CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction
This chapter consists of the literature review of previous published studies on factors associated with contraceptive use among sexually active adolescents which has been obtained from journals and text books.
2.1 Contraceptive use
Despite efforts towards making access and use of contraceptive services a basic reproductive right for all women, many countries still face high rates of unintended and unwanted pregnancies (Greek, 2019). In sub-Saharan Africa alone, about 14 million unintended (unwanted or mistimed) pregnancies occur every year; and adolescent girls and young women 15–24 years old are the most vulnerable group (WHO, 2019). The reasons behind this situation include the high prevalence (about 70%) of sexually active young women with low utilization of effective contraceptive methods (less than 10%) (WHO, 2019).
Additionally, unmarried sexually active adolescents are likely to have a high unmet need for contraception, which increases their risk of unintended pregnancies (Mishell, 2018). In low/middle-income countries, nearly half (49%) of pregnancies are unintended among adolescent girls of 15–19 years old. (Greek, 2019). Adolescence is viewed as the starting point in the continuum of care for reproductive, maternal, neonatal and child health; and is a phase when poor access and utilisation of contraception are likely to result in poor health outcomes across the continuum of care. Early and unintended pregnancies result in increased risks of maternal mortality and morbidity, premature births, low birth weight, unsafe abortions and social consequences such as stigmatisation, school drop-out and poverty (Chengen, 2019).
In Benin, although the use of modern contraceptives has been slowly increasing since 2006, it is still relatively low. The modern contraceptive prevalence among all women reached 12% in 2018 compared with 6% in 2006 (Africa, centre for Health Statistics, 2020). At the same time, almost half (48%) of all adolescent girls age 15–19 are sexually active, and one in five girls has already had a child or is pregnant. According to WHO,(2019), only 5.4% of women ages 15–24 were using modern contraceptive methods in 2017. Recent data showed a total fertility rate of 5.7 among all women of reproductive ages 15–49 years old, and the modern contraceptive prevalence rate was estimated at 12%. Of all pregnancies in the country, 19% were unintended, and in 2017, both the maternal mortality ratio and infant mortality rate remained high at 397 per 100 000 live births, and 30 per 1000 live births, respectively, (UNICEF, 2022, WHO, 2021).
Existing studies on the use of modern contraceptive methods in Benin largely reported on women of reproductive age as a whole, rather than focusing on specific age groups. MacQuarrie (2022) suggested that young women should be studied separately, as they do not have the same needs for or access to contraception as adult women.
2.2 Demographic characteristics of adolescents and contraceptive use
Population-based studies are important, as they are often used as a source of data on determinants of health and as a source of information on people’s health status (Ezzati, et al, 2019). As such, these surveys should adequately reflect the target population for the relevant indicators. A problem with population-based studies is that participation is voluntary, thus people can choose not to participate. Non-participation can reduce the precision of estimates, and more seriously may introduce selection bias if both the exposure and the outcome under investigation affect the probability of participation, and may reduce the generalizability of the results (Jousilahti, 2019).
The presence of selection bias cannot usually be inferred from the study data alone; participation studies are therefore necessary to identify any underrepresented subgroups (Lash & Rothman, 2021). Knowledge of the characteristics of non-participants may help to improve recruitment procedures and representativeness, leading to more accurate assumptions and conclusions in population-based studies, i.e., estimations of prevalence and incidence, and associations between exposures and outcomes.
Sociodemographic characteristics refer to a combination of social and demographic factors, including socioeconomic status (SES), which is often measured by an individual’s educational attainment, occupation, and income Mackenbach, 2019). Individuals with low SES have been reported to have poorer health status and to be less likely to participate in health surveys compared with individuals with high SES (Greek, 2021). Men, people who are unmarried, and those with low education or low income are also less likely to participate, according to previous studies (Greek, 2019). The association between participation and age or belonging to an ethnic minority (Palaba, 2019) is inconsistent in the literature.
2.3 Socio-economic factors associated with contraceptive use among adolescents
It has also been hypothesized that there is a positive correlation between contraceptive use and level of education (Feyisetan 2000). Other things being equal the higher the level of education the higher contraceptive use is expected to be. Although both the wives’ and husbands’ education is important there appears to be a consensus that the former is more important than the latter.
Use of family planning is higher in urban than rural areas. Urban-rural difference in the adoption of contraception is the highest in SSA, where the rate is more than twice as high as among urban than among rural in all surveyed countries (Curtis and Katherine, 2021).
The observed place of residence variation, in the practice of contraception, may be attributed to differences in the availability of social services. Such as, education information about method and access to family planning and health care services which are among the important ones.
Religious affiliation also affects contraceptive use (Gyimah et al. 2008). Religions differ in their stand on fertility regulation and among the major world religions, Catholicism and Islam are widely regarded as pronatalist in their ideology. However, the relationship between religion and contraceptive use is much more complex than expected. In one study conducted in India, it was discovered that even though the average number of children born to a Muslim or Christian couple is higher than that born to a Hindu couple, the acceptance of sterilization to limit family size was greater among Muslims and Christians than Hindus (Ullah and Chakraborty 2019). A study of contraceptive use in Bangladesh found that Muslim women here were less likely to use contraception than Hindu women (Ullah and Chakraborty 2022). The strength of one’s religiosity or degree of one’s adherence to the norms of a given religion may exert an influence on ones’ mode of life including reproductive behaviour. Furthermore, studies in developing countries reveal that social, cultural and religious unacceptability of contraception frequently emerged as an obstacle to use contraception (Oni and McCarthy, 2022).
The work status of women has also been linked to knowledge and use of contraceptives. Women who work outside the home have higher rate of use than women who do not work outside home (housewives) (Robey et al.2022). Working women, particularly, those who earn cash incomes are assumed to have greater control over household decisions and increased awareness of the world outside home. Consequently, they have more control over reproductive decisions (Hialemariam et al. 2021). Some studies also add that paid work also provides alternative satisfactions for women, which may complete with bearing and rearing children and may promote contraceptive use.
CHAPTER THREE: METHODOLOGY
3.1 Introduction
This chapter explains the various methods and procedures through which my research was carried out. It presents the study design, target population, area of study, data type and sources of data, data collection method, variable selection, data management, data analysis, ethical considerations and limitations of the study
3.2 Study design
The study was a cross-section study design approach. The study design was used because it studied the snap short of the characteristics of adolescents within a short period of time at a single moment/encounter. The design enabled the research determine the relationship between the factors and contraceptive use.
3.3 Area of the study
The study was conducted in Northern Uganda.
3.4 Population and the sample of the study
The study involved sexually active adolescents. The sample size consisted of 18506 and this was data collected from all over the country. However, only 3627 participants were engaged in northern Uganda taking Lango (1236), west Nile (1281) and Acholi (1110). This was the sample size that was engaged in this current study.
3.5 Target population
The target population comprised of female adolescents between the age of 15-19 years of age in northern Uganda. Region.
3.6 Data type and source
The study involved secondary data. The UDHS 2016 was used as the major source of data. The 2016 Uganda Demographic and Health Survey (UDHS) was implemented by the Uganda Bureau of Statistics (UBOS). Data collection took place from 20 June to 16 December 2016. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Other agencies and organisations that facilitated the successful implementation of the survey through technical or financial support were the Government of Uganda, the United Nations Children’s Fund (UNICEF), and the United Nations Population Fund (UNFPA). Only Data collected in Northern Uganda was utilized
3.7 Study variables
Dependent variable: Contraceptive use (Yes and No).
Independent variables: These was demographic factors i.e age, marital status, education level, religion and marital status, as socio – economic factors such as wealth index and employment status.
Enabling factors included access to the health facility, availability of health personnel and the price of the contraceptives.
3.8 Data analysis.
Data analysis was conducted using statistical package for social sciences (SPSS) version 20 at univariate, bivariate and multivariate levels.
At the univariate level: It involved analysing one variable at a time. Frequency distributions were run to show the number of observations in each category and find out the variable characteristics.
3 At the bivariate level of analysis, The chi-square using a cross was used because the data is categorical in order to find out if there is an association between the two categorical variables.
Chi square test statistics was also used to test for significance and independence between the dependent and each of the independent variables, variables at 5%. A high significance value below 5% indicated a relationship between two variables.
At multi-variate level; A binary logistic regression because my dependent variable is categorized into only two categories (using contraceptives and not using contraceptives). This was used to determine the degree of relationship significance within the dependent variable and independent variables.
The model is illustrated as follows;
The model permits the computation of a regression coefficient bi for each independent variable Xi. Where;
Variable (Contraceptive use)
= probability of using contraceptive use being influenced by demographic and socio – economic factors.
= is the probability of not using contraceptives.
= independent variable
= constant (y-intersect)
= regression coefficient of the variable.
The interpretation of the results was based on probabilities (B), significance and the p- value. For OR which is the positive = the likelihood of contraceptive utilization for that particular variable relative to the reference category is high. OR which is negative= the likelihood of contraceptive is lower for that particular variable relative to reference category. p<0.05, the result is statistically significant, otherwise not.
3.9 Limitations
The limitation of the study is basically on the account of secondary data adopted in the study. The study is limited in providing an understanding of the rate of contraceptive use. Women’s perception on whether the contraceptive use was planned or wanted could change over time.
3.10 Ethical considerations
Data from UDHS was requested from Uganda bureau of statistics. The data set was sent via email and used for analysis.
The researcher respected confidentiality and privacy of individuals represented in the data. Even anonymized data can sometimes be re-identified, so researchers should be cautious about how they use and present the data.
