Adolescent mothers' knowledge and perceptions of contraceptives in Tshwane, South Africa.
This descriptive quantitative survey attempted to identify reasons why adolescent mothers (aged 19 or younger at the birth of their babies) failed to utilise contraceptive contraceptive /con·tra·cep·tive/ (-sep´tiv)
1. diminishing the likelihood of or preventing conception.
2. an agent that so acts. , emergency contraceptive and/or termination of pregnancy termination of pregnancy Induced abortion. See Abortion. (TOP) services. The research population comprised all adolescent mothers in the region, the accessible convenience sample consisted of all adolescent mothers who visited Tshwane's Metropolitan Council clinics from 1 January till 31 March 2000, and who were willing to complete questionnaires, designed and tested during a joint World Health Organization and Commonwealth Reproductive Health Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene Workshop in Harare, Zimbabwe, during 1998. During pretesting, 12 questionnaires were completed by adolescent mothers who were excluded from the actual study. This report refers to data (analysed with the Epi-Info program) obtained from 61 completed questionnaires. Only a minority of these 61 adolescent mothers earned sufficient money to sustain themselves and their babies. In spite of these unfavourable financial circumstances, only 23 (37.7%) had used contraceptives prior to conception. None of them used emergency contraceptives and none accessed termination of pregnancy services. Although all these services are available free of charge in the region, these adolescent mothers did not use them. The adolescent mothers required more knowledge about contraceptives, emergency contraceptives and TOP services, and they need to perceive these services as being accessible and safe before they could utilise them effectively. Clinics providing these services should be open over weekends and during evenings so that adolescents can obtain contraceptive services without fear of meeting their mothers, aunts or teachers at these clinics. Reproductive health clinics should also strive towards providing more adolescent-friendly services.
Keywords: adolescent mothers; contraceptives; knowledge and utilisation of contraceptives; emergency contraceptives; teenage pregnancies teenage pregnancy Adolescent pregnancy, teen pregnancy Social medicine Pregnancy by a ♀, age 13 to 19; TP is usually understood to occur in a ♀ who has not completed her core education–secondary school, has few or no marketable skills, is ; termination of pregnancy services
Hierdie beskrywende kwantitatiewe opname het gepoog om redes te bepaal waarom adolessente moeders (wat 19 jaar oud oud
A musical instrument of northern Africa and southwest Asia resembling a lute.
[Arabic 'd, wood, stem, lute, oud.] of jonger was tydens die geboorte van hulle babas) nie gebruik gemaak het van kontrasepsie (voorbehoedmiddels) of noodkontrasepsie, en/of terminasie van swangerskap ("termination of pregnancy--TOP") dienste nie. Die navorsingspopulasie het bestaan uit alle adolessente moeders in die streek, die bereikbare gerieflike steekproef het bestaan uit alle adolessente moeders wat die Tshwane Metropolitaanse Raad se klinieke van 1 Januarie tot 31 Maart 2000 besoek het, en wat bereid was om vraelyste te voltooi. Die vraelyste is ontwerp en getoets tydens 'n gesamentlike Wereld Gesondheids Organisasie en Statebond Voortplantingsgesondheidwerkswinkel in Harare, Zimbabwe, gedurende 1998. Tydens die voortoetsfase is 12 vraelyste voltooi deur adolessente moeders wat nie aan die werklike studie deelgeneem het nie. Hierdie verslag verwys na die data (ontleed met behulp van die Epi-Info program) wat verkry is uit 61 vraelyste wat in die Tshwaneomgewing voltooi is tussen 1 Januarie en 31 Maart 2000. Slegs enkele van hierdie 61 adolessente moeders het inkomstes gehad wat voldoende was om hulleself en hulle babas te onderhou. Ten spyte van die ongunstige finansiele omstandighede, het slegs 23 (37.7%) enige kontrasepsie gebruik voor hulle swangerskappe. Niemand het noodkontrasepsie gebruik nie en ook nie terminasie van swangerskap dienste nie. Alhoewel hierdie dienste gratis GRATIS. Without reward or consideration.
2. When a bailee undertakes to perform some act or work gratis, he is answerable for his gross negligence, if any loss should be sustained in consequence of it; but a distinction exists between non-feasance and beskikbaar is in die Tshwane-omgewing, kon die respondente nie daarin slaag om die dienste te benut nie. Die adolessente moeders benodig meer kennis oor kontrasepsie, noodkontrasepsie en terminasie van swangerskap dienste, asook persepsies dat die dienste bereikbaar en veilig is, alvorens hulle die dienste kan benut. Klinieke wat sodanige dienste verskaf, behoort naweke en saans oop te wees sodat adolessente die klinieke kan bywoon sonder om te vrees dat hulle moeders, tannies of onderwyseresse ook daar sal wees. Reproduktiewe gesondheidsorgklinieke moet ook meer adolessente-vriendelike dienste daarstel.
INTRODUCTION AND BACKGROUND INFORMATION
Tshwane, previously known as Pretoria, has more than 1.6 million inhabitants
The game is based loosely on the concepts from SameGame. and encompasses approximately 900 square kilometres Square kilometre (U.S. spelling: square kilometer), symbol km², is a decimal multiple of the SI unit of surface area, the square metre, one of the SI derived units. 1 km² is equal to:
n. Abbr. Con. or Cons.
1. An official appointed by a government to reside in a foreign country and represent his or her government's commercial interests and assist its citizens there. See Usage Note at council. Guide to Pretoria, 1999/2000:1-2). Throughout this area, the Tshwane Metropolitan Council's clinics provide reproductive health services free of charge to the clients, including contraceptive, emergency contraceptive and termination of pregnancy (TOP) services, in accordance with the specifications of the National Health Plan for South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. (ANC ANC
African National Congress
ANC African National Congress: South African political movement instrumental in bringing an end to apartheid
ANC n abbr (= , 1994:10). The adolescent mothers thus failed to make effective use of these free services (O.Eng. Law) such feudal services as were not unbecoming the character of a soldier or a freemen to perform; as, to serve under his lord in war, to pay a sum of money, etc.
See also: Free . This survey attempted to identify possible reasons for not utilising these services.
The consequences of adolescent pregnancies adolescent pregnancy See Teenage pregnancy.
Adolescent pregnancies imply adverse health, social and economic implications for the mothers and their children--and usually for the grandmothers as well. Annually approximately 17 000 babies are born to mothers younger than 16 in the RSA (1) (Rural Service Area) See MSA.
(2) (Rivest-Shamir-Adleman) A highly secure cryptography method by RSA Security, Inc., Bedford, MA (www.rsa.com), a division of EMC Corporation since 2006. It uses a two-part key. (Mwaba, 2000:30). Physical problems experienced by adolescent mothers, younger than 16 years of age in the RSA, include pregnancy induced hypertension, premature labour Noun 1. premature labour - labor beginning prior to the 37th week of gestation
childbed, confinement, lying-in, parturiency, travail, labour, labor - concluding state of pregnancy; from the onset of contractions to the birth of a child; "she and anaemia anaemia
see anemia. (Lesser & Escoto-Lloyd, 1999:289; Sellers, 1993:1715). These physical problems might remain undetected because they attend prenatal prenatal /pre·na·tal/ (-na´tal) preceding birth.
Preceding birth. Also called antenatal.
preceding birth. clinics very late during their pregnancies. Many adolescent mothers will need to discontinue dis·con·tin·ue
v. dis·con·tin·ued, dis·con·tin·u·ing, dis·con·tin·ues
1. To stop doing or providing (something); end or abandon: their education, limiting their chances of finding jobs with salaries, which can sustain these mothers and their children. Financial hardships can aggravate the adolescent mothers' social adjustment problems, increasing the likelihood of resorting to prostitution prostitution, act of granting sexual access for payment. Although most commonly conducted by females for males, it may be performed by females or males for either females or males. to augment their incomes.
Prostitution implies health risks, especially in the RSA with its high HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome prevalence, indicated by 22.4% of pregnant women found to be HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. positive during 1998 (Department of Health, 2000:1). Forced early marriages can lead to social problems such as abuse and child battering (De Villiers de Villiers may refer to:
The utilisation of contraceptives
The adverse health, social and economic implications of adolescent pregnancies can be averted a·vert
tr.v. a·vert·ed, a·vert·ing, a·verts
1. To turn away: avert one's eyes.
2. by the effective utilisation of contraceptives. The potential impact of contraceptives has been estimated as having "averted an estimated 1.65 million pregnancies among the 15-19 year old women in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. during 1995. If these women had been denied access to both prescription and over-the-counter contraceptive methods Noun 1. contraceptive method - birth control by the use of devices (diaphragm or intrauterine device or condom) or drugs or surgery
birth control, birth prevention, family planning - limiting the number of children born , an estimated additional one million pregnancies ... would have occurred. These pregnancies would have led to 480 000 live births, 390 000 abortions, 120 000 miscarriages, 10 000 ectopic pregnancies ectopic pregnancy
or extrauterine pregnancy
Condition in which a fertilized egg is imbedded outside the uterus (see fertilization). Early on, it may resemble a normal pregnancy, with hormonal changes, amenorrhea, and development of a placenta. and 37 maternal deaths Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2000, the United Nations estimated global maternal mortality at 529,000, of which less than 1% occurred in the developed world. " (Khan, Brindis & Glei, 1999:29). Similar statistics could be applicable to the RSA generally, and to Tshwane specifically, where not only contraceptives, but also emergency contraceptives and TOP services are available free of charge. This survey attempted to identify why adolescent mothers were unable and/ or unwilling to use services required to prevent pregnancies.
Adolescents' knowledge and perceptions of contraceptives, emergency contraceptives and termination of pregnancy services
Adolescents require knowledge before they could consider using contraceptives, emergency contraceptives or TOP services. Makhetha (1996:1) reported that all 211 adolescent mothers who participated in a research project were sexually active by the age of 15, but lacked knowledge about menstruation menstruation, periodic flow of blood and cells from the lining of the uterus in humans and most other primates, occurring about every 28 days in women. Menstruation commences at puberty (usually between age 10 and 17). , conception and contraceptives to the extent that only 11 (5.2%) had used any contraceptives prior to conception. However, knowledge might be coloured by perceptions about these strategies and about the adolescents who use them. Peer pressure, cultural issues and family traditions as well as the accessibility of health services health services Managed care The benefits covered under a health contract might impact on the actual utilisation or non-utilisation of services enabling adolescents not to bear children in spite of being sexually active.
Even in the USA, despite continued health education efforts to reduce the number of adolescent pregnancies, an estimated 800 000 to 850 000 of the one million teenage pregnancies each year are reportedly unintended (Rhinehart & Gabel, 1998:61). In the RSA, Dlamini and McKenzie (1991:28) reported that 92% of all the adolescent mothers who participated in their study were unhappy about their (unplanned) pregnancies. These statistics do not reveal why these adolescent mothers failed to use contraceptives, emergency contraceptives or TOP services.
A review of the literature published about adolescent pregnancies from 1964 to 1994 indicates that variables strongly correlated cor·re·late
v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates
1. To put or bring into causal, complementary, parallel, or reciprocal relation.
2. with pregnancy included identification with the female role, positive beliefs about parenting and sexual activity (Gilliam, 1996:435). This author also indicated that variables strongly associated with the (non-pregnant) control adolescent group included educational expectations, good school grades, future orientations and occupational expectations. In the RSA some researchers also seem to support the possibility that a factor, which might be contributing to adolescent pregnancies, is poor school performance (Mogotlane, 1993:12).
PURPOSE AND OBJECTIVES OF THE RESEARCH
The purpose of the research was to identify reasons why adolescents become mothers in spite of the availability of free contraceptives, emergency contraceptives and TOP services in the Tshwane area. The objectives of the research aimed to gather information about adolescent mothers'
* knowledge and perceptions of contraceptives, emergency contraceptives and TOP services
* perceptions about contraceptive services in the Tshwane area
* suggestions for improving contraceptive services.
This information could be used to
* design a programme of information, education and counseling for schools, parents and health workers enabling adolescents to make informed decisions about their utilisation of contraceptives, emergency contraceptives and TOP services
* enhance the accessibility and user-friendliness of contraceptive services in the Tshwane area.
DEFINITIONS OF TERMS USED IN THIS REPORT
An adolescent mother is any mother aged 19 or younger at the time of the birth of her baby irrespective of irrespective of
Without consideration of; regardless of.
preposition despite the pregnancy outcome, and irrespective of her marital status marital status,
n the legal standing of a person in regard to his or her marriage state. .
Contraceptives are agents used to temporarily prevent the occurrence of conception, including (oral) pills, condoms, intra-uterine devices intra-uterine device n → dispositif intra-utérin, stérilet m
intra-uterine device n → dispositivo intrauterino , diaphragms and injections (Ketting & Visser, 1994:161).
Emergency contraception Emergency Contraception Definition
Emergency contraception or emergency birth control uses either emergency contraceptive pills (ECPs) or a Copper-T intrauterine device (IUD) to help prevent pregnancy following unprotected vaginal intercourse. prevents pregnancy from occurring by preventing implantation implantation /im·plan·ta·tion/ (im?plan-ta´shun)
1. attachment of the blastocyst to the epithelial lining of the uterus, its penetration through the epithelium, and, in humans, its embedding in the stratum compactum of the of the fertilised ovum in the uterine uterine /uter·ine/ (u´ter-in) pertaining to the uterus.
Of, relating to, or in the region of the uterus. wall (by using copper-containing intra-uterine devices (IUDs) within five days of unprotected coitus coitus /co·i·tus/ (ko´it-us) sexual connection per vaginam between male and female.co´ital
coitus incomple´tus , coitus interrup´tus , or altering the woman's hormone levels to inhibit ovulation ovulation /ovu·la·tion/ (ov?u-la´shun) the discharge of a secondary oocyte from a graafian follicle.ov´ulatory
The discharge of an ovum from the ovary. , ovum transportation and/or endometrial endometrial /en·do·me·tri·al/ (en?do-me´tre-il) pertaining to the endometrium.
n relating to the end-ometrium or cavity of the uterus. growth by using specific "morning after" pills or by using pre-calculated high doses of oral contraceptives Oral Contraceptives Definition
Oral contraceptives are medicines taken by mouth to help prevent pregnancy. They are also known as the Pill, OCs, or birth control pills. (http://www.who.int/inffs/en/ fact244.html, 24.08.2001).
Termination of pregnancy (TOP) refers to the act of bringing a pregnancy to a final end, preventing the birth of a live baby (Dickson-Tetteh, 1999:20).
The Choice on Termination of Pregnancy Act (Act 92 of 1996) permits TOP upon the request of the pregnant woman up to and including 12 weeks' gestation GESTATION, med. jur. The time during which a female, who has conceived, carries the embryo or foetus in her uterus. By the common consent of mankind, the term of gestation is considered to be ten lunar months, or forty weeks, equal to nine calendar months and a week. . Legal TOPs can be obtained from 13 to 20 weeks' gestation under specific definite conditions, and even after 20 weeks' gestation in rare cases (Dickson-Tetteh, 1999:20).
A non-experimental, quantitative, descriptive survey was used to collect information about adolescent mothers' knowledge, perceptions and utilisation of contraceptives. The research design was non-experimental because only one group of persons, namely adolescent mothers in the Tshwane area provided information for this survey, they were not subjected to any variables and were not compared with adolescents who were not mothers. A quantitative design was adopted because the adolescent mothers preferred to complete questionnaires anonymously, rather than being interviewed by field workers. The open-ended questions A closed-ended question is a form of question, which normally can be answered with a simple "yes/no" dichotomous question, a specific simple piece of information, or a selection from multiple choices (multiple-choice question), if one excludes such non-answer responses as dodging a were categorised Adj. 1. categorised - arranged into categories
classified - arranged into classes and coded similarly to the closed-ended questions, enabling data to be entered into the Epi-Info computer program. The research design was exploratory and descriptive because it attempted to explore and describe adolescent mothers' knowledge and perceptions of contraceptives, emergency contraceptives and TOP services (Burns & Grove, 2001:38). A special effort was made to identify possible reasons for failing to use contraceptives, emergency contraceptives and TOP services.
Research population and sample
The target population comprised all adolescent mothers, aged 19 or younger when their babies were born, who attended any clinics in the Tshwane Metropolitan Council's area from 1 January till 31 March 2000. Thus all the clinics in this area were included in the survey. Although reports relevant to each clinic were supplied to the health care authorities, this report refers only to the combined results of the 61 questionnaires completed at all these clinics, comprising the convenience sample of adolescent mothers who voluntarily completed questionnaires. Due to the non-availability of a census of adolescent mothers in the Tshwane region, it was impossible to select a random sample. "Convenience sampling refers to the selection of the most readily available persons (or units) as subjects in a study, also known as accidental sampling Accidental sampling is a type of non- probability sampling which involves the sample being drawn from people/items that are readily available and convenient. The researcher using such a sample cannot scientifically make generalizations about the total population from this sample " (Polit & Hungler, 1997:392). Sampling bias, referring to the "... systematic over representation or under representation of some segment of the population" (Polit & Hungler, 1997:185) could neither be excluded nor controlled in this survey, using a convenience sample. However, the purpose of this survey (obtaining information about adolescent mothers' knowledge and perceptions concerning contraceptives, emergency contraceptives and TOP services) could be achieved by using a convenience sample.
Data collection instrument
A questionnaire, comprising open and closed ended questions, was constructed based on information available from similar surveys conducted in the RSA (Bodibe, 1994; Boult & Cunningham, 1992; De Villiers, 1985; Makhetha, 1996; Mogotlane, 1993) and in other countries (Bloom & Hall, 1999; Gilliam, 1996; Lesser & Escoto-Lloyd, 1999; Rhinehart & Gabel, 1998). The questionnaire was critically reviewed by two medical practitioners providing reproductive health services at clinics in the Tshwane region, by nurses working in family planning clinics family planning clinic n → clínica de planificación familiar
family planning clinic n → centre m de planning familial
in this region, and by researchers who participated in the Reproductive Health Workshop organised jointly by the World Health Organization (WHO) and the Commonwealth in Harare, Zimbabwe, during 1998. The questionnaire comprised sections striving to obtain information relevant to the adolescent mothers' knowledge and perceptions of contraceptives, emergency contraceptives and TOPs. The last section of the questionnaire attempted to ascertain adolescent mothers' perceptions about clinics providing contraceptive services in the Tshwane region. In order to contextualise these research results, some biographic bi·o·graph·i·cal also bi·o·graph·ic
1. Containing, consisting of, or relating to the facts or events in a person's life.
2. Of or relating to biography as a literary form. questions were asked so that the adolescent mothers' knowledge and perceptions about contraceptives, emergency contraceptives and TOP services could be interpreted against some knowledge about their ages, socio-economic status, education levels, ages at menarche menarche /me·nar·che/ (me-nahr´ke) establishment or beginning of the menstrual function.menar´cheal
The first menstrual period, usually during puberty. and at becoming mothers.
Reliability and validity
Reliability is a measure denoting "... the consistency of measures obtained in the use of a particular instrument and is an indication of the extent of random error in the measurement method (Burns & Grove, 2001:395). The validity of an instrument "... is a determination of the extent to which the instrument actually reflects the abstract construct being examined"(Burns & Grove, 2001:399). During pretesting the instrument, a number of adolescent mothers refused to answer questions pertaining per·tain
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.
2. to HIV/ AIDS and the number of sex partners as they perceived these issues to be irrelevant to motherhood. These questions were removed as they apparently impacted negatively on the face validity face validity (fāsˑ v·liˑ·di·tē),
n . The revised questionnaires were provided to the health care authorities of the Tshwane Metropolitan Council. The face validity was evaluated by nurses and doctors working at the clinics where questionnaires were distributed. They perceived the questions to pertain to pertain to
verb relate to, concern, refer to, regard, be part of, belong to, apply to, bear on, befit, be relevant to, be appropriate to, appertain to adolescent mothers' knowledge and perceptions of contraceptives, emergency contraceptives and TOP services. Although some queries were raised about the biographic section of the questionnaire these were retained for contextualising the rest of the data.
Pretesting of the questionnaire
The questionnaire was pretested by 12 adolescent mothers who completed questionnaires during 1999, and who were excluded from participation in the actual survey during 2000. The questionnaire was available in English only, as translating it into all eleven official languages of the RSA would have been too expensive. The adolescent mothers and the field worker understood the questions asked, but suggested that questions about promiscuity Promiscuity
See also Profligacy.
constantly flits from one girl to another. [Aust. Drama: Schnitzler Anatol in Benét, 33]
promiscuous goddess of sensual love. [Gk. Myth. , number of sex partners, and HIV/AIDS knowledge should be removed because they regarded these questions as being irrelevant to adolescent motherhood, and as imposing on their privacy. The 12 adolescent mothers who pretested the questionnaire, refused to answer some or even all questions related to these issues. After further consultations, these questions were removed.
Initially the intention was to conduct structured interviews with the adolescent mothers, in an attempt to obtain answers to as many questions as possible, and to ask probing questions about answers to open-ended questions. During the pretest pre·test
a. A preliminary test administered to determine a student's baseline knowledge or preparedness for an educational experience or course of study.
b. A test taken for practice.
2. phase the field worker encountered resistance from adolescent mothers to answer questions pertaining to their personal lives to a stranger. They were willing to complete the questionnaire themselves anonymously, but not to supply answers to a strange interviewer. Therefore the research instrument changed from a structured interview to a self-completion questionnaire. This approach produced few responses to some questions, especially the open-ended questions. Another potential limitation was that only adolescent mothers who could read and understand English could participate in this research. However, during the pretesting phase no adolescent mother was found who was unable to read and write English.
Each participating adolescent mother was requested to sign a consent form indicating that she participated voluntarily and without any coercion coercion, in law, the unlawful act of compelling a person to do, or to abstain from doing, something by depriving him of the exercise of his free will, particularly by use or threat of physical or moral force. whatsoever. Accidentally these forms were attached to the questionnaires prior to distribution. As the researcher's telephone numbers were provided on the forms, some participants raised concerns about anonymity. It was decided that the signed consent forms would be placed into individual envelopes and sealed. The anonymously completed questionnaires were individually sealed into different envelopes and placed into a different container. The adolescent mothers accepted this procedure. Each participant could decide whether or not to answer any specific question, explaining why few responses were obtained to some questions, particularly the open-ended questions.
Unforeseen ethical issues arose when some clinic nurses allowed ONLY those adolescent mothers, accompanied by their mothers who signed the consent forms, to complete questionnaires. This was unexpected as the adolescent mothers' knowledge and perceptions were sought, not those of the mothers of these adolescents. However, the decisions of the professional nurses had to be accepted, yielding far fewer completed questionnaires than anticipated.
ANALYSIS AND DISCUSSION OF RESEARCH RESULTS
These questions attempted to obtain general information about the respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. so that the rest of the data could be placed within the context of the realities of the adolescent mothers' lives.
Adolescent mothers' ages
As indicated in Table 1, the majority (49 or 80,3%) of the 61 adolescent mothers (of whom only one was married) fell within the age group of 17-19 years. Only two respondents were 14, one was 15, and six were 16 years of age. This age distribution implies that these research results apply mainly to the older adolescent mothers falling within the 17-19 year age group, and might not necessarily apply to adolescent mothers aged 16 or younger.
Employment status and income
Out of the 61 adolescent mothers, 25 (41.7%) were not working, 34 (55.7%) were students or scholars, whilst one was a gardener and another one was a domestic worker. Fifteen (24.6%) of these mothers indicated that they had no income, whilst another 15 (24.6%) earned less than R500.00 per month. These statistics indicate that 59 (96.7%) of the adolescent mothers were unemployed implying that they lacked the finances to care for themselves and their babies. These dire financial circumstances of the adolescent mothers should have encouraged them to use contraceptives, emergency contraceptives or TOPs at least until they could financially afford to care for their babies.
Number of persons per household
The participants indicated that five or more persons lived in 68.8% (n=42) of their homes. Large numbers of persons per household, and low levels of household incomes, would seem to be factors which should encourage adolescents to utilise the available contraceptive, emergency contraceptive and TOP services, which these 61 adolescent mothers failed to do.
The age range of the adolescent mothers (as presented in Table 1) correlate with their highest school grades passed. These findings indicate a need to focus family planning family planning
Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. information campaigns at secondary school children, especially during grades 11 and 12. Those 23 adolescent mothers who reportedly passed grade 11, might have finished their schooling (grade 12) successfully if they had used effective contraceptives for at least one additional year. Completion of their schooling prior to becoming mothers, might have had inestimable in·es·ti·ma·ble
1. Impossible to estimate or compute: inestimable damage. See Synonyms at incalculable.
2. value for enhancing the quality of these mothers' lives as well those of their children. These findings did not support those reported by Mogotlane (1993:11), which revealed that the majority of adolescent mothers encountered academic problems and were deemed to be too old for their school grades.
Adolescent mothers' significant ages
Table 1 reflects the ages of the adolescent mothers as well as other significant ages in their lives.
The onset of menarche ranged from the age of 9 until the age of 17, with a mean age of 14.03 years. The figures in Table 1 indicate that 52.45% (n = 32) of the adolescent mothers started menstruating men·stru·ate
intr.v. men·stru·at·ed, men·stru·at·ing, men·stru·ates
To undergo menstruation.
[Late Latin m by the age of 14, whereas only 24.59% (n = 15) had received any sex education by that time. Most participants received sex education at the ages of 15 and 16--by which time most of them were reportedly sexually active, and some were already pregnant. This age-related finding indicates that some adolescents received sex education only after they were pregnant.
The bar diagram bar diagram
a method of presenting data in which frequencies are displayed along one axis and categories of the variable along the other, the frequencies being represented by the bar lengths. (figure 1) indicates that the majority of these adolescent mothers received sex education after menarche occurred. The first visit to the family planning clinic coincided with their initial use of contraceptives, possibly indicating that many of them obtained contraceptives at their first visit to the family planning clinic. However, these initial visits to family planning clinics, reportedly occurred mostly after initial sexual intercourse sexual intercourse
or coitus or copulation
Act in which the male reproductive organ enters the female reproductive tract (see reproductive system). , implying that many of them might have been pregnant when they commenced using contraceptives.
[FIGURE 1 OMITTED]
Adolescent mothers' reasons for engaging in sex for the first time
The adolescent mothers indicated that they engaged in sex for the first time because they
* did not know or that it just happened (8)
* were requested or coerced by their partners (8)
* loved their partners (6)
* were curious about the experience (5)
* succumbed to peer pressure (4).
KNOWLEDGE AND PERCEPTIONS ABOUT CONTRACEPTIVES, EMERGENCY CONTRACEPTIVES AND TOP SERVICES
Specific sections of the questionnaire attempted to identify whether adolescent mothers knew about contraceptives, emergency contraceptives and TOP services and what their perceptions were concerning these services. Unless adolescents know about and can access these services they cannot use them. In spite of knowledge and accessibility of services, adolescents' perceptions about potentially harmful consequences of these services could prevent their utilisation.
Although 28 (45.9%) respondents knew about contraceptives, only 23 (37.7%) indicated that they had indeed used injections (16), condoms (16), and pills (5). One adolescent mother indicated that she successfully used contraceptives for seven years (from the age of 11 until 18), starting off with condoms but later changing to injections and pills. She claimed that she conceived when she had forgotten to take one single pill, when the clinic nurse issued her with pills rather than giving her the requested contraceptive injection. Maintaining effective contraception contraception: see birth control.
Birth control by prevention of conception or impregnation. The most common method is sterilization. The most effective temporary methods are nearly 99% effective if used consistently and correctly. enabled her to complete grade 11 at school despite being sexually active since the age of 11. If only the clinic nurse had enabled her to continue with contraceptive injections she might have been able to complete her schooling (grade 12) successfully despite being sexually active since the age of 11. One respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. managed to maintain effective contraception for three years, four did so for two years, and four for one year. Two respondents claimed to have become pregnant three months after their first injections, presumably pre·sum·a·ble
That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. Depo Provera. Another respondent claimed that she became pregnant despite the regular use of condoms supplied by a clinic.
Reasons provided for not using contraceptives, included that their mothers did not approve, they were ignorant about contraceptives, they were afraid to go to the clinic because their mothers might find out, they feared picking up weight and/or never having children, their boyfriends opposed their use of contraceptives.
Other researchers reported similar findings revealing that only 23% of the sexually active school girls in the RSA had ever used contraceptives, of whom only a minority had ever used condoms (Buga, Amoko & Ncayiyana, 1996:523). Identified factors which impede im·pede
tr.v. im·ped·ed, im·ped·ing, im·pedes
To retard or obstruct the progress of. See Synonyms at hinder1.
[Latin imped condom 1. condom - The protective plastic bag that accompanies 3.5-inch microfloppy diskettes. Rarely, also used of (paper) disk envelopes. Unlike the write protect tab, the condom (when left on) not only impedes the practice of SEX but has also been shown to have a high failure use among adolescents in South Africa, include the lack of perceived risk, peer norms, condom availability, adult attitudes to condoms and sex, gendered power relations and the economic context of adolescent sexuality (MacPhail & Campbell, 2001:1613). Condoms have been described as a "... nuisance perceived to interfere with passion and performance" (White, 2000:480). Although this survey did not identify factors prohibiting condom use among adolescent mothers, it confirmed that only a minority of Tshwane's adolescents use condoms in spite of the country wide HIV/AIDS drive to abstain, be faithful to one faithful sex partner and to use condoms. This non-utilisation of condoms is of particular significance because the WHO estimates that more than 50% all new HIV infections occur among the 15-24 year olds, approximately 17 million girls younger than 20 give birth each year, and as many as 4.4 million abortions are procured by this age group in developing countries each year (Silberschmidt & Rasch, 2001:1815). The effective and regular use of condoms could prevent or at least significantly reduce all these consequences of adolescents' sexual behaviours.
Out of the 61 respondents, 55 (90.16%) indicated that they used the following contraceptives after the birth of their babies:
* 38 used injections, mainly because they would not need to take daily pills, the family members and boyfriends would not need to know that they used injections, and visits to the family planning clinic every third month were more feasible than more frequent visits
* 10 used condoms, because they would be protected against pregnancies and sexually transmitted diseases Sexually transmitted diseases
Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely
* 7 used contraceptive pills because they were familiar with pills and because they continued to menstruate men·stru·ate
To undergo menstruation. regularly.
Only six (9.8 per cent) of the adolescent mothers indicated that their pregnancies were planned. Subsequent to the birth of their babies, 55 (90.16%) used contraceptives, but it could not be ascertained why the other 6 (9.8%) did not consider using contraceptives.
Surprisingly 40 out of the 61 respondents, amounting to 65.57%, did not know about the availability of emergency contraceptives to be taken within 72 hours after unprotected sex Unprotected sex refers to any act of sexual intercourse in which the participants use no form of barrier contraception. Sexually transmitted infections
Specifically, unprotected sex .
Only 18 (29.5%) knew about the existence of emergency contraceptives, but only five (8.19%) knew that pills could be taken to prevent pregnancies after unprotected sex. However, only one respondent could name such a product. In spite of knowing about emergency contraceptives, none of these five respondents attempted to use these because they did not believe that they could become pregnant, did not have sufficient information to obtain these pills, or their boyfriends wanted the babies.
A survey conducted among 93 pregnant student nurses in the Northern Province of the RSA reported that 73.1% of these student nurses had no knowledge about emergency contraceptives. None of these respondents could access emergency contraceptives despite being student nurses (Netshikweta, 1999:96). A survey done among pharmacies and pharmacists This is a list of notable pharmacists.
To prepare and give out medicines. these pills if the patient had a doctor's prescription (Harris, 1999:5).
Knowledge about and Non-Utilisation of TOP services
Women in South Africa have legalised choices to request the termination of their pregnancies during the first twelve weeks of gestation, in terms of The Choice on Termination of Pregnancy Act, no 92 of 1996. TOP services can also be obtained after twelve weeks' gestation under specific circumstances in terms of this Act.
Out of the 61 adolescent mothers, 30 (49.18%) knew about legally TOP services, whilst 19 (31.15%) did not know about these services. However, knowledge about TOP services, did not imply that these adolescent mothers necessarily wanted to utilise such services.
Although the majority (40 or 65.57%) did not wish to use TOP services, 11 (18.03%) wanted to do so. Only six (9.8%) of the adolescent mothers asked about TOP services at the clinics they attended, but no one managed to obtain such services. Only two respondents indicated that they enquired too late (after twelve weeks gestation) about TOP services, the others did not provide any reasons for failing to obtain TOP services.
Varkey (1999:11) reported that the majority of women who obtained TOP services in South Africa were older than 20 years of age, thus excluding adolescent mothers aged 19 or younger at the time of delivery. Reportedly in the RSA requests for TOP services from large numbers of women were rejected because their pregnancies had progressed beyond three months' duration or because there were no hospital/clinic beds to accommodate them (Nursing Update, 2000:16).
PERCEPTIONS OF VISITS TO FAMILY PLANNING CLINICS
Many respondents failed to reply to the questions pertaining to their visits to family planning clinics, probably because they might have regarded these questions as being irrelevant to their pregnancies and babies. Out of the few replies the following aspects emerged:
* 3 respondents indicated that they waited less than 30 minutes
* 3 indicated that they waited very long but did not specify the time
* 2 claimed to have waited two hours or longer.
Although 6 respondents did not perceive the nurses to be helpful at the family planning clinics, 12 experienced the nurses to be very helpful indeed and 18 were satisfied with the services. Only one respondent was dissatisfied dis·sat·is·fied
Feeling or exhibiting a lack of contentment or satisfaction.
dis·satis·fied because she conceived despite using condoms received at the clinic--she did not complain about the service as such, merely about the quality of the condoms provided.
An open-ended question requested the adolescent mothers to indicate what advice they received at the family planning clinics. Their replies included:
* no advice (3)
* that the clinic should be attended regularly (2)
* information about contraceptive methods and their side effects Side effects
Effects of a proposed project on other parts of the firm. (2)
* not to sleep around and get pregnant (2)
* never have sex without a condom (3)
* you are too young to use contraceptives (1 respondent who was 18 years old and who became an adolescent mother because the clinic did not supply her with contraceptives)
* you do not have to give any man a lot of children to prove your love (1).
SUGGESTIONS FOR IMPROVING FAMILY PLANNING CLINICS' SERVICES
Only 20 (32.78%) knew during which days and hours their family planning clinics operated, and these respondents indicated that the clinics were within walking distance. Better advertisements of clinic venues and operating hours, would help the adolescent mothers to plan their visits to these clinics more effectively.
Only 13 (21.31%) of the respondents would prefer to attend family planning clinics during evenings whilst 29 (47,54 %) would not do so, probably for reasons of safety. On the other hand 29 (47.54%) would indeed prefer to attend family planning clinics over the weekend, whilst 17 (27.86%) would not prefer weekend clinics. Those who preferred to attend clinics during the evenings and/or over weekends indicated that they experienced problems to reach their family planning clinics during the week without informing their parents or teachers. Another problem was that clinic hours coincided with school hours which made it almost impossible to attend family planning clinics, except during school holidays.
Other general recommendations for improving the family planning clinics' services included that privacy should be ensured during counseling and examination. Heaters in the examination cubicles cubicles
individual cow bed spaces separated by half height and half length partitions. Usually located in loose housing cow accommodation in which the cow is free to wander at will. would be appreciated during winter months.
LIMITATIONS OF RESEARCH RESULTS
Due to problems of compiling a census of adolescent mothers, no random sample could be selected. At the Tshwane Metropolitan Council's clinics, convenience sampling was used by requesting each adolescent mother, who visited one of these clinics during the data collection phase, to complete a questionnaire. Limitations could be imposed on the generalisability of the research findings as no guarantees could be provided that those adolescent mothers who completed questionnaires held the same ideas as those who refused to complete questionnaires, or those who failed to visit clinics in the region during the data collection phase.
Using only questionnaires as a data collection tool could have imposed further limitations on the generalisability of the research results. However, as the majority of the adolescent mothers did not wish to be interviewed but agreed to complete questionnaires, this state of affairs had to be accepted.
RECOMMENDATIONS BASED ON THE RESEARCH FINDINGS
Despite the limitations of the research, the following recommendations, based on the research findings, could enhance adolescents' knowledge and choices about sex and motherhood:
* school children in the Tshwane region should receive sex education, including information about contraceptives, before reaching the age of 14 when most of the adolescent girls started menstruating
* school children should be taught about contraceptives, emergency contraceptives and TOP services before they reach grade 11 (the second last year at school when the majority of respondents conceived)
* contraceptives, emergency contraceptives and TOP services should be freely accessible to all adolescents--including school children
* clinics providing reproductive health services only for adolescents should be available over weekends and during evenings
* specific policies should guide clinic nurses about issues such as the types of contraceptives to be issued to adolescents, maintaining a non-judgmental attitude towards sexually active adolescents, and facilitating adolescents' access of contraceptives, emergency contraceptives and TOP services--not obstructing these efforts--if the issue of adolescent pregnancies is to be addressed successfully in the Tshwane region.
There appears to be a need to educate adolescents about emergency contraceptives, as almost 66% did not know about the existence of any emergency contraceptives, and to make these services accessible to adolescents. Thus emergency contraceptives would need to be advertised in clinics, at schools, and possibly also during radio and television broadcasts. Better utilisation of emergency contraceptives could reduce the need for termination of pregnancy services and could enable adolescents to postpone post·pone
tr.v. post·poned, post·pon·ing, post·pones
1. To delay until a future time; put off. See Synonyms at defer1.
2. To place after in importance; subordinate. having children until they are emotionally, socially and financially capable of caring for their children. Dickson-Tetteh (1999:22) also advocates the need to introduce, or reintroduce Re`in`tro`duce´
v. t. 1. To introduce again.
Verb 1. reintroduce - introduce anew; "We haven't met in a long time, so let me reintroduce myself"
re-introduce , emergency contraception throughout the RSA by training health care workers and by launching community education campaigns. However, any adolescent who needs emergency contraception, needs contraception and needs to be counseled in this regard.
Another area warranting further research is not only the accessibility of TOP services but also women's knowledge about their legal right to exercise their choice concerning the termination of their pregnancies within the first twelve weeks of gestation, and their right to sole consent for this procedure.
These adolescent mothers' comments about advice received at the family planning clinics could merely reflect their interpretations of actual advice received. However, if an 18-year old sexually active young woman had indeed been told that she was too young to use contraceptives, the policy of the family planning clinics and the attitudes of nurses need to be addressed. This 18-year old woman did conceive conceive /con·ceive/ (kon-sev´)
1. to become pregnant.
2. take in, grasp, or form in the mind.
1. To become pregnant.
2. and had to compromise her education during her final school year. This pregnancy could have been avoided if she had received contraceptive injections, as requested by her. This particular adolescent mother managed to postpone pregnancies from the age of 11 until 18, until a clinic nurse reportedly refused to give her a contraceptive injection, but in stead stead
1. The place, position, or function properly or customarily occupied by another.
2. Advantage; service; purpose: "His personal relationship with the electorate stands in good stead" supplied her with a packet of pills and advised her to abstain from abstain from
verb refrain from, avoid, decline, give up, stop, refuse, cease, do without, shun, renounce, eschew, leave off, keep from, forgo, withhold from, forbear, desist from, deny yourself, kick ( sex because she "was too young to use contraceptives". This advice seems to be out of context for this young woman who had been sexually active since the age of 11, but who managed to avoid pregnancies. Nurses who object to providing contraceptives, emergency contraceptives and/or TOP services to adolescents, nullify nul·li·fy
tr.v. nul·li·fied, nul·li·fy·ing, nul·li·fies
1. To make null; invalidate.
2. To counteract the force or effectiveness of. the potential value of the provision of these free services, because these nurses make it impossible for the adolescents to access these services at clinics. This issue needs to be addressed urgently in the Tshwane region and throughout the RSA. No matter how much adolescents do or do not know about sex and contraception, the accessibility and actual utilisation of these services are influenced to a great extent by the attitudes and quality of services rendered by nurses at family planning clinics. Nurses who object to providing these services to adolescents should preferably not work in clinics providing family planning services.
The majority of the adolescent mothers lacked information about contraceptives, emergency contraceptives and TOP services. None of the participants managed to access the latter two types of services. Although the majority of adolescent mothers were reportedly satisfied with the services received at the clinics in the Tshwane area, these clinics' services and locations need to be better advertised. Specific policies need to be formulated about providing contraceptives, emergency contraceptives and TOP services to adolescents at family planning clinics in the Tshwane area.
The findings of this survey appear to confirm those reported by Bodibe (1994) who found that 157 school children in the RSA had only moderate levels of sexual knowledge, but that no cause and effect relationships could be identified between sexual knowledge, attitudes and behaviors. However, nurses can play a major role in educating South African women, especially adolescents, about their rights so that they can claim these rights for themselves and for their daughters in making informed decisions about their sexuality and productivity. Such knowledge and accessible contraceptive, emergency contraceptive and TOP services, offer many women an escape from the vicious cycle Noun 1. vicious cycle - one trouble leads to another that aggravates the first
positive feedback, regeneration - feedback in phase with (augmenting) the input of adolescent motherhood, poverty, lack of education, and possibly prostitution. South African women could use the existing legislation to access contraceptive, emergency contraceptive and TOP services, to enhance the quality of their own and their families' lives--including the lives of their children and grandchildren GRANDCHILDREN, domestic relations. The children of one's children. Sometimes these may claim bequests given in a will to children, though in general they can make no such claim. 6 Co. 16. . All nurses in the RSA should: "... examine their own perspectives regarding clients' concerns about sexuality. Attention to the sexuality needs of women across the life span is an important component of holistic and sensitive care" (Lamp, Alteneder & Lee, 2000:391).
Sincere gratitude is expressed to each adolescent mother who completed a questionnaire. Without these contributions there would have been no data and no research report. Every nurse who distributed and collected questionnaires is thanked for investing time and effort into making this research possible. Doctors Tshibangu and Dousse are thanked for allowing and enabling adolescent mothers, who attended clinics in Tshwane, to complete questionnaires. The World Health Organization (WHO), the Commonwealth and the Eastern, Central and Southern Africa
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Table 1: Age distribution of adolescent mothers: (n = 61) Age in Age of Age at Sex ed- years ado- menarche ucation lescent received mothers up to 11 3 12 12 6 13 10 3 14 2 7 6 15 1 15 12 16 6 9 12 17 17 2 5 18 23 5 19 9 No 3 3 12 response TOTAL 61 61 61 Age in First Started First visit years sexual using to family inter- contra- planning course ceptives clinics up to 11 1 1 12 13 2 2 14 2 1 3 15 11 2 16 16 8 6 17 12 6 2 18 2 4 2 19 2 2 No 17 35 44 response TOTAL 61 61 61 Figure 2: Adolescent mothers' knowledge about emergency contraceptives Knowledge about contraceptives no reply 5% did not know about emergency ctcps 30% knew about emergency ctcps 65% Note: Table made from pie chart. Figure 3: Adolescent mothers' knowledge about termination of pregnancy (TOP) services Knowledge about TOPs no answer 20% did not know about TOPs 31% knew about TOPs 49% Note: Table made from pie chart. Figure 4: Adolescent mothers' intended utilisation of termination of pregnancy services Intention to utilise TOP services no answer 16% did NOT want to use TOP services 66% wanted to use TOP services 18% Note: Table made from pie chart.
Dr VJ Ehlers
B Soc Sc (Nursing); Honours BA SS (Psychology); BA Cur; Honours BA Cur; MA Cur; D Litt et Phil; Diploma in
Registered nurse, midwife MIDWIFE, med. jur. A woman who practices midwifery; a woman who pursues the business of an account.
2. A midwife is required to perform the business she undertakes with proper skill, and if she be guilty of any mala praxis, (q.v. , community health nurse, psychiatric psy·chi·at·ric
Of or relating to psychiatry.
psychiatric adjective Pertaining to psychiatry, mental disorders nurse, nurse educator A nurse educator is a nurse who teaches and prepares licensed practical nurses (LPN) and registered nurses (RN) for entry into practice positions. Nurse Educators also teach in graduate programs at Master’s and doctoral level which prepare advanced practice nurses, nurse and nurse administrator
Senior Lecturer senior lecturer
n. Chiefly British
A university teacher, especially one ranking next below a reader. , Department of Health Studies, UNISA UNISA University of South Australia
UNISA University of South Africa
UNISA Universiteit van Suid-Afrika (University of South Africa)
Corresponding author: email@example.com