Social demographic characteristics
The current study obtained responses from forty students of Kyambogo University, who were aged between 18 and 30 years. All participants were equally distributed across gender and year of study, that is, twenty males and females from all years of education – first, second, and third year at the university. These students were all from different academic backgrounds, stayed in private hostels and university halls of residence, and owned smartphones.
Perceptions of SRH among university students
One of the objectives of this study was to explore perceptions of SRH among university students. This was further classified into different themes that included the following; 1) general knowledge of SRH, 2) risky sexual behaviour, 3) misconception about contraception, 4) myths surrounding barrier methods, and 5) confusion over safe days.
General knowledge of SRH
From the participants' responses, it was clear that they had mixed reactions on what SRH meant. That is, some participants understood it to be sexual intercourse and its related consequences, body changes, sexuality and reproduction, marriage, and the use of family planning.
However, the majority of the participants (both male and female; 22.5%) recognized that SRH was related to the process of having sexual intercourse and its consequences.
One female respondent stated that;
Sexual and reproductive health is about the consequences after sex and its related diseases like STDs that may affect the reproductive system (KP 001, Female).
Similarly, a male respondent stated that;
Yeah, well, we know about all these bad effects, the STDs, and all the diseases come out of all that. So that's it, I consider protection and knowing your limits because none of us should always exceed what we are supposed to do. Like getting a kid when you didn’t plan to have one. Proper planning for that is required (KP 001, Male).
Similarly, an equal number of participants believed that SRH was related to the body changes one went through from infancy to old age like the start of menstruation periods, and sexuality and reproduction [having sex to give birth], as explained below by a female and male participant respectively.
About sexual and reproductive health, I will start with the youth how they come to know about menstrual periods. For example, when you’re starting to grow, you start to experience the changes with your body, so I think that’s the area where sexual and reproductive health comes from. You look at things like when do I have my periods and what am I supposed to do? (KP 002, Female).
With sexual and reproductive health, I would think about sex and reproduction. I would think about giving birth, and something like health is, of course, health. So, I would think about something like that, or maybe if you have sex and get pregnant, how am I going to give birth? What are the dangers of having unprotected sex? What can I use to if I don’t want unprotected sex? What will happen if I get an unwanted pregnancy, how can I give birth? Yes, that’s what I will think about (KP 002, Male).
A few participants, however, believed that SRH is related to marriage and the use of different family planning methods to limit the number of children a couple would like to have. Thus, demonstrating that they were aware of the effects of the number of children one can have towards their health. One respondent said:
What I think it is all about is to have a healthy family in terms of kids, children, and how you cannot have a lot of children that even can get problems in terms of their health. Because the high number of children sometimes can lead to poor health (KP 003, Female).
Risky sexual behaviour
Participants were further asked about some risky behavior that students engaged in, which could endanger their lives and expose them to SRH related problems.
The majority of the participants (21%) reported that having multiple sexual partners due to the love for money among many female students and engaging in unprotected sex were the most prevalent risky sexual behaviors among university students.
A male participant stated that;
That would be simpler, maybe sleeping around because most campus girls love money, including me. Our parents try to give us upkeep they can manage, but we feel it is not enough because you have seen your friend having this. You also feel you want to have it, and that will push some girls to start sleeping around with different men, including those who are married, and that’s so risky (KP 003, Male).
Another male participant stated that;
Maybe some of them have a backup plan in mind that if anything happens, I have a solution, thus behaving carelessly (KP 004, Male).
Other reported risky behaviors included; peer pressure, same-sex relationships, drug, and alcohol abuse, commercial sex, watching pornography, and masturbation.
A male participant stated that;
Even the myth all around sex, maybe yesterday you protected yourself, then your friend is like you man you are still using condoms do you know when you remove the rubber (KP 005, Male).
A female participant stated that;
I will talk about mismanaging life. For example, when you go to clubs, you find every manner of people willing to do anything at any time. So, the risk behavior will come when you over drink yourself uncontrollably and end up being used by men (KP 004, Female).
This means that many female students are exposed to having unprotected sex due to intoxication from drugs and alcohol.
Similarly, a male participant stated that;
It raises the alarm to me, because if I hear a friend of mine say. I rather buy a prostitute than having a campus girl. Buying a prostitute, I think it's risky (KP 006, Male).
In the same light, a male participant stated that;
There are some two ill sexual behaviors; the first one is oral sex practiced among, and the other is homosexuality because they have many side effects (KP 007, Male).
These expressions show that university students regarded engaging in homosexuality and commercial sex work as risky behaviors that expose them to SRH related problems.
Notably, one surprising risky behavior was the one related to masculinity where girls let their boyfriends decide everything for them, thus exposing them to unnecessary yet avoidable SRH related risks. This clearly demonstrates that there is gender power inequality when it comes to SRH related issues among university students. This was reported by a female participant thus:
Another risky behavior is that students worry a lot about their relationships; they are not aggressive in their relationships. Girls let their boyfriends decide on everything at the end of the day; it is the girls themselves that carry the biggest burden after sex. If you want to use a condom or contraceptive, go ahead and use it to avoid risks (KP 005, Female).
Misconceptions about contraception and other SRH services and tools
The participants were further probed about any misconceptions related to contraception and other SRH related services and tools. Many of them talked about their fear of the long-term effects of different SRH tools and services like reduced sexual sensitivity, struggle to bear children in the future due to excessive use of contraceptives and permanent damages on some reproductive organs. A female participant articulated this point of view;
By the way, I heard like, and read somewhere that if a lady is to use pills for a long time, she will lose that sexual sensitivity (KP 006, Female).
Similarly, another female respondent pointed out that;
I hear you take one pill for three months after that you take another one because someone fears getting pregnant even before three months can expire. The more you take them, the longer they last in your body, and those are the people you hear that she gave birth after 12 years. It’s not a miracle to give birth after 12 years; it’s because the pills last long in their bodies (KP 007, Female).
A male participant highlighted the adverse effects of circumcision in these words; Circumcision can lead to many infections and such stuff if your wounds are not cleaned well. Your penis can swell, or even be cut off because of infections and wounds (KP 008, Male).
Myths surrounding some SRH tools and services
Participants were also probed on some of the trending myths regarding some SRH tools and services like contraceptives, condoms, and others. Some of the participants had different perspectives like the likelihood of the bursting of the condom, pills killing ovaries, etc., as reported below by two females and a male participant, respectively.
I heard someone say that every time you want to conceive you just remove it and put it back when you don’t want to conceive, I think that’s safer because I feel condoms are not safe, healthy, what are they made of, what is content put in them? Leave alone the busting part of it; they might be harmful because of the chemical put in them. And then the pills people say they make them black, too much weight others lose (KP 008, Female).
I have not heard of any risk of condoms at campus lately, but they say that sometimes they get stuck inside the female organ, but I think they have worked, and we can go on and educate people on condom use (KP 009, Male).
“Pills are not good for us as they damage the growing ova (it reverses for our hormones), so they just destroy them. I would opt for a condom, and for the married people, if they have hope of getting other kids, they can go for any contraceptive like pills. For people who are contented with a number of children, they can opt for permanent methods like vasectomy or tuba ligation or be faithful to their partners (KP 009, Female).
Confusion over safe days
One striking observation during the interviews was the mix-up and uncertainty surrounding the counting of safe days as an SRH tool. This manifested across all participants, both male and female, as highlighted in the interview excerpts below.
Concerning the issue of pregnancy, safe days are very risky. They don’t work for everyone. It depends on someone’s cycle because they are those who have specific periods in a month, so after learning your cycle, you will be in a position to know whether you are in your safe days or not (KP 001, Female).
It is always four days before and after periods. You can’t have sex four days before and after your periods. The four days after your periods are okay because your reproductive system is still working (KP 010, Female).
Count eight days from the day you start your periods up to when you are to have your next periods. Then you also consider the fertility period. This takes place after your periods up to the fiftieth day. So, you start counting safe days on the day you start bleeding up to the eighth day, but the more you come closer to the ninth day, you are not safe… (KP 015, Female).
Sources of SRH information
The second objective of this study was to explore the sources of SRH information among university students. The participants reported various sources, including Google, social media, health centers, friends, parents, and government and non-government organizations. Furthermore, participants' views on barriers to SRH information were explored.
Google or the internet
The majority of the participants reported that they accessed information on SRH via the internet, that is, through published information on blogs.
Have you heard about the talk, the talk that the parent gives a kid when they are announcing their body? They start, they'll start developing to the adolescence stage. So, my parents took the time to tell me a few things they've experienced. But I couldn’t believe all of it. I headed to Google (KP 011, Male).
Friends and Health Centres
The second mentioned source of information was friends and health centers (medical personnel), as reported below.
I contact my older friends, most of the time, then somewhere you know a medical worker who can avail this information (KP 006, Male).
Whenever I need this information or anything related, I would talk to people who are much older than me and have the experience (KP 011, Female).
Government and other non-government organizations and social media
The third mentioned source of SRH information was government through the Ministry of Health, non-government organizations through outdoor activities and sensitizations, and social media via posts on Facebook, WhatsApp, and other media.
Many of the participants reported that the Ministry of Health distributes condoms and other tools to student residences as well as organizing health camps with other SRH related NGOs. This is illustrated by the interview excerpts cited below:
Most of the times, I think the government and some non-governmental organizations, they normally send people from different places, and they come and sensitize students about sex education and reproductive health. They tell them how to forego all those problems like using protection onwards (KP 013, Female).
Last semester, some people came to the university to sensitize about SRH tools and services. I think they were two ladies from the Ministry of Health. They were sensitizing about prep and pep (KP 016, Male).
A few participants (only 3 participants) mentioned that they were getting SRH information from their parents. One male participant stated that;
Have you heard about the talk, the talk that the parent gives a kid when they are announcing their body? They start, they'll start developing to the adolescence stage. So, my parents took the time to tell me a few things they've experienced (KP 012, Male).
To better understand this, participants were further probed on why they did not share or acquire such SRH information from their parents. Many of them reported that they feared being labeled as spoilt children by their parents or even lose their trust, thus clearly indicating that there is a lack of intergenerational communication on issues of sexuality.
Like the respondent quoted above, a male participant stated that;
Man…….there are somethings our parents shouldn’t know otherwise our tuition will be cut off; even if I asked in good faith, parents always have the other side of thinking that I am spoilt so to avoid that, I keep calm and ask my peers (KP 011, Male).
Asking my parents is like taking myself to prison because they may misquote me or erroneously get something different, which may bring conflicts between us. To avoid that trouble, let me keep googling or asking friends (KP 009, Male).
With some people, their parents are exposed, and such questions wouldn’t be news to them, but to some of us, village champions, you do not dare; otherwise, you will be chased out of the house or even stopped from schooling (KP 010, Female).
The above excerpts indicate that the fear of negative attitude and rewards prevent many youths from asking their parents questions on issues of sexuality.
Additionally, participants were asked about some of the challenges they faced while accessing SRH information. They reported that the most daunting challenges they had were lack of finances, inadequate or few medical personnel, and service provider bias. These challenges are captured in the interview excerpts below:
To its worst, some websites ask you to pay first before you can get the information (KP 005, Male).
It’s not easily accessible because I was at Kyambogo Medical Center one time in the morning feeling bad, and I got medication at 5 pm. I told them I wanted to talk to the nurse, and they told me I couldn’t get helped. So that’s not easy accessibility (KP 006, Female).
Some doctors don’t believe what we tell them. For example, I went to visit a doctor after explaining my challenge to him; he told me that it was a result of contraceptives. I told him I have never used contraceptives, and I don’t even know how they look like, but this is someone who could not even believe me, and I couldn’t get helped (KP 007, Female).
In other words, university students encounter issues of long waiting time to access SRH services and service provider bias.
Other reported challenges included; inadequate knowledge of medical jargon and language and insufficient knowledge by the medical personnel, as stated below by two female participants.
The challenge is when you are using google, the terminology used may hinder you from getting some information. The terms used to describe certain medicines are sometimes hard, so you may end up not knowing what they are talking about (KP 014, Female).
Some of the doctors don’t know much about the health needs of students, so they will not tell you much of the information that you need (KP 006, Female).
Because many university students cannot comprehend the information found on the internet and other online platforms, this clearly highlights the dangers of relying on the internet for SRH information.
Authentication of SRH information from different sources
The last objective of this study was to explore how university students authenticate the SRH information obtained from various sources.
Many of the study participants said that they confirmed the information from google or the internet by comparing information from different sites or bloggers, from friends and even medical personnel.
If you visit three different sites and find that the information is almost similar, then I will know that the information is right. Also, I can consult the medical worker concerning that information if he or she has the same information I got from the sites then I take up the decision (KP 013, Male).
With me, If I don’t understand something, I ask my friends; I do this indirectly so that I am not misquoted or misinterpreted (KP 005, Female).
I can also trust medical personnel, friends, and parents. But if it is not a medical personnel, then you don’t have to rely on him or her because you have to be sure of what you want to become in life (KP 008, Female).
The above excerpts indicate that at the end of the day, most university students largely depend on their peers to authenticate any SRH information obtained from the internet.