The Ghana Government developed a national population policy in 1960, an adolescent reproductive health policy in 2000 and a national HIV/AIDS and STI policy in 2004 among others to respond to the sexual and reproductive health needs of adolescents and young people11. Despite the existence of these policies and other programs, Ghana continues to record high incidences of teenage pregnancies resulting in unwanted teenage births and unsafe abortions which can be attributed to lack of sexual abstinence and/or low prevalence of modern contraceptive use among others12. Some nationwide studies13, 14, 15 that investigated contraceptive use among young people in Ghana have been too general, used quantitative methods and/or focused on prevalence thereby limiting empirical evidence which is a gap that the current study attempted to fill by investigating contraceptive use among basic school pupils in the study area to further inform policy and program decisions in Ghana.
The current research was a case study of contraceptive use among basic school pupils of a Municipality in Ghana. The researchers focused on respondents’ background characteristics, sexual relationships, pregnancy/ induced abortion history, awareness and use of contraceptives. From the study results, the majority of respondents (56%) were aged 13 – 15years, in JHS (72%), living with both parents (50%) and were the first child of their parents (56%). About 67% reported to be in a relationship and had ever had sexual intercourse in the relationship (60%). The majority (86%) of their sexual partners were aged 16–18years and were pupils (99%). Moreover, their first sexual encounters in the relationship were reported as on own will (80%).
Respondents’ awareness and use of contraceptives varied with about 65% reported to have ever heard of a contraceptive method and 21% ever used a modern contraceptive predominantly an emergency contraceptive pill (48%). Television (TV) was the main reported source of information on contraceptives (33%) and respondents’ parents, relatives, and guardians were the main sources of contraceptives used (72%). Regarding condom use during most recent sexual intercourse, about 83% of respondents reported to have tried using a condom. The majority (71%) however indicated that they started with condoms but ended ‘raw’. For respondents who used condoms, about 86% indicated it was a joint decision to do so.
Contrary to public perceptions that basic school pupils in Ghana are too young to indulge in sexual relationships16, the study results show that basic school pupils are in sexual relationships and have various reasons and experiences other than financial/material gains. The beginning of such relationships although started with platonic friendship, intimacy set in when the opportunity came to be alone in enclosed environments without parental/adult presence.
Although there is universal awareness of contraceptives in Ghana17, little information exists on the situation among basic school pupils. The existing discrepancy between awareness and use of contraceptives among the respondents in this study shows that Contraceptives information education and communication are not targeted at basic school pupils. In situations where awareness exists, the source of information is predominantly from peers whose credibility and authenticity of the correctness of the information received can’t be guaranteed thereby making contraceptive use among these age groups more discretional with the associated consequences.
The observation that some basic school pupil first heard about contraceptives and started using them following an unwanted pregnancy, childbirth or after an induced abortion confirms the relevance of the proposed comprehensive sexuality education by the Nana Ado Dankwa Affu Addo’s lead Government in 2019 which aimed at educating school children at the basic school levels of sexuality and health choices. Unfortunately, this proposal was aggressively received with religious and socio-cultural sentiments that aborted the implementation.
Respondents in the JHS were more sexually active than those in the primary school level. However, those sexually active pupils who received education on contraceptive use from their parents/guardians are more likely to use contraceptives consistently compared to their counterparts who do not. Consequently, awareness and use of contraceptives were more prevalent among the JHS pupils compared to those in the upper primary. There were reported instances of unwanted pregnancies that resulted in abortion which marked the beginning of contraceptive use. Teenage girls who get pregnant are likely to drop out of school and are unlikely to have the social and economic means to raise children18. Further, unintended pregnancy poses a major challenge to the reproductive health of young adults in developing countries. The researcher observed that sexual activity among the respondents is most of the time unprotected leading to unwanted pregnancies and invariably abortion. This situation has also been reported as common in countries where there is a persistent high rate of unmet need for family planning and low rates of contraceptive use among young people particularly in underdeveloped or developing countries19.
According to the World Health Organization, 2011, approximately 14-15 million teenage girls and young women become mothers every year and this accounts for more than 10% of births worldwide. Teenage pregnancy is a serious public health issue worldwide. Sexual activities among adolescents in sub-Saharan Africa occur mostly at the age of 15 years, this sexual debut develops at a time when the adolescent has insufficient knowledge about contraceptives and their use which expose them to high risks of STIs and unwanted pregnancies. Following the efforts to achieve the Millennium Development Goal (MDGs) 5 and the succeeding sustainable development goal (SDG) 3, Adolescent Sexual and Reproductive Health (ASRH) issues have gained more prominence and become a global concern 20. This emphasizes the crucial role of adolescent reproductive health research in achieving Sustainable Development Goal 3.
In the case of developed countries compared to developing and underdeveloped countries, teenage pregnancy rates have been reduced because of the intense campaign, education and subsequent uptake of contraceptives by young people without any form of social hindrances21. For instance between 1990 and 2008 pregnancy among teenagers in the United States of America reduced from 117 pregnancies per 1,000 women aged 15–19 to 67 per 1,000 women, representing 42 percent drop in teenage pregnancy22, 23. Analysis of data from the National Survey of Family Growth (NSFG), a major source of government data on population and reproductive health in the US found that 86 percent of the decline in teen pregnancy rates in 2002 occurred due to improved uptake of contraceptives among adolescents. Evidence-based interventions in family planning suggest that referring young adolescents to family planning clinic for contraceptives significantly improve contraceptive acceptance and use among this group24.
In Ghana, adolescent sexual and reproductive health has over the years been a great concern to stakeholders in the field due to the early commencement of sexual activity, poor knowledge of contraceptives, limited access to and underutilization of reproductive health services25. Poor knowledge of contraceptives among adolescents could result in exposure to inaccurate or incomplete information which may lead to the prevalence of sexually transmitted infections (STIs), unwanted pregnancies and related health problems26.
Evidence exists that Sexual activities among young adolescents in Ghana are most times unprotected leading to unwanted pregnancies and invariably complications of unsafe abortions27, 28. The high prevalence of unwanted pregnancy among teenagers in Ghana and the upsurge of HIV infection in the country pose a serious challenge to the Ghana Health Service, the Ghana Education Service, and relevant stakeholders. This situation underscores the critical need to explore awareness, knowledge and contraceptive use among young adolescents in basic schools to inform policy and programme interventions.
Evidence from Ghana also shows that older adolescents who receive education on contraceptive use from their parents are more likely to use contraceptives consistently compared to their counterparts who do not29. Despite the many setbacks to the implementation and delivery of Comprehensive Sexuality Education (CSE) in basic schools in Ghana, the urgency of finalizing and implementing this policy in basic schools in Ghana is greater than ever before.