CHAPTER 2: LITERATURE REVIEW
2.5 Causes of early childbearing
2.5.2 Contraceptives use, knowledge and access
One of the greatest barriers to a healthy lifestyle in South Africa is access to good quality health care; poor health care services have a negative impact on young people, hindering them from accessing health education (MiET Africa, 2011).
Reducing teenage pregnancy rates is an important factor; it is part of reaching the Millennium Development Goals (Jewkes et al., 2009). Young women continue to have high rates of pregnancy and it becomes hard for them to terminate pregnancy if they need to, because these kinds of services are not readily available all the time (MacPhail et al., 2007). The key to women’s health is to provide services that allow them to manage their reproductive health and encourage them to access contraceptive services, which contributes to HIV prevention (MacPhail et al., 2007).
Although many studies report high rates of pregnancies and HIV among South African teenagers, little research has been conducted to find out about their knowledge of contraceptives and their ability to access reproductive health services (Hoffman et al., 2013).
Research shows that pregnant teenagers do not have much knowledge about the types of
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contraception and how they can protect themselves from sexually transmitted infections.
International research reports that only 40 percent of young people aged 15 to 24 have correct knowledge about HIV and its transmission (Hoffman et al., 2013). While some research argues that young people do have knowledge about contraceptives, other studies argue that young people do not know much about contraceptive use. However, all these studies argue that most young people do not know much about emergency contraceptive services that provide a quick preventative method against pregnancy (Willan, 2013).
Kantu and Mash (2010) conducted a study to understand the attitudes and perceptions of teenagers in Taung with regards to teenage pregnancy and to explore their understanding of sexuality and contraception. In their study Kantu and Mash (2010) found that some of the teenagers did not have much information about contraceptives. When they asked a 17 year- old grade 12 learner, who was five months pregnant about any kind of contraceptives, she responded that she did not know anything about contraceptives (Kantu & Mash, 2010).
Bankole and Malarcher (2010) argue that adolescents’ needs are not being met by the current sexual and reproductive health information services. These authors found that the adolescents between the ages of 15 and 19 in their study knew at least one modern contraception method, but many adolescents believe that during the menstrual cycle the woman is more likely to become pregnant compared to other days (Bankole & Malarcher, 2010).
Naong (2011) argues that although there is a high level of knowledge about modern methods of contraception, a large number of young people seldom use contraceptives and many do not use them consistently or correctly. Knowledge about contraceptives is another challenge that
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is facing adolescents. The study that was conducted by Richter and Mlambo (2005) to explore and describe the perceptions of teenagers about pregnancy revealed that sometimes teenage pregnancy occurs due to the lack of knowledge of how to use contraceptives. One of the participants was quoted saying, “I take a pill when I know my boyfriend is coming and we are probably going to make love. I sometimes forget to take it before we make love so I take it after we have made love” (Mlambo 2005:65).
The 2008 national representative survey reported that among high school learners in South Africa, 30 percent of young women had had sex and 24 percent of those had been pregnant, with 15 percent of sexually active female learners reported not usually using contraception when they have sex and 67 percent reported not always using condoms (Holt et al., 2012).
Furthermore, condoms were the most commonly used contraceptive method, with about 42 percent of sexually active young females using condoms, while 12 percent reported that they were on injection and 5 percent were on the pill and other modern methods (Holt et al., 2012).
International research reports similar findings about knowledge and access to reproductive health services. For example, Zambian and Kenyan government health policies state that contraceptive services should be provided to young people who are sexually active; however this is not always the case, as young people have limited access to such services in these countries leaving them with one unreliable option of abstaining (Warenius et al., 2006). In both Kenya and Zambia, adolescent childbearing has been identified as a major factor that leads to school dropouts (Warenius et al., 2006). As a result of inaccessible legal abortion services Zambian girls engage in illegal abortions in order to prevent school dropouts and this
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puts their lives in danger. Findings from the Western Province of Zambia revealed that 1 in 100 school girls die from abortion related complications (Warenius et al., 2006).
Mmari and Mgnani (2003) assert that the largest and fastest growing populations in sub- Saharan Africa are young people between the ages of 10 and 24 years. However, these authors argue that in many of the sub-Saharan African countries, reproductive health services that are clinic-based are usually designed for older married women and many unmarried women face various challenges when they seek these kinds of services (Mmari & Mgnani, 2003). Furthermore, unmarried young women are unlikely to seek reproductive health services because they fear negative community perceptions (Mmari & Mgnani, 2003). They have a fear of being seen at facilities and fear that their privacy and confidentiality will not be maintained (Mmari & Mgnani, 2003).
Teenagers from rural areas become sexually active at a very young age without using any form of contraception and this is likely to increase their pregnancy rates (Richter & Mlambo, 2005 cited). In contrast, in the United Sates reducing barriers to accessing contraceptives has been found effective to reduce teenage pregnancy and sexually transmitted infections (Kohler et al., 2008).