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KWAMI, 2020

This thesis investigates the perception of contraceptive use and its impact on the sexual behaviors of adolescents in Senior High Schools in the Krachi-East District. The study found that adolescents have adequate knowledge of contraceptives and recognize their role in preventing sexually transmitted infections and unintended pregnancies. Recommendations include empowering adolescents, particularly females, to negotiate contraceptive use effectively.

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KWAMI, 2020

Uploaded by

ATORSAH NKPETRI

We take content rights seriously. If you suspect this is your content, claim it here.

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© University of Cape Coast https://ir.ucc.edu.

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UNIVERSITY OF CAPE COAST

PERCEPTION OF CONTRACEPTIVES USE AND ITS IMPACT ON THE

SEXUAL BEHAVIOURS OF ADOLESCENTS IN SENIOR HIGH

SCHOOLS IN THE KRACHI-EAST DISTRICT

ROWLAND DEY KWAMI

Thesis submitted to the Department of Education and Psychology of the

Faculty of Educational Foundations, College of Education Studies, University

of Cape Coast, in partial fulfillment of the requirements for the award of

Masters of Philosophy degree in Educational Psychology

OCTOBER 2020

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DECLARATION

Candidate’s Declaration

I hereby declare that this thesis is the result of my own original research and

that no part of it has been presented for another degree in this university or

elsewhere.

Candidate’s Signature ………………………….. Date ………………..…

Name:…………………………………………………….………………..

Supervisor’s Declaration

We hereby declare that the preparation and presentation of the thesis were

supervised in accordance with the guidelines on supervision of thesis laid down

by the University of Cape Coast.

Principal Supervisor’s Signature ……………………… Date ……………

Name: …………………………………………….……………………….

Co-Supervisor’s Signature;………………………………..Date………………

Name:…………………………………………………………………………...

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ABSTRACT

The study investigated the impact of contraceptive use on the sexual behaviours

of adolescents in Senior High Schools. The study espoused a descriptive survey

research method with the quantitative paradigm. Perception and Contraceptive

use on Sexual Behaviour questionnaire (PCSB) was administered to a sample

of 340 out of 2063 Senior High School students. Means and standard deviation

were used to analyse the data for the research questions. The hypotheses were

tested using independent samples t-test and ANOVA to test. The study revealed

that adolescents’ knowledge level on contraceptives use was adequate and was

above average. Again, it was established that those sources through which they

get the information included hospitals, peers, sexual partners, internet and

watching television. It was again found that adolescents agreed that

contraceptives knowledge and its usage would help prevent sexually transmitted

infections and unintended pregnancies among the adolescents. On the basis of

gender, there was no statistically significant difference between male and

female adolescent students in relation to contraceptive use. The researcher

recommends that, there is an urgent need for teachers, Ghana Education Service,

NonGovernmental Organizations (NGOs) and parents to undertake

programmes that would empower adolescents, especially females, to become

assertive in negotiating contraceptive use any time they want to have sex or

engage in unprotected sex.

iii

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ACKNOWLEDGEMENTS

I would like to express my utmost gratitude to Dr Dramanu Bakari of

the Department of Education and Psychology, who as my principal supervisor

made major contributions to the work, and offered professional guidance,

advice, and encouragement towards the success of this research work. I am

really grateful.

I wish to also recognize and acknowledge my indebtedness to Prof.

Kwao Edjah of the Department of Education and Psychology who as my

cosupervisor made immense contribution, and offered professional guidance for

me in line with the supervision of the work. I say a very big thank you.

Finally to my friends Yayra, Chris, Lady Barbara and Kafui for their

support and encouragement.

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DEDICATION

To my lovely wife Fafali Amehe, my late mother Victoria Akplah Dey, my

father Mr N. K. Dey, my sons, brothers and sisters.

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TABLE OF CONTENTS

Page

DECLARATION ii

ABSTRACT iii

ACKNOWLEDGEMENTS iv

DEDICATION v

LIST OF TABLES x

LIST OF FIGURES xi

CHAPTER ONE: INTRODUCTION

Background to the Study 1

Statement of the Problem 7

Purpose of the Study 8

Research Questions 9

Research Hypotheses 10

Significance of the Study 10

Delimitation 11

Limitations 11

Definition of Terms 12

Organization of the Study 12

CHAPTER TWO: LITERATURE REVIEW

Introduction 13

Theoretical Reviews 13

Sigmund Freud’s Psychosexual Theory of Development (1905) 13

Margaret Mead’s Cultural Anthropological Study of

Adolescence in Samoa (1928) 16

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Samoan Life and Education according to Mead 20

Social Learning Theory (SLT) – Albert Bandura 23

Social Learning Theory and Perception of Contraceptive Use 27

Conceptual Review 28

History of Contraceptives 28

Concept of Contraceptives 32

Contraceptives Usage 35

Type of contraceptives 39

Cervical cap – FemCap 40

Empirical Review 43

Age Difference in Contraceptive Use 43

Gender Difference in Contraceptive Use 44

Impacts of Contraceptive Use on the Sexual Behaviour of Adolescents 47

Knowledge Level of Adolescents about Contraceptive use 51

Sources of Information on Contraceptives and their usage 55

Impacts of Contraceptives use on Sexual Behaviour of

Adolescent Students 58

Ways in Improving/Enhancing Sexual Behaviours of Adolescent Students 60

Introduction of School-Based Sex Education Programmes 61

Parents-Adolescents’ Relationship Programmes 62

Adoption of Health-Based Adolescent Programmes 64

Youth-Based Development Programmes 65

Clinical-Based Programmes 67

vii

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CHAPTER THREE: RESEARCH METHODS

Introduction 71

Research Design 71

Population 72

Sample and Sampling Procedures 73

Data Collection Instruments 74

Validation of the instrument 75

Reliability of the Instrument 75

Ethical Considerations 76

Data Collection Procedure 77

Data Processing and Analysis 77

CHAPTER FOUR: RESULTS AND DISCUSSION

Introduction 79

Respondents’ Demographic Information 79

Analysis of Main Data 80

Research Question One 81

Research Question Two 83

Research Question Three 85

Research Question Four 88

Research Question Five 90

Factor Analysis Results 91

Factor Rotation 95

Analysis of Research Hypotheses 97

Research Hypothesis One 97

Research Hypothesis Two 98

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Research Hypothesis Three 99

Discussion 101

CHAPTER FIVE: SUMMARY, CONCLUSION AND

RECOMMENDATIONS

Introduction 107

Summary of Findings 108

Conclusion 109

Recommendations 109

Suggestions for Further Research 110

RFEERENCES 111

APPENDICES 130

A QUESTIONNAIRE 130

B RELIABILITY TEST 136

C SOURCES OF INFORMATION 137

D PERCEIVED EFFECTS 138

E PERCEIVED WAYS 139

F INTRODUCTORY LETTER 140

G ETHICAL CLEARANCE 141

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LIST OF TABLES

Table Page

1 Sample Size Proportions for the selected schools in the

Krachi - East District 73

2 Demographic Characteristics of the Selected Students 80

3 Results on the Perceived Knowledge Level of A

dolescent Students about Contraceptives Use 81

4 Results on the Sources of Information on Contraceptives Use 83

5 Perception of contraceptives Use on the sexual

behaviour of adolescent students 85

6 Results on the how Adolescent Students’ Perception of

Contraceptives use Improve their Sexual Behaviour 88

7 Results on the contraceptives well

known by the adolescents 90

8 KMO and Bartlett's Test Result 92

9 Results of the Exploratory Factor Analysis 93

10 Rotated Component Matrix 96

11 Results of t-test Comparing Gender Difference on the

Perception of the Use of Contraceptives 97

12 Results of t-test Comparing Type of School on the

Perception of the Use of Contraceptives 98

13 Summary of One-way Analysis of Variance (ANOVA) Results 100

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LIST OF FIGURES

Figure Page

1 Scree Plot 95

2 Mean Plots on ages of the Students by their

Perception of Contraceptives Use 100

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CHAPTER ONE

INTRODUCTION

Background to the Study

Pauline, Migosi and Mwania, (2013) reported that the population of

adolescents has been on the increase globally, representing more than 17 percent

of the total population and more than 90 percent of this adolescent population

lives in developing countries that includes Ghana. The Youth Net estimated

based on the trend in human population that by the year 2025, adolescent

population in the world will have doubled. This unprecedented increase in

adolescent population may pose enormous social and economic challenges to

nations globally (Pauline, Migosi & Mwania, 2013).

Generally, adolescence is an inevitable stage in human development as

it serves as a turning point in the life of everyone growing up. Adolescence by

definition is the transition from childhood to adulthood. It is the gap or stage

between the childhood and adulthood (Lewin-Bizan, Bowers & Lerner, 2010)

According to Larson and Wilson (2004), a thorough understanding of

adolescence as a period in human development in society depends on

information from various perspectives, including psychology, biology, history,

sociology, education, and anthropology. All these perspectives view

adolescence as a transitional period between childhood and adulthood, whose

cultural purpose is the preparation of children for adult roles. Coleman and

Roker (1998) were of the view that adolescence is a period of multiple

transitions involving education, training, employment and unemployment, as

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well as transitions from one living circumstance to another. Adolescence is

believed to be marked by increased rights and privileges for individuals as a

result of developmental changes. While cultural variation exists for legal rights

and their corresponding ages, considerable consistency in their development is

found across cultures. According to Fields, Bogart, Smith, Malebranche, Ellen

and Schuster (2012) many cultures define the transition into adult-like sexuality

by specific biological or social milestones in an adolescent's life. For instance,

menarche (the first menstrual period of a female), or semen arches (the first

ejaculation of a male) are frequent sexual defining points for many cultures. In

addition to biological factors, adolescents’ sexual socialisation is highly

dependent upon whether their culture takes a restrictive or permissive attitude

toward teen or premarital sexual activity. In the United States specifically,

adolescents are said to have raging hormones that drive their sexual desires.

These sexual desires are then dramatized regarding teen sex and seen as a site

of danger and risk; that such danger and risk is a source of profound worry

among adults (Fields et al, 2012).

Arnett (2007), in her view asserts that adolescence can be defined

biologically, as the physical transition marked by the onset of puberty and the

termination of physical growth; cognitively, as changes in the ability to think

abstractly and multi-dimensionally; or socially, as a period of preparation for

adult roles. Major pubertal and biological changes include changes to the sex

organs, height, weight, and muscle mass, as well as major changes in brain

structure and organisation.

According to Bailey (2003), the National Association of Social Workers

defined adolescence as the inception of bodily/erotic development and

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procreative ability in people. Adolescence is a developmental stage that is

characterised by many developmental changes that people are bound to adapt

and to learn new things. The changes in adolescence sometimes become

problematic due to societal factors which need to be understood and tackled.

These developmental changes compel adolescents to try new things that include

responses to their sexual urges which eventually lead adolescents to avoidable

problems. Bingenheimer, Asante and Ahiadeke, (2015) indicated, that

reproductive and sexual health problems attributable to sexual behaviours

among adolescents such as early initiation into sex, lack of contraceptives or

other contraceptive use, multiple partners, and high risk partners are widespread

among adolescents and young adults in sub-Saharan Africa. They explained that

adolescents within this part of the world are believed to be less knowledgeable

about contraceptives.

In fulfilling the biological need while developing as an adolescent,

different behaviours are depicted and this espouses sexual behaviours. Research

indicates that there is an urgent need for effective strategies to reduce the

number of problems in adolescence for the developing adolescents (Hilliard,

Powell, & Anderson, 2016). To develop such strategies, drivers of adolescents’

sexual behaviour and contraceptive use must be identified. In Latin America

adolescents start sexual activity at earlier ages and only few sexually active

youths take any measures for preventing pregnancy (Ali & Cleland, 2005).

Adolescents live within various backgrounds (family, peers, community etc.)

and their sexual behaviour is determined by diverse factors from these different

contexts that influence attitudes, knowledge, skills and norms (Pilgrim & Blum,

2012).

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According to the American Academy of Pediatrics (2001), the trend in

the sexual behaviours of adolescents have changed as latest statistics reveal

welcoming signs that primary and secondary prevention efforts may be starting

to have an effect as existing rates of sexual activity, pregnancy, and sexually

transmitted diseases (STDs) among adolescents remain a public health concern.

American Academy of Pediatrics, (2001) reported that when evaluating

available data for female and male adolescents, the increase in infections that

have taken place throughout time is greater, and this endorses the ongoing

reasons for concern on issues about adolescence. Doku (2012) reported that

apart from HIV infection, population explosion due to high birth rate in sub-

Saharan Africa is a global public health concern because adolescents constitute

the largest percentage of people in the developing countries, especially in sub-

Saharan Africa. To Doku (2012), promotion of safe sex and encouragement of

contraceptive use would contribute immensely to the reduction in sex-related

morbidity and mortality caused by teenage pregnancy, abortion, HIV/AIDS and

at the same time reduce population explosion.

According to Sonenstein, Pleck and Ku (1989), changes in sexual

activity among adolescent males have become surprising as the rate of 17 to 19

years old adolescents living in urban areas reported having sexual intercourse

with percentage increase from 66% to 76%. This revelation was followed by

similar studies that revealed a decrease in the number of adolescents aged

between 15 to 19 years old reporting having had sexual intercourse, from 60%

in 1988 to 55% in 1995 (Sonenstein, Ku, Lindberg, Turner & Pleck, 1998).

Although these are empirical evidence to show that adolescents engage in sexual

activities, it is believed that there exists little to no regularisation regarding

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adolescents having sex in the U.S., which causes conflict in how adolescents are

taught about sexual developmental changes and sex education. There is also a

continuous debate about whether abstinence-only, sex education or

comprehensive sex education should be taught in schools and this stems back to

whether or not it is being taught is permissive or restrictive.

According to Connolly, Craig, Goldberg and Pepler (2004), restrictive

cultures openly discourage sexual activity in unmarried adolescents or until an

adolescent undergoes a formal rite of passage. These cultures may attempt to

restrict sexual activity by separating males from females throughout their

development, or through public shaming and physical punishment when sexual

activity does occur. According to Chein, Albert, O’Brien, Uckert and Steinberg

(2011), in less restrictive cultures, there is more tolerance for displays of

adolescent sexuality, or of the interaction between males and females in public

and private spaces. Less restrictive cultures may tolerate some aspects of

adolescent sexuality, while objecting to other aspects. For instance, some

cultures find teenage sexual activity acceptable but teenage pregnancy highly

undesirable. Other cultures do not object to teenage sexual activity or teenage

pregnancy, as long as they occur after marriage. In permissive societies, overt

sexual behaviour among unmarried teens is perceived as acceptable, and is

sometimes even encouraged (Chein, et al. 2011). Regardless of whether a

culture is restrictive or permissive, there are likely to be discrepancies in how

females versus males are expected to express their sexuality. Cultures vary in

how overt this double standard is, in some, it is legally inscribed, while in others

it is communicated through social convention (Diamond, & Savin- Williams,

2009).

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The American Academy of Paediatrics (1998) indicated that,

approximately half of all adolescents are sexually active, have high rates of

adolescent pregnancies and STDs remain a significant concern for the fact that

about 900 000 adolescents become pregnant each year, with up to two thirds of

these pregnancies occurring in women 18 to 19 years old and one third in

women 17 years or younger. Kirby, (2002) reported that the menace of AIDS,

as well as the threat of other Sexually Transmitted Diseases(STDs) and

pregnancy, have called for concern and many schools across the world without

school-based sex education have started making contraceptives available

through school counsellors, nurses, teachers, vending machines, or baskets. This

step is laudable but it seems to be different in Ghana because it seems culturally

impracticable whereby students would be given contraceptives through school

counsellors to prevent sexual-related problems. The Ghanaian culture seems to

frown upon even the mere discussion of sex related issues, let alone supplying

goodies that may in one way or the other bring about a seeming wholesale

welcoming of sexual activities among adolescents.

Although it is unknown as to whether contraceptives are given to

adolescents in schools to control sexual behaviour, yet it is possible to believe

that adolescents may be using contraceptives and this may not be known by

many due to the lack of sex education and research in this domain in Ghana.

Consequently, although sexual health promotion including HIV/AIDS

prevention in Ghana, abstinence, being faithful to one’s partner and the use of

Contraceptives, the former is most emphasised because of religious and cultural

values. The extent to which these cultural, religious values and abstinence

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messages promote delay of sexual debut among young people as well as

adolescent sexual behaviours in general is less known (Doku, 2012).

Statement of the Problem

Issues about adolescence as a transitional period of development are

known to be an age-long thing yet many people are believed not to be equipped

with the challenges that hover around this period of development in humans.

Boamah (2012) indicated adolescence as a stage of life, can be a challenging

phase in life. People growing up at this stage have the responsibility of

identifying themselves in the society they are found. Their youthful vigour

predisposes them to lots of exploration and risk taking behaviours in all aspects

of life that is limitless including the use of contraceptives (Aras, Orcin, Ozan,

& Semin, 2007). It is believed also that the inadequacy of knowledge and

information related to adolescent development has been compounding.

The lack of useful adolescent sexual health education globally has

brought about the high rates of adolescent-related problems such as unplanned

pregnancies and sexually transmitted diseases among this group of people

(American Academy of Paediatrics 1998). A study conducted by the

Department of Primary Care in Brazil in 2011 revealed that virtually all

adolescents can identify a contraceptive method but its use has hardly been

altered. This information demonstrates that there are other factors responsible

for contraceptive use, thus, adolescents are now able to identify what a

contraceptive method is, but then, their sexual health and sexual behaviours

remain unchanged (Almeida, Estela, Lynne & Robert, 2003).

According to the American Academy of Paediatrics (2001) policy

document, the medical and social consequences of adolescent sexual activity

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are a national health concern for many countries globally, has been associated

with unplanned pregnancies and the contraction of sexually transmitted diseases

(STDs), including human immunodeficiency virus (HIV). The problem now is

how best to decrease unplanned pregnancies and STDs rates among adolescents.

It has become a topical issue and has attracted much debate worldwide, but with

particular misunderstandings surrounding the roles of sexuality education and

contraceptives availability for the teeming youthful population of the world

(American Academy of Paediatrics, 2001). It is therefore convincing to believe

that contraceptives use among adolescents may be common and possible as their

attitudes and behaviours towards sexual encounters or activities and their

associated problems or challenges remain questionable globally.

Krachi-East District is a community that is also burdened with issues of

adolescents’ sexual behaviours which results in teenage pregnancies and other

crippling consequences. A data collected from the Krachi-East District hospital

showed that, among the pregnant women in the district, majority of them are

between the ages of 12 to 19 years. It is based on this conviction that

I have investigated the perceptions of adolescents’ contraceptives use and its

impact on sexual behaviour among senior high schools in the Krachi-East

District in the Volta Region of Ghana.

Purpose of the Study

Generally, the study investigated the perception of contraceptives use

and its impact on adolescents’ sexual behaviour. Specifically, the study sought

to find out:

1. The knowledge level of adolescents’ contraceptive use.

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2. Sources from which adolescent students get information about

contraceptives use.

3. The influence of contraception use on sexual behaviour of adolescent

students.

4. Whether gender difference influence the perception of contraception

use.

5. Whether there is a difference in perception on contraceptive use among

public and private Senior High School adolescent students.

6. Whether age difference among adolescent students influence

contraceptive use.

7. Whether perception of contraceptives use can improve the sexual

behaviour of adolescent students.

8. The contraceptives that are well known by the adolescent students.

Research Questions

1. What is the knowledge level of adolescent students about contraceptives

use?

2. What are the sources of information on the usage of contraceptives

among adolescents?

3. What are the effects of the perception of contraceptives use on the sexual

behaviour of adolescent students?

4. What is the impact of the perception of contraceptives use on the sexual

behaviour of adolescent students?

5. What contraceptives are well known to the adolescent students?

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Research Hypotheses

1. H0: There will be no statistically significant difference between male

and female students’ perception on the use of contraceptives.

HA: There will be a statistically significant difference between male and

female students in their perception on the use of contraceptives.

2. H0: There will be no statistically significant difference in the perception

of contraceptives use among students in private and public schools.

HA: There will be a statistically significant difference in the perception

of contraceptives use among students in private and public schools.

3. H0: There will be no statistically significant age difference in the

perception of contraceptive use among adolescent students.

HA: There will be a statistically significant age difference in the

perception of contraceptive use among adolescent students.

Significance of the Study

The study was about how adolescents perceive contraceptives, their

knowledge of its usage and how such knowledge impacts on their sexual

behaviours.

The study findings may also direct the attention of stakeholders in sexual

health education and mainstream education, towards the introduction of sex

education in schools. In light of this, adolescents would be exposed to genuine

information about contraceptive use and how to control their sexual behaviours

in the positive dimension.

Corporate organisations such as Non-Governmental Organizations that

share interest in adolescent reproductive health can tap into the findings of the

study and use the result to educate adolescents in the country.

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Being the first of its kind in the district the study may serve as a wake-

up call for parents to push for the introduction of a sex education curriculum in

schools to educate their adolescents at this crucial developmental stage in their

lives.

Above all, the study may add up to literature and also serve as a point of

reference to other researchers in similar study focus.

Delimitation

The study was delimited to the private and public senior high schools in

the Krachi East District of the Volta Region. This is because it is believed that,

those in the senior high schools fall within adolescence. It is also delimited to

the use of Contraceptives that are available to adolescents. The study mainly

focused on the second year senior high school students only. This is because,

the third years have entered the critical period of their final examination and the

first years have not gained enough experience as far as adolescence life is

concerned especially at the senior high school.

Limitations

Like all other studies, this study may be susceptible to methodological

errors resulting from responses of the study participants. Having that in mind as

a researcher, there were modalities to curtail all methodological hitches in order

to come out with accurate and reliable findings. Such methodological strategies

included accurate representative sample from the population in order to arrive

at a reliable result and to empirically describe the phenomenon in the study. The

instrument for data collection was dully pre-tested.

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Definition of Terms

The following words have operationally been defined.

Adolescence: It is the period following the onset of puberty during which a

young person develops from a child in to an adult.

Perception: This refers to the organization, identification, and interpretation of

sensory information in order to represent and understand the presented

information.

Sexual behaviour: This refers to a broad spectrum of behaviours in which

adolescents display their sexuality.

Contraceptives: These are pills or devices, used during or after sexual

intercourse to reduce the probability of pregnancy or a sexually

transmitted infection (STIs). There are both male and female

contraceptives.

Organization of the Study

The study comprised of five chapters where the chapter one precedes

this level and will include the background to the study, statement of the study,

purpose of the study, research questions, and hypotheses, significant of the

study, delimitation and limitations. The chapter two was about the literature

review which included the theoretical review, conceptual review and empirical

review. Chapter three espoused the research methods and the foundational and

this includes the research design, population, sampling procedure, data

collection, validation, ethical consideration, data collection processes and data

processing and analysis. Chapter four considered results and discussion and

chapter five wrapped up the study with summary and conclusions.

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CHAPTER TWO

LITERATURE REVIEW

Introduction

The main purpose of the study was to investigate the impact of

contraceptive use on the sexual behaviours of adolescents in Senior High

Schools. The literature was reviewed under three sub-headings based on the

research questions. (1) Theoretical review (2) Conceptual review and (3)

Empirical review.

Theoretical Reviews

Sigmund Freud’s Psychosexual Theory of Development (1905)

The psychosexual theory held the view that, every transition in all the

stages from infancy to adult results in specific modes of need-gratification. One

has to be changing and modifying the ways of satisfying desires otherwise

stagnation on regression may occur Freud (1905).

Freud’s theory is part of the psychodynamic family who has the

general conviction about the unconscious mind and how it influences

personality. More specifically, Freud’s concentration was on pleasure, anxiety

or fear that people encounter as they keep growing. As a pioneer and proponent

of psychosexual development, Freud viewed human development to be

characterised by five (5) distinct stages namely oral, anal, phallic, latency and

the genital stages (Myre, 1974). Freud opined that human beings from birth are

with innate sexual energy built through the stages of development as the

individual progresses on the growth ladder (Bullock & Trombley, 1999).

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To Freud, the human mind is structured into three (3) distinct layers

namely id, ego and superego that work in tandem to determine the behaviour

people put up in their interaction with societal factors. The id is believed to be

animalistic as its concentration is about satisfying sexual energies instantly

without recourse to societal norms and their consequences. The ego tagged as

the mediator operates on the reality direction by valuing situations through

mutual coherence before executing any intended action initiated and motivated

by instinctual drives. The superego works with morals by putting negative

thoughts at bay and championing the cause of societal values.

According Freud (1905), people present behaviours and personalities

that are as a result of early childhood experiences because personality to Freud

is formed around age 5 where the id needs to be controlled to suit demands of

the society people live. The understanding is that, peoples’ behaviours and

personalities today come from the way they were nurtured in early years of life.

If children are not nurtured in good ways that conforms to established norms

within their environment, such children might be tagged with maladaptive

descriptive adjectives.

According to Freud, each developmental stage comes with challenges

that need to be resolved separately because development to him is

discontinuous. Success at any stage brings about good attributes to personality

and the failure brings about maladaptive personality attributes. For the case of

the present study, the concentration is on the latency and genital stages of the

psychosexual development because that stage represents the stage of

adolescence. With respect to the psychosexual development, in early stages of

adolescence, people reach the genital stage from latency stage and throughout

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the adolescence the genital phase is maintained. The sexuality, which remains

dormant during the latency stage becomes active during the genital phase.

During adolescence, the need for closeness and love making with the opposite

sex increases and adolescents explore about different appropriate ways to

express love and intimacy (Kar, Choudhury, & Singh, 2015).

According to Ott (2010), applying psychosexual views in adolescence

indicate that the development of an adolescent does not occur in isolation, rather

in the background of the family, society in a defined culture that meaningfully

influences the adolescent’s sexuality. Society’s attitude and cultural perception

of sexuality largely have an influence on the families in which an adolescent

nurtures and his or her sexuality values.

The genital stage marks the end of Freud’s psychosexual theory of

personality development and has its genesis from puberty. According to

McLeod (2008), the stage is a period of adolescent sexual experimentation, the

successful resolution of which is settling down in a loving one-to-one

relationship with another person in late adolescence. Sexual instincts are

directed to opposite sex pleasure, rather than self-pleasure. For Freud, the

proper channel of the sexual instincts in adults is through the opposite sex

intercourse. Fixation and conflict may prevent this with the consequence that

sexual perversions may develop. For example, fixation at the oral stage may

result in a person gaining sexual pleasure primarily from kissing and oral sex,

rather than sexual intercourse (McLeod, 2008).

This theory is relevant to this study because, regarding contraceptive

use, it is well thought that sexual behaviours adolescents put up are as a result

of their earlier (childhood) interactions with their environment. Any risky sexual

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behaviour detected might be caused by parents as they were nurturing the

growing child. The actions of parents and family members have toll on the

individual’s personality based on the kind of approval or disapproval meted out

such behaviours during childhood years. Children can be rebuked for sexual

wrong doings per Freud’s view but it should be in a welcoming way so that

children would feel unoffended. If they become offended, the worse might

happen as they grow. Ideally, parents need to be truthful to their adolescents

when it becomes evident that they are showing signs of sexual maturity so that

they can learn appropriate sexual behaviours that will aid their smooth

development to adulthood.

Taking this theory into consideration, being realistic as a parent with

issues in human sexuality is very critical as attitudes in children are developed

based on what they experience. Again, parents should try to avoid overemphasis

on some sexual behaviours shown by adolescents, as this alone can cause

adolescents to experience fear in attempting those sexual behaviours even if it

becomes ideal for them when they are grown and can lead to sexual dysfunctions

in later life.

Margaret Mead’s Cultural Anthropological Study of Adolescence in Samoa

(1928)

Mead (1928) was interested in the effect of early childhood influences

on adult personality and behaviour. Her investigations cantered on the interplay

between biological and cultural factors, based on Freud’s notion that

childrearing practices had profound effects on adult personality. Her attempts to

separate the biological and cultural factors that control human behaviour and

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personality development led to establishing the cultural configuration and

national character approaches in American anthropology.

Felder (2003) studied the sexual life of adolescents in Samoan society

in the early 20th century, and theorizes that culture has a leading influence on

psychosexual development. Due to her academic relationship studying with

Boas, who influenced Mead to answer the debate of whether adolescence was a

universally traumatic and stressful time due to biological factors or whether the

experience of adolescence depended on one’s cultural upbringing.

To answer the above questions, she conducted a study among a small

group of Samoans in a village of six hundred people on the island of Tau. Mead

based her research and study on youth, primarily adolescent girls. She got to

know, lived with, observed, and interviewed 68 young women between the ages

of 9 and 20 in three villages of Tau Island. Once she had an understanding of

Samoan culture she delved into the specifics of how adolescent education and

socialisation are carried out in Samoan culture and contrasted it with western

culture that is a bit restrictive in terms of adolescence sexuality (Mead, 1928).

In her findings, she reported that adolescence was not a stressful time, compared

with the expectation of adolescent “stress” in Western societies. She attributed

this difference to cultural factors. She argued that, living in a small culture where

people shared a similar value system, Samoan adolescent girls did not face

numerous conflicting personal choices and demands concerning issues of

human sexual behaviours. This conclusion was based on the observations that

Samoan cultural patterns were very different from those in the United States.

Mead’s theory was associated with general discussion of the problems

facing adolescents in modern society and the various approaches to understand

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these problems thus religion, philosophy, educational theory and psychology.

Mead (1928) posits that the transition from childhood to adulthood through

adolescence in Samoa was a smooth changeover, not constraint with emotional

or psychological distress, anxiety or confusion as seen in Western World and

the Americas. This portrays a society characterised by a lack of deep feelings

and by a lack of conflict, neuroses, and difficult situations. Mead concluded that

this was due to the Samoan girl’s belonging to a stable, monoculture society,

surrounded by role models where nothing concerning the basic human facts of

sexual intercourse, child birth, bodily functions and death were hidden.

To Mead the Samoan adolescent girl was not pressured to choose from

among a variety of conflicting values, as was the Western or the American girl.

Mead maintains that, generally, the major task facing adolescents today is the

search for a meaningful identity. This task is immeasurably more difficult in a

modern democratic society than in a primitive society like Samoa. The

behaviour and values of parents no longer constitute models, since they are

outmoded as compared to the models provided by the mass media and other

contemporary figures. Furthermore, the adolescent in the process of freeing the

self from dependency on parents is not only unresponsive, but frequently

antagonistic to their value system. Since the adolescent has been taught to

evaluate his or her behaviour against that of his age-mates, he or she now throws

out the parents value system and exchanges it for the customary of peers.

According to Muuss (1975), rapidity of social change, exposure to various

secular and religious value systems, and modern technology make the world

appear to the adolescent too complex, too relativistic, too unpredictable, and too

ambiguous to provide him with a stable frame of reference.

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Mead (1928), in describing the personality and sexuality of Samoans

posits that, the psychology of the individual Samoan is simpler, more honest,

and less driven by sexual neuroses than the west. Mead describes Samoans as

being much more comfortable with issues such as menstruation and more casual

about non-monogamous sexual relations and part of the reason for this is the

extended family structure of Samoan villages.

Mead does advocate greater freedom for the adolescent and less

conformity to family, peer and community expectations to allow the adolescent

to realise his creative potential. Muuss (1975) retorted that people can attempt

to alter out whole culture, and especially their child-rearing patterns, so as to

incorporate within them a greater freedom for and expectation of variations.

Mead criticized the American family for its too intimate organisation and its

crippling effect on the emotional life of the growing youth as she believed that

too strong family ties handicap the individual in his or her ability to live his own

life and make his own choices. Mead suggested that it would be desirable to

alleviate, at least in some slight measure, the strong role which parents play in

children’s lives and so eliminate one of the most powerful accidental factors in

the choices of any individual life.

Mead describes some specific skills the children must learn related to

weaving and fishing and then almost casually interjects the first description of

Samoan sexuality saying that in addition to work for adolescent girls “All of her

interest is expended on clandestine sex adventures”. This comes directly after a

passage where Mead describes how a reputation for laziness can make an

adolescent girl a poor candidate for marriage, implying that for Samoans a work

ethic is more important criteria for marriage than virginity.

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In the Samoan household according to Mead (1928), male adolescents

undergo various kinds of both encouragement and punishment to make them

competitive and aggressive. For the males there are many different possible

jobs, for instance a house builder, a fisherman, an orator, a wood carver in the

community. Status is also a balance between prowess and achievement and

appearing humble and also, social prestige is increased by his romantic or sexual

exploits. For the female adolescents, status is primarily a question of who they

will marry as Mead described adolescence and the time before marriage as the

high point of a Samoan female adolescents’ life: but the 17year-old female

adolescent does not wish to marry because it is better to live as a girl with no

responsibility but a rich variety of experience in terms of sexuality (Mead,

1928).

Samoan Life and Education according to Mead

Mead describes child education starting with the birth of children which

is celebrated with a lengthy ritual feast. After birth however, children are mostly

ignored, for girl children sometimes explicitly ritually ignored, after birth up to

puberty. She describes the various methods of disciplining children. Most

involve some sort of corporal punishment such as hitting with hands, palm

fronds, or shells in a hierarchical order. However, the punishment is mostly

ritualistic and not meant to inflict serious harm. Children are expected to

contribute meaningful work from a very early age. Initially, young children of

both sexes help to care for infants. As the children grow older however the

education of the boys shifts to fishing while the girls focus more on child care.

However, the concept of age for the Samoans is not the same as the west. They

do not keep track of birth days and they judge maturity not on actual number of

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years alive but on the outward physical changes in the child. As a child gets

bigger and stronger he or she gets more work and responsibility.

Mead describes some specific skills the children must learn related to

weaving and fishing and then almost casually interjects the first description of

Samoan sexuality saying that in addition to work for adolescent girls “All of her

interest is expended on clandestine sex adventures”. This comes directly after a

passage where Mead describes how a reputation for laziness can make an

adolescent girl a poor candidate for marriage, implying that for Samoans a work

ethic is more important criteria for marriage than virginity. Male adolescents

undergo various kinds of both encouragement and punishment to make them

competitive and aggressive. For the males there are many different possible

jobs, for instance a house builder, a fisherman, an orator, a wood carver in the

community. Status is also a balance between prowess and achievement and

appearing humble. Also, social prestige is increased by his amorous exploits.

For the adolescent girls, status is primarily a question of who they will marry.

Mead also describes adolescence and the time before marriage as the high point

of a Samoan girls’ life: But the seventeen-year-old girl does not wish to marry.

It is better to live as a girl with no responsibility, and a rich variety of experience.

According to Mead, this is the best period of her life (Mead, 1928).

According to Mead, a Samoan village is made up of some thirty to forty

households, each of which is presided over by a head man. Each household is

an extended family including widows and widowers. The household shares

houses communally, each household has several houses but no members have

ownership or permanent residence of any specific building. The houses may not

all be within the same part of the village. The head man of the household has

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ultimate authority over the group. According to Mead, the extended family

provides security and safety for Samoan children. Children are likely to be near

relatives no matter where they are and any child that is missing will be missed

quite rapidly. The household also provides freedom for children including girls.

According to Mead if a girl is unhappy with the particular relatives she happens

to live with, she can always simply move to a different home within the same

household. Mead also describes the various and fairly complex status relations

which are a combination of factors such as role in the household, the

household’s status within the village, the age of the individual. There are also

many rules of etiquette for requesting and granting favours (Mead, 1928).

Despite the freedom offered for adolescents in terms of adolescent’s

sexual behaviour, it is flawed on the following grounds: Muuss (1975) points

out that even though Mead objects to the pattern of the American family

produces conformity and dependency in its children, she considers the family a

tough institution and demonstrates that it is nearly universal. Mead knows of

no better way to produce wholesome individuals than through a tolerant family

system in which father says “yes” and mother says “no” about the same thing

and in which the adolescent can disagree with his parents without a resulting

loss of love, self-respect, or increase of emotional tensions.

Freeman (1983), in his criticism challenged all of Meads major findings.

He claimed Mead failed to apply the scientific method and that her assertions

were unsupported He participated in the filming of Margaret Mead in Samoa,

directed by Frank Heimans, which claims to document one of Mead’s original

informants, now an elderly woman, swearing that the information she and her

friend provided Mead when they were teenagers was false; one of the girls

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would say to Mead on videotape years later: We girls would pinch each other

and tell her we were out with the boys. We were only joking but she took it

seriously. As you know, Samoan girls are terrific liars and love making fun of

people but Margaret thought it was all true (Heimans, 1987). Pinker (2009) has

also contested many of Mead’s claims, and argued that she was hoaxed into

counterfactually believing that Samoan culture had more relaxed sexual norms

than Western culture.

In the light of Mead’s theory to the perception of contraceptive use and

its impact on adolescents’ sexual behaviour, the Ghanaian homes and families

can mostly be related to the Western culture where transition from childhood to

adulthood through adolescence is not a smooth changeover, filled with

emotional or psychological distress, anxiety or confusion. The sexual freedom

experienced by the adolescent Samoans, is strongly restricted and vehemently

prohibited among adolescents in Ghana by parents, adults and authorities. The

anxiety and confusion most Ghanaian adolescents experience as a result of this

restrictions, turn to rebel against parents and authorities by engaging in

unhealthy sexual behaviours and practices of which the end effect is well

known. On the other hand, in order to encourage smooth transition among

adolescents in Western world, the practice of the Samoans can be adapted by

parents and authorities to expose and educate early adolescents about sex and

the use of contraceptives. This practice can reduce the conflict and stress

between parents and adolescents.

Social Learning Theory (SLT) – Albert Bandura

The main focus of social learning theory is learning that occurs within a

social context. It posits that through concepts such as observational learning,

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imitation, and modelling, people learn from one another. Among others Albert

Bandura is considered the leading proponent of this theory. Earlier learning

theories emphasised how individuals behave in response to environmental

stimuli, such as physical rewards or punishment (Johnson, 2017). On the

contrary, social learning theory emphasises the reciprocal relationship among

social characteristics of the environment, how they are perceived by individuals,

and how motivated and able an individual is to reproduce behaviours they see

happening around them. Individuals both influence and are influenced by the

world around them (Johnson, 2017).

Social learning theory has become conceivably the most influential

theory of learning and development (Nabavi, 2012). The principles of social

learning theory according to Bandura (1977) are assumed to operate in the same

way throughout life. Observational learning may take place at any age. As long

as exposure to new influential, powerful models who control resources may

occur at life stage, new learning through the modelling process is always

possible. (Newman & Newman, 2007). Bandura (1965), mentioned that based

on these general principles, learning can occur without a change in behaviour.

In other words, behaviourists believe that learning has to be represented by a

permanent change in behaviour; while in contrast social learning theorists argue

that because individuals can learn through observation alone, their learning may

not necessarily be shown in their performance (Bandura, 1965). Learning may

or may not result in a behaviour change (Bandura, 2006b). Bandura (1965)

stated that, individuals learn from one another in the social context, through:

Observation; Imitation; and Modelling.

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In 1961 Bandura conducted an experiment known as the Bobo doll

experiment, to study patterns of behaviour, by social learning theory, and that

similar behaviour s were learned by individuals shaping their own behaviour

after the actions of models. Bandura’s results from the Bobo Doll Experiment

changed the course of modern psychology, and was widely credited for helping

shift the focus in academic psychology from pure behaviour ism to cognitive.

The experiment is among the most lauded and celebrated of psychological

experiments (Newman & Newman, 2007). The study was significant because it

departed from behaviour ism’s insistence that all behaviour is directed by

reinforcement or rewards. The children received no encouragement or

incentives to beat up the doll; they were simply imitating the behaviour they had

observed. Bandura (1977), termed this phenomena observational learning and

characterized the elements of effective observational learning as attention,

retention, reciprocation and motivation. He demonstrated that children learn and

imitate behaviour s which they have observed in other people.

Individuals that are observed are referred to as models. Children in the

society are surrounded by many influential models, such as parents within the

family, characters on children’s TV, friends within their peer group and teachers

at school. These models provide examples of behaviour to observe and imitate.

Children pay attention to some of these individuals (models) and encode their

behaviour. At a later time they may imitate (i.e., copy) the behaviour they have

observed. They may do this regardless of whether the behaviour is ‘gender

appropriate’ or not.

Bandura mentions four necessary conditions which are needed in

modelling process. By considering these steps, an individual can successfully

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make the behaviour model of someone else. These steps are attention, retention,

reproduction and motivation. Attention is the extent to which an individual is

exposed to /notice the behaviour (McLeod, 2016). For a behaviour is imitated,

it has to grab the observer’s attention. The person must first pay attention to the

model. The more striking or different something is the more likely it is to gain

attention (Nabavi, 2012). Likewise observers take more notice, of something or

someone that is regarded as prestigious, attractive or resemblance (Nabavi,

2012).

Retention is how well the behaviour is remembered (McLeod, 2016).

The behaviour may be noticed but is it not always remembered which obviously

prevents imitation (McLeod, 2016). The observer must be able to remember the

behaviour that has been observed. One way of increasing this is using the

rehearsal technique (Nabavi, 2012). The third condition is the ability to replicate

the behaviour that the model has just demonstrated (Nabavi, 2012). This

indicates that the observer has to be able to replicate the action, which could be

a problem with a learner who is not ready developmentally to replicate the action

(Nabavi, 2012). It is not always possible to reproduce behaviour we see on a

daily basis. We are limited by our physical ability and for that reason, even if

we wish to reproduce the behaviour, we cannot (McLeod, 2016). This influences

observer’s decisions whether to try and imitate it or not. For instance, imagine

a toddler who struggles to walk watching his or her brother play football. The

toddler may appreciate that the skill is a desirable one, but will not be able to

imitate it because he or she is physically not ready (McLeod, 2016).

Motivation is the will to perform the behaviour (McLeod, 2016). The

final necessary step for modelling to occur is motivation, learners must want to

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demonstrate what they have learned (Nabavi, 2012). It is worth to note that,

since these four conditions vary among individuals, different people will

reproduce the same behaviour differently. Reinforcement and punishment play

an important role in motivation (Nabavi, 2012). If the perceived rewards

outweigh the perceived costs (if there are any), then the behaviour will be more

likely imitated by the observer (McLeod, 2016). If the vicarious reinforcement

is not seen to be important enough to the observer, then the likelihood the

behaviour will not be imitated (McLeod, 2016).

The social learning theory takes thought processes into account and

acknowledges the role it play in deciding if a behaviour is likely to be imitated

or not. As such, SLT provides a more comprehensive explanation of human

learning by recognizing the role of mediational processes.

Social Learning Theory and Perception of Contraceptive Use

The principles of social learning theory can be applied to almost any

social and behaviour change that aims to influence social behaviour s,

particularly behaviour s that are complex or involve interactions with other

people (Health Communication Capacity Collaborative, 2014). It may be

especially useful when a particular behaviour like the sexual behaviour of

adolescents is difficult to describe, but can be explained through demonstration

or modelling. Also, when adopting or practicing a particular behaviour, for

instance perception in contraceptive use which requires overcoming barriers or

challenges, social learning principles can be used to demonstrate how a person

can overcome those challenges and succeed (Health Communication Capacity

Collaborative, 2014). Finally, because people tend to adopt and practice

behaviour s they see others doing, social learning principles can be used to

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change perceptions of the social environment (example; perception in

contraceptive use among adolescents), making behaviour s seem more common

and providing social support to people who are considering a behaviour change

(Health Communication Capacity Collaborative, 2014).

For instance, in the year 2010, there was high rise of HIV infection in

South Africa, a South African entertainment-education television applied

observational learning by producing a TV series about sex, love, and

relationships, and how secrets within those relationships can place individuals

at risk for HIV infection (Health Communication Capacity Collaborative,

2014). In 2011, the Centre for AIDS Development, Research and Evaluation

(CADRE) in South Africa, conducted an evaluation of the impact of the TV

series on viewer’s lives and health outcomes. Findings from the evaluation

showed that, 23,000 to 4 million viewers of the series reported taking concrete

steps to change or modify their behaviour in line with what they had seen

characters do on the show, particularly when it came to consistent

contraceptives usage and undergoing HIV testing and counselling (Health

Communication Capacity Collaborative, 2014). Therefore in dealing with the

perception of contraceptive use and its impact on the sexual behaviours of

adolescents, adopting the principles of social learning theory can be adopted to

address the issue.

Conceptual Review

History of Contraceptives

The earliest insight into fertility regulation at the personal level dates

back to the 13th century. Contraceptives are the methods of the family planning

framework which allows programme persons and couples to define the number

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of children, when and at what interval to have them (Intra Health, 2010).

According to a report by Encarta (2006), a variety of birth control methods have

been used throughout history and across cultures.

In ancient Egypt, women used dried crocodile dung and honey as vaginal

suppositories to prevent pregnancy. One of the earliest vaginal suppositories

appears in the Elders Medical Papyrus, a medical guide written in 1500. The

guide suggests that a fibre tampon moistened with herb moisture of acacia,

dates, colocynth and honey would prevent pregnancy. The fermentation of this

mixture can result in the production of lattice which today is recognized as a

spermicide. Before the introduction of the modern contraception like birth

control pill, women ate or drank various substances to prevent pregnancy. The

seeds of Queen Anns lace, pennyroyal giant fennel, and many other concoctions

of plants and herbs were used as oral contraceptives. However, such folk

remedies can be dangerous or fatal (Encarta, 2006). Women in other parts of the

world have used all forms of method to control birth. Chinese women drank

mercury – now known to be toxic to achieve contraception. The Greeks

consumed diluted copper ore; the Italians sipped a tea of willow leaves with

mule’s hoof, whilst the Africans drank gun powder and camel foam (Zimbard

& Weber, 1994).

Contraception or birth control is deliberate prevention of pregnancy

using any of several methods. Birth control prevents female sex cell from being

fertilized by a male sex sperm cell and implanting it in the uterus. In United

States of America, about 64% of women aged 15 – 40 years practice some form

of birth control. When no birth control is used, about 85% of sexually active

couple experience pregnancy within one year (American Academy of

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Pediatrics, 1999). There are a variety of birth control methods to choose from,

although most options are for women. Selection of a method is a personal

decision that involves consideration of many factors including convenience,

side effect and reversibility that is (whether the method is temporary or

permanent).

For instance, some people may prefer a birth control option that

provides continuous protection against pregnancy, while others may prefer a

method that only prevents pregnancy during a single act of sexual intercourse.

Because of contraceptives, men and women have been able to control the

number of children they produce while still fulfilling their own adult

relationships. In the past, contraceptives were symbols of control for women, as

they allowed more control over how many children they gave birth to, which

was a major health issue for many years. In recent years, birth control has been

more widely accepted and used although some religious groups, as well as

individuals, disagree with the use of birth control methods and drugs.

The concept of contraceptives and family planning, as earlier stated, is

an old one. It rose out of a universal need for people to enjoy sex and not be

saddled with a pregnancy after the act; that is, being able to space or limit births

(Glasier, Gülmezoglu, Schmid, Moreno, & Van Look, 2006). Methods such as

celibacy, sexual taboos, abstinence, withdrawal (coitus interruptus), and

induced abortion were commonly used by many ancient societies (Frejka, 2008;

Woods, Hensel, & Fortenberry, 2009).

The layman’s definition of contraception is about protection and

prevention of human related sexual problems. Contraception is noted to be a

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control method, to and represents a general term for the use of devices or acts

that prevent sexual-related problems during intercourse (Vocabulary.com).

The term is formed by blending together the Latin word “contra”, meaning

“against” and a shortened form of French word “concepcion”, meaning

“conception” (against conception). The term is believed to be propounded in the

19th century, when the science of birth control was beginning to be seriously

considered. Contraceptives such as birth control devices that had been around

then in unrefined forms, began to be produced in larger quantities and were

eventually socially accepted by people (Vocabulary.com). With this at the time,

it can be concluded that contraception was not all that effective because it was

in the early years.

According to Hanson, Burke and Anne (2010), contraception has been

used since ancient times, but effective and safe methods of birth control only

became available in the 20th century for people to plan their marital and sexual

relationship lives. According to Daniels, Daugherty and Mosher (2015) there

are a number of contraception types ranging from medical, hormonebased and

physical-based. The medical-based contraception is about caesarian methods in

preventing and controlling sexual-related problems on people (vasectomy, tubal

ligation, intrauterine devices (IUDs) and implantable controls). The hormone-

based is about introducing chemicals into the body of people to protect and

prevent them from contracting sexual-related problems (oral pills, patches,

vaginal rings, and injections). The physical-based is known as barrier method

and is about physically applying preventive and protective tools to avoid sexual-

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According to Daniels, Daugherty and Mosher (2015) among the

numerous types of contraception, it is touted that the medical-based are the most

effective protective and preventive measure as it is characterised by permanence

using. It is permanent and for one to get back normality is impossible, however,

the person will still look healthy but cannot forth bring offspring.

The least effective methods are spermicides and withdrawal by the male

before ejaculation (Daniels, Daugherty & Mosher, 2015) Sterilization, while

highly effective, is not usually reversible; all other methods are reversible, most

immediately upon stopping them. According to Taliaferro, Sieving, Brady and

Bearinger (2011), safe sex practices methods such as with the use of male or

female Contraceptives as contraceptive can also help prevent sexually

transmitted infections while the others cannot. Chin et al., (2012) reported that

not all contraceptives work for prevention of contractible sexual-related

problems, but Contraceptives do.

Concept of Contraceptives

The layman’s definition of Contraceptives can be termed as obstruction

or barricade to sexual-related problems. According to Hatcher and Nelson

(2007), a contraceptives is a sheath-shaped barrier device used during sexual

intercourse to reduce the probability of pregnancy or a sexually transmitted

infection (STIs). According to Daniels, Daugherty & Mosher (2015),

contraceptives are of different categories, thus, male and female Contraceptives.

Records show that with proper use and use at every act of sexual intercourse,

women whose partners use male contraceptives experience a 2% per-year

pregnancy rate (Hatcher & Nelson, 2007). Hatcher and Nelson (2007) indicated

that the use of contraceptives greatly decreases sexually transmitted infections

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and the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and

HIV/AIDS, protect against genital herpes, human papillomavirus (HPV), and

syphilis.

According to Speroff and Darny (2012), the use of contraceptives is

precautionary and its use by males should be trolled onto a rigid or an erected

penis before intercourse and works by blocking semen from entering the body

of a sexual partner. Male condoms are typically made from latex and less

commonly from polyurethane or lamb intestine and these contraceptives have

the advantages of ease of use, easy to access, and few side effects (Hatcher &

nelson, 2007). According to Hatcher and Nelson (2007), contraceptives as a

method of preventing STIs have been used since at least 1564. Rubber

contraceptives became available in 1855 followed by latex contraceptives in the

1920s (Allen, 2011). They are on the World Health Organisation's List of

Essential Medicines, the most effective and safe medicines needed in a health

system and the wholesale cost in the developing world is about 0.03 to 0.08

USD each (WHO, 2015). In the United States, contraceptives usually cost less

than 1.00 USD (Shoupe, 2011).

Chen, Amor and Segal (2012) were of the view that, globally, less than

10% of those using birth control are using the contraceptives and the rates of

contraceptives use are higher in the developed world. In United Kingdom the

contraceptives is the second most common method of birth control (22%) while

in the United States it is the third most common with 15% (Herring, 2014) and

remarkably around 6-9 billion are sold a year (Hermann, 2016). These empirics

show that contraceptives are no mean smaller contraceptive because it is the

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cheapest and most easily accessed control method when it comes to human

sexual relationship or intercourse.

According to Frost, Henshaw and Sonfield (2010) contraceptives are

generally commended for the avoidance of sexually transmitted infections

(STIs) as they have been revealed to be operative in decreasing infection rates

in both men and women. While not perfect, the contraceptives is effective at

reducing the transmission of organisms that cause AIDS, genital herpes, cervical

cancer, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.

According to a 2000 statement by the Natinonal Institute of Health ( Ford, Sohn,

& Lepkowski 2001), the constant use of latex contraceptives moderates the risk

of HIV/AIDS transmission approximately by 85% relative to risk when

unguarded, putting the seroconversion rate (infection rate) at 0.9 per 100 person-

years with contraceptives, down from 6.7 per 100 personyears. The review

settled that contraceptives use considerably decreases the risk of gonorrhea for

men.

In a related study, it was reported that proper contraceptives use

decreases the risk of transmission of human papillomavirus (HPV) to women

by approximately 70% (Winer et al., 2006) and another study found that the

constant Contraceptives use was effective at reducing transmission of herpes

simplex virus-2 also known as genital herpes, in both men and women (Wald

et al., 2005).

Despite the touts about contraceptives, it is possible that one uses it and

still contract sexual transmitted infections or diseases. According to Villhauer

(2005), although contraceptives use is effective in restrictive exposure, some

disease transmission may occur even with a contraceptives. Infectious areas of

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the genitals, especially when symptoms are present, may not be covered by a

contraceptives, and as a result, some diseases like HPV and herpes may be

transmitted by direct contact. Contraceptives may also be useful in treating

potentially precancerous cervical changes. Exposure to human papillomavirus,

even in individuals already infected with the virus, appears to increase the risk

of precancerous changes. The use of contraceptives helps promote reversion of

these changes (Hogewoning et. al., 2003).

Contraceptives Usage

Ideally Contraceptives are used to protect from unplanned pregnancies

and sexually transmitted diseases. Male Contraceptives for instance are usually

parceled inside a plastic wrapper, in a folded form and are applied to the tip of

an erected penis and then unfolded over. It is always advisable that some space

be left in the tip of the Contraceptives so that sperm from the man can be collect

to avoid the force out of the base of the device. After use, it is recommended the

Contraceptives be enclosed in a disposal material and then disposed in a

recommended way. According to Häggström-Nordin (2005), contraceptives are

regularly used in sex education programs for adolescents because they have the

capability to reduce the chances of pregnancy and the spread of some sexually

transmitted diseases when used correctly. In the United States, teaching about

contraceptives in public schools is opposed by some religious organizations

(Rector, Pardue & Martin, 2004). Advocates of family planning and sex

education, argues that no studies have shown abstinence-only programme to

result in delayed intercourse, and cites surveys showing that 76% of American

parents want their children to receive comprehensive sexuality education

including contraceptives use (Frost, Henshaw & Sonfield, 2010).

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Sexual behaviour is about how people show or express their feelings or

erotic emotions. According to Schacter, Gilbert and Wegner (2010), human

sexual behaviour is the manner in which humans experience and express their

sexuality. It is noted that people engage in a variety of sexual acts, ranging from

individualistic (masturbation) to pairs or multiples (sexual intercourse, non-

penetrative sex, oral sex) in varying patterns of frequency, for a wide variety of

reasons (Schacter, Gilbert & Wegner, 2010). According to Rosenthal (2012)

sexual behaviour commonly results in sexual arousal and bodily changes in the

aroused person, some of which are noticeable while others are unnoticeable.

Sexual behaviour may include conduct and activities which are intended to

arouse the sexual interest of another or enhance the sex life of another person,

such as strategies to find or attract partners or personal interactions between

individuals.

Weiner and Craighead (2010) opined that sexual behaviour may follow

sexual arousal and is characterised by sociological, cognitive, emotional,

behavioural and biological aspects that include personal closeness, sharing

emotions and the physiology of the reproductive system, sex drive, sexual

intercourse and sexual behaviour in all forms. Sexual behaviour can be risky

when precautions are not taken. It could be that a partner may be having sexual-

related infection that can be transmitted when he or she is not protected or the

use of other things that are not appropriate in sexual encounters. According to

Dimbuene, Emina, and Sankoh (2014), risky sexual behaviour is the description

of the activity that will increase the probability that a person engaging in sexual

activity with another person infected with a sexually transmitted infection will

be infected or become pregnant, or make a partner pregnant. To Hall (2004),

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risky sexual behaviour can be understood in two related ways, as in the

behaviour itself, the description of the partner’s behaviour. This behaviour could

be unprotected vaginal, oral, or anal intercourse. The partner could be a

nonexclusive partner, HIV-positive, or an intravenous drug user.

Sexual behaviours do not occur for nothing. It is based on multiple of

reasons ranging from procreation, joy and monetary purposes. Meston and Buss

(2007) indicated that in as much as the prime evolutionary purpose of sexual

behaviour is reproduction, however research on college students suggested that

people have sex for four general reasons; physical attraction, as a means to an

end, to increase emotional connection, and to alleviate insecurity. They further

reported that people engage in sexual activity because of pleasure they derive

from the arousal of their sexuality, especially if they can achieve orgasm.

Fortenberry (2013) was of the view that most commonly, people engage

in sexual behaviours because of the sexual desire generated by a person to whom

they feel sexual attraction and may engage in sexual activity for the physical

satisfaction they achieve in the absence of attraction for another, as in the case

of casual or social sex. He further indicated that a person may engage in sexual

activity for purely monetary considerations, or to obtain some advantage from

either the partner or the activity. Some people engage in hate sex, which occurs

between two people who strongly dislike or annoy each other. It is related to the

idea that opposition between two people can heighten sexual tension, attraction

and interest (Fortenberry, 2013).

The sexual behaviours people engage in are understood to possess some

psychological underpinnings. This means that sexual behaviours are linked to

mental aspects of those who depict them. From personal experience, sexual

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activity can lower human pressure and overall stress levels in people who

engage in it. It releases tension, elevates mood, and may create an insightful

sense of relaxation, especially within the ejaculation period.

According to Brunell and Webster (2013), in their study, revealed that

people who engaged in sexual activities had more positive psychological

wellbeing because as they engage in sexual activity they had a higher need for

satisfaction. The study also revealed that females had higher satisfaction and

relationship quality than males did from the sexual activities. It was therefore

concluded that psychological well-being, sexual motivation, and sexual

satisfaction were all determinants of sexual behaviour (Brunell & Webster,

2013). This can be best expatiated that sex in itself is psychologically medicinal,

if only practiced at the age-appropriate time. The age of sexual behaviours is

believed to be varied based on jurisdictional differences. Laws of people are not

universal when it comes to sexual behaviours. Different continents, countries

and culture have their own laws that govern what is termed age-appropriate

sexual behaviour, and such laws are strictly applied in those places. The

jurisdiction and the culture determines the age-appropriate for signs of sexual

behaviour for people of different places around the world.

In as much as age is known to be a determinant of sexual behaviour, so

goes to the gender of people. According to Suar and Gochhayat (2016), social

gender roles can influence sexual behaviour as well as the reaction of

individuals and communities to certain incidents especially where there is the

belief that male sexual entitlement are strong.

Suar and Gochhayat (2016), indicated that Human sexuality and gender

relations are closely interrelated and together affect the ability of men and

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women to achieve and maintain sexual health and manage their reproductive

lives. Equal relationships between men and women in matters of sexual relations

and reproduction, including full respect for the physical integrity of the human

body, require mutual respect and willingness to accept responsibility for the

consequences of sexual behaviour. Responsible sexual behaviour, sensitivity

and equity in gender relations, particularly when imparted during the

developmental years, improve and stimulate respectful and pleasant

relationships between men and women.

Type of contraceptives

According to www.Zavamed.com/uk, the following are some types of

contraceptives

Male condom

A male condom is a covering worn over the penis to stop sperm getting

into the womb. Condoms are most commonly made of latex but other types are

available. The condom is the most common form of male contraceptive. With

perfect use, male condoms are 98% effective at preventing pregnancy, but with

typical use this drops to 82%. A condom is the only form of contraceptive that

also helps to avoid getting STIs.

Female condom

A female condom is worn inside the vagina and stops sperm getting into

the womb. Like male condoms, they are most commonly made of latex. The

female condom is 95% effective with perfect use and 79% effective with typical

use. As with the male condom, a female condom will help to avoid getting STIs.

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Diaphragm

A diaphragm is placed inside the vagina to cover the lowest part of the

womb (the cervix) to stop sperm getting in. It’s made of a soft silicone and is

shaped like a shallow cup. It must be used with spermicide (commonly a gel or

cream) which slows down the movement of sperm. It is inserted before having

sexual intercourse and should left in for at least 6 hours afterwards. Depending

on the material and type of the diaphragm, it can be reused many times. With

perfect use, the diaphragm is 94% effective. With typical use, it is 88% effective.

Despite being a barrier method, the diaphragm does not protect against STIs.

Cervical cap – FemCap

The cervical cap (sold as FemCap) is a silicone cup, similar to a

diaphragm but smaller. It also needs to be used with a spermicide. The cervical

cap must remain in the vagina for at least 6 hours after sex and should be taken

out within 48 hours. The cervical cap is 92 to 96% effective with perfect use

and 71 to 88% effective with typical use. Cervical caps do not protect against

STIs.

Contraceptive coil

The contraceptive coil is a long-acting reversible method of

contraception. It is a plastic, T-shaped device fitted in the vagina by a doctor or

nurse. There are two types of coil: the intrauterine device (IUD) and the

intrauterine system (IUS). The IUD releases copper into the womb and is also

known as the copper coil. The IUS releases lab-made progesterone and is also

called the hormonal coil. Once it’s fitted, the IUS can stay in place for 3 or 5

years (depending on the brand) and the IUD for 5 or 10 years. Both coils can be

removed at any time by a doctor or nurse. The effectiveness rate for both is

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above 99%. IUDs can also be a form of emergency contraception if the device

is inserted within 5 days after unprotected sex. Coils offer no protection from

STIs.

Contraceptive implant

This is another long-acting reversible method of contraception. The

implant is a matchstick-sized piece of plastic, inserted under the skin on your

upper arm. It can be safely left in place for 3 years but can be taken out at any

time. The implant must be fitted and removed by a doctor or nurse. The implant

works like the mini pill by releasing lab-made progesterone. It’s

99.95% effective and does not protect against STIs.

Contraceptive injection

The contraceptive injection is a shot of lab-made progesterone, the

hormone that’s in the mini pill. The injection lasts for 12 weeks and once given

it cannot be reversed, so the user is effectively infertile for the next 3 months.

The contraceptive injection must be given by a doctor or nurse who will discuss

whether it is suitable for the adolescent. Injectable contraceptives are more than

99% effective with perfect use, 94% with typical use. The main thing that makes

perfect use more difficult is remembering to get a new injection every 3 months.

Like other hormonal methods of contraception, injections do not protect from

STIs.

Vaginal ring

The vaginal ring is a piece of circular plastic that is placed in the vagina.

The ring works in the same way as the combined pill, releasing progesterone

and oestrogen. The vaginal ring is more than 99% effective with perfect use,

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and 91% effective with typical use. You need a doctor's prescription to get the

ring. It does not protect from STIs.

Contraceptive patch

The contraceptive patch is the same thing as the contraceptive pill but in

the form of a plaster-like patch worn on the skin. It provides the same protection

against pregnancy. The patch can be worn on different places around the body.

It is changed once a week. You then start again with a new patch. You need a

doctor’s prescription to get the patch. The patch is over 99% effective with

perfect use and 91% with typical use. It does not protect from STIs.

Emergency contraception

Emergency contraception is used to prevent pregnancy after one had

unprotected sex. It’s not recommended as a regular method of contraception.

The morning after pill is the most common form of emergency contraception.

It’s a single pill containing synthetic hormones which stop or slow down the

release of an egg (ovulation). An IUD can also be used as emergency

contraception. Emergency contraception needs to be used within 3 or 5 days of

unprotected sex (depending on the method and brand used

Sterilisation

Sterilisation is an operation by a doctor which permanently protects

against pregnancy. It’s available to both men and women. In men, the procedure

is called a vasectomy. The tubes that carry sperm are cut or sealed. In women,

the fallopian tubes are clipped or tied so eggs cannot move into the womb.

Women can also have non-surgical sterilisation. This is when an implant is

placed in each fallopian tube to create scars that eventually block each tube. The

scars may take up to 3 months to completely block the tubes, so one needs to

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use another method of contraception in the meantime. Sterilisation offers more

than 99% protection against pregnancy. In rare cases blocked tubes grow back

and reconnect, or tubes are not effectively blocked.

Sterilisation does not provide any protection against STIs

Empirical Review

Age Difference in Contraceptive Use

Researches have typically generalised contraceptive use among all

women with age as a covariate, more recent studies have highlighted the need

to differentiate by age when studying factors affecting contraception use

(Tavrow, Withers & McMullen, 2012). These studies provide evidence that

adolescents in particular need special attention in order to control contraceptive

prevalence, recognizing that improving availability, affordability, and youth-

friendliness may not fully address the psychosocial barriers to contraceptive use

among adolescents (Ngome & Odimegw, 2014).

A study conducted by Decker and Constantine (2011), indicated age

differences as a necessary variable in studying the use of contraceptives. They

identified age to be associated with contraceptive use, with particularly low

level of contraceptive use among adolescents, concluding that young women

needed special attention with regards to family services in Angola (Decker &

Constantine, 2011). Prata et al., (2016) in their study reported that, contraceptive

use was prevalence among women between the ages of 25-49 years than women

between the ages of 15-24 years. Akotli (2010), in her study identified a

significant difference between age categories and contraceptive use. Findings

from a study conducted in Kenya by Okech, Wawire, and Mburu (2011)

revealed that contraceptive use was highest among women aged between 20

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years and 39 years compared to those below 20 years and above 39 years. They

reported that, 49 percent of the women that were using contraceptives were aged

20- 29 years, 41 percent were aged between 30 - 39 years, while 4 percent of

the women who were using contraceptives were less than 20 years.

Adolescence conceptually is categorised into three (3) stages because it

is believed that the period is not uniform for human generation. The

differentiation with respect to age in adolescence has the possibility to bring

about differences among adolescents with respect to knowledge and this is not

limited to sexual behaviours and knowledge contraceptives use. A study in

Angola among adolescent students revealed that, males in all adolescence

agegroups were more likely than females to be consistent users of

contraceptives with 19% against 13% (Prata, Vahidnia & Fraser, 2005).

Gender Difference in Contraceptive Use

Several studies conducted have focused on adolescents’ perception

about contraceptive use. Some of these studies revealed gender difference in the

use of contraceptives. A study conducted by Almeida, Aquino, Gaffikin and

Magnani (2003) revealed gender difference in contraceptive use among

adolescents in Brazil. The study revealed that, female adolescents used

contraceptives more than their male counterparts. They indicated that, the

factors positively linked to the regular use of contraceptive methods among

male students included; a) postponing their first experience of sexual intercourse

and interaction with a stable partner, b) the family as a potential provider of

contraceptive methods, and c) access to health services. Among female students

on the other hand, the factors positively associated with the consistent use of

contraceptive methods included; a) recent sexual initiation, and b) having a

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father as their source of information regarding sexuality, contraception and

STD/Aids prevention (Almeida, Aquino, Gaffikin & Magnani, 2003).

Manlove, Ryan and Franzetta (2003), in their study reported that, both

male and female adolescents used contraceptives. They mentioned that,

teenagers who had waited a longer time between the start of a relationship and

first sex with that partner, discussed contraception before first having sex or

applied dual contraceptive methods which had significantly increased

probabilities of ever or always using contraceptives (Manlove, Ryan and

Franzetta, 2003).

Similarly, Yilmaz, Kavlak and Atan (2010), reported that, male Turkish

students had started sexual relations at a younger age but had less often

unprotected first sex than female students. They revealed that, of the surveyed

students, 50.3% reported having engaged in sexual intercourse; the mean age at

first sexual intercourse was 18.4 years for girls and 16.9 years for boys. They

found that 44.5% of female and 30.6% of male students failed to use

contraception at their first sexual intercourse, whereas 2.2% of female and

13.7% of male students failed to do so at their most recent intercourse. The rate

of contraceptives usage for students’ first sexual encounter was 50.1% and was

67.8% at their most recent intercourse (Yilmaz, Kavlak & Atan, 2010).

A study conducted by Kareem and Samba (2016) on contraceptive use

among female adolescents in Korle-Gonno revealed that, the mean age at first

sexual intercourse was 15.9 years and 55.5% of female adolescents were

sexually active. Contraceptive use prevalence among sexually active female

adolescents was 38.0%. The commonest method used was the male

Contraceptives (73.9%). They further added that, the main reasons for the

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choice of this method were easy access and safety of method, and also dual

protection specifically for the male contraceptives. Most adolescents due to little

or no knowledge about protection at time of sexual intercourse had no specific

reason for not using contraception (Kareem & Samba, 2016). Boamah (2013)

who conducted a study at Kintampo Ghana, asserted that, 67% of sexually active

adolescents had ever used contraceptives. He also revealed that, 22.9% used

contraceptives consistently while 44.1% used contraceptives sometimes. He

gathered that, most of contraceptives used by these active adolescents were male

and female condoms and the pills. Thirty-five percent of adolescents had ever

used any contraceptives to prevent pregnancy or STIs. In as much as

adolescents can differ in gender, there is the likelihood that sexual behaviours

as well as knowledge about contraceptives usage by adolescents may differ.

Leland and Barth (1992) in their study asserted that females were more

likely than males to have discussed sexuality topics with parents, to have

engaged in sexual intercourse more frequently, to have experienced a pregnancy

scare, to have used contraceptives during their last sexual encounter. To

perceive that a larger proportion of their peers were engaging in sex and using

birth control, to obtain birth control from health facilities, and to report

intentions to abstain or use protection in hypothetical situations placing them at

risk for unprotected sex. In that same study, it was reported that adolescent

males were more likely to have always used birth control, to have used birth

control during their first sexual encounter, and to have used a Contraceptives

during their last sexual encounter. Furthermore, males were more likely to

obtain birth control from a store or a friend and males knew more about using

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Contraceptives correctly and their role in preventing sexually transmitted

diseases (Leland & Barth, 1992).

A study by Prata, Vahidnia and Fraser (2005) in Angola revealed that a

larger proportion of males than of females indicated that they had much

knowledge about contraceptives and used some of them with all of their partners

in the three months preceding the survey 17% against 12%. This synopsis above

puts the male adolescents in pole position against female adolescents when it

comes to Contraceptives usage in sexual behaviours.

Impacts of Contraceptive Use on the Sexual Behaviour of Adolescents

Adolescence is a period of experimentation for most developing

teenagers. Adolescents’ exuberance is not by accident but naturally-motivated

urge to try and explore new things as they keep growing. In the quest of

supplying the biological demands (erotic feelings) of this stage of development,

adolescents engage in a lot of sexual behaviours that do not exclude

Contraceptives usage. These behaviours at this period of development are

culturally illegal depending on the geographical jurisdiction. Taken Ghana for

instance, sexual behaviours as in intercourse at adolescence is culturally

frowned upon because Ghanaians are inclined that the stage is for learning to

become an adult but not to engage in adult sexual behaviours before one marries.

This means sexual intercourse is a reserve for the adults and not for adolescents.

This is traditionally observed, but quit the opposite is seen because many

adolescents can be seen carrying babies at their backs after defying these

culturally-oriented norms.

For the fear of being ridiculed in society for being pregnant or making

someone pregnant, adolescents in recent times resort to the use of

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Contraceptives as they engage themselves in amoral sexual behaviours. To

some, it may be for preventive measures towards contracting sexual transmitted

diseases and consequently preventing unplanned pregnancies. According to

Eaton (2012), the Condom remains the most popularly used contraceptive

method among teenagers. An increased proportion of sexually active

adolescents report using a Contraceptives at last intercourse, according to

Anderson, Santelli, and Morrow (2006). In the Youth Risk Behaviour Survey

in the United States, Condom use was reported to have increased from 46.2%

in 1991 to 60.2% in 2011. The prevalence of Contraceptives use was higher

among male with 68.6% than female with 53.9% students and higher among

white 63.3% and African American with 62.4% than Hispanic students with

54.9% (Eaton, 2012).

Contraceptive demand and prevalence is generally higher for sexually

active unmarried adolescent than for those married (Sanchez-Paez & Ortega,

2018). Research conducted have reported the effect of contraceptive use on the

sexual behaviour of adolescents. Sanchez-Paez and Ortega (2018), found in

their study that, the use of contraceptive was prevalent among adolescents and

had reduced adolescent fertility by 6.8% in Latin-America and

4.1%insubSaharan Africa. They concluded that, meeting the total demand for

contraceptives of unmarried adolescents would lead to an additional decrease in

fertility of 8.9% and 17.4% respectively (Sanchez-Paez & Ortega, 2018).

More so, Kiragu and Zabin, (1995) in their study on contraceptive use

among high school students in Kenya show that 69% of the males and 27% of

the females were sexually experienced. Among the sexually experienced

students, 49% of the males and 42% of the females had ever used a

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contraceptive. Only 25% of the males and 28% of the females had used a method

the first time they had sex, and similar percentages had done so the last time

they had sex (31% and 29%, respectively). The Condom was the method most

frequently used at last intercourse (55% males, 43% females), followed by the

“safe period” (29% males, 43% females) and the pill (6% males, 10% females)

(Kiragu & Zabin, 1995).

Amazigo, Silva, Kaufman and Obikeze, (1997) also reported in their

study that, young women had intercourse more frequently and were less likely

to restrict intercourse to the safe period of their cycle when they were involved

with older partners than when they had boyfriends who were of their own age,

only 17% of sexually active students had ever used a contraceptive method other

than abstinence (Amazigo, Silva, Kaufman & Obikeze, 1997). In the same vein,

Champiti, (2015) in his study revealed that, 30.8% of adolescents have had sex

without the fear of pregnancy or HIV because of Contraceptives use. Majority

(62.1%) had knowledge of at least three methods of contraceptives. Majority of

the adolescents recommended Contraceptives as the method to be used by

young people. His findings also showed that 19% of the students in the study

used contraceptives (Champiti, 2015).

In the National Survey of Family Growth by Martinez, Capen and Abma

(2011), Contraceptives use at last intercourse increased among females from

31% in 1988 to 52% in 2006-2010 and males from 53% to 75%. Rates of actual

Contraceptives use in both surveys may also be lower than thought because of

the uncertain/questionable validity of self-report of this and other sexual

behaviours that are prone to bias. According to Rose, Diclemente and Wingood

(2009), as an explanation to these findings, Contraceptives may have been used

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inconsistently or incorrectly, or youth might have provided socially desirable

answers.

According to Eaton et al. (2012), the Centre for Disease Control through

survey reported sexual risk behaviour s in a nationally representative sample of

adolescent students surveyed biannually. Boulet et al. (2016) revealed that

47.4% of the adolescent students reported that they had ever had sexual

intercourse with Contraceptives, 33.7% reported that they were currently

sexually active, and 15.3% had had sexual intercourse with four or more

partners in their lifetime. Among sexually active students, 60.2% reported

contraceptives use during their last sexual encounter. It would not be a mistake

for one to say that contraceptives use among adolescents has become rampant

or a norm in this 21st Century. According to Brown (2008), the motivation for

adolescents to have sex include the pursuit of fulfilling sexual experience in

addition to other impetuses such as intimacy, procreation, or in response to peer

or partner pressure. For Ghana, this may be as a result of adolescents’ desire to

satisfy their sexual urges that are common within that period of development

without becoming pregnant or contracting any sexualrelated diseases or

infections.

The use of contraceptives among adolescents by adolescents is believed

to be caused by many factors that are not limited to adolescent individual

personality, family, socio-demographic, attitude, education, relationship and

partner-related factors and influence contraceptives use (Manlove, Ikramullah

& Terry-Humen, 2008).

A study conducted in Rwanda by Dominique and Megan (2001) among

adolescents with a sample of 3013 revealed that overall, 42% of female

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adolescent students and 30% of male adolescent students report that they have

ever used a Contraceptives. In that same study, female adolescent students’

percentage on the use of Contraceptives was expressively higher for with 55%.

Among the male adolescent students, the percentage that report having used

Condom increased with age, from 20% for early adolescence to late adolescence

Comparing geographical location and use of Contraceptives among adolescents,

it was revealed that the use of Condom is substantially higher among males in

the urban with 35% than those in semi-urban with 21% or rural ones with 20%

(Dominique & Megan, 2001).

Dominque and Megan (2001) in making a reasonable case on the

consistency in the use of Contraceptives among adolescents reported that the

levels of Contraceptives use in the last sex act with partners was amazingly high

and the percentage of adolescents who reported Contraceptives use in last sex

with a regular partner is higher than the percentage adolescents’ who ever used

Contraceptives because many youths who have tried Contraceptives are no

longer sexually active. It was reported further that female adolescents report

much higher levels of Contraceptives use with 71% in their last sex act with a

regular partner than male adolescents with 46%.

Knowledge Level of Adolescents about Contraceptive use

Adolescents by nature are curious about events in their lives as that stage

touted to be a moment that presents both positive and negative consequences on

adolescents depending on how they handle and manage their lives. In the face

of adolescent sexual maturity and sexual behaviour, there is the possibility that

adolescents may be privy to sexual contraceptives like condoms and their usage

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as they may be pressured to get involved in amoral sexual relationships with

others.

Speroff and Fritz (as cited in Akpan, Ekott & Udo, 2014), reported that

since 1900, knowledge and application of contraceptives have been encouraged

and promoted and in 1960s, contraception teaching and practice became part of

the programme in academic medicine.

Silassie (2016) was of the view that Condoms are an integral part of

sexually transmitted diseases; unwanted pregnancy and human immune

deficiency virus (HIV) acquiring immune deficiency syndrome (AIDS)

prevention and their use has increased significantly over the past decade.

Correct use of Contraceptives reduces the risk of HIV transmission by almost

100 percent. According to Tarkang and Bain (2015), Sub-Saharan Africa (SSA)

remains the region hardest hit by the HIV/AIDS pandemic than any other in the

world, largely due to high risk behaviour and neglect of potential preventive

measures. This has led to most adolescents resorting to the use of Contraceptives

to prevent the HIV/AIDS canker in their lives. Unwanted pregnancy, sexually

transmitted diseases (STDs) and their adverse health consequences among

adolescents are widespread public health problems worldwide that has called

for the knowledge of Contraceptives (Public Health Progress Review, 2005).

An estimated 19 million new STDs occur each year in the United States of

America of which 50% are among persons between the ages of 15 and 24 (CDC,

2013).

Hearst and Chen (as cited in Tarkang & Bain, 2015) indicated that the

correct or right knowledge and consistent Contraceptives use whether male or

female, has been acknowledged to be effective towards successful prevention

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of sexually transmissible infections (STIs), including HIV/AIDS that come as a

result of adolescents sexual behaviours.

In a study conducted by Tarkang and Bain (2015) in Cameroon among

adolescents revealed that majority of the adolescents were having appreciable

knowledge about Contraceptives and their usage with 75.6%. However, these

adolescents were having negative attitudes towards the use of Contraceptives as

they exhibit sexual behaviours. This may be dangerous to them because they

may be exposed to the HIV/AIDS if the adolescents do not change their

attitudes.

In a related study among adolescents in Nigeria conducted by Akpan,

Ekott and Udo (2014) revealed that currently, there was increased awareness

and knowledge about Contraceptives as a means of contraception and

prevention of STDs/HIV among adolescent students in Nigeria. This is evident

by the fact that 100% of the respondents in this study reported knowing about

Contraceptives and its usage. They attributed the revelation to adolescents

belonging to one of the most educated segments of Nigerian societies. The

revelation was encouraging as adolescents may be safe from contracting any

sexual-related disease provided they correctly use the Contraceptives.

It is possible to believe that most adolescents become sexually active

early and the need to Contraceptives use knowledge is vital as they may be

protected from unplanned sexual-related problems that might result from their

pressing sexual behaviours. Mucugu, Joash & Mwania (2013) in their study

among adolescents in Kenyan Secondary Schools revealed that majority of the

students were sexually active and they also actively use Contraceptives so their

knowledge was above average. In the study, males using Contraceptives or

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while some adolescents have adopted measures to reduce their risks of sexually

transmitted infection and unwanted pregnancy others reported high risk sexual

behaviour. The results of the research indicate that it is common knowledge that

students are sexually active and engage in sexual activities with Contraceptives.

In a related study by Silassie et al. (2016), it was revealed that

adolescents had adequate knowledge about Contraceptives use with majority

290 (75.1%) of the respondents while 24.9% were not knowledgeable about

Contraceptives and their usage. Almost all 309 (89%) adolescent students knew

that Contraceptives will prevent HIV/AIDS transmission. Most participants 259

(74.6%) knew that Contraceptives uses can prevent both pregnancy; STIs and

HIV/ AIDS; hepatitis-b virus and equally had positive attitude towards

Contraceptives use with 290 (83.6%) against 57 (16.4%) adolescent students

who had negative attitude towards Contraceptives use.

There may be circumstances where the knowledge of Contraceptives use

would be delusional by adolescents and may come up with unsubstantiated tags.

According to Ochieng, Kakai, and Abok (2011), misconceptions about

HIV/AIDS and the protective role of Contraceptives in preventing its spread are

potentially dangerous since they may lead young people to avoid Contraceptives

during sexual intercourse.

In their study, Ochieng, Kakai, and Abok (2011) indicated that

misconceptions about Contraceptives also existed as more male than female

students believed that Contraceptives reduce sexual pleasure. Even though

Contraceptives play a protective role in the fight against HIV/AIDS their use

among the respondents was low and inconsistent, reflecting the fact that for

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adolescents, Contraceptives use may not be an effective tool in protecting them

against HIV/AIDS.

According to Masoda and Govender (2013) in their study among

adolescent students in DR Congo, 137 (99%) of respondents knew what

Contraceptives were. Ninety-two of the respondents (67%) knew that generally,

Contraceptives are made of latex. Sixty-five per cent of participants from other

studies also understood what Contraceptives were and what they comprised.

They stressed the reason that adolescent students’ knowledge about

Contraceptives was high could be as a result of the intensive efforts of the DRC

government and non-governmental organisations (NGOs) to educate students

about HIV and Contraceptives use. In this study, most participants (76%) knew

that Contraceptives prevented HIV, STIs and unwanted pregnancies, and that it

was important to use a Contraceptives every time that they had sexual

intercourse.

Sources of Information on Contraceptives and their usage

Boamah (2013) in a study in Kintampo revealed that 79.5 percent of

adolescents got information about contraceptives usage from friends. So in this,

peers or friends became one of their sources and is not surprising because

adolescents always learn from age groups to whom they may feel somehow safe

with when interacting on issues relating about sexuality.

In similar vein, a study by Benzaken, Palep and Gill (2011) in

Mumbai, India revealed that, adolescents’ source of information about

Contraceptives use were peers. A national survey in the United States,

conducted between 2001-2002 revealed that, about 76% of the sampled

adolescents reported citing friends as their source of information about

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contraception (Rideout, 2003). In a study in Ghana, it was revealed that 47% of

adolescents reported that they obtained information about contraceptives from

friends (Esantsi et al., 2015).

The 21st Century media serve a lot of purposes including presenting

information on both positive and negative sexual behaviours to adolescents.

Adolescents are curious and as such, they explore every avenue available to

them for any information they consider to be important and interesting.

Advocates for Youth in the U. S, in their policy document indicated that 21th

Century media is considered to be proofs of life for the new cohort. In

adolescence young people are exposed to resources on sex behaviours such

contraceptive use from several media sources (Rideout, 2001). Sutton, Brown,

Wilson and Klein (2002) indicated when interacting with adolescents about

sources of Contraceptives use and contraceptives in most occasions, adolescents

often mention media as the major source of information. Adolescent students

blessed with technology where at their liberty can browse the internet for any

information they intend searching or looking out for, watch television for similar

information, read books and graphics for information about similar sexual

related phenomena. Rideout (2004), in collaboration with the American

Academy of Paediatrics (2001) revealed in their study that adolescents spent

commonly some hours on the media daily and specifically about 65% of the

adolescents reported they got information about contraceptives and their usage

during advertisements. In that same study, 58% of the sampled adolescents

reported they got access to Contraceptives usage from the print media like sex

education magazines and about 39% of the adolescents confirmed they got

information about contraceptives from the internet. Among the various media

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platforms, the adolescents ranked the audio media and entertainment media as

the most sourced platforms. According to Foehr and Roberts; and Strasburger

(as cited in Mahama, 2017) American adolescents devote about seven hours per

day on media and the media are flooded with sexual messages and images where

preventive measures were equally offered.

Medical doctors and nurses are usually provide sex education

information including contraceptive use to adolescents anytime they visit the

health centres for issues pertaining human sexuality. Boamah (2013) in his study

in Kintampo among adolescents reported that, information on contraceptives at

health care facilities had been captured with 4.3%. Rideout (2003) in a national

survey revealed that about 51% of the sampled adolescents reported to have

received information about Contraceptives use and sex education from health

care providers or centres through the health professionals like doctors and

nurses. Benzaken, Palep and Gill (2011) revealed that 18.3% of the adolescent

respondents indicated medical doctors as their source of information about

Contraceptives use. According to Enuameh et al. (2017) this shows that health

professionals contribute a great deal on adolescents’ acquisition of knowledge

about sex education and this aspect cannot be overlooked when it comes to

human sexuality related issues.

It is common knowledge that pharmacy shops and other drug stores are

avenues for contraceptives. Most chemical shops are private-owned and are

profit-oriented, so sub-letting and educating adolescents about Contraceptives

and their usage may look simple because that alone can increase patronage from

adolescent. A study among adolescents in Kintampo, Ghana by Boamah et al.

(2013) revealed that majority of the respondents 62.1% (131/211) reported that

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they got information on contraceptives from the pharmacy and the chemical

sellers’ shops. The findings were not surprising as indicated because pharmacy

shops are less restrictive and less threatening to adolescents and besides they are

readily available in most parts of Ghana with contraceptives stalked for

patronage of the adolescents and the grown-ups.

Impacts of Contraceptives use on Sexual Behaviour of Adolescent Students

In as much as adolescents become abreast or the otherwise of

Contraceptives and their use, it may invariably have effects on the behaviours

they depict with regards to sexuality. According to Sellers, McGrow and

McKinlay (1994), the proponents of contraception education and

Contraceptives availability programmes argue that teenagers are sexually active

and must be provided with the means to protect themselves against pregnancy

and sexually transmitted diseases. This brings to bear that Contraceptives usage

has empirical potential to curb sexual-related problems that come as result of

adolescents sexual behaviour based on figures from 1988, which indicated that

about 50% of female adolescents and 60% of male adolescents between 15 to

19 years of age have had sexual intercourse, more than 1 in 10 teenage girls

became pregnant and 1 in 6 of sexually active adolescents had been infected

with sexually transmitted disease (CDC, 1990).

Others were of the view that Contraceptives use among adolescents

approves and promotes sexual activity at a time that may not be appropriate. It

is believed that this stance was initiated by Surgeon General of the United

States, Senator Dan Coates in 1993 as he was addressing some group

professionals. He expressed concern that just promoting Contraceptives as a

solution to the problem can promote promiscuity. A more extreme position was

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voiced by Phyllis Schlafly during the debate over the distribution of

Contraceptives in the New York City public schools. She stated that

Contraceptives distribution programmes produce an increase in teenage sexual

activity (Schlafly, 1994).

Cates and Stone (as cited in American Academy of Paediatrics, 2001)

reported that Contraceptives use decreases the rate of acquisition of HIV by

those who engage in high-risk sexual activity or whose partners are seropositive

for HIV, with relative risk ratios generally in the range of 60% to 96%

protective. A study revealed that consistent Contraceptives use decreased the

rate of HIV conversion by the negative partner to 1%, compared with 7% in

those who did not use Contraceptives among adolescents (Cates & Stones,

1992). Although Contraceptives use known to decrease sexual transmitted

infections, however, it is generally accepted that Contraceptives use is less

protective against transmission of STDs and HIV than it is for pregnancy when

used correctly and consistently and in real life use (Davis & Weller, 1992).

According to Blake (2003) in her study among 4,000 adolescents in high

school, making Contraceptives available and allowing their use in high schools

does not increase adolescent sexual activity, but it protects those who are

already sexually active from some sexually transmitted diseases. Blake (2003)

noted that Contraceptives availability was not associated with greater sexual

activity among adolescents but was associated with greater Contraceptives use

among those who were already sexually active, a highly positive result.

From the foregoing, it is evident to support the fact that the merits of

Contraceptives use among adolescents far outweigh that of non-usage because

it can help adolescents maintain their healthy lifestyles as they continue to grow.

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Ways in Improving/Enhancing Sexual Behaviours of Adolescent Students

Nothing can be hidden from adolescents in this 21st Century

environment that is bombarded with a lot of sexual information that are least

restricted. Having this in mind, there is no doubt that adolescents sexual

behaviours may change in conjunction with the growing trend of human

sexuality. To avoid doubt and the quest not to compound issues with adolescent

development, there is the need that well-thought strategies, wellinformed

modalities are put in place to improve and enhance adolescent students’ sexual

behaviours as they keep growing to become adults and future stakeholders in

various platforms and societies. Motivation at School

Motivations at school are programmes and activities that are of great

importance to nurturing adolescents against risk-taking sexual behaviours and

rather enhance the way they handle themselves against sexual pressures.

According to Kirby (2002), social scientists and educators have proffered a wide

variety of explanations for how schools reduce sexual risk-taking behaviours.

Some of their explanations have empirical research supporting them, while

others are plausible, but lack supporting research.

To Kirby (2002), educators concerned with adolescent sexual behaviour

have suggested that schools structure adolescent students’ time and limit the

amount of time that students can be alone and engage in sex. Schools increase

interaction with and attachment to adults who discourage risk-taking behaviour

of any kind (substance use, sexual risk-taking, or accident- producing

behaviour). More generally, schools create an environment which discourages

risk-taking as they affect selection of friends and larger peer groups that are

important to them. Schools can increase belief in the future and help youth plan

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for higher education and careers. Such planning may increase the motivation to

avoid early childbearing.

As noted above, multiple studies demonstrate that educational and career

aspirations are related to use of contraception, pregnancy, and childbearing.

Schools are believed to have the potential to increase adolescent students’ self-

esteem, sense of competence, and communication and refusal skills and these

skills may help students avoid unprotected sex (Kirby, 2002).

Introduction of School-Based Sex Education Programmes

Sex education is well-thought educative programme that is designed to

educate the growing populace of the world to understand everything about

human sexuality so that they can be guided against any sexual-related

misfortunes and help them improve upon their sexual behaviours to prevent

risk-taking sexual behaviours.

According to Bennell, Hyde and Swainson (2002), school-based sex

education is an encouraging platform for getting many adolescents with vital

health information and life skills that can avert accidental conditions and

sexually transmitted infections (STIs) including HIV/AIDS. Shrestha et al.

(2013) indicated that although sex education looks important to improving

adolescents’ sexual behaviours, yet it is challenged in many jurisdictions,

particularly in developing countries like as it is severely controlled by social and

cultural taboos on discussing issues related to sex whether in school or home.

According to Shrestha et al. (2013), in as much as school-based sex education

can influence students' knowledge, beliefs, and intentions regarding sexual

health, it is important to fully explicate and address the social and cultural

challenges of school-based sex education.

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The importance of school-based education is expatiated in a research

work by Enuameh et al. (2017) among adolescent high school students in the

Wa Municipality in Ghana. The study revealed that 85.1% of 390 adolescent

students surveyed agreed that sex education will have a positive effect on their

social lives while 14.9% of the respondents’ sex education will have negative

effects on them. This revelation was sounding as these adolescents were not

taught holistically on anything on sex education, yet they foresaw its

significance on their sexual behaviours, hence their suggestion. The adolescent

students with 92.6% further suggested that sex education should be part of

academic / school curriculum and 93.8% of the respondents agreed that sex

education should be taught by qualified teachers (Enuameh et al., 2017).

Parents-Adolescents’ Relationship Programmes

Adolescence is challenged with a lot of factors including parenting.

Adolescents usually would want to exert their boisterous stage of development

in terms of their sexual behaviours and this is met with opposition from parents.

It there leads to the breeding of hostility between children and their parents and

children are likely not to discuss anything with regards to their sexual

behaviours with parents but do it in the blind side of parental eyes. The

perceived hostility that become eminent between parents and their adolescents

can be tackled if parents understand the period of adolescence and tackle any

unsavoury sexual behaviour holistically in amicable way for their growing

adolescents.

Manlove, Fish and Moore (2015) in their study among American high

school students revealed that parent-youth relationship programmes are

particularly effective at influencing the sexual behaviours and reproductive

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health outcomes among adolescents’. The study revealed that, more than three-

quarters (9 out of 11) evaluated parent-adolescent relationship programmes

were effective for at least one outcome or population. In addition, several other

effective programs incorporated parent-involvement components. According to

Miller, Benson and Galbraith (2001) the important role that parent-adolescent

relationships provide include parental monitoring and parent-adolescent

communication as they help influence adolescents sexual and reproductive

health behaviours.

It is noted that parents-adolescents with relation to communication is

inevitable and is believed to possess the impetus to improve adolescents’ sexual

behaviours. According to Widman, Choukas-Bradley, Noar, Nesi, and Garrett

(2016), parent-adolescent sexual communication has received considerable

attention as one factor that could positively impact youth safer sex behaviour,

including adolescents’ use of contraception and Contraceptives. It is understood

that this communication relationship between parents and adolescents is

characterized with real-world and hypothetical motives why parenting may be

proxies of sexual socialization for adolescents as parents may realistically

convey sexual information and may exercise significant influence on

adolescents’ sexual attitudes, values, and risk-related beliefs (DiIorio, Pluhar, &

Belcher, 2003).

Hutchinson and Montgomery (2007) asserted that parental

communication about sex has appeared to be an essential component in the field

of adolescent sexual behaviour with suggestions for prevention programming.

Hutchinson, Jemmot, Jemmot, Braverman, and Fong (2003) in their

longitudinal study among adolescents suggested that higher levels of mother-

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daughter sexual risk communication correlated with a lower incidence of sexual

intercourse and more consistent contraceptive use. This assertion corroborates

with the results of a study conducted by (Enuameh et al., 2017)

The study among adolescents’ high school students in the Wa

Municipality in Ghana, where 95.1% of them suggested that their parents should

be involved discussing sexual behaviours and sex education so that they can

learn to protect themselves against risky sexual behaviours.

According to Ajidahun (2013), parental monitoring during

preadolescence affects the age at which adolescents start and begin sexual

activity. He was of the view that adolescents who are knowledgeable about sex

are more likely to use contraceptives consistently. They are also more likely to

postpone sexual intimacy the most effective means of preventing sexual

problems. Sex counselling can be regarded as a process of making an individual

develop a positive and wholesome attitude towards sex. Sex counselling is a

way of providing adolescents with valuable knowledge about sex so as to avert

risks associated with sex such as teenage pregnancy, sexual diseases and

emotional problems.

Adoption of Health-Based Adolescent Programmes

Information dissemination agencies are limitless provided they are accessible

to the teeming global population of adolescents. In managing adolescents’

sexual behaviours, health-based programmes can be adopted so that pertinent

and valuable information can be imparted on adolescents to guard against

unforeseeable risky sexual behaviours.

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Counselling

Counselling as way of guiding and giving sound offers for distraught

people to choose from in managing their lives cannot be overlooked. In curbing

potential setbacks that might come adolescents’ way as they behave sexually

can espouse or embrace the value of counselling. According to Ventura,

Mathew and Curtin (as cited in Ajidahun, 2013) touted that adolescents who get

sexual behaviour counselling from school or community programme have a

better chance of avoiding pregnancy and other risks connected with sexual

behaviours or activity.

To Ajidahun (2013), sexual behaviour counselling need to be shared

responsibility and should not be left in the hands of parents alone. Teachers,

professional counsellors and more importantly the society should be involved.

Sexual behaviour counselling is supposed to be the reproductive rite that gives

one knowledge about one’s body and value so that it cannot be abused. Despite

the possible different views on sexual behaviour counselling, it may be a

necessary end in the development of adolescents. It should be seen as part of the

formal education that every child needs to survive in the society. To prevent

young adult from ignorance, they need to be told about issues surrounding their

growth and developments. This will in turn reduce the number of

embarrassments they will receive when they begin to experience developmental

changes. Apart from this, the knowledge of sexual behaviour counselling will

help young adults to differentiate myths from truths (Ajidahun, 2013).

Youth-Based Development Programmes

Engaging the growing adolescents in developing and executing

adolescents-related programmes that target sexual behaviour is enormous as the

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good far outweigh the bad. Adolescents being involved can serve as turning

point for positive things towards healthy growth and development.

According to International Women’s Health Coalition (2015), young

people have a fundamental human right to participate in matters that affect their

lives. Meaningful participation is defined as seeking information, expressing

ideas, taking an active role in different steps of a process, being informed or

consulted on decisions concerning public interest, analysing situations, and

making personal choices. Several factors, including age, gender, social and

economic class, ethnicity, race, sexual orientation, and HIV status, are key

determinants of what role young people see for themselves in society and the

ways in which they participate in programs and policies. Giving decision-

making power to young people and integrating them into all aspects of program

development are vital components of ensuring meaningful participation. Simply

having a youth program within an organization does not necessarily guarantee

meaningful youth participation. Although there is relatively little evidence on

the impact of youth participation, according to the International Women’s

Health Coalition (IWHC) (2015) more meaningful participation will result in

better-developed interventions to promote adolescent sexual behaviours and

reproductive health and rights.

Adolescents’ participation can be in a form of youth leadership in sexual

behaviour promotion and peer education. According to IWHC (2015), many

organizations have established youth programs that staff young people or

include youth representatives in steering committees or youth councils. These

organizations have been very successful in advocating for adolescent and youth

sexual and reproductive health and rights at the UN level.

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To IWHC (2015), the most solid evidence on youth participation relates

to the peer education model, but the results are not promising for SRHR

programmes. While peer educators can help create a safe, youthoriented

environment, adolescents are more likely to turn to adults for information on

sexual and reproductive health. Several studies have shown that the selection of

appropriate peer educators may be a challenge: peer educators may not be seen

as legitimate, they may have competing demands, or there may be a feeling of

competitiveness between educators and other young people. However, many

components of peer educator programmes including youth needs assessments,

youth- focused recruitment strategies, and better training and mentoring for

young people can be used to more effectively engage young people. This

dichotomy demonstrates a need to clearly set roles, responsibilities, and

effective partnerships between young people and adults when implementing

SRHR programmes.

Clinical-Based Programmes

Development of clinical-based sexual behaviour programmes may go a

long way to reduce risky sexual behaviours adolescents get themselves engaged.

There is no denying fact that health professionals coming into contact

adolescents as and they visit clinics offer them a lot information that they can

draw on as adolescents in managing their natural turbulent situations. According

to Maria, Guilamos-Ramos, Jemmott, Derouin and Villarruel (2017), health

professionals’ care for adolescents in a variety of settings, including

communities, schools, and public health and acute care clinics, which affords

them many opportunities to improve adolescents’ sexual behaviours and

reproductive health and reduce sexual-related problems such as unplanned

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pregnancy and sexually transmitted infections. To ensure that adolescents have

access to sexual and reproductive health care (which includes both preventive

counselling and treatment) in all nursing practice sites, health professionals

need to gain the knowledge and improve the skills required to deliver evidence-

based sexual-clinical services to adolescents and parents. Collectively, they can

use their unique combination of knowledge and skills to make a positive impact

on adolescent sexual and reproductive outcomes because they have the capacity

and opportunity to disseminate information about sexual and reproductive

health to adolescents and their parents in communities, schools, public health

clinics, and acute care settings (Maria, Guilamos-Ramos, Jemmott, Derouin &

Villarruel, 2017).

Perceptions of contraceptives use among adolescent students

Studies conducted have reported on the perception of adolescent

students regarding the use of contraceptives and how these perceptions

influences their usage of contraceptives.

A study conducted by Agyemang, Newton, Nkrumah, TsokaGwegweni

and Cumbe (2019) on contraceptive use among sexually active female

adolescents in Ashanti Region-Ghana indicated that the perceived side effects

of contraceptives among female adolescents was found to be the main reason

for about 53.66% of them not using the contraceptives. Hagan and Buxton

(2012) in a study on contraceptive knowledge, perceptions and use among

adolescents in the Central Region of Ghana revealed that, adolescents in Senior

high Schools perceived contraceptives are meant for only married adults hence

do not see the need to use contraceptives themselves. Similarly, Nana and

Esinam (2012) found that, most adolescents did not use contraceptives because

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of their perceived side-effects of contraceptives. In the same study, Nana and

Esinam (2012) reported that, the use of contraceptive by the adolescent students

was a reserve for the married adults. Kareem and Samba (2016) also reported

that, misconceptions and misinformation of adolescent girls in Korle-Gonno,

Accra, Ghana on contraceptives discouraged them from using contraceptives.

Komey (2016) indicated in a study on perceptions of contraceptive use among

second cycle institutions in the Adentan Municipality that, adolescents’

misperceptions about contraceptives tended to cloud the judgment towards

contraceptives, thus serving as a barrier to the use of contraceptives.

Mohammed, Abdulai, and Iddrisu (2019) revealed in their study that, most

adolescents perceived contraceptives use as not morally right and tends to

promote promiscuity among adolescents in Northern Ghana. Ekstrand (2008) in

a study on perceptions of contraceptive use, abortion, and sexually transmitted

infections among adolescent in Sweden mentioned that, main barriers to

contraceptives especially condom use were interference with spontaneity,

pleasure reduction, loss of erection, and embarrassment or distrust. Many of the

young men generally preferred coitus interruptus to condom use. An

investigation into contraceptive use, knowledge, attitude, perceptions and

sexual behaviour among female University students in Uganda by Nsubuga,

Sekandi, Sempeera and Makumbi (2015) indicated that, students perceived

contraceptives use are only for females. Etenikang, Uji, Obinna and Ife (2017)

interestingly revealed that, religious adherence and myths about the side effects

of modern contraceptives accounted for low prevalence of modern

contraceptive use among literate adolescents in Calabar, Nigeria. In the same

vein, Okanlawon, Reeves and Agbaje (2010) reported that most adolescents in

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Nigeria had little correct information about contraceptives, with 42.9% having

misperceptions about its safety, believing that contraceptives are dangerous and

that chemicals in contraceptives can damage their reproductive system.

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CHAPTER THREE

RESEARCH METHODS

Introduction

It is generally accepted that, the quality of any research project hinges on

gathering relevant information that would be used to solve a stated problem.

The quality of these processes determines the validity and reliability of data

collection and the results obtained (Willington, 2000). This chapter outlines the

methods used in the research work. The research methods and procedures used

in the study are described under the following sub-heading: research design,

population, sample and sampling procedure, instrument, and data collection

procedure and data analysis.

Research Design

A research design can be viewed as a plan, structure and strategy of a

research to find the tools to solve the problems and to minimize the variance

(Creswell & Creswell, 2017). Its function, therefore, is to ensure that the

evidence obtained ensures that the initial question is answered as

unambiguously as possible. A research design is a plan of a study (McMillan &

Schumacher, 2001). This means a research design is a programme that guides

the researcher to collect, analyse and interpret data. According to Ary, Jacob,

and Raavieh (2002), research studies are designed to obtain information

concerning the current status of a phenomenon. Descriptive survey research was

used for this study. Seidu (2006) described descriptive survey design as the

study of existing condition, prevailing view points, attitudes, ongoing processes

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and developing trends in order to obtain information that can be analysed and

interpreted to come up with a report of the present status of the subject or

phenomenon under study. This design was found suitable for this study because

it gave an in-depth description of the phenomenon under study and also, it was

economical in collecting data from a large sample with high data turn over

(Kothari, 2004).

The study investigated the perception of contraceptives use and its

impact on the sexual behaviour of adolescence in Senior High Schools in the

Krachi East District. This invariably involves finding out the opinions of

students on how the perception of contraceptives use impacts their sexual

behaviour. Against this background, the descriptive survey was the research

design used for the study. Again, the descriptive survey design was used because

it has the advantage of producing good responses from a wide range of people.

It also provided a picture of a situation as it naturally occurs or happens (Burns

& Grove, 2003). At the same time, it provides a meaningful picture of events

and explains people’s opinions and behaviour on the basis of the data gathered

at a point in time (Best & Khan, 1986). Again, descriptive survey research was

deemed most appropriate because it involved the collection of data in order to

answer questions concerning current status of the subject matter under study.

Population

Based on data collected from the District Education office, the target

population for Senior High Students in the District is 6030 with an accessible

population of 2063 second year students. Form two (2) students were chosen

because, they are quite exposed to sexual behaviours and the use of

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contraceptives. The third years were not chosen because, they were preparing

for their April-May West African Senior Certificate Examination (WASCE).

Sample and Sampling Procedures

The quality of any research not only stands or falls by the

appropriateness of methodology and instrumentation but also by the suitability

of the sampling strategy that is adopted (Cohen, Manion & Marrison, 2011).

Polit (2001) defined a sample as a proportion or a subset of the accessible

population that serves as true representation of the accessible population. The

sample size was 317. In arriving at this sample size, the sample size

determination table of Krejcie and Morgan (1970) was used as a guide. But for

attrition purpose, the sample size was increased to 340. There are seven (7) SHS

in the District which consists of four (4) public schools and three (3) private

school. Four (4) out of seven (7) Senior High Schools in the Krachi - East

District in the Volta Region of Ghana were simple randomly sampled. These

include two (2) private schools and two (2) public schools were simple

randomly sampled. This enabled the researcher to compare the perceptions of

contraceptives use and its impact on sexual behaviour since these schools

belong to different categories. Table 1 represents the various schools and their

sample proportions:

Table 1-Sample Size Proportions for the selected schools in the Krachi - East
District
School N % n Male Female Category
Dambai SHS 95 5 17 9 8 Private

Mist SHS 571 30 104 56 48 Private

Oti SHS 1022 55 185 100 85 Public
Asukawkaw 184 10 34 18 16 Public
SHS
Total 1872 100 340 183 157
Where; N denotes the accessible population; n denotes the Sampled Size
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The study employed the multistage sampling procedure where the

following were considered: Simple Random sampling method was used to

sample the various schools based on the categories. This procedure was

employed because both private and public schools have an equal chance of

being selected and on their specific categories they belong to. Also both private

and public schools have similar characteristics of elements for the research.

Purposive sampling: The purposive sampling procedure was used in the

selection of the class thus: all second year students in these schools for the study.

This is due to the fact that, the third years who were more exposed to the use of

Contraceptives were preparing for their West African Examination Certificate

were exempted to give them the chance to study. The stratified method was used

to group male and female students.

Data Collection Instruments

A Perception and Contraceptives Uses on Sexual Behaviour

Questionnaire (PCSBQ) designed by the researcher was used to collect data for

the study. The questionnaire was considered most appropriate because it could

reach a large number of respondents more easily. Also, the questionnaires could

be filled at the respondents’ own convenience and it’s less expensive. The

questionnaire comprised six (6) sections with fifty-one (51) items. Section A

contained the demographic information of the respondents with three (3) items.

The section B solicited information on adolescents’ perception of contraceptives

use with ten (10) items. The section C solicited information on the perceived

contraceptives use influence on adolescents’ sexual behaviour with ten (10)

items. The section D was about the effect of perceived contraceptives use on

adolescent students’ sexual behaviour with ten (10) items. The section E was

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about the improvement of sexual behaviour of adolescents concerning

Contraceptives use with seven (7) items. The last section was the types of

contraceptives used by the adolescents with eleven (11) different types of items.

The questionnaires were administered to the sampled population within a period

of four (4) working days with the help of two (2) well trained colleagues after

which the questionnaires were collected for sorting.

Validation of the instrument

Validity is the exactness and precision of deductions based on the

findings from the research (Mugenda & Mugenda, 2003). The validation of the

instrument was carried out to check correctness of the data collection instrument

during the pilot study.

In order to enhance the validity of the study, the questionnaire was given

to the researcher’s supervisors and some lecturers in the Department of

Education and Psychology in the Faculty of Education and Foundation for

expert assessment as their vast knowledge in research studies seemed enormous.

This ensured both face and content related evidence to the items in examining

whether the items would relate to the research questions and also

comprehensively cover the details of the study.

Reliability of the Instrument

Leedy and Ormrod (2005) explained reliability as the consistency with

which a measuring instrument yields certain result when the entity being

measured has not changed. Consistency of the instrument was achieved through

a number of initiatives. Reliability reveals that when procedures of the study are

repeated, the exact same result are expected (Mugenda & Mugenda, 2003). A

reliability test was carried out with the purpose of testing the consistency of the

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instrument. The questionnaire was pre-tested in Yabram Senior High School

which is a public school and Action Senior High School a private school to test

for its reliability. The choice of these schools was based on the fact that, they

are all located in the Krachi East District where the participants share similar

characteristics. The obtained reliability for Section B (Perceptions of

adolescents about contraceptives use) was (r) = .728 (See appendix B). Section

C (Sources of information on Contraceptives) was gotten to be (r) =.824 (See

appendix C). In addition, section D (Perceived effects of Contraceptives use on

sexual behaviour of adolescents) also had a reliability of (r) =.791 (See appendix

D) and section E (Perceived ways in which Contraceptives use education can

enhance sexual behaviours of adolescent students) also saw a reliability co-

efficient of (r) =.672 (See appendix E). The overall obtained reliability co-

efficient for all the sections was .764 indicating that, the questionnaire was

reliable.

Ethical Considerations

Ethical consideration is a matter of necessity due to the nature of this

research. In conducting research, there are ethical principles that must be

considered, some of these are informed consent, assuring anonymity and

confidentiality. Informed consent is the major ethical issue in conducting

research. The consent of participants were first sought through a consent letter,

stating the purpose of the research.

The participants were constantly assured of anonymity by asking them

not to write their names or anything that could reveal their identity and the

information they provided was kept confidential. That is keeping private

information by the researcher in order to protect the respondents’ identity since

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this research is a highly sensitive one and that the ethical clearance form was

taken from the University of Cape Coast to ascertain the confidentiality of the

study.

Data Collection Procedure

Permission was sought from authorities of the various schools, after

being cleared by the Department of Education and Psychology and the

Institutional Review Board to carry out this study. A preliminary visit to these

was organized by the researcher to familiarize himself with these schools.

Meetings were later organized to meet these research participants where the

purpose and significance of the research were clearly explained to the

participants and the various school authorities. Participants were made aware

that their participation was voluntary and that they would have the opportunity

to withdraw freely from the research along the study period. The participants

were assured of confidentiality of the study with regards to the information they

provided and were equally given directions with regards to answering the

questionnaire. The researcher then issued the PCSB questionnaires to the

participants to answer all questions on it by the help of the researcher and his

assistants.

The researcher used four (4) days to collect data with the help of two

(2) research assistants who have much knowledge in research. The assistants

were academic friends who have much knowledge in research so their

understanding of the questionnaire administration process was of importance.

Data Processing and Analysis

The completed questionnaire by the respondents were serially numbered

and coded. The analysis involved coding, organizing, describing, interpreting,

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cross tabulation and drawing conclusion. The analysis was done in two stages.

Data for research questions 1-4 were analysed by using means and standard

deviation. With respect to the hypotheses, hypothesis 1 was tested using the

independent samples t-test because the researcher tested for differences between

male and female adolescent students about contraceptive use for which males

and females are natural dichotomies. Hypothesis 2 was tested using independent

samples t-test because the researcher wanted to find the effects of contraceptive

use on the adolescent students. Hypothesis 3 was tested using one way analysis

of variance (ANOVA) to test the statistical significance difference in the

perception of contraceptive use among the ages of the students. The one- way

analysis of variance (ANOVA) was used to determine whether there were any

statistical significance between the means of three or more independent

(unrelated) groups (ages ranges).

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CHAPTER FOUR

RESULTS AND DISCUSSION

Introduction

This chapter presented result analysis and the data collected from the

field. This is followed by the interpretation of the results and discussion of

findings. The purpose of the study was to investigate impact of contraceptive

use on the sexual behaviours of adolescents in the Krachi-East District. The

analyses and interpretation of data were done based on the data of the research

and question set for the study. The analysis was based on the 100% return rate

data obtained from 340 respondents used in the study. The first part of this

chapter designates the demographic characteristics of the selected Senior High

School students in the Krachi-East District which was analysed using

frequencies and percentages. In the second part, the research results were

presented based on the research question and hypotheses framed for the study.

Respondents’ Demographic Information

This section relates to the background information of the selected Senior

High School students in the Krachi-East District who responded to the

questionnaire. Demographic variables that were measured included the

students’ age, gender and school type. The demographic data were analysed

using frequencies and percentages. Table 2 presents the results:

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Table 2-Demographic Characteristics of the Selected Students

Demographic Variables Subscale Freq. Percent

Gender Male 183 53.8

Female 157 46.2

Age Range 12-15 25 7.3

16-19 256 75.3

20-23 59 17.4

Category of school Public 219 64.4

Private 119 35.6

Source: Field Data, (2018) (n=340)

From Table 2, it is evident that the male students (53.8%) were more

than female students (46.2%) in the Krachi-East District. The responses of the

respondents concerning their age revealed that those within 16-19 were the

majority (75.3%), this was followed by those within 20-23 (17.4%). Those

within the ages of 12-15 were the least (7.4%). Lastly on their school category,

those selected from the public schools were the largest (64.4%) while students

who were selected from the private schools were the least (35.6%).

Analysis of Main Data

To realize the purpose of the formulated research questions, descriptive

statistics (means and standard deviations) were used to analyse the obtained data

on perceptions of contraceptives use and its impact on adolescents’ sexual

behaviour in the Krachi-East District. In the analysis, means provides the

summary of the responses from the selected students from the Krachi-East

District and the standard deviation indicates whether their responses were

clustered to the mean score or dispersed. Standard deviation ranges from 0 to

1.70. Therefore, where the standard deviation is relatively small (within 0), the

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respondents were homogeneous. On the other hand, where the standard

deviation is relatively large (around 1.02), the responses were heterogeneous.

The test value of 2.50 was used to determine the degree of the impact on

adolescents’ students from the Krachi-East District responses. By implication,

a mean of 2.50 and above indicates agreement of students in the Krachi-East

District concerning contraceptives use while a mean of 2.49 and below indicates

disagreement towards contraceptives use. The findings are presented as below.

Research Question One: What is the knowledge level of adolescent students

about contraceptives use?

The purpose of this research question was to assess the perceived

knowledge level of adolescent students about contraceptives use. To achieve

this, means and standard deviations were used to assess the adolescents’

knowledge level. The results are presented in Table 3.

Table 3-Results on the Perceived Knowledge Level of Adolescent

Students about Contraceptives Use

Test value=2.50
Mean Std. D
Condom is a form of contraceptive that is available for both 2.96 .948
males and females
Contraceptives use prevents the contraction of sexually 2.90 .943
transmitted diseases
Contraceptives use prevents any unplanned pregnancy 2.86 .993
related issue in relationships
Contraceptives use reduces the sexual pleasures that one is 2.83 .933
supposed to have during sexual intercourse.
Contraceptives can disappear inside a female’s vagina when 2.51 .970
it strips from the male’s penis
One Contraceptives can be used more than once 2.18 1.02
Contraceptives use means that one does not trust the partner 2.14 .965
Contraceptives use indicates that one is spoilt or leads an 2.01 immoral .961
life
Mean of means/ Std.D 3.07 1.17
N=340
Statements
Source: Field Survey (2018). Where N is the sampled size

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As represented in Table 3, the results show that generally, adolescents

in the Krachi-East District have perceived knowledge about contraceptives use.

This was quite evident after the responses from the respondents scored a mean

greater than the test value (2.50). Dwelling on the individual items, the results

indicated that some of the items were rated higher than the others. This implies

that each of the students had different understanding about contraceptives use.

For example, it was evident that most of the adolescents in the

KrachiEast District know that condom is a form of contraceptive that is

available for both males and females (M=2.96, SD=.948). In other evidence, it

was revealed that adolescents in the Krachi-East District are aware that

contraceptives use prevents the contraction of sexually transmitted diseases

(M=2.90, SD=.943).

The results from most of the adolescents in the Krachi-East District

indicated that they know that contraceptives use prevents any unplanned

pregnancy related issue in relationships (M=2.86, SD=.993). In another related

results, the adolescents specified that Contraceptives use reduces the sexual

pleasures that one is supposed to have during sexual intercourse (M=2.83,

SD=.933). The adolescents in the Krachi-East District further demonstrated

their knowledge level that contraceptives can disappear inside a female’s vagina

when it strips from the male’s penis (M=2.51, SD=.970).

Few of the items scored a mean less than the test value of 2.50 indicating

that adolescents in the Krachi-East District do not have much knowledge in that

aspect of contraceptives use. For example, they disagreed that one

Contraceptives can be used more than once (M=2.18, SD=1.02). Also they

disagreed that contraceptives use means that one does not trust the partner

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(M=2.14, SD= .965) and finally they disconfirmed that contraceptives use

indicates that one is spoilt or leads an immoral life (M=2.01, SD=.961).

From the foregoing, it can be concluded that adolescent senior high

school students in the Krachi-East District knowledge level about

contraceptives use was adequate as their observed grand mean 3.07 was above

the criterion grand mean of 2.50.

Research Question Two: What are the sources of information on the usage

of contraceptives among adolescents?

To provide more evidence to the study, the researcher went ahead to

determine the sources of information on Contraceptives use among adolescents

in the Krachi-East District. To measure this, means and standard deviations

were used for the analysis. Table 4 offers the results.

Table 4-Results on the Sources of Information on Contraceptives Use

Statements Test Value=2.50
Mean Std. D
I got to know the use of contraceptives at the hospital, clinic, 2.79 1.067
health centres etc. from the doctors and the nurses
I got to know the use of contraceptives through my sexual partner 2.67 1.027
I got to know the use of contraceptives through my friends 2.61 2.377
I got to know the use of contraceptives through watching 2.60 1.016
television and other social media platforms
I got to know about contraceptives use through the internet by 2.59 1.092
browsing with my phone
I got to know about the use of contraceptives at the chemical shop 2.39 1.068
I got to know the use of contraceptives through the association I 2.35 1.038
joined (Clubs)
I got to know the use of contraceptives through my 2.33 1.055
teachers in school
I got to know the use of contraceptives through my siblings 2.01 1.116
I got to know the use of contraceptives through my parents (mother1.99 1.254
and father)
I got to know about contraceptives usage in my church/mosque1.81 1.065
(pastors, imams etc.)
Mean of means/ Std. Deviation 3.07 1.171
N=340
Where N is the sampled size
Source: Field Survey (2018)
83

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Table 4 presented the results on the sources of information on

contraceptives and their usage. The means and standard deviations results from

the study suggest that most of the adolescents in the Krachi-East District know

the sources of information on contraceptives use and other contraceptives.

For example, the students postulated that they got to know the use of

Contraceptives at the hospital, clinic, health centres etc. from the doctors and

the nurses (M=2.79, SD=1.067). The respondents further stated that that they

got to know the use of contraceptives through their sexual partners (M=2.67,

SD=1.027).

In furtherance, it was further stated by the respondents in the Krachi East

District that most of them got to know the use of contraceptives through their

friends (M=2.61, SD=2.377). In other evidence, they further confirmed that

they got to know the use of Contraceptives through watching television and

other social media platforms (M=2.60, SD=1.016). Most the adolescents in the

Krachi-East District were of the view that they got to know about contraceptives

use through the internet by browsing with their phones (M=2.59, SD=1.092).

Nevertheless, most of the adolescents were ignorant about other sources

of information for Contraceptives use. For example, they demonstrated that they

did not get to know about the use of Contraceptives at the chemical shop

(M=2.39, SD=1.068). In similar results they indicated they did not get to know

the use of Contraceptives through the association I joined (Clubs) (M=2.35,

SD=1.038).

The adolescents agreed that they did not get to know the use of

contraceptives through their teachers in school (M=2.33, SD=1.055). They

again indicated that they did not get to know the use of contraceptives through

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their siblings (M=2.01, SD=1.116). The source of information about the use of

contraceptives was not attributed to the adolescents’ parents (mother and father)

(M=1.99, SD=1.254). Finally, the source of information about use of

Contraceptives was not ascribed church/mosque (pastors, imams etc.) (M=1.81,

SD=1.065).

From the foregoing, it is indicative that the sources where adolescents

got to know about Contraceptives and it usage were many. However, those

sources through which they got the information included hospitals, peers, sexual

partners, internet and watching televisions.

Research Question Three: What are the effects of the perception of

contraceptives use on the sexual behaviour of adolescent students?

To establish more comprehensive results for the study, the researcher

further investigated the effects of the perception of contraceptives use on the

sexual behaviour of adolescent in the Krachi-East District. The mean and

standard deviations were used for the analysis. Table 5 illustrated the results.

Table 5-Perception of contraceptives Use on the sexual behaviour of adolescent

students

Test Value=2.50
Statements
Mean Std. D

Contraceptives use decreases the contraction of sexually 2.74 .987

transmitted infections

Contraceptives use helps minimize issues about unintended 2.69 1.013

pregnancies among adolescents

Contraceptives use increases the rate at which people engage in 2.44 .987

sexual intercourse

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Table 5: Continued
Contraceptives use exposes adolescents more than necessary to 2.41 .999

infidelity even after maturity

Contraceptives use allows for multiple sexual partners among 2.39 1.023

adolescents

Contraceptives use is panacea to less sexual gratification or 2.26 1.052

unsatisfied sexual-intercourse

Contraceptives use leads adolescents to act in similar ways 2.24 .991

sexually like adults and this would not be good

Contraceptives use brings about early initiation of sexual 2.20 .970

intercourse among adolescents

Contraceptives use pressures intercourse among adolescents 2.17 .991

Contraceptives use makes one unreligious among adolescents 2.13 .964

Mean of means/ Std.Deviation 2.36 0.99

Source: Field Survey, (2018)

N=340
Where N is the sampled size

Table 5 presents results on the effects of the perception of contraceptives

use on the sexual behaviour of adolescents in the Senior High Schools in the

Krachi-East District. The results show that generally, there is less effects of the

perception of Contraceptives use on the sexual behaviour of adolescent in the

Krachi-East District. This was clearly evident after most of responses from the

adolescents scored a mean less than the test value (2.50).

Only few of the items were agreed to have greater effect on the

perception of contraceptives use on the sexual behaviour of adolescent in the

Krachi-East District. For instance, they agreed that Contraceptives use

decreases the contraction of sexually transmitted infections (M=2.74,

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SD=.987). Similar results were found after they pointed out that contraceptives

use helps minimize issues about unintended pregnancies among adolescents

(M=2.69, SD=1.013).

In addition, adolescents in the Krachi-East District were of the view that

contraceptives use did not increase the rate at which people engage in sexual

intercourse (M=2.44, SD= .987). Similar results was found when the

adolescents indicated that contraceptives use did not expose adolescents more

than necessary to infidelity even after maturity (M=2.39, SD= 1.023).

In furtherance to the above, adolescents pointed out that contraceptives

use was not a panacea to less sexual gratification or unsatisfied

sexualintercourse (M=2.26, SD= 1.052). The adolescents in the Krachi-East

District further pointed out that, contraceptives use did not lead adolescents to

act in similar ways sexually as adults (M=2.24, SD= .991).

The results further show that according to adolescents, the

Contraceptives use do not brings about early initiation of sexual intercourse

among adolescents (M=2.20, SD= .970). Again, the adolescents asserted that

Contraceptives use do not pressures intercourse among adolescents (M=2.17,

SD= .991). Finally, they were of the view that contraceptives use did not make

one unreligious among adolescents (M=2.13, SD= .964).

On basis of the findings, it could be seen that majority of the respondents

disagreed that knowledge on contraceptives and their usage would lead to

teenage pregnancy and the contraction of sexually transmitted diseases.

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Research Question Four: How can the perception of contraceptives Use

improve the sexual behaviour of adolescent students?

Lastly on the research questions, the researcher examined how the

perception of contraceptives use improve the sexual behaviour of adolescent

students. Means and standard deviations were deemed appropriate for the

analysis. Table 6 presents the results.

Table 6-Results on the how Adolescent Students’ Perception of

Contraceptives use Improve their Sexual Behaviour

Test Value=2.50
Statements
Mean Std. D
Adolescents’ sexual behaviours can be improved through 2.90 1.009
the use of clinical-based programs that are championed by
nurses and other health professionals
Adolescents’ sexual behaviours can be improved by 2.85 1.014
taking them through sex education
Adolescents’ sexual behaviours can be improved by 2.78 1.002
encouraging and motivating them to avoid amoral sexual activities
and think of school and academics
Adolescents’ sexual behaviours can be improved by 2.76 .954
adopting health-based programmes to educate them on the best
practices

Adolescents’ sexual behaviours can be improved by 2.71 .989

counselling them on the values of remaining pious and sexual
intercourse free at their age
Adolescents’ sexual behaviours can be improved by 1.023
2.63 using adolescent role models in championing their
course so that they can learn from such role models
Adolescents’ sexual behaviours can be improved through 2.60 1.058
programmes that are parent-oriented where parents can engage
their adolescents on the consequences of teenage sexual
relationships
Mean of means/ Std.D 2.747 1.00

N=340
Where N is the sampled size

Source: Field Survey, (2018)

As illustrated in Table 6, the results give indication that some measures

can be used to improve the use of contraceptives on sexual behaviour of

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adolescent students in the Krachi-East District. The results however show that

some of the measures can be more effective and more conducive to the

adolescent students than others.

For instance, the adolescent students agreed that adolescents’ sexual

behaviours could be improved through the use of clinical-based programs that

were championed by nurses and other health professionals (M=2.90, SD=

1.009). They further suggested that adolescents’ sexual behaviours can be

improved by taking them through sex education (M=2.85, SD= 1.014).

The result above showed that, adolescents’ sexual behaviours can be

improved by encouraging and motivating them to avoid amoral sexual activities

and to think of school and academics (M=2.78, SD= 1.002). The adolescent

students were also of the idea that adolescents’ sexual behaviours can be

improved by adopting health-based programmes to educate them on the best

practices (M=2.76, SD= .954).

The respondents pointed out that adolescents’ sexual behaviours could

be improved by counselling them on the values of remaining pious and sexual

intercourse free at their age (M=2.71, SD= .989). Measure like adolescents’

sexual behaviours can be improved by using adolescent role models in

championing their course so that they can learn from such role models was not

left out (M=2.63, SD= 1.023). Lastly, the measure by which adolescents’

sexual behaviours could be improved was through programmes that were

parent-oriented where parents could engage their adolescents on the

consequences of teenage amoral sexual relationships was least approved by the

adolescents (M=2.60, SD= 1.058).

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In general, adolescent students’ knowledge about contraceptives and

their usage can go a long way to improve upon their sexual behaviours as they

continue to grow in societies that allow interaction among adolescents of both

sexes.

Research Question Five: What contraceptives are well known to the

adolescent students?

The main aim of this research question was to assess the types of

contraceptives that are well known by the adolescents. The results are presented

in Table 7.

Table 7-Results on the contraceptives well known by the adolescents

Types of Contraceptives Freq. (no) Percentage (%)

Male Condoms 202 59.4

Female Condoms 110 32.4

Diaphragm 9 3.0

Cervical cap-fem cap 5 1.5

Contraceptive coil 4 1.2

Contraceptive patch 3 0.9

Contraceptive implant 2 0.6

Vaginal Ring 2 0.6

Contraceptive injection 1 0.3

Emergency Contraceptive 1 0.3

Sterilizer 1 0.3

Source: Field Survey, (2018) n=340

Table 7 presents results on the contraceptives that are well known by the

adolescents. From the results, it is clear that Male Contraceptives was well

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known by the adolescents (n=202, 59.4%). Female Contraceptives followed

(n=110, 32.4%). The rest of the contraceptives were not very common among

the adolescents in the Krachi-East District.

Factor Analysis Results

Factor analysis is a statistic procedure or analysis which allows the

researcher to condense a large set of variables or scale items down to a smaller,

more manageable number of dimensions or factors. It does this by summarizing

the underlying patterns of correlation and looking for groups of closely related

items. In this study, exploratory factor analysis using principal components

analysis (PCA) has been employed. In PCA, the original variables are

transformed into a smaller set of linear combinations, with all of the variance in

the variables being used. It is admitted a preference for PCA and gives a number

of reasons for this. He recommends that it is psychometrically sound, simpler

mathematically and it avoids some of the potential problems with factor

indeterminacy associated with factor analysis.

The purpose of the study was to find out the perceptions of

contraceptives use and its impact on adolescents’ sexual behaviour in the

Krachi-East District. In obtaining this, all the factors (perceived knowledge

level of adolescent students about contraceptives use, sources of information on

Contraceptives and their usage, effects of the perception of contraceptives use

on the sexual behaviour of adolescent students and how the perception of

contraceptives Use improve the sexual behaviour of adolescent students)

measuring perceptions of contraceptives were analyzed confirmatory factor

analysis. Table 8 presents the KMO and Bartlett's Test Result.

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Table 8-KMO and Bartlett's Test Result

KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling
Adequacy. .821
Bartlett's Test of Approx. Chi-Square 783.085
Sphericity df 66
Sig. .000
Source: Field Survey, (2018) Significant @ 0.05 n=340

The adequacy of the sample is measured by KMO in SPSS. The

sampling is adequate or sufficient if the value of Kaiser Meyer Olkin (KMO) is

larger than 0.5 Field (2000), according to Pallant (2013) the value of KMO is

0.6 and above. Kaiser (1974) recommends a bare minimum of 0.5 and the value

between 0.5 and 0.7 are mediocre, value between 0.7 and 0.8 are good, value

between 0.8 and 0.9 are great and value between 0.9 and above are superb

(Hutcheson & Sofroniou, 1999). From Table 8, the results show the Kaiser-

Meyer-Olkin Measure of Sampling (KMO=.821) was adequate and good.

Again, the strength of the relationship in SPSS can be measured by a

Bartlett Test of Sphericity. It is actually a measure of a multivariate normality

of set of distribution. This test also checks the null hypothesis that the original

correlation matrix is an identity matrix. The significant value less than 0.05

indicates that these data do not produce an identity matrix and are thus

approximately multivariate normal and acceptable for further analysis (Pallant,

2013; Field, 2000). From Table 8, the Bartlett Test of Sphericity result

(sig=.000) was less than .05 indicates that these data do not produce an identity

matrix and are thus approximately multivariate normal and acceptable for

further analysis.

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Table 9-Results of the Exploratory Factor Analysis

Factors Variables included in the factor Loadings Eigenvalues % of Variance Cronbach’
explained s Alpha
Perceived Contraceptives use prevents any unplanned pregnancy related issue in 0.650
Knowledge (I) relationships
Condom is a form of contraceptive that is available for both males and
0.618 4.679 29.526 .847
females
Contraceptives use reduces the sexual pleasures that one is supposed to
have during sexual intercourse 0.533
Contraceptives can disappear inside a female’s vagina when it strips from
the male’s penis
Sources of I got to know the use of contraceptives at the hospital, clinic, health centers
Information etc. from the doctors and the nurses 0.506
(II)
I got to know the use of contraceptives through my sexual partner 0.736 3.255 21.459 .785
I got to know the use of contraceptives through my friends
0.662
I got to know about contraceptives use through the internet by browsing with
my phone
Effect Factors Contraceptives use decreases the contraction of sexually transmitted
0.746 2.069 17.671 .129
(III) infections
93

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Table 1: Continued
Contraceptives use helps minimize issues about unintended pregnancies
0.666
among adolescents
Use of Adolescents’ sexual behaviours can be improved through the use of clinical-
Contraceptives to based programs that are championed by nurses and other health professionals
improve
Sexual
Behaviour (IV)

Adolescents’ sexual behaviours can be improved by taking them through

.773 1.133 9.867 .525
sex education
Adolescents’ sexual behaviours can be improved by encouraging and
motivating them to avoid amoral sexual activities and think of school and .804
academics

Adolescents’ sexual behaviours can be improved by adopting health-

based programmes to educate them on the best practices

Total variance 78.523

Source: Field Survey, (2018)
Bartlett's Test of Sphericity=783.085, Significance=0.000
Kaiser-Meyer-Olkin Measure of Sampling Adequacy=0.821
94

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As shown in Table 9 total variance of 78.523% is achieved for four

factors using perceived knowledge level of adolescent students about

contraceptives use. The first Eigen value is equal to 4.679 and explained

29.526% of the variance in the original data. The second factor (Sources of

Information) Eigen value is equal to 3.255 and explains 21.459% of the

variance, the third component (Effect Factors) Eigen value is equal to 2.069

and explains 17.671% of the variance. The last factor (Use of Contraceptives

to improve Sexual Behaviour) Eigen value is equal to 1.133 and explains

9.867% of the variance.

Figure 1-Scree Plot

The scree plot show that not all the factors were loading to predict the construct

Factor Rotation

It can be hard to name the components after extraction based on their

factor loadings because PCA criteria is that the first factor / component

account for the maximum part of the variance. This understanding of the

factors might be hard. Therefore to interpret them, the rotation of factors

assists in this process, for this reason the factors are rotated. Accordingly,

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factor rotation changes the pattern of the unrotated factors (as shown in

component matrix) and increases the understanding of each factor, by

presenting the pattern of loadings in a manner that is easier to interpret and

understand.

Table 10-Rotated Component Matrix

Rotated Component Matrix and Internal

Consistencies
Principal Component Loadings
Varimax Variance Cronbach's
Items Variables Explained Alphas
Factor 1 (PK) PKF1 .800 .86596 .960
PKF2 .743
PKF3 .615

.663 .65294 .855

Factor 2 (SI) SIF1
SIF2 .833
SIF3 .856
SIF4
.786

Factor 3 (EF) EF1 .76569

EF2 .844
EF3 .866
EF4
.807
.575 .58694 .833
Factor 4 ISBF1
(ISBF)
ISBF2 .818

ISBF3 .678

ISBF4 .785

Source: Field Survey, (2018) Significant @ 0.05 n=340

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In order to increase the interpretability of the extracted factors, rotation

is necessary to maximize the loadings of some of the items. Later, these items

can be used to identify the meaning of a factor. It is noteworthy to mention that

rotation does not change the underlying solution, rather, it presents the pattern

of loadings in a manner that is easier to interpret. From the analysis, the items

in Table 10 are factored in familiar component as for perceptions of

contraceptives use and its impact on adolescents’ sexual behaviour in the

Krachi-East District item 1, item 2, item 3 and item 4, are consistently moving

together and are in one group.

Analysis of Research Hypotheses

Research Hypothesis One: There will be no statistically significant

difference between male and female students’ perception on the use of

contraceptives.

One of the objectives of the study was to determine the differences

between male and female students’ perception on the use of contraceptives in

the Krachi-East District. To achieve this, independent sample t-test was

deemed appropriate for the analysis. The results are presented in Table 8.

Table 8-Results of t-test Comparing Gender Difference on the Perception of

the Use of Contraceptives
Gender N Mean SD t-value Df Sig-Value

Male 183 19.394 3.384

Female 157 19.306 3.502 .236 .338 .814

Source: Field Data, (2018) *Significant difference exists at P<0.05, (n=340)

Results on the male and female students’ perception on the use of

contraceptives are presented in Table 8. As depicted in the Table, the means

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and standard deviation gives slight indication that male students (mean=

19.394, Std.D=3.384) have high perception on the use of contraceptives than

female students in the Krachi-East District (mean=19.306, SD=3.502).

However, a critical look at the t and p-value show that, there was no

statistically significant difference between male and female students’

perception on the use of contraceptives (t (df =338) =.236, p = .814, p>0.05,

n=340, 2-tailed). Hence, the null hypothesis that; “There is no statistically

significant difference between male and female students’ perception on the use

of contraceptives” was upheld.

Research Hypothesis Two: There will be no statistically significant

difference in the perception of contraceptives use between students in

private and public Senior High Schools.

This hypothesis set out to determine the differences in the perception

of contraceptives use between students in private and public schools. To

achieve this, independent samples t-test was deemed appropriate for the

analysis. Table 9 offers the results on the differences on the perception of

contraceptives use between students in private and public schools in the

Krachi-East District.

Table 9-Results of t-test Comparing Type of School on the Perception of the

Use of Contraceptives
Type of
N Mean SD t-value Df Sig-Value
school

Public 219 19.4220 3.12502

.464 .844 .643

Private 121 19.2295 3.94128

Source: Field Data (2018)

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The Table showed the results on the private and public schools’

perception on the use of contraceptives. As described in the Table, the means

and standard deviation gives small differences in the mean scores of the private

and public schools. In comparing the means scores, the results show that public

schools (mean= 19.422, Std.d=3.125) have different perception on the use of

contraceptives than private schools in the Krachi-East District

(mean=19.2295, SD=3.94128, n=122). However, the t and p-value showed

that, there was no statistically significant difference between private and public

schools’ perception on the use of contraceptives (t (df=.844)t =.464, p = .643,

p>0.05,). Therefore, the null hypothesis which stated that; “There is no

statistically significant difference in the perception of Contraceptives use

between students in private and public schools” was upheld.

Research Hypothesis Three: There will be no statistically significant

difference in the perception of contraceptive use among the ages of the

students

This enabled the researcher to test the hypothesis and find out whether

ages of the students could have different perception on contraceptives use

among adolescent students in the Krachi-East District. To achieve this,

oneway between-groups analysis of variance (ANOVA) was used for the

analysis.

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Figure 1-Mean Plots on ages of the Students by their Perception of

Contraceptives Use

Figure 1 presents a graphical way to compare the means scores of the

ages of the students by the perception of Contraceptives use. The results from

the Means Plots Figure show there were no differences in the scores among

the ages of the students. To gain more statistical evidence, one-way

betweengroups analysis of variance (ANOVA) was conducted to gain more

statistical confirmation.

Table 10-Summary of One-way Analysis of Variance (ANOVA) Results

Sum of
Sources
Squares Df Mean Square F Sig.

Between Groups .766 2 .383 .032 .968(ns)

Within Groups 4000.881 337 11.872

Total 4001.647 339

Source: Field Data, (2018)

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A one-way between-groups analysis of variance (ANOVA) was

conducted to compare mean scores of the ages of the students with respect to

their perception of Contraceptives use. From Table 9, the results show that

there was no a statistically significant difference ages of the students with

respect to their perception of Contraceptives use. This was evident after the

between-groups analysis of variance (ANOVA) produced an F-ratio results of

F (2, 337) = .032, p<.05, n=340, Sig. = .968, 2-tailed). Henceforth, null

Hypothesis two which states that “There is no statistically significant

difference in the perception of Contraceptives use among the ages of the

students” was upheld.

Based on the result, it can be affirmed that, there is no statistical

significant difference among the ages of adolescent students about their

knowledge level concerning contraceptives usage.

Discussion

Perceived knowledge level of adolescent students about contraceptive use

The objective was to find out the knowledge level of adolescent

students about contraceptives use and the study revealed that adolescent senior

high school students in the Krachi-East District knowledge level about

contraceptives use was adequate as their observed grand mean 3.07 was above

the criterion grand mean of 2.50. Based on this, adolescents would be able to

protect themselves from sexual transmitted infections due to their knowledge

on contraceptives and their usage. The result therefore agreed to the study

findings of Tarkang and Bain, (2015), who indicated that the correct or right

knowledge and consistent contraceptives use whether male or female, has been

acknowledged to be effective towards successful prevention of sexually

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transmissible infections (STIs), including HIV/AIDS that come as a result of

adolescents sexual behaviours. The findings further confirmed that of Masoda

and Govender (2013) in their study that, adolescent students in DR Congo, 137

(99%) of respondents knew what condoms as a form contraceptives. Ninety-

two of the respondents (67%) knew that generally, Contraceptives are made of

latex. Sixty-five per cent of participants from the same study also understood

what contraceptives were and what they comprised. They stressed the reason

that adolescent students’ knowledge about Contraceptives was high could be

as a result of the intensive efforts of the DRC government and

nongovernmental organisations (NGOs) to educate students about HIV and

Contraceptives use. In the same study, most participants (76%) knew that some

contraceptives prevented HIV, STIs and unwanted pregnancies, and that it was

important to use a contraceptives every time that they had sexual intercourse.

Sources of Information on contraceptive and contraceptive use

The objective of the question was to identify sources of information to

contraceptives use by adolescents and it was indicative that the sources where

adolescents got to know about contraceptives and it usage were many.

However, those sources through which they get the information

included hospitals, peers, sexual partners, internet and watching televisions.

The study findings agreed with Boamah (2013) on adolescents in Kintampo,

Ghana revealed that a lot of participants indicated they got information about

contraceptives and other contraceptives usage from friends. On that same note,

the findings corroborate the findings of Sutton, Brown, Wilson and Klein

(2002) who indicated when interacting with adolescents about sources to

condom use and other contraceptives in most occasions, adolescents often

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mentioned media as the major source of information and such media include

television and internet. The study finding was in conformity with findings by

Rideot, Foehr and Roberts; and Strasburger (as cited in Mahama, 2017) which

reported that American adolescents devoted about seven hours per day on

media and the media are flooded with sexual messages and images.

On the issue of health care providers being an information source to

adolescents in Krachi-East District concerning sex education, it agreed with

the assertion of Mahama (2017) in his study that, health care providers are

essential as every responsible avenue where adolescents learn about their

bodily changes and understand what these changes entailed.

Impact of the perception of contraceptive use on the sexual behaviour of

adolescent students

The aim of the objective was to find out the effects of knowledge on

contraceptives use among adolescents. This revealed that adolescents agreed

that knowledge on contraceptives and its usage could help prevent sexually

transmitted infections and unintended pregnancies among the adolescents

which was consistent with the findings of Cates and Stone (as cited in

American Academy of Paediatrics, 2001) that condoms use decreased the rate

of acquisition of HIV by those who engaged in high-risk sexual activity or

whose partners were seropositive for HIV, with relative risk ratios generally

in the range of 60% to 96% protective. The findings further agreed with that

of Blake (2003) who studied 4,000 adolescents in high schools and posited

that making contraceptives available and allowing their use in high schools did

not increase adolescent sexual activity, but it protects those who are already

sexually active from some sexually transmitted diseases. Blake (2003) noted

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that contraceptives availability was not associated with greater sexual activity

among adolescents but was associated with greater contraceptives use among

those who were already sexually active, a highly positive result.

How perception of contraceptive use improved the sexual behaviour of

adolescent students?

The aim was to accentuate adolescent sexual behaviours can be

improved based their knowledge on Contraceptives use and all respondents

agreed to the statement as adolescent students’ knowledge about

Contraceptives and their usage can go a long way to improve upon their sexual

behaviours as they continue to grow in societies that allow interaction among

adolescents of both sexes. Programmes can be initiated including school-based

ones. According to Mahama (2017) study among adolescent high school

students in the Wa Municipality in Ghana. The study revealed that 85.1% of

390 adolescent students surveyed agreed that sex education will have a

positive effect on their social lives while 14.9% of the respondents’ sex

education will have negative effects on them. It is important to note that issues

about Contraceptives and its usage is part of sex education and as such a

probable way getting adolescents sexual behaviours improved.

Again, communication between parents and adolescents being

espoused was in line to improve adolescent students’ sexual behaviours and

this touted that parents-adolescents with relation to communication is

inevitable and is believed to possess the impetus to improve adolescents’

sexual behaviours. According to Widman, Choukas-Bradley, Noar, Nesi, and

Garrett (2016), parent-adolescent sexual communication has received

considerable attention as one factor that could positively impact youth safer

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sex behaviour, including adolescents’ use of contraception and

Contraceptives. It is understood that this communication relationship between

parents and adolescents is characterized with real-world and hypothetical

motives why parenting may be proxies of sexual socialization for adolescents

as parents may realistically convey sexual information and may exercise

significant influence on adolescents’ sexual attitudes, values, and risk-related

beliefs (DiIorio, Pluhar, & Belcher, 2003).

Discussion on Hypothesis One

The study revealed that there was no statistically significant difference

between male and female adolescent students about their perceptual level

concerning contraceptives usage. In this regard, the findings disagreed with

that of Leland and Barth (1992) which revealed that females were more likely

than males to have discussed sexuality topics with parents to have engaged in

sexual intercourse more frequently, to have experienced a pregnancy scare, to

have used contraceptives during their last sexual encounter. In addition to

perceive that, most of their peers were engaging in sex and using birth control,

to obtain birth control from health facilities, and to report intentions to abstain

or use protection in hypothetical situations placing them at risk for unprotected

sex. In that same study, it was reported that adolescent males were more likely

to have always used birth control, to have used birth control during their first

sexual encounter, and to have used a contraceptives during their last sexual

encounter. Furthermore, males were more likely to obtain birth control from a

store or a friend and males knew more about using Contraceptives correctly

and their role in preventing sexually transmitted diseases (Leland & Barth,

1992). The findings equally refute Prata, Vahidnia and Fraser (2005) study

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findings which revealed that a larger proportion of males than of females

indicated that they had always used Contraceptives with all of their partners in

the three months preceding the survey 17% against 12%. This synopsis above

puts the male adolescents in position against female adolescents when it comes

to contraceptives usage in sexual behaviours.

Discussion on Hypothesis Two

The study revealed that there was no statistically significant difference

between public and private schools’ adolescent students about their knowledge

level concerning contraceptives and their usage. The findings of this study

were incoherent with existing empirically-based literature as a study in Angola

among adolescent students revealed otherwise that males in all adolescence

age-groups were more likely than females to be consistent users of

contraceptives (Prata, Vahidnia & Fraser, 2005)

Discussion on Hypothesis Three

The study revealed there was no statistically significant difference

among the ages of adolescent students about their knowledge level concerning

contraceptives usage. The results were in line with a study in Angola. The

findings of the study indicated that no differences existed among males in all

adolescent age groups were more likely than females to be users of

contraceptives with 19% against 13% (Prata, Vahidnia &Fraser, 2005)

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CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

Introduction

This chapter presents a summary of the research findings, discussion

of the research findings, the conclusion and the recommendations. The study

sought to investigate the impact of Contraceptives use on sexual behaviours

among adolescent senior high school students in the Krachi-East District in the

Volta Region of Ghana. The study espoused a descriptive survey research

method with the quantitative paradigm. A sample of 340 from 2063 adolescent

senior high school students were used for the study. The participants were

selected using the simple random and purposive sampling procedures. A close-

ended type questionnaire developed by the researcher was used and it

comprised five (6) sections (A-F) containing 51 items. Section “A” solicited

demographic information of respondents. Section “B” sought information

from the respondents on their knowledge of contraceptives usage. Section “C”

dealt with the sources of information on contraceptives and their usage.

Section “D” gathered information on the effects of contraceptives usage on

adolescents’ sexual behaviour. Section “E” sought information about how

sexual behaviours could be enhanced through the knowledge of contraceptives

and their usage. Section ‘F’ gathered information on the types of

contraceptives known to adolescent students.

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Summary of Findings

Adolescent students in the Krachi-East District knowledge level on

contraceptives especially condoms use was adequate and was above average.

Research question two indicated that, hospitals, peers, sexual partners, internet

and watching televisions were the major sources about contraceptives and their

usage. Adolescents agreed that contraceptives knowledge and its usage would

help prevent sexually transmitted infections and unintended pregnancies

among adolescents. Adolescent students’ knowledge about contraceptives and

their usage could go a long way to improve upon their sexual behaviours as

they continue to grow in societies that allow interaction among adolescents of

both sexes.

There was no statistically significant difference between male and

female adolescent students about their perceptual level concerning

contraceptives and their usage. Which means that, both male female

adolescent students were aware of contraceptives and how they are used.

There was no statistically significant difference between public schools’ and

private schools’ adolescent students about their perception on contraceptives

and their usage. This finding means that, students in both private and public

schools were highly aware of contraceptives and their usage. Finally, there was

no statistical significant difference among the ages of adolescent students

about their knowledge level concerning contraceptives usage. This also means

that all the adolescent age group were aware of contraceptives and their usage.

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Conclusion

Based on the findings of the study, it was concluded that, adolescent

students in the Krachi-East District were knowledgeable on contraceptives use

with observed mean of 3.07 above the criterion mean of 2.50. It was also

concluded that hospitals, peers, sexual partners, and internet and watching

televisions are the main sources adolescents get information about

contraceptives and it usage.

It was again concluded that, adolescent students were affected

positively through contraceptives knowledge and its usage since they were

protected from sexually transmitted infections and unintended pregnancies

among the adolescents.

Recommendations

In light of conclusions drawn from the findings of the study, the following

recommendations are offered:

The researcher recommends that, adolescent students be guided by

teachers on their information sources, especially the media. It is possible that

information presented by these electronic media might be beyond the reality

of contraceptives usage and could bring about emotional destabilisation in the

lives of the adolescents. In this, parents, peer-educator groups and teachers can

be implored to sway adolescents from some unwholesome sexual information

presented by these uncensored media outlet (internet and television). Finally,

there is an urgent need for Ghana Education Service to undertake programmes

that would empower adolescents, especially females, to become assertive in

negotiating contraceptive use every time they want to have sex or engage in

unprotected sex. Continued advocacy by NGOs and GES should be available

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to adolescents who are not abstaining from sex, so they can continually use

contraceptives as a way of protecting themselves from unwanted pregnancies

or contracting sexually transmitted disease.

All these interventions, if put in place will go a long way to improve

and sustain contraceptive use among adolescents in the Krachi-East District.

Suggestions for Further Research

The researcher suggests for further studies on factors the influence

modern contraceptive practices among adolescents in rural areas in the Krachi-

East District of Ghana.

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APPENDICES

APPENDIX A

UNIVERSITY OF CAPE COAST

COLLEGE OF EDUCATION STUDIES

FACULTY OF EDUCATIONAL FOUNDATIONS

DEPARTMENT OF EDUCATION AND PSYCHOLOGY

QUESTIONNAIRE

Dear Respondent,

I am embarking on a study that seeks to find out “Perception of

Contraceptives use and its impact on the sexual behaviours of adolescents

in senior high school in the Krachi – East District. I would be grateful if

you could answer the questions below. There is no right or wrong answer. I

am interested in your personal experience and opinion. The confidentiality of

your information is guaranteed.

Instruction: For each item, please choose the answer which best describes

your experiences by ticking [√]

SECTION A

Demographic Data

1. Gender/Sex: Male [ ] Female [ ]

2. Age Range: 12-15 [ ], 16-19 [ ], 20-23 [ ]

3. Type of School: Public [ ] Private [ ]

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Instruction: In the tables below for each statement mark how much you agree

with a tick [√] in the box to the right of each statement. The responses are on

the scale 1-4, where 1 = Strongly Disagree [SD], 2 = Disagree [D], 3 = Agree

[A] and 4 = Strongly Agree [SA]. You are kindly required to tick only one

response in each case.

SECTION B

Perceptions of adolescents about Contraceptives use

SN Statements SD D A SA

1 Condom is a form of contraceptive that is available for both

males and females

2 Contraceptives use prevents the contraction of sexually

transmitted diseases

3 Contraceptives use prevents any unplanned pregnancy related

issue in relationships

4 Contraceptives use reduces the sexual pleasures that one is

supposed to have during sexual intercourse.

5 Contraceptives can disappear inside a female’s vagina when

it strips from the male’s penis

6 One Contraceptives can be used more than once

7 Contraceptives use means that one does not trust the partner

8 Contraceptives use indicates that one is spoilt or leads an

immoral life

9 Contraceptives are very painful when used

10 Contraceptives are same in structure and size for male and

females

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SECTION C

Sources of information on Contraceptives and other contraceptives

S Statements S D S

N D A A

1 I got to know the use of Contraceptives through my friends

2 I got to know the use of Contraceptives through watching

television and other social media platforms

3 I got to know the use of Contraceptives at the hospital, clinic,

health centers etc. from the doctors and the nurses

4 I got to know about the use of Contraceptives at the chemical

shop

4 I got to know the use of Contraceptives through my sexual

partner

5 I got to know the use of Contraceptives through my parents

(mother and father)

6 I got to know the use of Contraceptives through my siblings

7 I got to know the use of Contraceptives through my teachers in

school

8 I got to know about Contraceptives usage in my church/mosque

(pastors, imams etc.)

9 I got to know the use of Contraceptives through the association

I joined (Clubs)

10 I got to know about Contraceptives use through the internet by

browsing with my phone

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SECTION D

Perceived effects of Contraceptives use on sexual behaviour of adolescent

students

SN Statements SD D A SA

1 Contraceptives use increases the rate at which people

engage in sexual intercourse

2 Contraceptives use decreases the contraction of sexually

transmitted infections

3 Contraceptives use allows for multiple sexual partners

among adolescents

4 Contraceptives use helps minimize issues about unintended

pregnancies among adolescents

5 Contraceptives use makes one unreligious among

adolescents

6 Contraceptives use brings about early initiation of sexual

intercourse among adolescents

7 Contraceptives use pressures intercourse among

adolescents

8 Contraceptives use leads adolescents to act in similar ways

sexually like adults and this would not be good

9 Contraceptives use is panacea to less sexual gratification or

unsatisfied sexual-intercourse

10 Contraceptives use exposes adolescents more than

necessary to infidelity even after maturity

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SECTION E

Perceived ways in which contraceptives use education can enhance sexual

behaviours of adolescent students

SN Statements SD D A SA

1 Adolescents’ sexual behaviours can be improved by taking

them through sex education

2 Adolescents’ sexual behaviours can be improved by

encouraging and motivating them to avoid amoral sexual

activities and think of school and academics

3 Adolescents’ sexual behaviours can be improved through

programmes that are parent-oriented where parents can engage

their adolescents on the consequences of teenage amoral sexual

relationships

4 Adolescents’ sexual behaviours can be improved by

counselling them on the values of remaining pious and sexual

intercourse free at their age

5 Adolescents’ sexual behaviours can be improved by adopting

health-based programmes to educate them on the best practices

6 Adolescents’ sexual behaviours can be improved by using

adolescent role models in championi ng their course so that

they can learn from such role models

7 Adolescents’ sexual behaviours can be improved through the

use of clinical-based programs that are championed by nurses

and other health professionals

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SECTION F

Types of Contraceptives known by adolescent students

Types of Contraceptives YES NO

Male Condoms

Female Condoms

Diaphragm

Cervical cap-fem cap

Contraceptive coil

Contraceptive patch

Contraceptive implant

Vaginal Ring

Contraceptive injection

Emergency Contraceptive

Sterilizer

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APPENDIX B

RELIABILITY TEST RESULTS OF THE INSTRUMENT

PERCEPTIONS

Case Processing Summary

N %

Cases Valid 30 100.0

Excludeda 0 .0

Total 30 100.0

a. Listwise deletion based on all variables in the procedure.

Reliability Statistics

Cronbach's

Alpha Based on

Cronbach's Standardized

Alpha Items N of Items

.728 .408 10

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APPENDIX C

SOURCES OF INFORMATION

Case Processing Summary

N %

Cases Valid 30 100.0

Excludeda 0 .0

Total 30 100.0

a. Listwise deletion based on all variables in the procedure.

Reliability Statistics

Cronbach's

Alpha Based on

Cronbach's Standardized

Alpha Items N of Items

.824 .778 10

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APPENDIX D

PERCEIVED EFFECTS

Case Processing Summary

N %

Cases Valid 30 100.0

Excludeda 0 .0

Total 30 100.0

a. List wise deletion based on all variables in the procedure.

Reliability Statistics

Cronbach's

Alpha Based on

Cronbach's Standardized

Alpha Items N of Items

.791 .793 10

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APPENDIX E

PERCEIVED WAYS

Case Processing Summary

N %

Cases Valid 30 100.0

Excludeda 0 .0

Total 30 100.0

a. List wise deletion based on all variables in the procedure.

Reliability Statistics

Cronbach's

Alpha Based on

Cronbach's Standardized

Alpha Items N of Items

.672 .672 7

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APPENDIX F

INTRODUCTORY LETTER

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APPENDIX G

ETHICAL CLEARANCE

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