Manks KAP on contraception / Gender /sec sch / 200 1-2002
4.2.2.2.3.2
Bilateral tuballigation
The fallopian tubes are ligated thus preventing the meeting of gametes.
Efficiency is high (Pearl's index
=
0.005-0.04). However, the same
inconveniences as for vasectomy are present. In addition, abdominal
and/or shoulder tip pain; abdominal bloating and tiredness are also
reported.
Women who can use this method should be above 35; have 5 kids at least
or should have achieved desired family size; have a stable social status
e.g. be married; have a written consent signed by her partner and herself
or have a medical indication for this to be carried out.
It is worth mentioning that the methods described as natural are the oldest
and have been used traditionally by many peoples. The Egogi of Kenya
knew about the "wrong time of the moon" or fertile period (18).
Withdrawal has been practised among many different populations for
centuries. Infact, it is mentioned in the biblical account of the life of
Joshua. Non-penetrative sex was aiso used with varying degrees of
success. In Cameroon, most tribes had the culture of sending off a woman
during confinement to her parents. She could only return when the child
was oid enough to "fetch water" meaning he couid waik properIy. This
meant about 2 years after birth. It was believed that sexuai intercourse or
another pregnancy rendered the breast milk improper for the baby's
consumption. The result was that optimum breast-feeding was ensured for
as long as possible. In addition, a period of abstinence of about 2 years
was observed.
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In our modern context we must not lose sight of the fact that sorne
countries have legalized abortion as a means of birth control. Examples
include
China,
Japan,
India~
U.S.A.
Page 26 sur 101
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Manks K.-\P on contraception
jl
Gender /sec sch / 2001-2002
4.2.3 Importance of contraception (41).
The importance of contraception is twofold:
~
Prevention of unwanted pregnancies.
>-
Prevention of Sexually Transmitted Infections and HIV transmission.
4.2.3.1
Prevention of unwanted pregnancies
4.2.3.1.1
On the individual and family.
-
Reduces the demand for abortion, especially those carried under
unsafe conditions.
-
Reduces maternaI mortality and injuries linked to pregnancy and chiid
bearing, especially among adolescents.
Promotes chiid spacing and famiIy planning therefore increasing the
chances of child survival and ensuring that families are financially and
emotionally capable of taking care of themselves.
Offers better opportunities for
education~
economic progress and
therefore empawerment of adolescents and adults of bath sexes.
4.2.3.1.2
-
On the community and country
Permits the control of demographic growth and therefore offers
greater possibilities to match provision of basic needs with demande
-
Permits more sustainable development.
-
Permits more rational use of natural resources and environmental
protection.
Page 27 sur 101
Manks
4.2.3.2
~~p
on contraception / Gender /sec sch / 2001-2002
Prevention of SIls, HIV/AIDS.
Prevent transmission of SIls and AIDS.
-
Reduces resources allocated to the treatmenr of these conditions.
Reduces mortality linked to these conditions thus preserving the
reproductive and working population and reduces the number of
orphans left to the change of aIder relatives and the state.
4.2.4
Gender ineguity and contraception.
In many countries, gender inequities exist ln matters of reproductive
health in general and contraception in particular. Women are more liable
to problems linked to sexuality and reproduction than men. This is
because of certain biological, cultural, social and economic factors.
Funhermore, the adolescent girl is more vulnerable to the consequences
of unsafe sexual activity. This is the reason why conferences and
. campalgns have laid more emphasis on the female. However, these
programs did not succeed because the women and girls were not
empowered. They can not make decision even concerning their own
sexual lives. This includes decisions about contraceptive use. The ICPD
tried to encourage the empowerment of the female in a bid to improve the
situation. Unfortunately, this is sometimes misunderstood to mean
usurping men's rights. Therefore, there is the need to increasingly involve
men. This will bring them to understand that they too have a right to be
protected, and that the protection of the female is no threat to them.
Such a solution must therefore tackle the sources of this inequity. They
include:
Page 28 sur 10 l
Manks K.-\P on contraception / Gender /sec sch / 2001-2002
y Cultllre: In most developing nations, the woman is not allo\ved
participate in decision-making processes. Traditional leaders can help
change this if they are confronted with the negative effects of such
societal norms.
~
Religion: Sorne religions subordinate females and do not encourage
them ta take initiatives ta improve their sexual and reproductive lives.
Sorne challenge wornen' s rights to contraception and abortion.
Unfortunately, they sometimes influence even state policies. A change
is needed to improve the situation.
~
.Economie factors: Wornen are usually less economically viable than
men. Many of them are not financially independent and therefore on
their own, cannot make any moves towards better sexual lives
including acquisition of contraception. In addition, young girls are
withdrawn from school and sent into early marriage or prostitution
because their families cannot afford their upkeep. There is therefore
the need to financially empower the women. This includes educating
the girl child sa that she may be able ta have a better life.
4.2.5
Contraception during adolescence.
4.2.5.1
Specifie Contraceptive needs for Adolescents (30).
At the onset of sexualactivity, the adolescent usually does not think of
the risks involved in unprotected sexual intercourse. In France, 1/6th of
sexually active adolescents do not use contraceptives during 1st sexual
intercourse. In Cameroon only 18% of them do. (32)
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Because of their age, degree of compliance and preoccupations for the
future, adolescents have different needs from adults when it cornes to
contraception. A contraceptive method applicable to adolescents must
comply with the following recommendations:
-be reversible
-be easily available ~ cheap and easy to use.
-be able to prevent both pregnanc:!, STIs and HIV/AIDS
preferably.
-should be dissociable with the act of sexual intercourse as much as
possible. Methods that hinder spontaneity in engaging in intercourse will
be rarely accepted because most sexual acti\!ity among adolescents is
unplanned.
-be compatible with the health of the adolescent. Should not be the
source of any unaesthetic changes e.g. weight gain, acne, etc.
-should be one accepted by the adolescent.
In 3 words it should be efficient, viable and void of dangerous
consequences.
2 main methods are advisable for adolescents:
-
The condom
-
The pill
4.2.5.1.1
The condom:
This is the best method as it easily complies with aIl of the above
recommendations. However, because it is put on during foreplay and
arousal it may reduce pleasure. This reduces motivation to use it.
Moreover, each act demands a change of condom. It is but normal that the
Pearl's Index may be as high as 22 reported by a study in France (30).
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Manks KAP on contraception / Gender /sec sch / 2001-2002
4.2.5.1.2
The piii:
Usually combined oestro-progestatives are prescribed. Unfortunately ~
protection against STIs and HIV is not afforded by this method. Besides
this.. it needs everyday administration, which is usually not easy for
adolescents whose quest for sexual intercourse is usually occasional and
unplanned. However, it is dissociable with the act of sexual intercourse.
It is however important that a medical evaluation rules out cardiovascular,
liver disease, venous thrombosis etc and that the adolescent be advised
strongly against tobacco and alcohol. Three months after prescription the
adolescent should be reviewed for re-evaluation of compliance and
tolerance.
Emergency contraception with the "day after pill" 72 hours after
intercourse should also be readily available to all adolescents.
4.2.5.1.3
Contra-indicàted methods
1) Permanent method should not be .prescribed to adolescents.
2) The IUD should not be used because of the risk of PID involved.
3) AlI other methods are not contra-indicated but are not recommended
either because their impose more risks than benefits and costefficiency ratio may be unfavorable.
4.2.5.2
How should an adolescent be prescribed a contraceptive?
This needs to be done by a medical practitioner or other health personnel
trained in contraception and having particular experience working with
adolescents. He /she should be attentive, patient and simple in choice of
words. Enough time should be given to the adolescent to express himself
on the subject, and on his hopes and fears. Attention should be paid to
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Manks KAP on contraception / Gender /sec sch / 2001-2002
every little detail, in order that corrections and clarification may be
politely made. The consulting officer should be able to assess the
personality and capabilities of his client in order to give the best advice
the on the choice of a method. The patient should be given advice on safe
sexual behavior, prevention of STIs, HIV lAIDS and pregnancy, as weIl as
hepatitis B.
A complete medical evaluation comprising a detailed medical history,
physical examination and paraclinical examinations should be done to
assess the state of health at the time A gynecological examination is
necessary for adolescents who are sexually active.
The health officer should guide the adolescent in choosing a method. The
adolescent should be informed of the advantages, disadvantages and
implications of the chosen method. He/she should then be taught how to
use the method and what to look out for.
The adolescent should be discouraged from smoking, multiple sexual
partners and casual sex, unwanted pregnancy and unsafe abortion. He/she
should be encouraged to come back for assessment of compliance and to
look for side effects. Where possible his/her partner should take part in
the consultation.
4.3
TRENDS
IN SEXUALITY
AMONG ADOLESCENTS.
AND
CONTRACEPTION
The UNO defines an adolescent as a human being between ages 10 and
19. It is generally agreed that puberty occurs earlier in girls than in boys.
Worldwide the date of onset of puberty is estimated to coincide with
menarche and is taken to be 12.8yrs (21) This figure is close to that
Page 32 sur 101
Manks K.-\P on contraception
Gender /sec sch / 2001-2002
proposed by kagho Jean YIarie in 1998 for Cameroon which stands at
12.75 +0.99 (14). This is a long way off from the age at first marriage
among females. According to the July 99 issue of population reports the
median age at first marriage differs from one country to the next (33). In
the developed world between 1985 and 1996 ir was estimated at 25 years
as against 21 for developing nations. In sub-Saharan Africa it ranges from
16 in Chad to 29.0 in Swaziland. In Cameroon the figure stood at 19.7.
Before marriage, 28 % of Latin America and Caribbean girls and 38 % of
girls in sub-Saharan Africa have had their 1st sexual intercourse.
According to the UNFPA (39) above half of the world's adolescents are
sexually active. In Switzerland Narring F, Vlydler H & Michaud P-A
reported that 75% of students aged 16-20 admitted being sexually active
(26). According to the Kenya Demographie and health survey median age
of 1st intercourse was 16. 8years in women aged 20-49 (18). However
median age of 1st marriage was 19.2. Only 4% of men of the same age
group had gotten married by age 18 but 64 % had had intercourse before'
that age. In Mali Mouhamadou Gueye and al reported median age at 1st
sexual intercourse to be 17.9 and 15. 7 among urban and rural adolescents
respectively. (10). In Nigeria 51 % of students less than 20 are sexually
active and 52 % of their Cameroonian counterparts are too (15) . In
Cameroon the mean age at 1st intercourse is 12. 99 + 1.01 (15). In fact the
same study reported that 19 % of the students had had intercourse before
menarche. This shows beyond reasonable doubt that most of our
adolescents are sexually active and yet unmarried.
The use of contraception shows worse trends. Figures seem to be higher
in the developed countries. Narring, Wydler and Michaud reported a high
use of condoms and pills among adolescent. At first sexual intercourse
86.5 % of Swiss adolescents used either of the methods. This is very high
compared ta figures reported in developing countries especially in subPage 33 sur 101
Manks K.-\P on contraception
~
Gender /sec sch / 2001-2002
Saharan Africa. In Kenya, Kiragu in 1989 reported that only 49 % male
and 42 % female secondary school students had even used a contraceptive
method (18). In Nigeria, the Demographie health survey of 1990 reported
that only Il % of girls aged 15-19 had ever used contraception while
Uche Amazigo and al reported in 1997 that only 17% of sexually active
in-school adolescents had used a contraceptive method other than
abstinence (41). In
Cameroon~
Kamtchouing and al reported that 41 % of
Cameroon's secondary students used contraceptives. Leke and al
estimated that 46 % of Cameroonian adolescents practised contraception
(19). Keja and Kagho estimated that 18 % and 20% respectively of
Cameroonian adolescents used a contraceptive during their 1st intercourse
(17, 18). Most studies in sub-Saharan Africa and aIl Cameroonian studies
cited above were unanimous that adolescents preferred natural family
planning methods (periodic abstinence using the safe period) and the
condom and that they could hardly
accurately~
situate the safe period in
the menstrual cycle. Their peers in developed nations preferred the pill
and the condom.
The UNFPA (39) estimates that 1 out of 10 newborns has a teenage
mother. Most of these live in developing countries. In developed nations
teenage pregnancy rates in the early 90s were highest in the UK 6.5 % and
the USA 10%. In Nigeria and Cameroon it is estimated at 15% and 24%
among unmarried teenagers. Most of them
DOW
tend to abortion as a
means of birth control. In developed Countries it is fairly safe because it
is legalized. The maternaI mortality imputable to abortion and its
complications is 0.6 per 100.000. In most developing countries it is still
illegal and usually practiced under unsafe conditions leading to between
100 and 600 deaths per 100.000 abortions (33). Among 15-19 year olds
4.4million abortions are carried out yearly \vith 40% being unsafe. In
Page 34 sur 101
Manks KAP on contraception / Gender /sec sch / 2001-2002
addition girls less than 18yrs of age are 5 times more likely to die during
pregnancy and childbirth rhan those above 20 (39).
The world has over 35million people infected wirh HIV, 95 % live in
developing countries, 2/3 are found in sub-Saharan Africa, 1/3 are aged
bet\veen 15 and 24 .Of the 15000 newly infected daily, 1/2 are under 25.
In Cameroon, 7.2 % of the population is infected with HIV most of whom
are between 15 and 24. Other STIs are also frequent. 500,000 youth are
infected daily with the majority aged below 24 and a good number aged
between 15 and 19.
These trends emphasize the great need to promote the use of
contraceptives among adolescents, which will not only curb pregnancy,
STIs and HIV/AIDS but reduce the number of unsafe abortion and reduce
injuries and maternaI mortality imputable to pregnancy and childbirth. It
will also offer better opportunities for education and financial security to
these adolescents who are the world's next generation of adults.
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Manks KAP on contraception / Gender /sec sch / 2001-2002
5.1
Type of study
The study was a cross-sectional alld descriptive study
00
the knowledge,
attitudes and practice of contraceptioll among secoodary school students
ill Yaoundé .It was essentially geared towards finding out if any
differences exist between males and females.
5.2
Place of study
The study was carried out in secondary schools in the city of Yaoundé,
Cameroon.
5.3
Period of study
The study lasted from September, 2000-Decerrlber, 2001. Details of our
schedule are shown in the chart overleaf.
Page 37 sur 101
Manks KAP on contraception / Gendcr /scc sch / 200 }-2002
ORGANISATIONAL CHART
July, Aug, Sept, Oct, Nov, Dec Jan , Feb------------------Sept , Oct , Nov , Dec . Jan, Feb, March
Research proposaI
Acquisition
collection,-~
1
of
funds and material
Data
1
1
1
1
1
Data analysis
1
Write-up
1
Defense.
1
1
1
1
Page 38 sur 101
Manks KAP on contraception 1 Gender Isec sch 1 2001-2002
5.4
Stndy population
The population involved in the study were students of secondary schools
located in Yaoundé.
5.4.1 Selection of schools:
We opted to take schools from aIl 4 healtll districts in Yaoundé. We obtained
the Health Map of the city of Yaoundé from the Provincial Delegation of
Public Health. We also obtained the list of secondary schools situated in
Yaoundé froln the Divisional Delegation of Education. The lis cOlltained
their location within the city, their student and teacher population and other
information for the year 2000/2001. The two documellts are found in the
appendix of this document.
To participate in the study schools had to respond to the following criteria:
-
be accredited by the state.
-
have a population of at least 200.
-
be open to both sexes.
-
the administration of the school must have accepted to participate in the
study.
We selected aIl corresponding schools on our liste For each health district we
grouped them in 3: public, private denOlninational, lay private. We
numbered the schools in each group.
We then randomly selected one school from each group by drawing the
corresponding number. We ended up with Il schools. We visited the
administration of each school and presented them with an introductive Ietter
Page 39 sur 101
l
1
1
1
1
1
Manks KAP on contraception / Gender /sec sch / 2001-2002
from the faculty and a copy of our questiolmaire. We briefed them on wllat
the study was about and how we intended to carry it out. We discussed in
practical terms how we could adjust our research to suit their school
program in order to do our work without disrupting it.
We expected each school to give us access to a single class and stream for a
period of 50 minutes corresponding to one teachillg periode The class was
selected randomly by drawing a piece of paper bearing the corresponding
class level from among a lot each pertaining to one level. The school
administration went through the timetable of the class and selected a day and
time when they had a free periode We were tllen permitted to come at that
time. We were usually accompanied by a staff member to facilitate our
work, and to ensure that order was maintained.
Our final selection of schools included the following.
a) Biyem-Assi:
Government Bilingual High School, Etoug-Ebé.
Mevick Bilingual Grammar School.
Institut Secondaire d'Enseignenlent Industriel et General
(ISEIG) Melen.
b) Cité-verte:
Lycée de la Cité-verte
College Privé Meyong-Meyeme.
c) Nkoldongo:
Lycée d'Anguissa.
Complêxe Scolaire d'Odza.
College Privé Madeleine.
Page 40 sur 101
.
Manks KAP on contraception 1 Gender Isec sch 12001-2002
d) Elig-ESSOll0:
Lycée Bilingue d'Essos.
College Adventist, Nlongkak.
College de l'Unité.
5.4.2 Selection of stndy snbjects
To be included in the study, subjects had to meet the following criteria:
-
be officially enrolled in one of the schools participating in the study.
-
be permaIlently resident in Yaoundé for at least a year prior to the I st of
October when data collection began.
-
be Cameroonian.
-
Be between 10 and 19 years of age.
-
Should have agreed to participate voluntarily.
When a class was selected, its members were informedon what the stndy
was about; what the objectives were and what they were required to do as
participants. Those who met the criteria were then selected to participate.
5.4.2.1
Sal11p/e size
This was calculated using the Lowrenz formula:
N =P (1-P)(Za/d)2
where, P is the percentage of secondary school students who are sexually
active. This is an estimate of those who need contraception and therefore
Sllould at Ieast know about it. It is estimated at 52 % (Kamtchaouing).
d was taken at 0.05
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Manks KAP on contraception 1 Gender Isec sch 1 2001-2002
Zn is tllerefore 1.96
l"]lerefore N = 0.52(1-0.52)(1.96/0.05)2 ==384 persons.
We calctllated tl1at an average of 34 stlldents was to be taken frOITI eacll
SCllool but the class poplilatiolls varied greatly. Sonle classes llad up to 90
stlldetlts. We preferred to take aIl WllO cotnplied so as not to instill a feeling
of frllstration ill ot]lers. In addition, it was easier to tnaintaitl order. Tllirdly,
tlle students were more likely to he open and honest with everybody
involved.
We did not concern ourselves witll gender (sex) in our selection because we
wanted to 11ave as representative a salnple as possible.
We ended
5.5
IIp
witll a total of 613 st,udents.
Materials and methods
5.5.1
Materiais
Tile materials tlsed were:
-
A copy of the questiOntlaire per participant.
-
Writing tnaterial (pen, pencil)
-
A computer witll Microsoft word, access, excel and EPI info progralns.
-
A pllOtocOpy tnaclline.
- A record book (for jotting down dates, rendez-vous, scllools visited,
l1utnber of participants per SCll00t, problems etlCOllntered, etc).
Internet atld telepll0tle facilities.
-
Transportation facilities (usually taxis).
Page 42 sur 101
lYianks KAP on contraception / Gender /sec sch / 2001-2002
5.5.2
Methods
The study was purely a questionnaire study. It offered the advantage that we
could draw a large sample size. Besides, the smdents felt more secure in
giving information, as their identity could not be disclosed from the
questionnaire.
5.6
Data collection:
The questionnaire was conceived in English and translated into French.
Ten secondary and five university (medical) students pre-tested the
questionnaire. It was then photocopied.
The questionnaire guaranteed the highest confidentiality. A copy is found in
the appendix of this write-up.
The subjects chosen from each school were assembled in a spacious room,
usually their classroom or refectory was used. The students were briefed on
the study and its objectives. They were re-assured that there was no way
their identity could be disclosed from the questionnaire. They were
encouraged to be as honest as possible. They were asked to follow the
instructions keenly and answer just the sections corresponding ta their state.
HO\lleVer, no one was forced to answer a question they felt they shouldn't or
couldn't. They were encouraged to be independent. During the process, the
investigator answered any questions and gave clarifications where necessary.
Ho\vever, where a question was found on the questionnaire the student was
told to finish filling the questionnaire first. For example, if a participant
Page 43 sur 101
Manks KAP on contraception 1 Gender Isec sch 12001-2002
wanted to
kllOW
what contraception is, no answer was given immediately
because that was the saIne as question 13. At the end of the session when aIl
questionnaires had been collected the question was then answered. At that
time any other questions on the topic were aiso answered.
Tile investigator herself collected questionnaires so that participants could
not peep into each other's questionnaires. After the dialogue session we left
our address so that those students who had further questions couid contact us
for answers.
5.7
Data analysis:
Information was anaIyzed using computer database programs. We used
Microsoft Access, Microsoft Excel and EH Info. The results are presented
as tables, charts and prose. An example of the dummy table used is
below:
Knowledge of sex MALE
FEMALE
TOTAL
contraception.
Yes
No
TOTAL
-
Percentages, proportions and means, have aiso been calculated and
compared using the chi-square test and Hanover test where appropriate.
-
The results are presented in the next chapter followed by discussion of
findings.
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Manks KAP on contraception / Gender /sec sch / 2001-2002
5.8
Ethical principles and respect for human rights.
Eve~7
participant joined the study voluntarily and retained the right to pull
out \\·hen so desired. No information was forced out of any participant.
Secondly, privacy and confidentiality were guaranteed. No details on the
identity of the participant that could permit information to be traced bBk to
himlher were to be filled on the questionnaire. There was no room for name,
ID card number, parent's name, phone numbers etc. The administration of
the school was not given access to the questionnaires. This further reassured
the srudents of the confidentiality.
The students were given as much time as possible to ask any question they
had. We left our address in case they had other concerns, which needed our
attention.
5.9
Budget
The investigator provided aIl funds for the study. This made the study very
difficult to carry out as· costs of materials and services are high. Below is an
inventory of our expenditure:
Protocol -------------------------------------------------50.OOOfrs CFA
Reviews, articles, Internet services----------------lOO.OOO
Transportati 0 n------------------------------------------50.000
Writing material (paper, pens, peneils etc1--------30.000
Printing and photocopying---------------------------100. 000
Computer maintenance--------------------------------30.000
Unforeseen----------------------------------------------50.000
TOTAL---------------------------------------------41 O.OOOfrs CFA.
Page 45 sur 101·
Manks KAP on contraception 1 Gender /sec sch / 2001-2002
We recruited a total of 613 students in our study. The tables below show the
distribution of the students according to various characteristics.
6.1
IDENTIFICATION OF STUDY PARTICIPANTS:
Table 1: Distribution of studv participants according to sex
Characteristic
Frequency
Percentage
Males
273
44.5
Females
340
55.5
TOTAL
613
100
Distribution of participants according to marital status.
AlI of our male participants where single while two of our female
participants were married.
Table 2
i
Distribution of study participants according to age
Age
<15
15-19
Unspecified
Total
Male
Female
(18.2)
41
(15.0%) 62
182 (66.7%) 223
(65.6%)
50
(18.3 %) 55
(16.2%)
(100%)
273
(100%) 340
Total
103 (16.8%)
405 (66.0%)
105 (17.1 %)
613 (100%)
~
The majority of students are found within the 15 - 19 age group.
~
The age range was 10 to 19.
Page 46 sur 101
Manks KAP on contraception / Gender /sec sch / 2001-2002
Table 3
1
Class
Distribution of study participants according to class.
Male
l
Total
Female
i
1
1
13
47
:
(17.2 %) i 40
1
(11.7%~
~
122
87
(14.2%)
:
1
(44.7%) 1172
(50.6%}j294
(48.0%)
1
j
1
15
10
(03.8%~ 23
(03.8%)
(22.7%) i 52
(15.3%~
114
(18.6%)
(11. 7%) 1 63
(18.5%~
32
(15.5 %~
(03.7%) 113
1
1
62
6
7
32
i
Total
273
(100%)
1
i
1
340
(99.9%)1 613
(100.1 %)
Nearly haif of the study participants were from class 4. The reason is that the
schools in which class 4 was selected had highly populated classes.
Table 4
Distribution of study participants according to religion
RELIGION
Frequency
Percentage
Christian
580
94.6
Muslim
26
4.2
Atheist
01
0.2
Unspecified
06
1.0
Total
613
100
There was a large Christian majority.
Page 47 sur 101
Manks KAP on contraception / Gender /sec sch / 2001-2002
Distribution of study participants by region of origine
Table 5
Region
1
Frequency
Percentage
244
39.8
200
32.6
114
18.6
14
2.3
41
06.7
613
100
1
!
Southerners
1
Westerners
i
1
Coastal peoples
1
1
Northerners
i
1
Unspecified
1
1
Total
1
We considered southerners to be participants from the center, south and east
provinces; westerners to be from the northwest and western provinces;
coastal people to be those from the littoral, southwest, Bassas and Batanga;
and northerners to be persons from the far north, north and Adamawa
provinces.
Page 48 sur 101
Manks KAP on contraception / Gender /sec sch / 2001-2002
6.2
KNOWLEDGE ON SEXUALITY AND REPRODUCTION
Table 6
Distribution of study participants according to different
sources through which they had been informed about
reproductive health.
: Source of information i Frequency
; 463
Friend
Media
! 340
: Parent
283
School/seminar
i 204
Health worker
155
18
: Church
j No response
! 07
i
1
1
j
~
1
1
1
1
Percentage
75 .6
55.5
46 .2
33 .3
125.3
i 02.9
01 . 1
1
1
» Peers and the media were the largest sources of information. Most of the
srudents cited multiple sources. The total of frequencies therefore,
18
above the total number of participants who answered the question.
» In the entire population only
one male participant reported not having
heard about sex before.
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Manks KAP on contraception / Gender /sec sch / 2001-2002
Distribution of study participants by consequences of unsafe
sexual intercourse they cited.
Table 7
i
Percentage
Consequences
Frequency
Pregnancy
595
97.1
STls/ AIDS
563
91.8
Sterility
131
21.4
Abortion
Il
01.8
Death
03
0.5
Hepatitis B
01
0.2
No response
28
4.6
1
Though pregnancy and STIs/AIDS were the most frequently known
consequences, indirect consequences like sterility, death and abortion were
also cited. One student cited hepatitis B.
Table 8
Distribution of study participants by whether or not they
could correctly situate the fertile period within the
menstrual cycle according gender.
Male
Female
AlI
Situated correctly 43
(29.7%~ 144
(15.8%~ 101
Situated wrongly 230
(84.2%) 239
(70.3%~ 469
(100%) 273
273
(100%) 340
Total
»
(23.4%)
(76.5%)
(99.9%)
Overall, females tend to be are more knowledgeable than males (p value
= 0.00)
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Marlks KAP on contraception / Gender /sec sch / 2001-2002
Table 9
Distribution of study participants bv whether or not thev
could situate fertile period within the menstrual cycle
according to age.
<15
15-19
(09.7%) 89 (22.0%)
10
Situated correctly
(90.3%) 316 (78.0%)
Situated incorrectly 93
103 (100%) 405 (100%)
Total
With increase in age there tends to be a bener understanding of when
conception occurs.
Table 10
Class
3
4
5
6
7
Distribution of study participants by whether or not they
could situate the fertile period within the menstrual cycle
correctly, according to class.
Situated correctly
24
49
04
53
34
(27.6%)
(16.7%)
(18.2%)
(46.5%)
(35.8%)
Situated incorrectly
63
245
19
61
61
(72.4%)
(83.3%)
(81.8%)
(53.5%)
(64.2%)
Students of the tirst cycle (Forms 3, 4 and 5) appeared to he less
knowledgeable than those of the second cycle (Forms 6 and 7). This is
consistent with increase in age.
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Nlanks KAP on contraception / Gender /sec sch / 2001-2002
Table Il
Distribution of study participants by whether or not thev
could situate the fertile period "ithin the menstrual cycle
and by whether they were sexuall,- active or note
Sexuallyactive
Situated correctly
Situated incorrectly
Total
91
223
314
Not sexually active
(29.0%) 53
(71.0%) 240
(100%) 293
(18.0%:
(82.0%)
(100%)
There was a tendency for sexually active participants to be more
knowledgeable.
Table 12
Distribution of male study participants by whether or not
they could situate the fertile period within the menstrual
cycle by and whether they were sexually active or note
Not sexually active
Sexually active
(18.0% Il
(11.8%~
132
1
Correctly situated
Incorrectly situated i 145
177
Total
1
1
1
(82.0%~
83
(100%) 94
(88.2%1
(100%)
The difference in knowledge between sexually active males and those who
were not sexually active was not significant (p value = 0.17).
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Manks KAP on contraception / Gender /sec sch / 2001-2002
Table 13
1
1
Distribution of female study participants by whether or not
they could situate the fertile period within the menstrual
cycle, and br and whether they were sexually active or note
Sexuallyactive
Correctly situated 59
Incorrectly situated 78
137
Total
Not sexually active
(43.1 %) 42
(56.9%) 157
(100%) 199
(21.2%)
(78.8%)
(100%)
There was a significantly higher level of knowledge among sexually active
females compared to those who were not (P value = 0.00).
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Manks KAP on contraception / Gender /sec sch / 2001-2002
6.3
SEXUAL ATTITIJDES AND PRACTICES
Table 14
Distribution of study participants by whether they were
sexually active or note
Male
177
Sexually active
Not sexually active 94
No response
02
273
Total
Female
(64.9%)
(34.4%)
(0.7%)
(100%)
137
199
04
340
(40.4%)
(58.6%)
(01.0%)
(100%)
Total
314
293
06
613
(51.2%)
(47.8%)
(01.0% )
(100%)
A significantly larger proportion of males was sexually active compared to
females (p value = 0.00).
Age at tirst sexual intercourse
.
~
The ages at first intercourse ranged from 7 ta 19.
~
The mode was 14 for girls and 16 for boys .
~
Overall males started sexual activity earlier than females.
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Manks KAP on contraception 1 Gender Isec
Number of sexual
part~ers
SCll 1 2001-2002
and freguency of sexual
illtercoul"se.
~
40.5 % of sexually active males and Il.3% of females had multiple
partners.
On a monthly basis:
~
50.7% of sexually active males and females had intercourse at most once.
~
35.1 % and 33.8% respectively had intercourse 2 to 4 times.
»
15.4 % and 3.2 %respectively had intercourse at least 5 times
Most adolescents engaged in sexual activity occasionally.
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Manks KAP on contraception / Gender /sec sch / 2001-2002
Table 15
Distribution of sexually active study participants by reason
they gave for initiation into sexual intercourse.
Curiosity
Please partner
Felt of age
,Peer pressure
Love/desire
Rape
Economie reasons
Ignorance at the time
Playing with brother
Male (N = 177)
Female (137)
(48.5% 49
86
(35.9%)
(27.1 % 47
48
(34.6%)
(24.2% 30
43
(22.2%)
(04.6%)
(17.5% 06
31
(06.5%)
(04.6% 09
08
(03.9%)
(01.0% 05
02
!û2
(01.0%) 04
(02.6%)
(0.7%)
(0.00% 01
00
(0.5%) 00
(0.0%)
01
1
1
~
Peer pressure appeared ta be a stranger influence on males than females.
~
Sorne participants cited multiple reasons.
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Manks KAP on contraception / Gender /sec sch / 2001-2001
6.4
KNOWLEDGE OF CONTRACEPTION
Table 16
Distribution of study participants by whether they
understood what contraception is or note
Male
Understood
Did Dot
Total
174
99
273
Female
(63.9%) 282
(36.1%) 58
(100%) 340
(82.8%
(17.2%>
(100%)
Females were more knowledgeable than males (p value = 0.00)
Table 17
Distribution of study participants br whether they
understood what contraception is or not, according to age.
<15
Understood
Did not
Total
70
33
103
1.5-19
(67.9% )294
(32.1 %)111
(100%) 405
(72.6% ~
(27.4%)
(100%)
With age understanding of contraception increased for both sexes
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Manks KAP on contraception / Gellder /sec sch / 2001-2002
Table 18
Distribution of study participants who understood wllat
contraception is according to class.
Class
3
4
5
6
7
Male
27
28
03
37
28
Female
(57.4%
(57.0%
(75.0%
(69.6%
(83.3%
50
189
Il
56
59
Total
(80.0% 77
(77.2%~ 217
(59.1 % 14
(91.0% 93
(96.2% 87
(88.5%
(73.8%~
(60.9%
(81.6%
(91.6%
There seemed to be an increase in knowledge with class among males but
the rise was not clearly visible among females. However among femals of
forms 6 and 7 there appeared to be a remarkably higher Ievel of knowledge.
Page 58 sur 101
Manks I(AP on contraception / Gender /sec sch / 2001-2002
Table 19
Percentage distribution of study participants who
understood what contraception is, according to different
methods they knew.
METHOD
Condom
Pill
Periodic abstinence
IUD
Injection
Fidelity *
Coitus interruptus
Diaphragm
Family planning *
Norplant
Spermicides
Sterilizatiolt *
Vasectomy
Abortion*
Vaginal douching
l'raditional portion*
No response
~
MALE
(56.3%)
98
(28.7%)
50
52
(29.9%)
(05.7%)
10
(08.6%)
15
05
(02.9%)
(02.9%)
05
02
(1.10%)
(1.10%)
02
(0.06%)
01
00
(0.06%)
01
(0.06%)
01
01
(0.40%)
00
00
(06.3%)
Il
ALL
FEMALE
(67.8%)
211 (74.8%) 309
(45.8%)
159 (56.4%) 209
(34.0%)
103 (36.5%) 155
(20.2%) 67
57
(14.7%~
(17.0%) 63
48
(13.8 %;
(04.3%) 17
(03.7%)
12
(03.5%) 15
10
(03.3%~
(04.0%) 13
Il
(02.9%~
(02.1 %) 08
(01.8%~
06
(01.5%
(02.1 %) 07
06
(02.1 %) 06
(01.3%
06
(0.70%)
(0.70%) 03
02
(0.40%) 02
(04.4%:
01
(0.40%) 02
01
(04.4%~
(0.40%) 01
(02.0%~
01
(0.40%) 01:
(02.0%:
01
(07.1 %) 31
(06.8%~
20
The most frequent Inethods cited were: tlle condom, the pitt, periodic
abstiIlence, IUD and injections.
»
Sorne wrong answers were given. They are marked with an asterix.
~
Most participants cited several rnetllods.
Inconveniences of contraceptives
Among stndy participants who understood what contraceptives were,
»
62 % knew that tlley were not 100% efficient;
~
9% thought they lead to sterility;
~
2 % thought they could lead to death.
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~lanks
6.5
ATTITUDE
KAP on contraception / Gender /sec sch / 2001-2002
TOWARDS
Al"r.>
PRACTICE
OF
CONTRACEPTION.
Table 20
Distribution of male study participants by whether they
thought contraception was necessary for them or not, and
according to \vhether they were sexually active or note
1Sexually active
(74.0%)
i Thought it necessary
! 131
(26.0%~
l Did not
46
(100%)
: Total
! 177
f
Not sexually active
(64.8% )
61
(35.2%)
33
(100%)
94
There was no significant difference between males who were sexually active
and those who were not concerning whether the)~ thought contraception was
necessary for them or not (p value = 0.16).
Table 21
Distribution of female study participants by whether they
thought contraception was necessary for them or not, and
according to whether they were sexually active or note
1
1
; Thought it necessary
Did not
1Total
1
1
1
j
Sexually active
(76.6%)
105
(23.6%)
32
(100%)
137
Not sexually active
(75.9%
151
(24.1 %)
48
(100%)
199
There was no significant difference between females who were sexually
active and those who were not concerning whether they thought
contraception was necessary for them or not' (p value = 0.87).
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Manks KAP on contraception / Gender /sec sch / 2001-2002
Table 22
1
Distribution of sexuallv active study participants by
whether they had ever used contraceptives before or note
!Male
179
Bad ever used
Had never-used
Total
1
!98
(177
1
Female
(44.8%) 93
(55.2%) 44
(100%) ,137
(68.0%)
(32.0%)
(100%)
Females were more frequent eveFusers than males. (p value
Table 23
= 0.00).
Distribution of sexually active study participants by
whether they had ever used contraceptives, accordi~ to age
<15
Bad ever used
Had never used
Total
Il
92
103
15-19
(09.4% )104
(90.6% )301
(100%) 405
(25.7%)
(74.3%)
(100%)
Contraceptive use was higher among the 15-19 age group (p value
= 0.00)
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Nlanks KAP on contraception / Gender /sec sch / 2001-2002
Table 24
Frequencies at which non-users of contraception cited
different reasons to justify non-use.
iREASON
FREQUENCY
Don't know what ta use
92
47
Did not think it is necessary
14
Not accessible
27
Shame
Trust in partner
~ 01
Ignorance at the time of sexual 01
1 intercourse
, Reduce pleasure
03
Needed parental consent
01
i
1
Most non-users did not know what to use or did not think it was necessary.
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Manks KAP on contraception / Gènder /sec sch / 200 1-2002
Table 25
Freguencies at which contraceptive users cited different
methods thev had used in the past and those they used
presently.
METHOD
FREQUENCY
Presently
In the past
Condom
Periodic abstinence
Pill
Injection
Total abstinence
Coitus interruptus
Fidelity
157
63
13
04
01
01
00
00
00
Trust
None
140
101
05
04
06
00
01
01
04
There was a slight tendency to move away from modern methods like the
condom and pills in favour of natural methods such as total and periodic
abstinence.
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ManIes KAP on contraception / Gender /sec sch / 2001-2002
Table 26
Frequencies at \vhich users cited different sources from
which the y get their contraceptives.
SOURCE
Store/pharmacy
F .P. clinic/health unit
Friends
Parents
Stolen
None
l\;lALES
68
14
09
15
05
02
FEMALES
71
25
04
15
02
06
1
1
!
1
!
!
!
1
1
While the store and pharmacy were highly frequented, the Famil)planning
clinic/health unit, were less frequented.
Table 27
Always
Sometimes
No response
Total
Distribution of contraceptive users according to how
freguently at which users use contraceptives.
Male
44
30
05
79
Female
(55.7%~ 48
(38.0%) 40
(06.3%~ 05
(100%) 93
(51.6%)
(43.0%)
(05.4%)
(100%)
Totàl
92
(53.4%~
70
(40.7%~
(05.8)
10
(99.9%)
172
A linle above half of the users used contaceptives always.
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Manks KAP on contraception / Gender /sec sch / 2001-2002
Table 28
Percentage distribution of study participants of both sexes
by level of education of most educated parent or guardian
and whether they encouraged contraception.
Level
of MALE
education
Encourage
None
0
45.5
Primary
Secondary
42
44.9
University
LTnknown
31.3
FEMALE
Don't
100
154.5
i
58
155.1
1
168.7
Encourage
50
22.2
44.4
44.9
40.0
Don't
50
77.8
55.6
55.1
60.0
~
No matter how high the level of education was, the parents who
encouraged contraception were never above 50 % There was however a
slight rise with increase in level of education.
~
Females were encouraged more.
Occurrence or pregnancy.
14.4 % of males and 14.4% of females had either been responsible for or
victim of a pregnancy before.
Table 29
Distribution of male study participants who had been
responsible for a pregnancy before by whether they had
used contraception at least once before or note
Users
Non-users
Pregnancy +
(14.1%)
25
(20.4%)
20
Pregnancy (85.9%)
54
(79.6%)
78
There was no statistically significant difference between male users and nonusers in responsibility for pregnancy (p value = 0.26).
Page 65 sur 101
Manks KAP on contraception / Gender /sec sch / 2001-2002
Table 30
Distribution of female study participants who had been
responsible for a pregnancy before by whether
used contraception at least once before or note
Pregnancy
l.:sers
Non-users
12
26
+
(12.9%)
(59.1%)
the~·
had
Pregnancy 81
18
(87.1 %)
(40.9%)
There was a higher rate of pregnancy among female non-users (p value
0.(0).
Percentage distribution of participants who have been victims of 8Th
~
6.2 % of males and 8.0% of females reported having contracted an STI.
>
82 % an 62.6 % respectively had used condoms at least once before.
Condoms were frequently used by victims of STIs.
Page 66 sur 101
=
Manks KAP on contraception / Gender /sec sch / 2001-2002
On \vho should be responsible for contraception in a relationship.
542 study participants (88.4%) thought both partners should be.
Their reasons were that:
~
both enjoy the sexual act and are equally exposed to risks.
~
They find it hard to trust each other;
~
It will he more efficient
~
It was a matter of common sense.
18 males (6.9%) and 14 females (4.1%) thought males should be. This
represents 5.2 % of the study population.
Their reasons were that:
~
males are ecoIDmically stronger;
~
methods used by men are cheaper and easier to use;
~
females already have a lot of other problems to solve.
9 males (3.3%) and 20 females (5.9%) thought females should be. This
represents 4.7% of the study population.
Their reason was tmt women are more exposed to risks and public disgrace.
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Nlanks KAP on contraception / Gender /sec sch / 2001-2002
7.1
7.1.1
DESCRIPTION OF THE STUDY
POPl~LATION:
Sex distribution:
Of the 613 students, 273 were male (44.5%) and 340 (55.5%) were female.
These figures resemble those of the general student population. According to
statistics for the year 2000/2001
frOID
the Divisionai Delegation of National
Education for the MfoWldi, Yaoundé has a student population of more
females (52%) than males (48%). [Appendix 3 ].
Our study population is therefore, representative where age is concemed and
is consistent with age distnbution in Fonns 3 to 7.
7.1.2 Age distribution:
Our students were aged between 10 and 19. The mean age was 17. From
previous works on the Cameroonian student it is reported that 56% of
students become sexually active between ages 15 and 17 (15). It is also
reported that mean age. of 1st intercourse is 15.5
± 2.6
(14). We therefore
decided to group the study participants into 2 age groups: <15 and 15-19.
However, the majority of study participants was fOWld in the 15-19 age
group. This can be explained by the fact that only Forms 3-7 were included
in our study. Students of these classes are usually ofthis age range.
7.1.3 Distribution according to class:
Our students were selected from Forms 3 to 7. Fonn 4 had the largest
number of participants. Form 5 was selected only once because it was bard
to find a free period when we could work with them.
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NIanks KAP on contraception / Gender /sec sch / 2001-2002
7.1.4 Distribution according to marital status:
On1)~
2 females were married. They represent 0.6% of the female population
recruited in our study and 0.3 % of the entire sample. This reflects the
general tendency in our urban secondary schools. Most girls now marry later
than before, preferring ta attain intellectual and financial security and
independence first. In Cameroon the age at 1st marriage amongst females is
19.7 (33). Besides, girls \vho get married usually quit school in favor of
childbearing and housewifery. If one considers that the males marry even
later than females, it is understandable that no married male was found ..
7.1.5 Distribution according to religion
Our population was made up of: 613 Christians (94.6%); 26 Muslims
(4.2 %); and 1 atheist (0.2 %). 6 persons did not specify their religious group
(1.0%).
Though Yaoundé is a metropolis, it still retains a lot ofits original religjous
tendencies. Yaoundé is situatedin the Southern part of Cameroon, which is
predominantly Christian. The northerners who form the majority of the
Muslim community, as weIl as the Bamouns from the West are found in
much lesser numbers. These two reasons explain the large Christian
majority.
7.1.6 Distribution according to tribe:
A large number of tribes live together in the city. It is important to note that
the entire state is fairly weIl represented. However, the Beti, who are the
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Manks KAP on contraception / Gender /sec sch / 2001-2002
indigenous tribe still constitute a relativel)'· high proportion of the
population.
7.2
SEXUAL KNO\VLEDGE, ATTITUDES AND PRACTICES.
7.2.1 Knowledge on reproductive health:
Dnly one male had not heard about sex from any source at aIl.
7.2.1.1
Sources of information
The students who were informed cited 3 main sources of information:
Their peers (75.6%);
The media (55.4%);
Their parents (46.2 %).
Schools/seminars and the health personnel were only rarely cited. It is worth
mentioning that a few cited the church. Most of the students had been
informed from several sources at the same time. Amazigo and al reported the
media and health personnel to be the biggest sources of information among
Nigerian students (2), while Population Reports cited the media and peers
(32).
These figures look encouraging but should be interpreted with caution. As a
matter of fact the sources of information cited most are not the best.
Adolescents are ignorant and therefore are more likely to misinfonn and
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Nlanks KAP on contraception / Gender /sec sch / 2001-2002
miseducate each other. The media usually dishes out sketchy, equi\local
messages, which respond more to market and commercial exigencies than ta
the needs of the population. Even when parents talk to their kids, the)' are
judgmental and sentimental rather than realistic. Therefore it wilInoI be
surprising to find that our adolescents are only acquainted with the subject or
misinformed altogether. The school/seminar and the health personnel maybe
more realistic, open and at the disposaI of the youth. They are definitely
more versatile and therefore may complement the other sources. In this way
adolescents will be better educated on contraception and reproductive health.
7.2.1.2
Knowledge ofrisks ofunsafe seXe
The study participants were aware of risks of unsafe sexe The majority knew
about pregnancy (97. 1 %) and STIs/AIDS (91.8 %). Sorne mentioned indirect
consequences like sterility, abortion and death. 4.6 % did not know of any
consequences at aIl. As above females were more informed probably
because they have benefited more from educational programs.
7.2.1.3
Knowledge orthe menstrual cycle and conception.
Most participants did not understand what the menstrual cycle was. The
males were less informed than the females. (20.1 % versus 40.1 % could give
a correct definition.). The same trend was observed when it came to situating
the fertile period within the menstrual cycle. Males were less likely to do
this correctly (15.8% versus 29.8%). With P=O.OO, there was a statistically
significant difference between the sexes. Participants 15 years and above
appeared to be better informed. In addition, study participants attending the
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