Attitude of teenagers towards contraceptive use in the prevention of pregnancy

Introduction

According to Barbara and Mike (2004), teenage pregnancy is define as pregnancy occurring before age 20years and sometimes it refer to girls younger than 18years.

A large population of pregnant women are teenagers who lack basic knowledge about contraceptive method and also have negative attitude towards contraceptive use. Teenager have little or no awareness about contraceptive method as a large percentage of them do not even know what contraceptive is (Elizabeth and Robert, 2006).

According to Bemay (2007), the attitudes of teenagers towards contraceptive use are being influence by women with broken marriages who sees little or no importance of contraceptive use. Some teenagers both pregnant and non-pregnant have this same attitude.

The attitude of teenagers towards the use of contraceptive method should be influence by programs that promote positive attitude to contraceptive methods and its use in order to prevent unwanted teenage pregnancy. Basic education concerning various contraceptive methods has proven to prevent unwanted pregnancy especially among teenagers (Santelli, 2003).

As observed most teenager have poor/negative attitude about the use of contraceptive and this has affected them greatly. This research tends to expose the importance of contraceptive method in prevention of teenage pregnancy, various types of contraceptive methods, common myths (misconception) and facts about the use of contraceptive method and the various ways of limiting teenage pregnancy, socio-economic, psychological and emotional outcome associated with teenage pregnancy.

Conceptual framework

Teenagers have a great need for education about sexuality and the way this education is brought to them is very important. The attitude of teenagers towards the use of contraceptive method is based on programs that promote positive attitude towards contraceptive use rather than focusing solely on the negative consequence of becoming pregnant. Between 1991 and 2003, the use of condoms by teenagers increased where as their use of no conceptive method dropped resulting in a lower risk of pregnancy and to declines in teen pregnancy and childbirth. Sexually experience teens with positive attitude towards contraceptive are more likely than others to use contraceptive, the more positive their attitude, the more likely they are to use them, further reducing their risk of pregnancy (Santelli, 2003).

Contraceptive method and sexuality education should be provided to teenagers by parents and health care providers in order to influence them positively towards the use of contraceptive method. However, the ability to practically explain in details the various contraceptive methods and its importance to the teenagers is of great importance (Marlow, 2007).

Causes of teenage pregnancy

The cause of teenage pregnancy includes the following:

1. Lack of contraceptive use: Is a major factor as most teenage pregnancies are unplanned.Teenagers may lack knowledge of or access to conventional method of preventing pregnancy as they may be too embarrassed or frightened to seek such information. In other cases, contraceptive use may prove inadequate. In experience teenagers may use condom incorrectly or forget to take oral contraceptive (Leonard, 2001).
2. Rape: Is another factor contributing to teenage pregnancy. Studies have shown that between 15% and 20% of pregnancy among teenagers are direct results of rape (Gult, 2004).
3. Poverty: Is associated with increased rates of teenage pregnancy. The fact that teenagers crawls for things they sees their peer do and she’s not able to cope neither their standard makes her go into immorality (sex) in order to get money to meet with the standard of their peers (Barbara and Mike, 2004).
4. Attitude of providers: According to Gull (2001). The attitude of many providers makes teenagers not to go for contraceptive. Instead of counselling the teenagers when they come, they are judgemental and sees the teenagers and irresponsible. The teenage will not go back again.

Other factors which contribute to teenage pregnancy include:

1. Lack of accurate information about how to use contraceptive correctly.
2. Limited access to contraceptive.
3. Peer pressure to begin sexual activity
4. Lack of appropriate role model.

Effects of teenage pregnancy

1. They are at increased risk for pre-eclampsia, anaemia, urinary tract infection, vesico vagina fistula and depression (Breedlove and Schorfheide, 201).
2. High incidence of sexuality transmitted infections such as HIV/AIDS, Gonorrhea and Chlamydial infection and these diseases can be transmitted to the infant.
3. High infant and maternal mortality rate.
4. Prematurity (birth before the end of thirty seven weeks of gestation).
5. Low birth weight babies (lets than 2500gm).
6. Drop out from school.
7. Poverty.

Common teen attitudes towards contraceptive use

1. Partner Issues: “I don’t know him well enough to ask him to use a condom” or “I would have used contraceptive if the gay weren’t so opposed to it”.
2. Media influence: “Sex just happens and in the movies they never stop to put on a condom”.
3. Ambiance about their actions: “I really did not think it was right for me to be having sex, so I never thought about contraception until it was too late”.
4. Fear and misconception: “I didn’t talk to my doctor about contraception because I didn’t want to have a pelvic exam” or my friends say that birth control pills aren’t safe”.
5. Confidentiality concerns: If I talk to the doctor, she will have to tell my mum and dad and they will kill me.
6. Health care access challenges: “I didn’t know where to go, I didn’t have any way to get to the clinic” or “I couldn’t get an after-school appointment.
7. Health care delivery challenges: “I never had a doctor who tells me anything about any type of birth control, never ever asked me if I was having sex” or they wait until you are already knocked up to throw it at you.

Benefits/importance of contraceptive methods

1. It decreases unwanted pregnancy
2. It increased educational potentials
3. It reduces maternal and infant mortality rate
4. It prevent the risk of unsafe abortion which may lead to complication
5. It decreases pregnancy related stress as well as emotional and physical stress.
6. Reduction high parity will lead to decreased in associated complication like pre-eclampsia and hemorrhage.
7. It reduces crime rate in the society.
8. It helps to check population surge
9. It gives protection against certain types of cancer when hormonal methods like oral contraceptive are used.
10. It gives protection against sexual transmitted infection when barrier methods together with spermicidal are used correctly.
11. It offer more relaxed sexual intercourse because fear of been pregnant is ruled out.

Types of contraceptive methods used by teenagers

The following are the various types of contraceptive methods used by teenagers:

1. Barrier method
2. Hormonals method: Injectable, emergency contraceptive.
3. Intrauterine contraceptive device (IUCD)
4. Abstinence

Barrier method

• Barrier methods of contraception are techniques that prevent spermatozoa from reaching the ovum for fertilization.
• There are two types of barrier method; they are the chemical and mechanical.
• The chemical method involved the use of vaginal foam, tables, jellies and spermicidal creams.
• Mechanical method involves the use of male and female condom, diaphragms and cervical cap.

Advantages of barrier method

1. Protection against sexually transmitted disease and HIV/AIDs.
2. Used only when needed
3. Immediately effective
4. Do not affect body system
5. No prescription needed
6. Inexpensive per single use
7. Can be carried discreetly
8. Quick and easy for use

Disadvantages

1. May interfere with sensation
2. Contraindicated for allergies to component of spermicidal or latex.
3. Vaginal condom may seen unattractive
4. Can be used only once
5. Can break or slip off

Hormonal method

These are synthetic compounds that resembles the human compound/components namely eostrogen and progesterone.

Hormonal method includes oral contraceptive, injectables and the emergency contraceptive. The oral contraceptive are the pills which is either minipill, combined or progestin only pills. The injectables contraceptive are given as injection and contain mainly progesterone. They are of three (3) types; depoprovera which is given every 3 months, noristerate which is given every 2months and cyclo-provera which is given every month.

The emergency contraceptive is often called the “morning-after pill”. It is a method to prevent pregnancy after unprotected intercourse. It may be used after contraceptive failure such as condom breaking during intercourse. It may also be used after rape or in other situation in which contraceptive were used in correctly or not at all.

It involves taking two tablets that contain a high dose of progestin, the first tablet is taken as soon as possible after unprotected intercourse within 72hours not later than 72hours while the second tablet is taken 12hours later.

Advantages of hormonal method

1. It has 90 – 100% effectiveness rate
2. Reduces ovarian and endometrial cancer
3. It regulates menstrual cycles and reduces cramping, menstrual blood lost and associated anaemia.
4. Enhanced sexual enjoyment
5. Reduces menstrual pain and midcycle ovulation pain where present.
6. Can be discontinued independently

Disadvantages

1. It has to be taken daily
2. May cause minor but temporary side effect such as nausea, vomiting, spotting, weight gain and headache.
3. No protection against STIs/HIV/AIDS
4. It is expensive
5. It may lead to mood swing

Intrauterine contraceptive device (IUCD)

This is a method of contraceptive which is inserted into the uterus to provide continuous pregnancy prevention. It works by preventing sperm from fertilizing the ova. It immobilizes sperm, interferes with migration from vaginal to the fallopian tubes, it also inhibit fertilization, makes implementation impossible and causes inhibition making the endometrium hostile to receive fertilized eggs.

Advantages

1. Immediate return to fertility on removal.
2. No interaction with any medication
3. Single dose is highly effective, safe and long lasting
4. It does not interfere with lactation
5. It does not interfere with sexual intercourse
6. It can last for ten years
7. Can be used through menopause one year after last menses.

Disadvantages

1. Does not protect against STI, HIV/AIDS
2. Severe cramp and pain beyond the first three to fill days after insertion.
3. Menstrual changes in the first three months but likely to be lesser after three months.
4. Pelvic inflammatory disease in more likely to occur with the use of IUCD which can lead to infertility if untreated.
5. Everyday checking of the strings.
6. Longer and heavier menstrual periods.
7. Bleeding or spotting in between period.

Abstinence

This is avoidance of sexual intercourse and any activity that may allow sperm to enter the vagina.

Advantages

1. It is 100% effective
2. It has no cost
3. It avoid the use of hormone
4. It has no side effect.

Disadvantages

1. It must be practiced perfectly to avoid risking pregnancy or sexuality transmitted infection.

Misconceptions (myths) and fact about contraceptive method

Myth: A woman cannot get pregnant the first time she engages in coitus.

Fact: A woman can become pregnant the first time she engages in sexual intercourse. Provided she is in a fertile period and sperm is able to reach the eggs.

Myth: Condom can only be used by people who have sex with sex workers.

Fact: Condoms are appropriate contraceptive method for any one regardless of marital status or sexual behavior.

Myth: If a teen becomes pregnant her relationship with her parents will grow stronger.

Fact: Often the case is reversed. Adolescent relationship often suffer when burdened by all the responsibilities of parenthood.

Myth: Condoms interfere with sexual pleasure.

Fact: It does not reduce sexual pleasure or sexual drive in men. Condom should be put on before foreplay.

Myth: The intrauterine contraceptive device is painful for me and for my partner because the strings will hurt his penis.

Fact: The intrauterine contraceptive device is not painful and the strings does not hurt the penis.

Myth: The intrauterine contraceptive device can get lost in my body.

Fact: The intrauterine contraceptive device normally stays within the uterus like a seed inside a shell. Rarely it may perforate the uterine wall into the abdominal cavity. It never travels to other parts of the body.

Myth: If I use an injectables oral contraceptives now, I will not be able to get pregnant in the future after I stop using it.

Fact: The average time it takes for fertility to return depends on the type of injectable used, but an average it can take between five to six months after the last injection before you can get pregnant again. The pill does not cause any permanent change to your fertility.

Ways of limiting teenage pregnancy

The following are some of the ways of limiting teenage pregnancy.

1. Introducing sexuality education as part of the curriculum in secondary schools.
2. The mass media should have programmes that influence teenagers positively towards the used of contraceptive.
3. Providing teenagers with sexuality education that will help them to identify their own values and beliefs about sexuality, sexual activity and understand effective measures to prevent pregnancy when they decide to become sexually active.
4. Educating teenagers on abstinence only and if they must involve themselves in sexual activity they should use contraceptive method depending on their choice of contraception.
5. Educating teenagers about contraception, including the various types of contraception available, the risk and benefit of each, how to ensure proper use of each method and what to do if an error is made.
6. Better support for teenage mother including them to return to their educational pursuit.

Socio-economic and psychological outcomes associated with teenage pregnancy

1. Early motherhood can affect the psychological development of the infant which can bring about disabilities and behavioural issues.
2. Daughter worn to teenage parents are more likely to become teenage mother themselves while their son’s are three times likely to become hooligans since the negative cycle often is repeated.
3. Poor academic performance in children of teenage mother because they show higher incidence of impaired intellectual function and poor school adjustment.
4. Teenage motherhood affects employment and social class and many of them in poverty.
5. Teenage motherhood have a great influence on younger sibling.
6. Being a teenage mother can affect one education. Teenage mother are likely to become school dropout as many of them never go back to school to complete their education.

References

Bissell, Mary (2001), Socio Economic Outcomes of Teen Pregnancy and Parenthood California, Wadsworth Company

Frost J.J, Singh S. Frier L.B. (2004), Contraceptive use and no use United States.

Mikkelson, Barbara (2004), Youngest Mother United States

Myles (2003), Textbook for Midwifes (14^th ed) New York Churchill Livingstone

Parker E.M. (2003) Nursing Theories and Nursing Practice Philadelphia; F.A. Davis Company.

Sharon S. Murray, Emily S. Mckinney (2006), Foundations of Maternal Newborn Nursing (4^th ed) Philadelphia Saunders Company.

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