KNOWLEDGE AND ATTITUDE OF HEALTH WORKERS TO CONTRACEPTIVES PROVISION AND USE AMONG UNMARRIED ADOLESCENTS IN IBADAN

Abstract

Many studies have confirmed the practice of unprotected sex by unmarried adolescents (UA), and their vulnerability to unplanned pregnancy and Sexually Transmitted infections (STD), including HIV/AIDS. Unfortunately, many Adolescent Reproductive Health (ARH) stakeholders do not disapprove provision of contraceptive to UA. However, studies and anecdotal evidences suggest that health-workers do not approve of use of contraceptives by UA. This study therefore explored the knowledge and attitude of health-workers in Ibadan municipality to the provision and use of contraceptives for UA. The study was conducted in the five Local Government Areas in Ibadan. Using cross-sectional study design, Focus Group Discussion (FGD), Key Informant Interveiw (KII) and questionnaire administration were adopted to collect information from respondents. While UA participated in 10 FGDs, senior officials from five public and four private health facilities were interviewed as key informants. Using systematic sampling technique, 236 health-workers, selected from 50 public and 186 private health facilities provided quantitative information through a semi-structured questionnaire. Data were processed with EPI-INFO and analyzed using SPSS to generate frequencies and comparison of variables respectively. Respondents mean age was 36.2±8.1years, with 94.9% females, 65.3% are married. Seventy-five percent attended professional schools of nursing/midwifery and 62.5% are professional nurses/midwives. Respondents' general knowledge of contraceptives was high with average score of seven on a scale of 0-9. Ninety four percent of respondents know at least four out of the listed nine contraceptives. Conversely, respondents’ knowledge of suitable contraceptives for UA was low with only 8.1% of respondents knowing the three non-prescriptive contraceptives (condom, spermicides and Emergency Contraceptives Pills) that are suitable for UA. An average score of 2.19 was obtained from a scale of 0-6. In order of importance, respondents ranked condoms (95%), pills (55.6%), ECP (33.3%), and IUCD (26.7%) as more suitable for use by UA. Respondents from private facilities knew more about condoms, spermicides, and ECP than their public facilities counterparts. Higher knowledge was associated with married, 20-25 and >40year olds, Pentecostal Christians and professional health-workers. Overall, three-quarter of respondents was favourably disposed to use of contraceptives by UA, with more of respondents that are Pentecostal Christians (34.5%), 25- 29year olds (34.3%) and professionals (59%) approving UA using contraceptives. About 82% of respondents would provide contraceptives to UA under whatever conditions while 45.7% feared UA might become promiscuous if they used contraceptives. Half of participants stated that there were no policy restrictions on contraceptives for UA. Moslems, >30years, married, with tertiary education had provided contraceptives to UA one-month preceding the survey. irrespective of this assertion, UA during FGDs expressed concern over the negative attitude of health-workers to contraceptives provision for them but supported the finding that those in private facilities are better disposed to contraceptives provision to UA. The finding showed that respondents had a high knowledge of general contraceptives. but lower knowledge on suitable ones for UA. This underscores the need for an update for health-workers on suitable contraceptives for UA. This study also disproved the general belief that health-workers’ have negative attitude to contraceptives provision to UA.