Knowledge, Attitude and Use of Contraceptive Among Secondary School Students in the Gambia

doi:10.21203/rs.3.rs-4613032/v1

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Knowledge, Attitude and Use of Contraceptive Among Secondary School Students in the Gambia

https://doi.org/10.21203/rs.3.rs-4613032/v1

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Background: Family planning assists individuals and couples in anticipating and achieving their desired number of children as well as the spacing and timing of their births. The public healthcare system in many nations neglects adolescents and young people. Lack of proper awareness and utilization of family planning services by secondary school students poses a significant public health challenge, particularly as the government strives to reduce mother and child morbidity and mortality in the Gambia.

This paper aimed at assessing the knowledge, attitude, and use of contraceptives among secondary school students in The Gambia.

METHODOLOGY: An exploratory cross-sectional study was conducted among secondary school students in The Gambia. Semi-structured questionnaire was administered to students through face-to-face interviews. Data was analyzed using Statistical Package for Social Sciences version 22.0. Descriptive statistics were used to summarize the data.

RESULTS: The findings showed a low level of good knowledge of family planning with only 17.5% of the participants having good knowledge. The most common source of information was radio and television. The attitude of students towards family planning was relatively positive with 50.4% had positive attitude. About one in ten (9.8%) were practicing family planning. Seventy-nine (20.8%) were sexually active and out of these 41.3% were engaged in risky sexual behaviors.

CONCLUSION: There was a low level of good knowledge and uptake of family planning commodities in both regions and the proportion of urban participants with positive attitudes was higher than the rural.

Health sciences/Health care

Health sciences/Health care/Health services

Knowledge

Attitude

Practice

Family Planning

Contraceptives

risky sexual behaviors

Family Planning helps individuals and couples anticipate and attain their desired number of children, in addition to the spacing and timing of their births, through the use of modern contraceptive methods. Family planning encompasses a wide range of services such as sex education, prevention and management of sexually transmitted infections, preconception counseling and management, and infertility management (Health Policy Plus, 2017; WHO, 2018).

Use of family planning services has increased steadily. Presently, 874 million and 92 million women of reproductive age are using modern and traditional contraceptive methods respectively (United Nations, 2022). Despite these significant gains in family planning use, there are more women globally (164 million) who want to avoid getting pregnant but are not using an effective method due to lack of supplies, cultural and political barriers, and subpar care (Belay et al., 2024; Kusheta et al., 2019). UNFPA observed that about 64 % of women of reproductive age 15–49 married or in a union, areusing some form of contraception, either modern or traditional (UNFPA, 2016). The report further revealed the current contraceptive prevalence rates (CPR) as 68.5% in Asia, 51.5% in Arab States, 65% in Eastern Europe and Central Asia, 72.6% in Latin America and the Caribbean, 38.6 in Eastern and Southern Africa, and the least in West and Central Africa with 17.6 (UNFPA, 2016). It has been observed that there has been a decline in the prevalence of induced abortion from 1995 (UNFPA, 2016). As of 2008, the prevalence of induced abortion globally was 28% (UNFPA, 2016). The report further revealed the trends in various regions of the world, such as; Africa (29%), Asia (28%), Europe (27%), Latin America (32%), Northern America (19%) and Oceania (17%)(UNFPA, 2016).

Adolescents are an imperative asset for any country. There are varied definitions for adolescents, however, many consider an adolescent to anyone between the ages of 10 and 19 years (Singh et al., 2019). It is recognized that many of the health-related behaviors that arise during adolescence has implications for present and future health and development (De et al., 2018). Adolescents are one-fifth of the global population, and the rapid changes in population growth are more prominent in developing countries (Shinde et al., 2023).

The shifting moral and social ideals, as well as the transition in the standard of society’s behavior from conservatism to liberal contact between the sexes, may be traced largely to media exposure, particularly television and movies. Adolescents find themselves caught between a glamorous Western influence and a harsh conservatism at home, which rigorously prohibits discussion of sex. This dichotomy aggravates the confusion among adolescents (Devi, 2015). This has led to an increase in premarital sexual activity and pregnancy among unmarried girls, apart from the increasing incidence of abortion and sexually transmitted infections (Devi, 2015).

In spite of the gains made in reducing maternal deaths globally, WHO has ranked pregnancy related deaths as the second leading cause of death among teenagers aged 15–19 (WHO et al., 2013). A lot of factors could be attributed to this menace, such as unsafe abortion, hypertensive disorders, hemorrhage, sepsis and obstructive labor due to the size of pelvic(Ray et al., 2024).

It was also found out that adolescents don’t have access to information about their sexuality and reproductive health, and as a result, they are less likely to seek out or utilize reproductive health services. Teenage pregnancy is considered a major public health problem as it does not only increase adolescents’ risk of instrumental delivery, obstetric complications, and obstetric fistulae but also increases the risk of having a poor pregnancy outcome for both the mother and the baby (WHO et al., 2013). Adolescents are more likely to die from pregnancy related causes when compared to older women because their pelvis and reproductive organs are not fully developed to begin reproduction.

According to the UNFPA, pregnancies among girls under the age of 18 have irreversible consequences, including: violations of girls' rights, life-threatening consequences for sexual and reproductive health, and high development costs for communities, particularly in perpetuating the cycle of poverty (UNFPA, 2016). Early pregnancy will have a negative effect on their education and health needs, increase the risk of violence in society, increase HIV infection, and increase maternal deaths and disability (Equilibres & Population, 2016).

In The Gambia, adolescents constitute 23% of the population, or approximately 386 thousand population (GBoS, 2013). Like their peers in other developing countries, they are faced with early physical maturation (Khan et al., 2015). As a result, many of them venture in early unprotected sexual activities, which predisposes them to unintended and often unwanted pregnancies(Eberendu et al., 2023; Khan et al., 2015). The consequences of unwanted pregnancy include, unsafe abortion practices that expose them to pelvic inflammatory diseases, ectopic pregnancy, secondary infertility, baby-dumping, sexually transmitted infections, including HIV/AIDS, and involvement in drug use and abuse (James & Joan, 2013). However, even though there are no data on the impact on the consequences of limited Family Planning services to students, the uptake of family planning services is very low (GBoS, 2014, 2021).

Young people’s sexual rights are denied by both religious and traditional forces in The Gambia, which promote early marriage and stigmatize premarital sex and pregnancy outside marriage. Misinformation about sex and a lack of youth friendly sexual and reproductive health services also pose challenges to the sexual and reproductive health of young girls (UNFPA, 2016).

This paper aims at assessing the knowledge, attitude and utilization of family planning commodities among secondary school students in The Gambia. The findings could be used to influence policy towards young people’s access to family planning services in The Gambia.

STUDY AREA

The research was carried out in two Regional Education Directorates of the Ministry of Basic and Secondary Education of The Gambia, Regions Two and Four. The Gambia is located midway on the bulge of the West Africa coast and stretches over 400 kilometers inland from west to east on either side of the River Gambia, varying in width from about 50 km near the mouth of the river to about 24 km upstream (GBoS, 2021). The country is surrounded on its three sides by the Republic of Senegal and to the west by the Atlantic Ocean (GoBS, 2014). The River Gambia runs through the entire length of the country (GoBS, 2014).

The education system in The Gambia is a continuum from early childhood development (ECD) to university education, with three years of pre-school education, nine years of uninterrupted basic education, three years of secondary education and four years of tertiary and higher education (MoBSE, 2014).

The Region II Education Directorate covers the West Coast Region and spans from Kartong to Kanlagi. It has a population of 699,706 and an annual growth rate of 6.1% (GBoS, 2014; GBos & ICF, 2021). Region II has one hundred and seventy secondary schools and a student population of 54,698 (MoBSE, 2015). Region IV Education Directorate covers the Lower River Region, and stretches from Jattaba to Pakaliba and has a population of 82,361. It has 28 secondary schools and a student population of 5649(MoBSE, 2015). There were 60,347 secondary school students in the two REDs.

STUDY DESIGN

An exploratory cross-sectional analytical study design was conducted with the use of quantitative method.

STUDY POPULATION

The study population consisted of secondary school students in REDs II and IV; students in Grades 7 to 12 were recruited in the study irrespective of age and sex and were willing to participate in the study.

SAMPLE SIZE DETERMINATION

The sample size for this study was determined from a study conducted in The Gambia among adolescents, which indicated the contraceptive prevalence among adolescents in The Gambia was from 7–9% (Lowe et al., 2021) and used Abramson and Gahlinger's 2002 formula for estimating single proportions (L. Naing et al., 2022; N. N. Naing, 2003).

n = p(1 − p) × Z2∝/d² ×3

This sample size formula was used: n is the minimum sample size, Z2∝ is the standard normal deviation, which equals 1.96 at 95% confidence level, and p is the proportion of the target population to have specific characteristics 9% and d2 is the degree of desired accuracy at 0.05 with a design effect of 3:

= (0.09 × 0.91 × (1.96)²)/ (0.05)² x 3 = 377.

The sample size of the research will be 379 respondents from the chosen REDs during the multi-stage sample technique.

Sampling Technique

A multi-stage sampling technique was used to select the study participants: the first stage was the selection of the REDs, followed by the selection of the schools in which the study was carried out. The third and fourth stages were the random selection of the classes/grades, and students.

Study Instruments

Questionnaire

questionnaire on knowledge, attitude, and practice of family planning was administered on the students. The tool consisted of both open-ended and closed-ended questions to the study participants. This addressed the objectives of knowledge, attitude, and practice.

DATA COLLECTION METHODS

The quantitative data collection method was carried out among the study participants.

Questionnaire Survey

A structured, self-administered questionnaire with open and closed-ended was used to collect the quantitative data. The questionnaire covered socio-demographic data, knowledge, attitude and practice on family planning.

Pre-testing:

The questionnaire was peer-reviewed by experts in family planning and pretested for reliability and validity at a different regional educational directorate. The outcome of the questionnaire greatly depends on how well the research participants understand the questions, and their understanding may be affected by language skills, education, and culture (Burns et al., 2008). Pre-testing started with reviewing and revising questions process (Burns et al., 2008). The aim of pre-testing is to evaluate whether respondents interpret questions in a consistent manner, as intended by the investigator, and to judge the appropriateness of each included question (Burns et al., 2008).

PLAN FOR DATA MANAGEMENT

Measurement of variables

the knowledge of the participants was assessed using questions 8 to 13. Each correctly answered question scored 1, while a wrong answer scored 0. The total score for each participant was expressed as a percentage and classified as follows;

Poor knowledge if the participants score less than 50%
Good knowledge when the participant scores more than 50% and more

The attitude of the participants was assessed using questions 14–19 of the questionnaire. Each correct question carried about 15%. The total score of the participants was expressed as a percentage and classified as follows;

Negative attitude if the participant scores less than 50%
Good attitude if the participant scores above 50%

Research assistants

Five research assistants were recruited to assist the researcher with data collection. The research assistants reviewed the questionnaire for better understanding and mastery of the study instruments.

Ethics committee approval

The study followed the relevant standard guidelines and regulations with reference to human study participants. Ethical approval was granted by the Ethics Review Board of the University of Benin. Another clearance was obtained from the Ministry of Basic and Secondary Education. Informed consent and assent from students and school head teachers.

Study participants were informed that the information collected would be treated with confidentiality. Participants were assured that participating in the study was completely voluntary, and they were free to withdraw at any time during the study. Emphasis was placed on the fact that withdrawing from the study would not result in any penalties no loss of benefits for them.

The findings of the study are presented in the form of tables addressing the goal of the study assess students’ knowledge, attitude and practice on family planning among secondary school students in The Gambia. The specific objectives are (1) to determine the knowledge of secondary school students on family planning (2) to assess the attitude of secondary school students towards family planning (3) to identify practices of family planning among students.

Table 1

SOCIO-DEMOGRAPHIC DESCRIPTION OF THE RESPONDENTS
Socio-Demographic characteristics
Socio-Demographic characteristics		frequency	Percentage (%)
Age of respondents (n = 379)
	13–15	66	17.4
	16–18	219	57.8
	19–21	86	22.7
	22+	8	2.1
	Mean (standard deviation	17.27(1.93)
Gender of respondents
	Male	118	31.1
	Female	261	68.9
Participants' level of education
	Senior Secondary School	230	60.7
	Junior Secondary School	149	39.3
Participants' religion
	Islam	368	97.1
	Christianity	11	2.9
Living with parents
	Yes	199	52.5
	No	180	47.5
Electronics in the home
	Television	219	57.8
	Radio	54	14.2
	Smartphone	17	4.5
	Multiple assets	72	19
	*Others	17	4.5
	*Others – digital video player

Table 1 shows the sociodemographic characteristics of the participants. A total of 379 participants were recruited for the study and majority (219; 57.8%) of them were within the age bracket of 16 and 18 years; with a mean age of 17.27 years and standard deviation of 1.93. A little more than two-thirds (261; 68.9%) were females. Concerning participants educational status, 230(60.7%) were in senior secondary school.

The sample was predominantly made of Muslims; 368 (97.1%) while a little more than half (199; 52.5%) were living with at least a parent at the time of the study.

Regarding assets in the house that could enhance access to health information including family planning, the study showed that about two-thirds of the participants (219; 57.8%), 54(14.2%) and 72 (19.0%) had multiple appliances (television, radio, smartphones all found in the house).

Table 2

PARTICIPANTS’ KNOWLEDGE ON FAMILY PLANNING
Knowledge of Family Planning
Knowledge of Family Planning		frequency	percentage n (%)
Awareness of Family Planning (n = 379)
	Yes	181	47.8
	No	172	45.4
	I don’t know	26	6.9
**Family Planning method mentioned
	Condom	364	96.0
	Pills	109	28.8
	Injections	195	51.5
	Withdrawal	30	7.9
	Others (Traditional methods)	23	6.1
Category of knowledge
	Poor	313	82.5
	Good	66	17.5
Meaning of Family Planning to Participants
	Planning of one’s family	21	5.5
	Prevention of unwanted pregnancy	80	21.1
	Prevention of STI&HIV	58	15.3
	Having desired number & spacing of children	15	4.0
	Do not know	204	53.8
Source of information**
	Radio and Television	220	58.9
	Parent	26	6.7
	Partner	13	3.3
	Friend	28	7.3
	School	1	0.3
	Healthcare Worker	4	0.8
	Internet	13	3.2
	Multiple source	45	11.0
	Others (Priests, Imam, “Kanyelen”)	29	7.8
	** Multiple response

Table 2 shows participants’ knowledge of Family Planning. The study revealed that less than half (181; 47.8%) are were aware of family planning. The two most known contraceptives were the condom (364; 96.0%) and injectables (195; 51.5%). More than half (204; 53.8%) do not know what family planning is while 80(21.1%) attributed family planning to prevention of unplanned pregnancy.

Knowledge on family planning is generally poor with only 66(17.5%) of the students had good knowledge. The most common sources of information on family planning for the participants were radio/TV (58.9), friends, and others such as priests, imams and “kanyelen” (Traditional Communicators).

Table 3

PARTICIPANTS’ ATTITUDE TOWARDS FAMILY PLANNING
Attitude towards Family Planning
Attitude towards Family Planning		Frequency (n)	Percentage (%)
Attitude
Positive 191			50.4
Negative 188			49.6
View friend practicing Family Planning
	Prostitute	34	9.0
	Unreligious	60	15.8
	“Loose” friend	83	21.9
	Protective	200	52.8
	Others (uncultured, depraved)	2	0.5
Continuation of friendship even practicing Family Planning
	Yes	336	88.7
	No	43	11.3
Will practice FP when opportune
	Yes	104	27.4
	No	274	72.6
Reasons for practicing FP
	Prevent pregnancy	48	46.2
	Prevent HIV	32	30.8
	Prevent STIs	24	23.1
Reasons for not practicing FP
	Religious belief	163	58.8
	Practicing abstinence	1	0.4
	Fear of side effects	95	34.3
	Protect virginity	13	4.7
	Others (fear of parents, banishment etc.)	5	1.8
	Statistical significance χ² Chi-square test* † Fisher’s exact test

Table 3 depicts participants’ attitude towards family planning varied. The study revealed that more than half (191; 50.4%) of participants had positive attitude towards family planning.

Majority (200; 52.8%) of the participants viewed friends using contraceptive as being protective, however 43(11.3%) claimed that they will sever their friendship one they found out that their friend is using contraceptives. A quarter (104; 27.4%) are willing to use contraceptives in the future. Pregnancy (46.2%) and HIV/AIDS (30.8%) were reasons that will prompt participants to use FP commodities while religious belief and fear of side effects were found to be deterrent.

Table 4

PARTICIPANTS’ PRACTICE WITH REFERENCE TO FAMILY PLANNING
Family Planning practices		Region Urban n (%)
Family Planning practices		Region Urban n (%)	Rural n (%)
Practicing Family Planning
	Yes	37	9.8
	No	342	90.2
Opinion to practice Family Planning
	Personal	33	89.2
	Advised	4	10.8
Advised by ***
	Partner	2	50.0
	Others (parents, siblings, Friend, Teacher)	4	100.0
Reason for practicing Family Planning
	Feared pregnancy	16	40
	Protection from STI	20	50
	Others (Advised and peer pressure)	4	10
Family Planning method practiced
	Pills	2	5.4
	Withdrawal	3	8.1
	Condom	27	73.0
	Injection	5	13.5
Experienced side effects
	Yes	2	5.4
	No	25	94.6
Ever had sex
	Yes	79	20.8
	No	300	79.2
Age at first sex
	Less than 15years	24	30.4
	15 years and above	55	69.6
Sex without condom
	Yes	44	58.7
	No	31	41.3

*** Multiple choicest

Table 4 showing participants’ family planning use. Thirty-seven (9.8%) participants practiced at least one form of family planning. Among those practicing family planning 33 (89.2) participants took personal decision to start family planning uptake. The most common contraceptives used by participants was the condom (23, 73.0%) and injectable (5; 13.5%). Among reasons proffered for FP uptake were unplanned pregnancy prevention (16; 40.0%) and STI and HIV/AIDS prevention (20; 50.0%).

Only two participants of those using contraceptives had experienced side effects.

One-fifth (79; 20.8%) of the participants were sexually active. Twenty-four (30.4%) participants had their first sexual debut before the age of 15 years. Furthermore, 35 (44.3%) were into risky sexual behaviors such as having unprotected sex and multiple sexual partners.

This paper assessed the secondary school students’ knowledge, attitude, and practice of family planning in The Gambia. The ages of the participants ranged from 13 to 22 years, with a mean age of 17.27 years and a standard deviation of 1.93. The Gambia, like many countries in the Sahel region, has a very youthful population. The female participants were more than the males with three out of five participants being in senior secondary. Evidence has shown that there are more girls in primary and secondary school categories and a shrinkage in tertiary and higher education (Baboucarr Fatty & Maame Akua Amoah Twum, 2023; Gajigo, 2016; MoBSE, 2014). The government and stakeholders are galvanizing efforts to encourage and empower the girl’s education. The Gambia is predominantly Muslim, with pockets of Christians and other faiths, as observed in the current study (United States Department of State, 2020). The living arrangements of participants in both regions are very similar to each other, as almost one in every two is living with their parents. It is a very common situation in The Gambia where a student lives with a close relative such as an uncle, aunt, grandparent or close family friend.

It was interesting to know that all families of study participants had one form of electronic asset or another. Among the assets, television and radio were the most common. These assets would be of value, especially in accessing health information including family planning.

Knowledge on family planning among the students was generally poor, with only one-fifth having good knowledge. A little more than half of the participants do not know what family is, while two out of every five participants said that the services were meant for the prevention of unwanted pregnancies and STI/HIV&AIDS. The observations made in the current study are similar to what prevails in Tanzania, where more than four-fifths of the participants had little or no knowledge about family planning(Ayubu & Kabeya, 2019; Dangat & Njau, 2013). This similarity could be attributed to the fact that in most typical setting, people do not discuss sex and sexuality openly because of discrimination. Condoms and injectables are the most known contraceptives students knew, and this corroborated a study carried out in Nigeria (Chimah et al., 2016). Condoms are free in all public health facilities and Red Cross Society branch offices across the country and are easily reached by students. Students most common sources of information on family planning are the radio and television. These findings are slightly consistent with results in Ghana and differ from findings made in rural Tanzania, where the main source of information was the healthcare provider(Gbagbo & Nkrumah, 2019; Lyimo et al., 2024). These sources of information have the advantage of having wider coverage. The Ministries of Basic and Secondary Education and Health can capitalize on the numerous radio stations, most especially the community radios, where they can schedule family planning programs at a time convenient to the target audience. Interestingly, parents and partners had surfaced as sources of information. Effective parent-child communication has the benefits of a delayed of child’s first sexual debut, increased uptake of contraceptives, prevention of STI, HIV/AIDS and adoption of healthy sexual behaviors(Faudzi et al., 2020; Naftaly & Greenley, 2019). The study has revealed that the culture of parents shying away from discussing sexual and reproductive health matters openly is fading. This finding corroborates a study in Uganda where parents have decided to start open discussion on sexuality with their children(Achen et al., 2022). The Gambian like many typical African societies, open discussion on sex with children is seen as taboo (Kurevakwesu et al., 2023). Many a time, most communications were more of a stern warning on the consequences of having an unplanned pregnancy outside of wedlock. Having a child outside in typical Gambia society is frowned upon at most, especially for girls.

Participants’ attitudes towards family planning were generally positive across the regions; the majority saw a friend practicing family planning as protecting themselves. These findings support the findings of a study in Ethiopia, where majority of the participants had a positive attitude towards family planning (Tejineh et al., 2015). Although the current study showed participants’ positive attitude towards family planning, there were others who felt otherwise. For instance, some participants viewed singles practicing family planning as prostitutes, unreligious, “loose” people, or even called them other offensive names, while others were willing to sever all forms of relationships because of family planning. This phenomenon could be attributed to the fact that most Gambian tribes celebrate and cherish the deflowering of a virgin on her wedding night, so anyone, especially girls who are not married and yet practice family planning, may be seen as bringing shame to their families. Cultural values, norms, and religion could have played a role in how participants viewed a friend practicing family planning. These findings were similar to the findings of a study in Nigeria where participants viewed family planning as sinful (Ifeadike et al., 2015).

About one third of the participants were willing to practice family planning if they had the opportunity. Like in many developing countries, many urban dwellers preferred having smaller families than rural dwellers, who would want to have larger families so as to have more hands on the farm (Ayaz & Mughal, 2022; Horlu et al., 2023; Olayemi, 2012).

The most motivating reason for sexually active students to practice family planning was to prevent unwanted pregnancy, HIV, and other STIs. This scenario manifests how much dreaded an unwanted pregnancy outside of wedlock is in typical Gambia societies. Many a time, it is so serious that a girl with unwanted pregnancy outside wedlock is disowned by her family. This could also explain the reason why parents would marry off their daughters at a tender age to prevent them from being outside wedlock, which brings shame to the family.

On the other hand, those who said they would not practice family planning even when the opportunity was available cited religious belief and fear of side effects as the main reasons. Myths and misconceptions surrounding contraceptives such as being obese and finding it difficult to conceive after stopping taking contraceptives, are well established among the participants. These findings are similar to the findings of a study carried out in Southeast Asia, where almost one-third feared side effects (Gore & Katkuri, 2016). Therefore, there is a need for an aggressive health awareness campaign to spell out the myths and misconceptions among students.

Most tribes in The Gambia, especially the Fulani and Mandinkas, celebrate and uphold the deflowering of a virgin on her wedding night. Due to the high price tag on virgins, some people justify the necessity of female genital mutilation, where the vagina is sealed until the wedding night.

Contraceptive uptake among participants was generally very low, just one out of every ten participants. This finding is similar to a systematic review of the sexual and reproductive health among Gambian adolescents and what also prevails in the West Africa bloc (Equilibres & Populations, 2016; Lowe et al., 2021). The findings further reinforce The Gambia Multiple Indicator Cluster Survey (MICS), which showed an overall low uptake of contraceptives in The Gambia (GBoS, 2021). However, the current study findings differ from those carried out with the West Africa bloc (Asiedu, 2019; Issah et al., 2022). The majority of those participants who used contraceptives made personal decisions. This is encouraging, and for this scenario to be sustained, it is necessary to reinforce it through mass awareness campaigns and make family planning commodities accessible to students, and by extension to young people. However, some of the participants were advised either by their parents, friends, or partners. Parents should continue bridging the gap between them and their children, for this will help children adopt healthy sexual behaviors. The revelation that some of the study participants practicing family planning were advised by their parents. In many African cultures, sex has always been treated as sacred, and hardly do parents discuss sex openly, much less advise their sexually active children to uptake family planning (Ojong et al., 2014).

The reasons for practicing family planning across the studied regions were the same, as the majority of those practicing family planning at the time of the study were due to fear of getting pregnant and protection from sexually transmitted infections, including HIV/AIDS. This finding is similar to a study in Imo State University in Nigeria (Eberendu et al., 2023). Pockets of individuals were advised because they were sexually active while others practiced family planning due to peer pressure. These findings supported the findings of a study in northern Ghana and contradicted a study at Cross River State, Nigeria, which highlighted privacy and the attitude of service providers among other reasons for adopting family planning (Yidana et al., 2015). The reasons proffered by participants in the current study were more convincing than those in Cross River State, Nigeria.

Condoms were the most commonly used method among participants. These were similar to the findings of a study in Tanzania, where the condom was found to be the most commonly used method among participants. The reason for the condom to be the most widely used method could be attributed to the fact that distributors do not need special training to distribute and also that most of the myths attributed to other family planning are not associated with the condom. Secondly, condoms in The Gambia public health facilities are free.

Side effects were very rare among participants; however, some participants experienced some forms of side effects. Side effects like irritation from the latex of the condom and prolonged menses have been reported in a study in Zambia (Mukanga et al., 2023). These conditions can discourage individuals from purchasing family planning commodities.

One-fifth of the participants were sexually active. Most of these had their first sexual debut as a result of peer pressure, curiosity, and seeking favor. These findings contradicted what was observed in Ekiti State, Nigeria as substance abuse, alcohol, and rape were reported to be the causes of first sexual debuts (Durowade et al., 2017). Early initiation into sexual exposure could be attributed to poor knowledge and information on sexuality and its associated health implications. These findings supported the findings of a study in Osun State, Nigeria, which revealed participants being sexually active before their 15th birthday (Olalekan & Esther, 2012).

Two-fifths of the sexually active participants were engaged in risky sexual behaviors such as having unprotected sex and multiple partners. Similar findings have been seen in other countries (Durowade et al., 2017; Srahbzu & Tirfeneh, 2020). This finding could be the result of little or no knowledge on the prevention of sexually transmitted infections and unwanted pregnancies. Ministries of Basic & Secondary Education and Health, and their partners should scale up the Comprehensive Sexual Education program and provide adolescent-friendly sexual and reproductive health facilities. These interventions will provide students with access to accurate information and help them make informed choices about when, how, and how to adopt positive sexual behaviors.

The study has revealed that there are gross discrepancies in participants’ knowledge and practice. Ministries of Basic & Secondary Education and Health should scale up the comprehensive sexual education program so as to bridge knowledge lapses. The Ministry of Health (MoH) must champion adolescents’ sexual and reproductive health services across the country, especially in rural local government areas. MoH should seize the opportunity to use RED and PHC/VHS structures to deliver SRH services to adolescents and young people. Furthermore, PHC/VHS staff and teachers need to be equipped with relevant knowledge and skills on counseling, screening, and management of side effects.

Future research should be focused on assessing the factors that determine the low knowledge and practice of family planning among secondary school students in the Gambia. The findings from these studies will inform policymakers to develop school-based and adolescents’ targeted interventions that will bridge the knowledge gap, increase uptake of FP services, and reduce risky sexual behaviors in students.

Ethics approval and consent to participate

The study followed all the relevant guidelines and regulations when dealing with human participants. Ethical clearance was attained from the Ethics Review Board of the University of Benin. Another clearance was obtained from the Ministry of Basic and Secondary Education. Informed consent and assent from students and school head teachers for student under 18 years of age.

Study participants were assured that the information collected would be treated with confidentiality. Participants were assured that participating in the study was completely voluntary, and they were free to withdraw at any time during the study. Emphasis was placed on the fact that withdrawing from the study would not result in any penalties no loss of benefits for them.

Consent for publication

Participants consented for the study to be published. However, they were assured of confidentiality before commencing the study. Respondents were given the opportunity to ask questions and get clarification at any stage of the study. They were informed that they can withdraw from the study at any time they feel so, and they will not be penalized.

Availability of data and materials

Data are available in a public, open-access repository. Data are available upon reasonable request. The data used to support the findings of this study are available from the corresponding authors upon reasonable request.

Competing Interests

We declare that the authors have no competing interests as defined by Publishers, or other interests that might be perceived to influence the results and/or discussion reported in this paper

Funding

There was no funding for this work.

Author’s contributions

SPSJ conceptualized the study and reviewed the literature. SPSJ conducted data collection in the field. SPSJ and MB cleaned and analyzed the data. SPSJ, MB and AS drafted the manuscript. All authors proofread, reviewed, and approved the original manuscript's publication. SPSJ accepts full responsibility for the work and the conduct of the study, has access to the data, and controls the decision to publish.

Acknowledgement

This project has been funded by the E4LIFE International PhD Fellowship Program offered by Amrita Vishwa Vidyapeetham. I am grateful to the Amrita Live-in-Labs® academic program for providing all the support. The Live-in-Labs® program draws on the principles of lean research for development.

Furthermore, we would like to thank the staff of the Ministry of Basic and Secondary Education of The Gambia and the participants without their contribution, this work could have been impossible.

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No competing interests reported.

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Knowledge, Attitude and Use of Contraceptive Among Secondary School Students in the Gambia

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Abstract

BACKGROUND

METHODOLOGY

STUDY AREA

STUDY DESIGN

STUDY POPULATION

SAMPLE SIZE DETERMINATION

DATA COLLECTION METHODS

Pre-testing:

PLAN FOR DATA MANAGEMENT

Ethics committee approval

RESULTS

*** Multiple choicest

DISCUSSIONS

CONCLUSION

Declarations

Consent for publication

References

Additional Declarations

Status:

Version 1