Factors Associated with Unplanned Pregnancy among Unmarried Adolescents in Selected Communities of Ogun State, Nigeria

Unplanned pregnancy is a leading reproductive health problem among unmarried adolescents in Nigeria. A clinic and community survey of 1,041 respondents in selected communities of Ijebu North local government area of Ogun State, Nigeria, showed that a substantial proportion of the female respondents (21.5% urban and 8.8% rural) had their fi rst child during adolescence. 11.8% of the pregnant female respondents interviewed were unmarried adolescent girls who rarely used contraceptives and lacked access to sexuality education before becoming pregnant. Child-neglect (50.4%) and ignorance of sexrelated issues among adolescents (37.5%) were reported as the proximate causes of the adolescent pregnancy in the communities studied. Many of the respondents (49.1% urban and 69.1% rural) condemned the use of contraceptives by adolescents. A smaller proportion of the general respondents (9.9% urban and 20.4% rural) perceived sexuality education as inappropriate for unmarried adolescents. The fi ndings suggest the need for appropriate educational interventions on sexual and reproductive health. Emphasis of such interventions targeting the adolescents should be on the risks associated with sex particularly if unprotected. Research Article Factors Associated with Unplanned Pregnancy among Unmarried Adolescents in Selected Communities of Ogun State, Nigeria Adeneye AK1*, Erinosho OA2, Adeneye AA3 and Obasi CC4 1Public Health Division, Nigerian Institute of Medical Research, 6 Edmond Crescent, P.M.B. 2013, Yaba, Lagos, Nigeria 2Department of Sociology, Olabisi Onabanjo University, Ogun State, Nigeria 3Department of Pharmacology, Lagos State University College of Medicine, Lagos, Nigeria 4Department of Psychology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria Dates: Received: 18 November, 2016; Accepted: 28 December, 2016; Published: 02 January, 2017 *Corresponding author: AK Adeneye, Public Health Division, Nigerian Institute of Medical Research, 6 Edmond Crescent, P.M.B. 2013, Yaba, Lagos, Nigeria, Tel: +234-805-788-7698; +234-816-945-3782; E-mail:


Introduction
Studies have increasingly focused on adolescent reproductive health in sub-Saharan Africa and other parts of the world. This is largely due to adolescents' vulnerability to high-risk behaviours and the growing concern over the socioeconomic and reproductive health problems manifesting in experimentation with drug use, unintended and unwanted pregnancy, sexually transmitted infections (STIs) including HIV/AIDS, infertility and death among this age group [1][2][3]. Many studies from various parts of Africa have shown increase in the incidence of premarital sexual activity among adolescents [1,[4][5][6].
It is estimated that about 16 million women aged 15-19 years give birth each year representing about 11% of all births worldwide [7]. Ninety-fi ve per cent of these births occur in low-and middle-income countries. The proportion of births that take place during adolescence is about 2% in China, 18% in Latin America and the Caribbean and more than 50% in sub-Saharan Africa. Half of all adolescent births occur in seven countries: Bangladesh, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and the United States of America [7]. Studies from Kenya, Nigeria and Ethiopia for example showed a disproportionate number of unwanted pregnancy and abortion among adolescents [8,9].
In Nigeria, the incidence of unwanted pregnancy, abortions, abandoned babies and child abuse has rapidly increased, constituting a serious social problem [10]. Adolescent pregnancy is a major health concern in the country because of its association with higher morbidity and mortality for both the mother and the child [11]. Studies showed that a substantial number of unmarried young people aged 14-25 years in the country are sexually active [5,11,12]. The average age at fi rst intercourse is 16 years and many girls become pregnant before the age of 20 years [12]. Inspite of the high premarital sexual activity among the adolescents, their use of contraceptive is very low [13,14].
The number of adolescent girls aged 15-19 years who have started childbearing in Nigeria has continued to decrease over the years, yet the number remains high. Results of the 1990 Nigeria Demographic and Health Survey showed that 40% of adolescent girls aged 15-19 years sampled had either given birth or were expecting their fi rst child [15]. In  childbearing (17.0% have had a child and 5.0% are pregnant with their fi rst child). The percentage that had started childbearing increased with age from 2.2% of those aged 15 years to 35.5% of girls aged 19 years [11]. A larger proportion of adolescent girls in rural areas compared to those in urban areas have started childbearing (32.0% versus 10.0%). A comparison of the geo-political zones of the country shows that adolescent girls in the north of the country were found to give birth at three times the rate of those in the south. The North West has the largest proportion (36%) of adolescent girls who have started childbearing, while the South East (8.0%) and South West (8.0%) have the lowest proportions [11].
Results showed that women who became pregnant when aged 15-19 years are predisposed to greater pregnancyrelated risks than those older than 20 years (16)(17)(18). Although adolescents aged 10-19 years account for 11% of all births worldwide, they account for 23% of the overall burden of disease (disability-adjusted life years) due to pregnancy and childbirth. In Nigeria for example, the highest rate of low birth weight babies was reported among young mothers aged 15-19 years [19]. Similarly, studies showed that hypertensive disorders of pregnancy, cephalopelvic disproportion, iron-defi ciency anaemia, obstructed labour, vesico-vaginal fi stula (VVF) and/ or recto-vaginal fi stula (RVF) are common pregnancy-related complications in adolescents which result in higher morbidity and mortality for both themselves and their babies [20][21][22][23][24][25].
It is consequent to the pervasiveness and magnitude of the reported incidence of adolescent pregnancy in Nigeria that a study was carried out to document the distribution of pregnant women by their age and the factors associated with unplanned pregnancy among unmarried adolescents in Ogun State where there was dearth of information on these.

Study design and population
This was a descriptive and cross-sectional study that used both quantitative and qualitative methods together to investigate factors associated with unplanned pregnancy among unmarried adolescents in selected communities Ogun State, Nigeria.

Study setting/area
The study was designed as a cross-sectional descriptive investigation on the factors associated with the prevalence of adolescent pregnancy. It was carried out using a combination of community and clinic surveys in six randomly selected communities in Ijebu North local government area (LGA) of Ogun State, South-West Nigeria. The LGA is one of the 20 LGAs in Ogun State, located 140km North-East of Lagos. The LGA has its headquarters in the town of Ijebu Igbo and lies at latitude 6 o 57' N and longitude 4 o 00' E. It covers an area of 967 km 2 . It is predominantly a Yoruba-speaking community with urban and rural settlements with the major occupations of the people being farming and trading [26,27]. It has a population of 280,520 people based on the 2006 National Population Census with a projected population of 372,461 people for 2015 [28] comprising 50.3% and 49.7% males and females respectively [29], and a population growth rate of 3.2% per annum [11].
Basic social infrastructure like roads, water, formal educational institutions and health facilities abound in the area. The health facilities in particular are available in both the urban and rural communities of the LGA. There are twelve public health clinics and about thirty private hospitals/clinics in the LGA.

Sampling procedure
Of the 1,095 respondents selected through the multi-stage sampling technique for both the community and clinic surveys, 1,041 consented to be interviewed representing 95.1% response rate.
Six communities comprising two urban (Ago-Iwoye and Ijebu Igbo) and four rural (Awa, Ilaporu, Oru and Mamu) were randomly selected for the study.

Techniques and instruments for data collection
Data were collected using semi-structured questionnaire and in-depth interview. The data collection covered a period of 8 weeks.

Ethical issues
Formal approval and consents of the local health authorities and the communities were obtained prior to the commencement of the study through trusted and respected community leaders. Permission was also obtained from the management of each of the hospitals where the survey was conducted. The informed consent of the study participants was obtained before the interviews. The study participants were made to understand the nature and purpose of the study, the potential risks and benefi ts of participation to them and their community, and their right to refuse or participate voluntarily.
The study was conducted in accordance to the tenets of the Helsinki Declaration of 1964 as amended in 2000.

Processing and analysis of data
Following data cleaning, the completed questionnaires were coded. The coded data were subsequently entered into the computer and analysed using the Epi Info 6.04a software [30].
The analysis was essentially descriptive refl ecting the concerns expressed through the different objectives of the study.
Linear frequency analysis provided the categories of tables describing the socio-demographic profi le of the respondents, the differences in their knowledge, attitude and perception of the trend of adolescent pregnancy and its cause(s), the use of contraception by adolescents and attitude to allowing adolescents have access to sexuality education. Single and multiple associations between the different variables were tested at the threshold of 95% confi dence interval using the comparison tests such as Chi square and regression analysis.
On the other hand, following review and correction, all transcripts from the in-depth interviews were typed with a standard word processing package and converted into ASCII Text fi les. These were subsequently coded and sorted using the textual analysis programme developed by Bo Summerlund and distributed by Qualitative Research Management of Desert Hot Springs, California, Textbase Beta software [31,32].

Knowledge of prevalence and causes of adolescent pregnancy
A large number (840, 80.7%) of the respondents were aware of the prevalence of adolescent pregnancy in their communities, 12 (11.6%) were not aware and 80 (7.7%) were undecided. A large number of respondents (84.7% urban vs. 69.1% rural) described adolescent pregnancy as prevalent in their localities ( 2 = 32.13, df = 2, p<0.05)  Figure 1, those who had their fi rst child in their teen years in the urban communities were signifi cantly greater than those from the rural communities ( 2 = 11.8, df = 2, p<0.05). Table 2 shows the age distribution of the female respondents. All 41 pregnant adolescents identifi ed in Table 2 were never married. were undecided. Majority of those who perceived 20-29 years as the ideal age at fi rst birth mentioned the need for sociopsychological and physiological maturity that is attainable at this prime age range as their reason. Among those interviewed, they pointed out that at this age, the reproductive system of a woman would have fully developed for child-bearing. It was further argued that a woman at the age will be capable of taking adequate care of herself and her family of procreation, particularly the baby.     a few (4/10, 40.0%) of the girls had ever used any of the modern contraceptive methods they knew through friends before their pregnancy. These girls admitted to have used birth control pills, which they claimed they did not know how to use correctly at some point in time, and then stopped. The reasons given for discontinuing the contraceptive use during the interviews were: "…infrequent unplanned sexual intercourse" and "…I didn't know I would get pregnant". All 10 (100.0%) pregnant adolescent girls interviewed had poor knowledge of ovulation time in relation with conception. They had the misconception that it was necessary for a woman to have sexual intercourse many times befor e she could become pregnant.

Respondents' awareness and use of contraceptives
More males (49.4%) than females (39.6%) in the survey were willing to allow the use of contraceptives by their adolescent children ( 2 = 24.5, df = 4, p<0.05).
Among those interviewed, those who supported adolescents' use of contraceptives were of the opinion that it will help safeguard against unwanted pregnancy, while many of those who condemned it had the misconception that the use of contraceptives among adolescents is tantamount to condoning immorality and giving them the liberty to indulge in illicit sexual activities. Others also discredited it on the grounds of fear of the failure and side-effects of some of contraceptives.
They explained that they would rather advocate for sexual abstinence for young people of this age group. There was no gender difference in the perception of contraceptive use by adolescents among those interviewed.

Discussion
The  [9,12,13]. If this fi nding is anything to go by, it may contribute to rapid population growth of the country which has increased at exponential rate from 140.4 million in 2006 [28] to 167 million in 2016 [34]. This is attributable to the fact that early childbearing is positively associated with high fertility [16]. The population momentum of the country considering the young age structure of the population suggests that the population size could double within a shorter time [10]. Hence, interventions to   and ICF International [11]. The low contraceptive use by the female respondents reported in the study confi rmed the results of earlier studies [40][41][42]. The fi ndings imply that inadequate knowledge about sex and its consequences acquired mostly from friends, the improper or non-use of contraceptives and parents' insistence on absolute abstinence from sex are major factors that could have contributed to the unintended pregnancy reported among the adolescent girls interviewed.
Appropriate parental support and intervention through parent-child communication as emphasised by Akinwale et al [5] should be fostered for the provision of simple, adequate, accurate and factual information on all changes and challenges that are associated with physical and emotional development experienced by adolescents as they transit from childhood to adulthood. This is to combat general ignorance about reproductive health issues and contraception as emphasised by Makinwa-Adebusoye [13]. Sexuality and family life education help provide a profound gateway to change in the attitude among the adolescents as it helps prepare them to make better and informed decisions [43,44]. This is evident in the fi ndings of Steinberg [45] that adolescents who engaged in effective communication with their parents on sexuality issues are more likely than others to delay sexual intercourse.
Morally, it is encouraging that some respondents advocated sexual abstinence for adolescents. Nonetheless, the use of condoms or contraception needs to be discussed or promoted among these adolescents because the reality of the fact that they are sexually active cannot be overemphasised. With the use of condoms by those who could not abstain from sex, the incidence of unwanted pregnancy and spread of STIs/HIV will be effectively controlled and prevented to a large extent.
The illustration in Figure 1 suggests that early childbearing is more of an urban phenomenon in the communities studied. This is not unconnected with the strict social control mechanisms surrounding the issue of sexuality that restrain premarital sex more among unmarried young people in the rural communities than the urban communities [46]. This fi nding is however contrary to the fi ndings of the 2013 Nigeria Demographic and Health Survey, which reported early childbearing as a rural phenomenon with 32.0% of rural women aged 15-19 years having begun childbearing compared with 10.0% from urban [11].
The trend in adolescent sexual activity shown in the results calls for concern because many of the adolescents are not only sexually active but unwanted pregnancy is rife among them. This implies the preponderance of unprotected provision of youth-friendly sexual and reproductive health services designed to respond to and meet the health needs of the apparently sexually active young people as captured in the Nigeria's Policy on Population for Development [10]. It is expected that this will contribute to meeting a target of the Sustainable Development Goal (SDG) 3 which aims at ensuring universal access to sexual and reproductive healthcare services, information, education, including family planning [48,49].
Knowing that educational levels for girls have risen in most countries, and low education levels are closely associated with early childbearing [7], it is therefore important that the National Policy on education in Nigeria [50] with its objectives and scope emphasising compulsory free and comprehensive universal primary and secondary education for every Nigerian child particularly the girl-child needs to be adequately invested in and implemented. In addition, government should strengthen its poverty alleviation programmes, as well as involve the private sector and community participation in the basic education programme as suggested by Etuk et al. [51]. Through the poverty alleviation programmes, it becomes important to empower parents fi nancially to be able meet up with basic fi nancial demands of the basic education programme for their children which itself is not entirely free. Parents would also need to be enlightened, to step up their enthusiasm towards their children's education as observed by Etuk et al. [51].

Conclusion
It is apparent that the factors associated with adolescent pregnancy in the communities have been established by the study. The study provides useful policy insights for need to strengthen and improve the adolescent sexual and reproductive health services in the study communities in particular and the LGA at large. It also highlights the need to take cognisance of the high prevalence of unwanted and unplanned adolescent pregnancy and develop strategy of expanding access to adequate and appropriate health services that will met the health needs of young people in the studied communities and LGA as a whole.