r ibu ted to the p r egnancy . T h e o the r 50 pe rcen t t houg h t it wa s in p l ace lor the chi ld to he mar r ied by age 17 years t hough r egret t ing that no t r ad i t ional ma r r i age had taken place pr ior to the p r egnancy . Mo th e r s o f the t e e n a g e m o t h e r s b em o a n e d the i r respons ibi l i t y o f the m e n r e spons ib l e for the p r egn ancy . The D istrict Assembly instituted a curfew on the youth in the community as a measure to curb teenage pregnancies where no youth is to be seen in dark shadowy places after 8pm or the guardian/ parent will pay a fine after two admonitions. University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS 5.1 Summary and Conclusions The study researched the causes of teenage pregnancy in the Senya Bereku community o f the Awutu Effutu Senya District. Teenage pregnancies accounted for 17.2 percent o f the total pregnancies in the Senya Bereku community o f the Awutu Effutu Senya District in the Central Region in the year 2004 from a total o f 878 antenatal visits to the health centre. Central Region has the highest teenage fertility rate in the nation from the GDHS (2003) at a rate of 24.1 percent. Drop out rate o f girls from the educational institutions is higher in Senya Bereku than the other communities in the district and this is primarily due to teenage pregnancy. Fifty six percent o f the students in the survey had ever had sex before, the median age at sexual debut being about 16 years. The median age o f the respondents was also 16 years. M ale students were more likely to have engaged in sexual intercourse than female respondents. Coercion was an important feature in sexual debut for the female respondents though it also featured for some men. There exists a relationship between age at menarche and age at sexual debut where girls who had menarche before age 12 years also had an earlier sexual debut. The study found a strong relationship between extracurricular activities such as religious activities and sexual debut, where those who were active in extracurricular activities delayed their sexual debut to later teen year. No relationship was found between sexual debut and sleeping arrangements; sexual debut and bathing arrangements. There was a relationship between sexual activity and the various career aspirations with all the health professional aspirants abstaining from sexual activity. 55 University of Ghana http://ugspace.ug.edu.gh All respondents had knowledge about condoms but only 50 percent o f sexually active students used this method to prevent pregnancy in the past 6 months and not to prevent HIV/AIDS. Twenty one percent o f respondents are using natural family planning methods to prevent pregnancy and only ten percent are using conventional family planning methods. As much as 5 percent o f the respondents are using traditional methods o f herbs to prevent pregnancy. Getting students to use condoms is fraught w ith many challenges because despite education, some still resorted to herbs and natural family planning methods to prevent pregnancy despite numerous educations on teenage pregnancy and HIV/AIDS. The attitude to condom usage is an indirect reflection o f how relaxed the students view the threat o f the HIV/AIDS epidemic. The most common reasons for teenage pregnancy given by the students themselves were need for financial support, followed by sexual promiscuity, then peer pressure. Lack o f parental control may play a significant role since many respondents and all teenage mothers were from female headed households. Opinion leaders confirmed that poverty and lack o f parental control played a key role in teenage fertility in the community. Teenage pregnancy is not perceived to be a problem in the community because early marriage is acceptable and having a child in adolescence is perceived to be the optimum period to start raising a family. Majority o f students knew o f a girl who had had to drop out o f school because o f pregnancy but only 13.8 percent o f respondents knew o f teenage mothers who were formally schooling, the rest were either idling at home or in petty trading. None o f the teenage mothers were married to the one who impregnated her. Ninety percent o f the 56 University of Ghana http://ugspace.ug.edu.gh fathers had denied responsibility for the pregnancy and caused further burdens on the young mothers and their families. 5.2 Recommendations More education on teenage pregnancy and HIV/AIDS should be given as often as possible at least on a yearly basis with emphasis on contraceptive usage by all stakeholders in the schools and in the society. Cultural beliefs on early marriages can be addressed at festivals by all concerned to reach a larger target group o f all levels o f society in Senya Bereku. Teenage mothers should be used in the peer education programmes. Talking about practical experiences will help discourage their peers from indulging in sexual intercourse or at least promote the usage o f contraceptives. Peer educators and counselors should be more youth friendly, offer adolescent health services not ju st information and encourage a feedback from the youth. Improved communication between students and teachers will help the students who have problems especially financial and psychological ones. Communication between teachers and students should be encouraged. Most students could not talk to their teacher about their problems. Social problems in teenagers’ lives can reflect on their performance in school. Counseling for students with visiting professionals will help those who have no one to talk to if they have problems In- school and out o f school activities will help channel sexual energy o f the youth into asexual means. Peer pressure, sexual promiscuity and adventure can be channeled into other non sexual activities like book clubs, quiz and athletic activities. 57 University of Ghana http://ugspace.ug.edu.gh Mentoring programmes with successful people from the community, especially male role models will help the youth stay focused. Prizes for brilliant students and well behaved students should be given to boost the morale o f students. National programmes like the implementation of the Ghana Poverty Reduction Programme will reduce the need for financial support by some students and scholarships can be given to needy teenagers to help them continue their education. Vocational training for teenage mothers will increase their employable skills and reduce any conjugal dependence for financial support. Skills training should be an integral part of the formal education to help needy students support themselves. Cultural activities for the adult in the community during festivals can incorporate education on teenage pregnancy and early marriage so that the community’s acceptance of teenage pregnancy can be changed. 58 University of Ghana http://ugspace.ug.edu.gh REFERENCES 1. Adolescent Reproductive Health Policy, Ghana ( October 2000). National Population Council 2. Awusabo-Asare, Abane and Kumi- Kyereme, Adolescent fertility in Ghana, The Allan Guttm acher Institute, h ttp ://www .aai-usa .o rg /pubs/or n o l3 .p d f 3. Bucht B. and Gubhaju B.: Child Mortality in Developing Countries, Health Care o f Women and Children in Developing Nations (1995): 363- 370 4. Card J. and Wise L. “Teenage Mothers and Teenage Fathers: The Impact o f Early Childbearing on the Parents’ Personal and Professional Lives.” FAMILY PLANNING PERSPECTIVES 10 (July/August 1978): 139-155 5. CDC (1995), National survey o f family growth htt p : //www. c d c. o r g/s u rv/no. 9 5 6. Cohen Donald and Ryda Rose. “Male Adolescent Birth Control Behaviour: The Importance o f Developmental Factors and Sex Differences.” JOURNAL OF YOUTH AND ADOLESCENCE 13 (1984): 239-252 7. Crieghton - Zollar, A. Adolescent pregnancy and parenthood. Garland Publishing Inc.: New York, 1990. 8. FH ID igestNo.10 h ttp ://www . fh i.org/en/Youth/YouthNet/Pub lications/preqD revfonj m/d iaest 10.htm 9. Finkel M. and Finkel D. “Sexual and Contraceptive Knowledge, Attitudes, and Behaviour o f Male Adolescens.” FAMILY PLANNING PERSPECTIVES 7 (November/December 1975): 256-260 10. Ghana Health Foundation - Active and Successful Projects: Educational programme to reduce the incidence o f teenage pregnancy in New Edubiase. h ttp ://www .hfahana.ora/paaes/D roiects.h tm 11. Ghana Statistical Service, (2004). Ghana Living Standards Survey 4. Ghana Printing Press, Accra 12. Ghana Statistical Service, (2004). Ghana Demographic and Health Survey 2003 13. Hanson R. and Jones W. “Maternal Employment and Adolescent Sexual Behaviour.” JOURNAL OF YOUTH AND ADOLESCENCE 10 (1981): 55-60 14. Henshaw S., Jones E., Darroch J. and Goldman Noreen. Teenage Pregnancy in Industrialised Countries: A study sponsored by The Allan Guttmacher Institute. New Haven: Yale Printing Press, 1986. 15. Hojcak F. and Garwood P. “What Parents can do to Prevent Pseudo­ Hypersexuality in Adolescents.” FAMILY THERAPY 15 (1988): 99-105 59 University of Ghana http://ugspace.ug.edu.gh 16. Karim A.(2003) - Reproductive Health Risk and Protective factors among unmarried youth in Ghana http://vAvw.guttmacher.org/pubs/journal/2901403 .pdf.htm 17. M iller C. and McCoy K: “Parental Discipline and Control Attempts in Relation to Adolescent Sexual Behaviour.” JOURNAL OF MARRIAGE AND THE FAMILY 48 (August 1986): 503-512 18. Moore K., Peterson L. and Furstenberg F: “Parental Attitudes and the Occurrence of Early Sexual Activity.” JOURNAL OF MARRIAGE AND THE FAMILY 48 (November 1986): 777-782 19. Mott F. and Haurin J. : “The Impact o f Sex Education on Sexual Activity, Contraceptive Use and Premarital Pregnancy Among American Teenagers.” FAMILY PLANNING PERSPECTIVES 20 (May/ June 1988): 128-136 20. Nabila I and Fayorsey C (1995) Adolescent Fertility and Reproductive Behaviour in Ghana; a case study, o f Accra and Kumasi, UNFPA/FADEP project 21. Report o f the International Conference on Population, 1984, Mexico City, August 1984. (United Nations publications, Sales no. E.84.XIII.8 ) 22. Sadik Nafis : Fertility and Family Planning, Health Care o f Women and Children in Developing Nations (1995): 48-53 23. Teen Pregnancy in Ghana http://www .avaon line .ora/S tra tea ies/BCC .htm 24. Teenage Clinic and Rehabilitation Project - Ghana http : //www. icomp.ora.mv/SSouth/Inven/NewInven/TCRP.htm 25. United Nations Population Fund, 1991 Report 26. Vadies E. and Hale D. “Attitudes o f Adolescent Males Towards Abortion, Contraception, and Sexuality.” SOCIAL WORK IN HEALTH CARE 3(Winter 1977): 169-174 27. Westney O. and Cole J. “Adolescent Unwed Prospective Fathers: Readiness for Fatherhood and Behaviours Towards The Mother and the Expected Infant.” ADOLESCENCE 21 (Winter 1986): 901-911 28. Zelnik M. and Kantner J. “First Pregnancies to Women Aged 15-19: 1976 and 1971.” FAMILY PLANNING PERSPECTIVES 10 (January/ February 1978): 11-20 60 University of Ghana http://ugspace.ug.edu.gh APPENDIX 1 RESEARCH TOPIC CAUSES OF TEENAGE PREGNANCY IN SENYA BEREKU COMMUNITY OF THE AWUTU-EFFUTU SENYA DISTRICT QUESTIONNAIRE FOR TEENAGERS IN SCHOOL INFORMED CONSENT My name is Jesseline Asamoah, a student at ISSER- Legon. I would like to ask you some questions about teenage pregnancy in this district. This information will help in my research studies. Participation in this survey is voluntary. All the information collected will be treated with confidentiality and in aggregation form. Name o f sampled schools:................................................................................................................ Section A DEMOGRAPHIC 1- Age............................................... 2. Sex 1. Male [ ] 2. Female [ ] 3. Is your biological mother alive? 1. Yes [ ] 2. No [ ] 61 University of Ghana http://ugspace.ug.edu.gh 4. Is your biological father alive 1. Yes [ ] 2. No [ ] 5. Who do you stay with? 1. Father only [ ] 2. Mother only [ ] 3. Both parents [ ] 4. Relatives [ ] 5. Other, specify.................................. 6. What is your level o f education? 1. Primary [ ] 2. JSS incomplete [ ] 3. SSS incomplete [ ] 4. JSS complete [ ] 5. SSS complete [ ] 7. What is your religion? 1. Muslim [ ] 2. Christian [ ] 3. Traditional [ ] 4. Other, specify................................... 8. How often do you practice your religion? 1. daily [ ] 2. twice a week [ ] 3. weekly [ ] 4. fortnightly [ ] 62 University of Ghana http://ugspace.ug.edu.gh 5. not at all [ ] 6. other, specify................................... 9. Which ethnic group do you belong to? 1. Akan [ ] 2. Ga/ Dangme [ ] 3. Ewe [ ] 4. Talesme [ ] 5. Hausa [ ] 6. Other, specify.................................. 10. How many siblings do you h av e? ......... Section B SOCIO-ECONOMIC STATUS 11. What work does your father do? 1. farmer[ ] 2. fisherman [ ] 3. artisan [ ] 4. civil servant [ ] 5. other, specify.................................. 12. What work does your mother do? 1. trader [ ] 2. housewife [ ] 3. seamstress [ ] 63 University of Ghana http://ugspace.ug.edu.gh 4. civil servant [ ] 5. other................................................. 13. Do you live in a compound house? 1. Yes [ ] 2. No [ ] 14. Where do you sleep? 1. In the same room as parents [ ] 2. Share the room with siblings [ ] 3. Sleep alone in one room [ ] 4. Sleep outside on corridor [ ] 15. Where do you take your bath? 1. Open space outside the house [ ] 2. Bathroom is within the house [ ] 3. Neighbour’s house [ ] 16. Who pays your school fees? 1. mother [ ] 2. father [ ] 3. m yself [ ] 4. other , specify................................. 17. Do you work as well as go to school? 1. Yes [ ] 2. No [ ] 18. I f yes what work do you d o ? .................. 19. What do you aspire to be in the future? 1. don’t know [ ] 64 University of Ghana http://ugspace.ug.edu.gh 2. civil servant [ ] 3. seamstress/tailor [ ] 4. fisherman [ ] 5. other, specify............................................................ Section C CULTURAL PRACTICES 20. Do you have any festivals in your community? 1. Yes [ ] 2 -[ ] 21. What months do you celebrate the festival? ..................... 22. Do you stay out late during the festival season? 1. Yes [ ] 2. No [ ] 23. Do you make new friends during the festival season? 1. Y e s [ ] 2. No [ ] Section D EDUCATION AND KNOWLEDGE 24. Have you had any education on teenage pregnancy? 1. Y e s [ ] 2. No [ ] 25. When did you have the education on teenage pregnancy? 1. This year [ ] 2. Last year [ ] 65 University of Ghana http://ugspace.ug.edu.gh 3. Two years ago [ ] 4. Three years ago [ ] 5. Other, specify............................................................................ .............. 26. How did you get the education on teenage pregnancy? 1. School [ ] 2. Media [ ] 3. Peer education [ ] 4. NGO [ ] 5. Hospital [ ] 6. Other, specify.............................................. 27. Do you think that teenage pregnancy is on the increase? 1. Yes [ ] 2. No [ ] 28. I f yes, what do you think may be the cause for the increase in teenage pregnancy? 1. Teenagers are pressurized by friends [ ] 2. Adventure [ ] 3. Sexual promiscuity [ ] 4. Lack o f financial support [ ] 5. Then need to have children by a certain age [ ] 6. Coercion [ ] 7. Need to love and feel loved [ ] 8. Lack o f parental control [ ] 9. Don’t know [ ] 29. Do you know someone who got pregnant and had to drop out o f school in the past four years? 66 University of Ghana http://ugspace.ug.edu.gh 1. Yes [ ] 2. No [ ] 30. If yes to question 29, what is the girl doing now? 1. Nothing, idling at home [ ] 2. Petty trading [ ] 3. Schooling [ ] 4. Apprenticeship [ ] 5. Married to the one who impregnated her [ 6. Married to someone else [ ] 7. Cohabiting with the one who impregnated her [ ] 8. Cohabiting with someone else [ ] 31. What age do you think is ideal for a girl to get married? 32. Have you heard o f HIV/AIDS? 1. Yes [ ] 2. No [ ] 33. How did you hear o f it? 1. TV [ ] 2. Radio [ ] 3. Print media [ ] 4. Friends [ ] 5. School/Teacher [ ] 6. Relatives [ ] 7. Church/ Mosque [ ] 67 University of Ghana http://ugspace.ug.edu.gh 8. Other, specify...................................... j 6. What conventional family planning method do you know? Section E INVOLVEMENT 37. A t what age did you have your first menstruation?........................................... 38. Have you had sex before? 1. Yes [ ] 2. No [ ] 39. Are you currently doing something or using any method to delay or avoid getting pregnant or impregnating someone? 1. Yes [ ] 2. No [ ] 40. I f yes to 39, what method did you use? 1. Abstinence [ ] 2. Natural family planning [ ] 3. Conventional family planning [ ] 4. Herbs [ ] 41. How old were you when you first had sexual intercourse? 42. How did the first sexual intercourse happen? 1. It was planned [ ] 2. It ju s t happened [ ] 3 . 1 was tricked [ ] 68 University of Ghana http://ugspace.ug.edu.gh 43. How often do you have sexual intercourse? 1. Everyday [ ] 2. Once a week [ 3. Twice weekly [ ] 4. Thrice weekly [ ] 5. Once a month [ ] 6. Twice a month [ ] 44. Have you had sexual intercourse in the past 6 months? 1. Y e s [ ] 2. No [ ] 45. Did you use a condom? 1. Yes [ ] 2. No [ ] 46. What is your relationship to the person you last had sex witih? 1. Boyfriend/ Girlfriend [ ] 2. Spouse [ ] 3. Stranger [ ] 4. Casual acquaintance [ ] 5. Relative [ ] 47. Is the person older, younger or about the same age as you? 1. Younger [ ] 2. Older [ ] 3. Same age [ ] 4. No idea [ ] 4. I was forced [ ] 69 University of Ghana http://ugspace.ug.edu.gh 48. Does your sexual partner give you money? 1. Yes [ ] 2. No [ ] 49. Do you give your sexual partner money? 1. Yes [ ] 2. No [ ] 50. If your partner gives you money, what do you use it for? 1. Food [ ] 2. School fees [ ] 3. Clothes [ ] 4. Other, specify.................................................. 50. Do you know o f a place where a person can get condoms, i f yes specify. 1. Health facility [ ] 2. Shop [ ] 3. Chemist 4. Peer educator [ ] 5. All the above [ ] 51. I f you have problems who do you talk to? 1. Friend [ ] 2. Father [ ] 3. Mother [ ] 4. Church elder/pastor [ ] 5. No one [ ] 6. Other, specify................................................................ 70 University of Ghana http://ugspace.ug.edu.gh APPENDIX 2 RESEARCH TOPIC: CAUSES OF TEENAGE PREGNANCY IN THE SENYA BEREKU COMMUNITY OF THE AWUTU-EFFUTU- SENYA DISTRICT GUIDELINES FOR IN-DEPTH INTERVIEW WITH OPINION LEADERS IN COMMUNITY 1. Introduction 2. What is your pro fession? .................................................................................. 3. How long have you lived in this community?................................................ 4. Do you believe teenage pregnancy is on the increase?........................................ 5. What in your opinion may be the reason for teenage pregnancy in the community? 6. What is the perception about teenage pregnancy in the community? 7. How can teenage pregnancy be curbed or decreased in the community in your opinion? 71 University of Ghana http://ugspace.ug.edu.gh GUIDELINES FOR FOCUS GROUP DISCUSSIONS WITH NEVER PREGNANT TEENAGERS 1. Introduction 2. Do you socialize after classes? APPENDIX 3 RESEARCH TOPIC: CAUSES OF TEENAGE PREGNANCY IN SENYA BEREKU COMMUNITY OF THE AWUTU-EFFUTU- SENYA DISTRICT 3. What extracurricular activities do you participate in after classes? 4. Have you heard about HIV/AIDS? 5. How did you hear about it? 6. Do you think you are at risk o f getting HIV/AIDS? 7. How can one protect oneself from the disease? 8. Is it fashionable in the community to have a boyfriend/ girlfriend? 9. Do you have a boyfriend/ girlfriend? 72 University of Ghana http://ugspace.ug.edu.gh 10. When and how do you fellowship with your partner? 11. Have you had any education on teenage pregnancy? 12. Are you doing something to prevent getting pregnant or impregnating someone? 13. What do you think is the reason for teenage pregnancy in the community? 14. Do you know someone who got pregnant and had to drop out of school? 15. What is the person doing now? 16. How is she coping with rearing a child? 17. Is the father helping in the upbringing o f the child or did he deny responsibility for the pregnancy? 18. How does the community view teenage pregnancy? University of Ghana http://ugspace.ug.edu.gh APPENDIX 4 RESEARCH TOPIC: CAUSES OF TEENAGE PREGNANCY IN SENYA BEREKU COMMUNITY OF THE AWUTU-EFFUTU- SENYA DISTRICT GUIDELINES FOR IN-DEPTH INTERVIEWS WITH TEENAGE MOTHERS 1. Introduction 2. How old are y o u ? ........................................................................................................... 3. How old is your child? 4. A t what age did you get p regnan t? ............................................................................. 5. What class were you in when you got pregnant? 6. Did you use any method to prevent pregnancy prior to your getting pregnant? 7. What circumstance led to your getting pregnant, where you coerced or you had a mutual agreement? 8. What is your relationship to the father o f your child, before the pregnancy and after the pregnancy? 9. Is the father o f the child sharing in the responsibility o f caring for the child? 74 University of Ghana http://ugspace.ug.edu.gh 10. Are your relatives helping you care for the child? 11. Are the relatives o f the child’s father helping you care for the child? 12. Do you plan to further your education? 13. Are you working to earn some income to help you care for your child? 14. How do you see your prospects in the future for marriage, education, etc.? University of Ghana http://ugspace.ug.edu.gh