KNOWLEDGE AND USE OF CONTRACEPTIVES AMONG ADOLESCENTS: A CASE STUDY OF STATE HOSPITAL ABEOKUTA SCHOOL OUTREACH CLINICS

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Adolescent sexual and reproductive health (SRH) continues to be a major public health problem in sub-Saharan Africa where adolescent (aged 10–24 years) unintended pregnancy, unsafe abortion and sexually transmitted infections (STIs) account disproportionately for the burden of disease. Access to accurate information and appropriate contraceptive options is essential to adolescent reproductive rights and health, and contraceptive knowledge and use among adolescents is a key part of the solution to these problems. The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) have repeatedly called for increased access to adolescent-friendly contraceptive services as a precondition for improving the situation of adolescent pregnancy, maternal mortality and unsafe abortion in low- and middle-income countries.

The adolescent fertility rate is high in Nigeria with around 17% of women reporting that they started giving birth between 15-19 years as obtained in the Nigeria Demographic and Health Survey (NDHS) 2018. Contraceptive prevalence rates are low: modern contraceptive use was reported to be 28% among women who are sexually active and unmarried while only 12% of women who are currently married are using modern contraceptive (Agboola et al., 2022). This is a stark divide, which reflects entrenched stigma and a lack of adolescent friendly services, provider bias, parental opposition, religious/cultural factors, and structural barriers to accessing contraceptive services in many communities. In addition, contraceptive information, especially with regard to emergency and long-lasting contraceptive methods, continues to be scarce and unclear among adolescents in Nigeria.

The problems faced by Nigeria are mirrored in Ogun state, the capital of which is Abeokuta. School outreach clinic is a reproductive health approach for adolescents in State Hospital Abeokuta, a secondary health facility. Such clinics are a key opportunity to deliver SRH services and education outside the walls of the formal health facility, which may help to mitigate stigma and provider bias that may prevent adolescents from going to their regular hospital clinics. But the effectiveness of these outreach clinics to influence contraceptive knowledge and uptake among secondary school adolescents has not been explored in a systematic way.

A comparative study of contraceptive use among youth between Northern and Southern Nigeria in 2025 revealed that socioeconomic status, level of education, exposure to media and urban-rural residence were among important determinants of contraceptive uptake in the two regions (PLOS Global Public Health, 2025). A study in 2023 in Enugu among secondary school adolescent girls showed that limited access to contraceptive services was one of the major factors contributing to unwanted pregnancy among adolescents in LMICs; and less than a majority of adolescent girls had accurate knowledge of all available modern contraceptive methods (Integrity Research Journal, 2025). These results highlight the need for facility-based services for adolescents that are focused on the needs of adolescents across the geographic context.

1.2 Statement of the Problem

Although there are school health programmes and reproductive health outreach activities in Ogun State, incidences of unwanted teenage pregnancies, unsafe abortions, sexually transmitted infections is reported among the youths in Abeokuta and environs. This indicates that the present interventions for increasing contraceptive knowledge and use among adolescents might be ineffective, under-targeted or under-resourced. State Hospital Abeokuta clinic services are potentially significant points of intervention, but the effect on adolescent contraceptive awareness and uptake has not been systematically evaluated.

The low uptake of contraceptives by the Nigerian adolescents has been attributed to various supply and demand side challenges such as lack of knowledge about available contraceptive methods, myths about the side effects of contraceptives, lack of access to services for youth and negative attitudes of providers (Nmadu et al., 2020). With no specific evidence of such barriers from the facility level in Abeokuta, it is hard for health planners and programme managers to design an intervention specific to the local context. This study has filled this gap by investigating the knowledge, attitudes and attitude towards the utilization of contraceptives among school-based adolescent clinic users at State Hospital Abeokuta and the social and cultural factors as well as service delivery factors that influence the use of contraceptives among the adolescent users at the school clinics in Abeokuta State Hospital.

1.3 Research Questions

This study is guided by the following research questions:

1. What is the level of knowledge of contraceptive methods among adolescents attending school outreach clinics at State Hospital Abeokuta?
2. What are the attitudes of adolescents towards contraceptive use in the context of the school outreach clinics?
3. What is the prevalence and pattern of contraceptive use among sexually active adolescents attending the school outreach clinics?
4. What are the barriers to contraceptive uptake among adolescents at the State Hospital Abeokuta school outreach clinics?
5. What is the association between sociodemographic factors and contraceptive knowledge and use among adolescents at the study site?

1.4 Objectives of the Study

1.4.1 General Objective

The general objective of this study is to assess the knowledge and use of contraceptives among adolescents attending school outreach clinics at State Hospital Abeokuta, Ogun State.

1.4.2 Specific Objectives

The specific objectives are to:

1. Determine the level of knowledge of contraceptive methods among adolescents at the study site.
2. Assess the attitudes of adolescents towards contraceptive use at the study site.
3. . Determine the prevalence and pattern of contraceptive use among sexually active adolescents at the school outreach clinics.
4. Identify the barriers to contraceptive uptake among adolescents at the study site.
5. Examine the association between sociodemographic characteristics and contraceptive knowledge and use among the study population.

1.5 Significance of the Study

This study makes several important contributions to reproductive health programming and policy in Nigeria. For the management of State Hospital Abeokuta and the Ogun State Primary Health Care Development Agency, the study provides evidence on the effectiveness of school outreach clinics as a delivery platform for adolescent contraceptive services, informing decisions on resource allocation, service redesign, and outreach frequency. Identification of specific knowledge gaps and barriers to contraceptive use will enable programme managers to tailor health education messages and counselling approaches to the actual information needs of adolescents in the area.

At the national level, the study contributes empirical evidence from the South West geopolitical zone to Nigeria's reproductive health database, complementing findings from other regions and enriching the evidence base for national adolescent reproductive health policy. The study findings are also relevant to the Federal Ministry of Health's National Adolescent Health Policy and to international organisations such as UNFPA and WHO engaged in adolescent SRH programming in Nigeria. Academically, the study adds to the literature on adolescent contraceptive knowledge and use in Nigeria, addressing a geographical gap from Abeokuta that has not been previously documented in peer-reviewed literature.

1.6 Scope of the Study

The study is confined to school outreach clinics operated by State Hospital Abeokuta in secondary schools within Abeokuta South and Abeokuta North Local Government Areas of Ogun State. The study population consists of in-school adolescents aged 10–19 years who attend these outreach clinics. Thematically, the study covers knowledge of contraceptive methods, attitudes towards contraceptive use, prevalence and patterns of contraceptive use, barriers to uptake, and sociodemographic correlates of knowledge and use. The study excludes out-of-school adolescents, university students, and adult populations.

1.7 Limitations of the Study

The study is limited to in-school adolescents attending State Hospital Abeokuta outreach clinics, and findings may not be representative of out-of-school adolescents who may have different knowledge and behavioural profiles. Self-reporting on sexual behaviour and contraceptive use may be subject to social desirability bias, particularly in a school setting where stigma around adolescent sexuality is prevalent. Parental consent requirements for minor participants may result in selection bias towards adolescents from more supportive family environments. These limitations will be mitigated through the use of anonymous self-administered questionnaires and appropriate sampling strategies.

1.8 Definition of Terms

Adolescent: An individual aged 10–19 years as defined by the World Health Organization; in this study, the term refers to secondary school students attending the outreach clinics.

Contraceptive Knowledge: The ability of an individual to accurately identify, name, and describe the mechanism of action and availability of at least one or more modern and traditional contraceptive methods.

Contraceptive Use: The actual and reported practice of employing any modern or traditional contraceptive method to prevent pregnancy, measured by current use, ever-use, and consistent use.

Modern Contraceptive Methods: Clinically approved methods of family planning including condoms, oral contraceptive pills, injectables, implants, intrauterine devices (IUDs), and emergency contraceptive pills.

School Outreach Clinic: A reproductive health service delivery point established outside the main hospital facility and operated within secondary school premises to improve adolescent access to SRH services.

Sexually Active: Having engaged in any form of sexual intercourse, regardless of frequency, marital status, or age of sexual debut.

Unmet Need for Contraception: The proportion of sexually active adolescents who do not wish to become pregnant but are not currently using any contraceptive method.

REFERENCES

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