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Attitudes toward abortion and contraception among Nigerian secondary school girls
Int. J. G.vnaecol.Obstet.. 1983,?1: International
Federation
423-426
ofGynaecology& Obstetrics
ATTITUDES TOWARD ABORTION AND CONTRACEPTION AMONG NIGERIAN SECONDARY SCHOOL GIRLS
A.U. ORONSAYEa
and G.I. ODIASEb
aDepartnzentof Obstem’csand Gynaecology and bMentalHealth, UniversityofBenin, Benin City, Nigeria (Received (Accepted
December February
2 lst, 1982) 8th, 1983)
Abstract Oronsaye AU, Odiase GI (Depts of Obstetrics and Gynaecology and Mental Health, University of Benin, Benin City, Nigeria). Attitudes toward abortion and contraception school girls. among Nigerian secondary Int J Gynaecol Obstet 21: 423-426.1983 A study of the attitudes of school girls in Benin City, Nigeria, toward abortion and contraception was carried out in three of the city’s postprimary schools, using a uniform multiple-choice questionnaire. The findings show that although a significant proportion of the school girls had resorted to abortion to solve their problem of unwanted pregnancy, liberalized abortion law was only favored by a minority (approx. 30%). Also, although this indicated a high rate of sexual activity, their knowledge and practice of contraception and contraceptive methods is deficient and prejudiced. The latter findings may be responsible for the high rate of abortion among school girls in Nigeria.
Key words: Attitudes of school girls; Abortion and contraception; Postprimary schools; Multiple choice questionnaire; Knowledge of contraception deficient and prejudiced Introduction The literature from Nigeria on the subject of induced abortion has repeatedly high0020-7292/83/$03.00 o 1983 International Federation Printed and Published in Ireland
lighted the dominant contribution of the adolescent, particularly school girls [2,3,5,6]. For instance, Akingba and Gbajumo [2 1 stated that ‘procured abortion as seen at the Lagos University Teaching Hospital, Lagos, Nigeria, from 1963 to 1967, was a school girls’ problem.’ In Omu’s report [6] from Benin City, approximately 72% of induced abortion during the period 1974-1979 was among school girls. Although these reports document the fact that a substantial proportion of school girls in Nigeria are engaging in illegal abortions, none investigated the attitudes of the school girls themselves toward abortion and contraception. In 197 1, Akingba [ 11 reported on the Nigerian attitude to unwanted pregnancy, but the subjects of his study were adults, namely, the staff and students of four Nigerian universities and Nigerians in other walks of life. The present study was designed to investigate, by means of a multiple-choice questionnaire, the magnitude of abortion among school girls, the reasons for terminating the pregnancies, and the girls’ attitude toward induced abortion and contraception. Materials and methods Study subjects were girls in three secondary schools in Benin City, Nigeria. The schools were each all-female, representing private, missionary and government-established institutions (the three main category of schools Int J Gynaecol Obstet 21
of Gynaecology
& Obstetrics
424
Oronsaye and Odiase
in the state). Having obtained the permission of the principals of these institutions, we issued 200 copies of questionnaires under confidential cover to the pupils of each school. Of the total 600 copies sent out, 530 were returned with sufficient data for analysis, a response rate of 88.3%. The results of the analysis of these data form the basis of our report. Results
Age of respondents.
Age in years
No. (N = 530)
214 15-19 20-24 >24
88 380 48 14
Table II.
Age
% Sample
2.8
Sexual behavior of study population.
Sexual intercourse before age 15 Sexual intercourse before age 16 Others
112 (21.1%) 180 (34.0%) 238 (44.9%)
TOTAL
530 (100.0%)
Int J Gynaecol Obstet 21
Single
Married
(years) G14 15-19 20-24 >24 TOTAL
Table I shows the age distribution of the respondents. Teenagers made up 88.2% of the sample. Table II shows the sexual behavior of the study population. The girls had their first experience of sexual intercourse early, 2 1.1% before the age of 15. Table III shows the statistics of the abortion group of the study population. A total of 160 of the respondents admitted to having had an illegally induced abortion. These girls represented 30.2_% of the entire study population. Among the abortion group, 81.2% were single teenage girls aged 15 - 19. Table IV shows the various reasons cited for terminating pregnancy by the abortion group. By far the most common reason was the fact that they were still in school. The factor of not being married was given as a reason in only 6.8% of cases. Figure 1 is a histogram showing the attitude of the teenage school girls toward induced abortion. For study puproses, the Table 1.
Table III. Age and civil status of 160 girls who indicated a previous abortion.
Table IV.
No.
%
5 130 8 2 -
3.1 81.2 5.0 1.2
_ _ I 8
145
90.5
15
No.
% _ 4.4 5.0 9.4’
Reasons cited for terminating pregnancies.
Still in school Cannot afford responsibility Ashamed of pregnancy Advice of parents/others Not married
106 (66.2%) 19 (11.7%) 13 (8.5%) 11 (6.8%) 11 (6.8%)
TOTAL
160 (100.0%)
teenage girls of the study population (N = 380) were divided into two groups. The first was the control group, comprising those who had never had a termination of pregnancy (N = 24.5), and the second was the abortion group (iV= 135). The opinions of the two groups on induced abortion and contraception were compared. The opinions of the two groups on the under which abortion is circumstances justified were compared first. The response that abortion was ‘wrong under any circumstances’ (abortion is murder) was noted in 15% of the control subjects and 5% of the abortion subjects. There was a significant difference of opinion on this subject between the two groups (P < 0.01). The response that abortion was justified ‘on medical grounds only’ was identically favored by the majority of both groups, 58% and 55%, respectively. The views on formal or conventional contraceptive practice supplied and supervised by the family planning clinics were then compared. The findings are shown in Fig. 2. A majority of both groups were totally against the use, of contraceptive methods such
Abortion and contraception
go-
Table V.
85-
(N = 530).
Contraceptive
practice --
BO-
None “Safe period” only Coitus interruptus Condom Pill Combination
7570-
65 60-
55 -
among school girls among
study
425
population --~
44% 2% 8% 30% 6% 10% --_____
50 ls5L’J-
as the ‘pill’ and intrauterine devices, on the grounds that these are considered harmful to health and detrimental to future reproductive performance. This negative attitude to formal contraception is further illustrated in Table V which shows the contraceptive practice among the entire study population. Only 6% ever used the ‘pill’, while 44% had never used any contraceptive method.
3530 3025201510 5 0
Fig. 1. groups.
Attitude
towards
abortion
-
abortion
vs. control
Discussion
Abort,ongmup&=~~) Control
liwmtul to hcdlth and fcrtlllty
Attitude Fig. 2. control groups.
toward
contraceptives
N=2L5
No response
-
‘Abortion’
vs.
The subject of unplanned pregnancies and abortion among school girls is a topical one in Nigeria. There is the general impression that the attitude of young girls of school age toward sexual intercourse is tending toward more liberal acceptance of premarital coitus in the context of a somewhat informal heterosexual relationship [4]. Such attitudes inevitably expose the adolescent girl to the risk of unplanned pregnancy, the consequence of which is obviously an increase in the abortion rate. This study has confirmed the high abortion rate among school girls in Nigeria, approximately a third of the study population, with the teenage group constituting over 809, of those having had an abortion. In the past, prohibition of intercourse was effective among young girls. This is no longer the case, as shown by the more than 20% of girls in this study who had their first sexual intercourse under the age of 15, and by the more than 50% of the girls whose first experience came under the age of 16 (Table II). Int J Gvnaecol Obstet ?I
426
Oronsaye and Odiase
This high rate of sexual activity is not matched by effective contraceptive practice. Only 6% of the study population has ever used the pill, and 44% had never used any contraceptive method whatsoever. The response given by a majority of the school girls that contraceptives are harmful is a reflexion of the ignorance and fear of family planning methods in the general population. Sex education classes need to be provided in schools. But even this view is currently controversial, as the subject of how to safely operate a curriculum on sexuality and family life for adolescents is not an easy one. In spite of the high abortion rate, our finding that liberalized abortion or abortion on demand is not particularly favored even by the group who had had an induced abortion is remarkable. This attitude may be the effect of the current strict abortion laws in Nigeria. This is opposite to the finding reported among American adolescents [41, where a majority of girls who had had abortions favored abortion on demand, thus reflecting the attitude of a more permissive society, already accustomed to a system of liberalized abortion laws.
Int J Gynaecol Obstet 21
Acknowledgement The authors are grateful to the principals of the institutions where this study was conducted, and also to Mr. David Enabulele for secretarial assistance. References Akingba JB: Attitude of Nigerians to unwanted pregnancy. Nig Med J 4: 17, 1971. Akingba JB, Gbajumo SA: Procured abortion: counting the cost. J Nig Med Assoc 7: 17, 1970. Akinla 0, Adadevoh BK: Abortion, a medico-social prob lem. J Nig Med Assoc 6: 16,1969. Gispert M, Falk R: Adolescent sexual activity: contracep tion and abortion. Am J Obstet Gynecol 6: 132, 1978. Okojie SE: Induced illegal abortions in Benin City, Nigeria Int J Cynaecol Obstet 14: 517, 1976. Omu AE, Oronsaye AU, FalI MKB, Asuquo EEJ: Ado lescent Induced Abortion in Benin City, Nigeria Int J Gynaecol Obstet 19: 495, 1981. Address for reprints: A.U. Oronsaye Dept of Obstetrics amI Gynecology University of Benin P.M. Box 111 Benin City, Nigeria
Federation
423-426
ofGynaecology& Obstetrics
ATTITUDES TOWARD ABORTION AND CONTRACEPTION AMONG NIGERIAN SECONDARY SCHOOL GIRLS
A.U. ORONSAYEa
and G.I. ODIASEb
aDepartnzentof Obstem’csand Gynaecology and bMentalHealth, UniversityofBenin, Benin City, Nigeria (Received (Accepted
December February
2 lst, 1982) 8th, 1983)
Abstract Oronsaye AU, Odiase GI (Depts of Obstetrics and Gynaecology and Mental Health, University of Benin, Benin City, Nigeria). Attitudes toward abortion and contraception school girls. among Nigerian secondary Int J Gynaecol Obstet 21: 423-426.1983 A study of the attitudes of school girls in Benin City, Nigeria, toward abortion and contraception was carried out in three of the city’s postprimary schools, using a uniform multiple-choice questionnaire. The findings show that although a significant proportion of the school girls had resorted to abortion to solve their problem of unwanted pregnancy, liberalized abortion law was only favored by a minority (approx. 30%). Also, although this indicated a high rate of sexual activity, their knowledge and practice of contraception and contraceptive methods is deficient and prejudiced. The latter findings may be responsible for the high rate of abortion among school girls in Nigeria.
Key words: Attitudes of school girls; Abortion and contraception; Postprimary schools; Multiple choice questionnaire; Knowledge of contraception deficient and prejudiced Introduction The literature from Nigeria on the subject of induced abortion has repeatedly high0020-7292/83/$03.00 o 1983 International Federation Printed and Published in Ireland
lighted the dominant contribution of the adolescent, particularly school girls [2,3,5,6]. For instance, Akingba and Gbajumo [2 1 stated that ‘procured abortion as seen at the Lagos University Teaching Hospital, Lagos, Nigeria, from 1963 to 1967, was a school girls’ problem.’ In Omu’s report [6] from Benin City, approximately 72% of induced abortion during the period 1974-1979 was among school girls. Although these reports document the fact that a substantial proportion of school girls in Nigeria are engaging in illegal abortions, none investigated the attitudes of the school girls themselves toward abortion and contraception. In 197 1, Akingba [ 11 reported on the Nigerian attitude to unwanted pregnancy, but the subjects of his study were adults, namely, the staff and students of four Nigerian universities and Nigerians in other walks of life. The present study was designed to investigate, by means of a multiple-choice questionnaire, the magnitude of abortion among school girls, the reasons for terminating the pregnancies, and the girls’ attitude toward induced abortion and contraception. Materials and methods Study subjects were girls in three secondary schools in Benin City, Nigeria. The schools were each all-female, representing private, missionary and government-established institutions (the three main category of schools Int J Gynaecol Obstet 21
of Gynaecology
& Obstetrics
424
Oronsaye and Odiase
in the state). Having obtained the permission of the principals of these institutions, we issued 200 copies of questionnaires under confidential cover to the pupils of each school. Of the total 600 copies sent out, 530 were returned with sufficient data for analysis, a response rate of 88.3%. The results of the analysis of these data form the basis of our report. Results
Age of respondents.
Age in years
No. (N = 530)
214 15-19 20-24 >24
88 380 48 14
Table II.
Age
% Sample
2.8
Sexual behavior of study population.
Sexual intercourse before age 15 Sexual intercourse before age 16 Others
112 (21.1%) 180 (34.0%) 238 (44.9%)
TOTAL
530 (100.0%)
Int J Gynaecol Obstet 21
Single
Married
(years) G14 15-19 20-24 >24 TOTAL
Table I shows the age distribution of the respondents. Teenagers made up 88.2% of the sample. Table II shows the sexual behavior of the study population. The girls had their first experience of sexual intercourse early, 2 1.1% before the age of 15. Table III shows the statistics of the abortion group of the study population. A total of 160 of the respondents admitted to having had an illegally induced abortion. These girls represented 30.2_% of the entire study population. Among the abortion group, 81.2% were single teenage girls aged 15 - 19. Table IV shows the various reasons cited for terminating pregnancy by the abortion group. By far the most common reason was the fact that they were still in school. The factor of not being married was given as a reason in only 6.8% of cases. Figure 1 is a histogram showing the attitude of the teenage school girls toward induced abortion. For study puproses, the Table 1.
Table III. Age and civil status of 160 girls who indicated a previous abortion.
Table IV.
No.
%
5 130 8 2 -
3.1 81.2 5.0 1.2
_ _ I 8
145
90.5
15
No.
% _ 4.4 5.0 9.4’
Reasons cited for terminating pregnancies.
Still in school Cannot afford responsibility Ashamed of pregnancy Advice of parents/others Not married
106 (66.2%) 19 (11.7%) 13 (8.5%) 11 (6.8%) 11 (6.8%)
TOTAL
160 (100.0%)
teenage girls of the study population (N = 380) were divided into two groups. The first was the control group, comprising those who had never had a termination of pregnancy (N = 24.5), and the second was the abortion group (iV= 135). The opinions of the two groups on induced abortion and contraception were compared. The opinions of the two groups on the under which abortion is circumstances justified were compared first. The response that abortion was ‘wrong under any circumstances’ (abortion is murder) was noted in 15% of the control subjects and 5% of the abortion subjects. There was a significant difference of opinion on this subject between the two groups (P < 0.01). The response that abortion was justified ‘on medical grounds only’ was identically favored by the majority of both groups, 58% and 55%, respectively. The views on formal or conventional contraceptive practice supplied and supervised by the family planning clinics were then compared. The findings are shown in Fig. 2. A majority of both groups were totally against the use, of contraceptive methods such
Abortion and contraception
go-
Table V.
85-
(N = 530).
Contraceptive
practice --
BO-
None “Safe period” only Coitus interruptus Condom Pill Combination
7570-
65 60-
55 -
among school girls among
study
425
population --~
44% 2% 8% 30% 6% 10% --_____
50 ls5L’J-
as the ‘pill’ and intrauterine devices, on the grounds that these are considered harmful to health and detrimental to future reproductive performance. This negative attitude to formal contraception is further illustrated in Table V which shows the contraceptive practice among the entire study population. Only 6% ever used the ‘pill’, while 44% had never used any contraceptive method.
3530 3025201510 5 0
Fig. 1. groups.
Attitude
towards
abortion
-
abortion
vs. control
Discussion
Abort,ongmup&=~~) Control
liwmtul to hcdlth and fcrtlllty
Attitude Fig. 2. control groups.
toward
contraceptives
N=2L5
No response
-
‘Abortion’
vs.
The subject of unplanned pregnancies and abortion among school girls is a topical one in Nigeria. There is the general impression that the attitude of young girls of school age toward sexual intercourse is tending toward more liberal acceptance of premarital coitus in the context of a somewhat informal heterosexual relationship [4]. Such attitudes inevitably expose the adolescent girl to the risk of unplanned pregnancy, the consequence of which is obviously an increase in the abortion rate. This study has confirmed the high abortion rate among school girls in Nigeria, approximately a third of the study population, with the teenage group constituting over 809, of those having had an abortion. In the past, prohibition of intercourse was effective among young girls. This is no longer the case, as shown by the more than 20% of girls in this study who had their first sexual intercourse under the age of 15, and by the more than 50% of the girls whose first experience came under the age of 16 (Table II). Int J Gvnaecol Obstet ?I
426
Oronsaye and Odiase
This high rate of sexual activity is not matched by effective contraceptive practice. Only 6% of the study population has ever used the pill, and 44% had never used any contraceptive method whatsoever. The response given by a majority of the school girls that contraceptives are harmful is a reflexion of the ignorance and fear of family planning methods in the general population. Sex education classes need to be provided in schools. But even this view is currently controversial, as the subject of how to safely operate a curriculum on sexuality and family life for adolescents is not an easy one. In spite of the high abortion rate, our finding that liberalized abortion or abortion on demand is not particularly favored even by the group who had had an induced abortion is remarkable. This attitude may be the effect of the current strict abortion laws in Nigeria. This is opposite to the finding reported among American adolescents [41, where a majority of girls who had had abortions favored abortion on demand, thus reflecting the attitude of a more permissive society, already accustomed to a system of liberalized abortion laws.
Int J Gynaecol Obstet 21
Acknowledgement The authors are grateful to the principals of the institutions where this study was conducted, and also to Mr. David Enabulele for secretarial assistance. References Akingba JB: Attitude of Nigerians to unwanted pregnancy. Nig Med J 4: 17, 1971. Akingba JB, Gbajumo SA: Procured abortion: counting the cost. J Nig Med Assoc 7: 17, 1970. Akinla 0, Adadevoh BK: Abortion, a medico-social prob lem. J Nig Med Assoc 6: 16,1969. Gispert M, Falk R: Adolescent sexual activity: contracep tion and abortion. Am J Obstet Gynecol 6: 132, 1978. Okojie SE: Induced illegal abortions in Benin City, Nigeria Int J Cynaecol Obstet 14: 517, 1976. Omu AE, Oronsaye AU, FalI MKB, Asuquo EEJ: Ado lescent Induced Abortion in Benin City, Nigeria Int J Gynaecol Obstet 19: 495, 1981. Address for reprints: A.U. Oronsaye Dept of Obstetrics amI Gynecology University of Benin P.M. Box 111 Benin City, Nigeria