The Health Implications of Sexual Behaviours Among Adolescents in Uromi
Objectives of the study
To explore the factors influencing the sexual behaviour and reproductive health problems of adolescents in Nigeria in order to recommend a more appropriate adolescent sexual and reproductive health policies and services. The specific objectives of the research:
- To describe the sexual experiences of adolescents in Nigeria
- To describe the knowledge and attitude of adolescents in Nigeria on SRH
- To describe the sources of information and the health seeking behaviour of adolescent on SRH in Nigeria
- To explore the influences to adolescent sexual behaviour in Edo State.
- To explore the reproductive health problems of adolescents and their treatment seeking behaviour in Uromi L.G.A
- To make recommendation that will inform better policy formulation and services that will address the SRH needs of adolescents in Nigeria in general and Uromi Local Government in particular.
This chapter reports the findings of the context in which adolescents in Nigeria are living and their various sexual experiences, sources and preferences of SRH information and services. It describes how the context has implications on their sexual and reproductive choices and behaviour and the outcome of their sexual behaviour if unprotected.
Context of Adolescents Lives Influencing Sexual Behaviour
Individual Characteristics of Adolescents Influence Sexual Behaviour
Many factors act as drivers to adolescent sexual initiation and reasons for sexual relationship. Love, pleasure and fun were among the top reasons given by adolescents who participated in a national survey across 12 states in Nigeria for their sexual activity while others said they were forced into sex. Although sexual debut is reported by some at earlier age, the median age has been 15 years with adolescents between the ages of 15 to 19 years engaging more in sex (Wright, 2016).
Controversy exists from studies about the association between educational status and sexual behaviour of adolescents. While some studies have found that literate adolescents engage more in sex due to exposure to social media, others have found that sexual activity was more among adolescents with no or lower form of education (Gomwalk, 2012).
Socio- economic status viewed as a proxy for poverty was perceived to have influence on sexual behaviour of adolescents. Though arguable, but transactional sex was associated with sexual initiation mainly among female adolescents in Nigeria who viewed it as a means of survival. Financial benefit was also the reason given by some adolescents for sexual initiation especially with older person which restricts their power to negotiate condom use.
On the other hand, data extracted from the 2013 NDHS did not support the view that the high level of sexual activity is a function of household poverty. It reported that although poverty exposed adolescents to sexual risk such as low condom use, those from wealthy homes were exposed to pre-marital sex due to access to media (Nnebue, 2016).
Environmental Influence on Adolescent Sexual Behaviour
Peer influence was the reason a significant number of adolescents in a study in Imo state gave for sexual activity. Pressure from peers to initiate sex and information sharing on sexual activity, how to prevent pregnancy and what to do when pregnant were mentioned as triggers to sexual initiation. The same finding was reported among adolescents in Northern Nigeria. Studies have shown that having sex due to the influence of alcohol was documented mainly among males than females. Other adolescents however stated that their uncontrollable sexual urge is the reason they cannot abstain from sex (Olalekan, 2008).
Quality parental relationships and social support are seen as avenues of communication and sexual education among adolescent. Lack of this connectedness and ties between parents and children allow for negative influence and early sexual activity as reported in some studies in Nigeria. Also, family members are seen to exert some influence on adolescents through their own risky behaviour which adolescent learn very fast (Gomwalk et al., 2012).
Institutional Influences on Adolescent Sexual Behaviour
Religion is another factor that was documented in some studies to be associated with abstinence from sexual activity, as adolescents who had high religious value self-reported lower experience of sexual intercourse but of course this is ambiguous and debatable by others who are of the opinion that religion may not really have an influence (Aliyu et al., 2013).
Community and Gender Norms
The socially defined role and power ascribed to men and women has been shown to affect the reproductive health of adolescent differently. In some part of Nigeria, especially the northern part of the country, the persistence of child marriage is a norm exposing the adolescent to early sexual initiation. The mother in-laws, couples with the community norm and the desire for children, put pressure on the adolescent girl to have children thereby denying them access to contraceptives and exposing them to early child bearing. Adolescent males also face intense pressure to initiate sex without adequate knowledge due to the gender norms build around power, risk taking and masculinity. These norms promote gender base violence and having multiple sexual partners believing that the male have utmost control. These gender roles bring about unbalanced power relations making adolescent females vulnerable to sexual assault (Olalekan, 2008).
A tradition in southern Nigeria view men as sexually aggressive and virile, permitting them to have as many sexual partners as they wished. This is unlike the females, who are expected to submit to the men, placing them in a difficult position to resist sexual advances from the men. Some adolescent students who participated in a study reported that males always prove to be “macho” while females have to “prove their love” in a relationship as a result of gender roles. Either way, it has a consequence on the sexual behaviour of both sexes (Aliyu et al., 2016). The inequality faced by Nigerian females on the bases of the gender norm setting that places the male child above the girl has been reported to have a negative effect on their SRH. A study in western Nigeria reported that females are unable to assert their right to negotiate sex or condom use because of the perceived superiority of the man and the expectations to submit to the demands of the man (Okonofua et al., 2011).
The study was conducted in s a city located in north-eastern Esan, a sub-ethnic group of the Binis in Edo state, Nigeria. At various points in Uromi’s history, the city and people have been an important part of Edo State. Uromi is not a municipality and has therefore no overall city administration or governance but instead, it is run by the Local government council headed by a Chairman. Uromi is not a local government but is the seat of the local government council governing the Esan-North-East local government area. The administration of the government of Uromi is divided into eleven (11) wards. Each ward delegates a Councillor who represents it at its local council election who is normally tenured for four years.
RESULT AND DATA ANALYSIS
Results of case study
This chapter describes the study findings and especially the results of 8 FGDs conducted with adolescent males and females aged 18 to 19 years in school and out of school. Also, the IDI conducted with 4 HCP and 4 Parents.
Discussion of Findings
The findings from the literature search and that of the case study were used for the discussion.
Sexual experiences of adolescents
The responses from the different respondents concurred with the fact that adolescent in Nigeria initiate sex quite early. Both in school and out of school had similar responses agreeing with findings from the literature. It seems from this study and studies in Ibadan and Port Harcourt that females initiated sex a little earlier than males probably because some are forced into sex.146,147
The reports of various forms of sexual practices ranging from penetrative vaginal sex to anal sex including “same-sex” were in line with the review of literatures. However, forceful sex and rape was commonly reported among out of school females. It could be deduced that being out of school could have exposed them to being on the street or at the mercies of people who in the bid to help them take advantage of them. The experiences of these adolescents is similar to those of their peers in other parts of the country reporting forceful sex among out of school adolescents.68,111,148
Few adolescent reported sex with more than one sexual partner either of the same sex or opposite sex; an example is a girl having sex with two males through different routes at the same time. This has also been documented in few studies but the fear is the higher risk of unprotected sex during such sexual act .
It was observed from this study that both females and males engage in transactional sex, though reported commonly among out of school females and confirming the findings from the literature search. This is against the popular belief that it is a practice among females. It is usually with partners much older, nicked name as either sugar mummy or sugar daddy with obvious power relation’s asymmetry but for the monetary benefit.
Other sexual partners mentioned here which were not a common findings from studies were close relations/ family members such as uncles, aunts, fathers and teachers. This is obviously a forceful and non-consensual sex as reported by most of adolescents,93 although both sexes and groups reported multiple and concurrent sexual partners, it was commonly reported by out of school-females. Some studies have reported similar findings with unequal power relations, attributing less education and economic status as reasons for such practice.
Conclusion and Recommendation
Both the literature findings and results of the case study found that sexual debut among Nigerian adolescents begin about the age of 15 years. Various forms of sexual practices were reported ranging from penetrative vaginal to anal sex. Same-sex practice was reported by both sexes but predominantly among in school adolescents.
Diverse reasons have been proffered by adolescent for their sexual activities, those in school mostly mentioned pleasure and love while those out of school mostly initiated sex because they were either forced into it or go into sex for the financial gain.
Transactional sex that is frequently reported among out of school females is now seen among males also. Their sexual partners are either their age mates or much older including close relations. Multiple and concurrent partners were mentioned more among adolescents out of school.
Social media was the most important source of information for adolescents in school unlike those out of school who relied mainly on the information from friends.
Despite the reported challenge of unintended pregnancy, abortion and STI among adolescents, HCP and parents have not approved the provision of contraceptives for adolescents contributing to the reasons why adolescents seek care from unqualified sources.
The following recommendations are made based on the findings of both the literature review and the case study. It is divided into three major sections; research, policy and implementation
There is a need to research into the various methods of abortion especially the local methods of abortion practice by adolescents in Nigeria
Interventional Research should be conducted among the patent medicine dealers (chemist) to ascertain the methods of abortion provided to adolescents.
More research is needed determine the structural influences of transactional sex among adolescents
Adolescents should be allowed full involvement in the policy formulation, strategic development and the implementation of the strategies. This will ensure better understanding of their problems and design of programme that will address their challenges.
The government should reverse the law decriminalizing abortion in the interest of young females who seek for abortion at the detriment of their lives with quacks The government should come up with a strong policy against school proprietors expelling females from schools as a result of pregnancy, which terminates their education, and expose them to early marriage and poverty It is a violation of human rights for a teacher to have sex with an adolescent student, punitive measures should be taken against both teachers and family members convicted of sexually abusing children
- Adolescent sexual and reproductive health counseling should be constituted in school and out of school to equipped adolescents on how to handle sexual and reproductive health challenges
- Skill Training and acquisition should be organized for adolescents who are out of school as a form of empowerment to limit the rate of transactional sex and child marriage
- NGO and government should organize workshops and seminars for parents and teachers on ASRH and how to initiate SRH education at home
- ASRH should be part be part of the school curriculum for HCP with refresher training and supportive supervision to improve their skills and attitude on service delivery to adolescents.
- Health care facilities should be organized to provide a convenient environment and opening hours to meet the needs of adolescent.
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