The purpose of the study was to develop a life skills programme on reproductive health for female adolescents of secondary schools in Enugu State. To achieve this purpose, nine research questions were posited and five null hypothesis formulated for their verification. The cross-sectional research design was used in the study for collecting base line data. Data were collected using the students’ life skills programme on Reproductive Health Questionnaire from a sample of 300 secondary school students, which was analysed using means and percentages. This formed the baseline data. A forty-four item life skills programme Assessment Questionnaire was developed from the baseline data and given to 845 experts in reproductive health to assess for appropriateness. Data collected were analysed using percentages, mean score and standard deviation to answer the research questions, while the t-test statistic and ANOVA were used to verify the null hypotheses at .05 level of significance. The findings show that all the objectives designed for the life skills programme on reproductive health for female adolescents were adjudged to be appropriate by the experts on reproductive health. Similarly, all the promotive life skills designed for the life skills programme on reproductive health were considered appropriate by the experts. Also, all the protective life skills designed for the life skills programme on reproductive health were considered appropriated by experts on reproductive health. Furthermore, the study revealed that occupation significantly influenced the opinion of experts on the items in the life skills programme on reproductive health. The study showed that level of education, location of work place, length of service and gender had no significant difference on the opinion of experts on reproductive health regarding the items in the life skills programme on reproductive health for female adolescents. Finally, the study developed a life skills programme on reproductive health for female adolescent
Background of the Study
Reproductive health is an area in health education that has gained a lot of recognition recently. This recognition stems from the fact that awareness of the extent and consequences of reproductive ill health has increased over the pass decade. The group mostly affected by reproductive health problems are the adolescents because of their very active sexual life, (Paxman, 1980; Chiwuzie, Okolocha , Okojie, Ande & Onoguwe, 1995). Reports of Reproductive Health Research (RHR) have shown that the bulk of the world’s population is made up of females. The same reports affirmed that the bulk of the world’s sexually active population is made up of adolescents. The adolescents indulge in unprotected sexual activities and end up with reproductive health problems such as unwanted pregnancy, sexually transmitted infections (STIs) including HIV and AIDS, abortions, infertility, among others.
The United Nations (1992) indicated that in many developing countries, births to women under 20 years represent an increasing proportion of all births. UNICEF (1994) revealed that world-wide, more than 15 million girls aged 15-19 years give birth every year, and as many as 5 million have abortions.
The World Health Organization (WHO) (2001) reported that 1,000,000 conceptions and 356,000 sexually transmitted infections (STIs) occur each day among the adolescents, about 50 per cent of the conceptions are unplanned and about 25 per cent are definitely unwanted, resulting in about 150,000 induced abortions and 5000 deaths everyday. These figures show that adolescents’ sexuality and fertility pose health-related problems of a special kind.
The WHO (1994) biennial report stated that unwanted pregnancy was a major reproductive health problem with potentially serious consequences for the health of the young adolescents. This is because it exposes her to the hazards of pregnancy and childbirth or possibly an abortion most often done under unsafe conditions. The United Nations Population Fund (UNFPA) (1994) reported that in the developing countries of which Nigeria is one, one in 50 women dies from complications of pregnancy and child birth, compared to only one in 2,700 in developed countries.
Nigerian Demographic and Health Survey (Federal Office of Statistics, 2002) report shows that nationwide, the median age at first sexual intercourse for women aged 30-40 years is 16.3 years. These girls were within the secondary school age and were mostly in-school adolescents. Early exposure to sexual activity is the cause of so many reproductive health problems. Juhasz and Sonnenshein-Schneider (1987) affirmed that reproductive health problems arise from decisions about sexual intercourse, pregnancy, and childbearing, use of birth control, parenting and marriage.
According to a Reproductive Health Research (2007) there were 4.5 million abortions every year of these 1.9 million were unsafe and about 2.6 million took place in countries where the procedure is considered illegal. This according to them translates to 160 pregnancies per 1000 women aged 15 years and above per year. RHR further disclosed that 1.5 million of these abortions occur in Africa. Furthermore, HIV for instance, infects 5.2 million people every year, and over half of them are young people below 24 years. There are 450,000 new cases of cancer of the cervix every year, and not to mention 2 million little girls subjected to female genital mutilation (Reproductive Health Research 1991). They concluded by observing that the cost of failing to ensure that the young have the knowledge, skills and services they needed to enable them make health choices in their sexual and reproductive lives, will be enormous. The above reports on sexual and reproductive health problems of adolescents make it necessary for a life skills programme to be developed for these adolescents and this is the focus of the present study.
WHO (1992) observed that because young people lack good life skills, they might be led into dangerous, risky activities. These activities according to the WHO include unprotected sex and sexual promiscuity, or they may become subjected to unhealthy pressures or become victims of abuse or bullying, not knowing how to seek help from their peers or their elders. Continuing, the WHO affirmed that to equip children and adolescents with skills for life, life skills programmes should be introduced in schools or in other settings where young people learn.
Elias (1993) defined life skills as skills to carry out effective interpersonal relationships and social role responsibilities, and to make choices and resolve conflicts without resorting to actions that will harm oneself and others. Life skills are skills for the enhancement of psychosocial competencies, that is, those skills that enable individuals to deal effectively with the demands and challenges of everyday life (WHO, 1994). This means that life skills programme is an effective learning medium because the skills are generic and once learned in one context can be applied to a whole range of behaviours. For the purpose of this study, life skills is taken to mean skills needed by an individual to operate effectively in society in an active and constructive way.
Analysis of the life skills field by WHO (1992) revealed that there is a core set of skills that are at the heart of life skills–based initiatives for the promotion of health and well-being of children and adolescents. These include decision-making, problem-solving, creative thinking, critical thinking, effective communication, interpersonal relationship, self-
awareness or esteem, empathy, coping with emotion or stress and resisting peer pressure. These life skills are to be taught to young people as abilities they can acquire through learning and practice.
The life skills found very useful in studies in reproductive health education, such as in prevention of HIV/AIDS, STDS, teenage pregnancies, abortion, sexual violence, among others, are communication, negotiation, decision-making, problem-solving, critical thinking, assertiveness, peer pressure resistance, coping with emotions and self-esteem/awareness (Gold & Kelly, 1991; Mclean 1994; & Pick de Weiss, et al.1997). However the WHO (1998) grouped these life skills into three major areas. These include promotive life skills, preventive, and protective life skills. The promotive life skills, according to them include self–confidence, self-esteem, self-awareness, stress and anxiety management; and interpersonal skills. The preventive life skills are creative thinking, critical thinking, problem-solving, decision-making, negotiation and communication skills. The protective life skills are assertiveness, peer pressure resistance and coping with emotions. The WHO (1993) attested that the skills that can be said to be life skills are innumerable, and the nature and definitions of life skills are likely to differ across cultures and settings.
The life skills for this study were derived based on the culture and the prevailing condition in the setting. The life skills items for this study were developed by the researcher through literature search. The life skills followed the three dimensions of health as defined by the WHO (1998) which are promotive, preventive and protective life skills.
The promotive life skills are, feeling good and worthy, managing stress and anxiety, strengthening interpersonal relationship, promoting health-giving behaviour, determining and selecting goals, understanding health problems and generating solutions for them, selecting best solutions to problems and understanding and maintaining good behaviour in relation to sexual life.
The preventive life skills are avoiding risky situations, negotiating issues of sex, drug and alcohol diligently with partners, setting limits or say “No” to sex, drug and alcohol, responding reasonably to sexual violence, insisting on the use of condom, using health services available, identifying issues and problems concerning reproductive health, refusing to engage in unprotected sex, and using information available for decision making and problem solving.
The protective life skills are ability to give and receive information, improve relationship with opposite sex and peer group, thinking carefully of every situation before taking action, weighing all alternatives before taking decision and knowledge and ability to make the right decision, managing emotions and feelings regarding sex and feeling free and safe to discuss their reproductive health matters with adults. It is pertinent to point out that one life skill can be useful in more than one area. In addition, the study examined the influence of such demographic variables as, gender, occupation, location of place of work, level of education, and length of service (experience).
Gender inequality has been a great problem in various societies the world over. In many areas women are not allowed to express their views freely. So this study deemed it necessary to seek the opinion of both males and females in this study since, especially the topic centers on reproductive health which concerns women most.
The saying goes that ones occupation influences his attitude and opinion regarding certain issues of life that relate to the job. It also influences him physically, socially and emotionally which is the essence of having occupational health. As a result, this study sought to find out whether the fact that one was a medical or para-medical personnel had any influence on their opinion regarding the life skills items designed.
Education is very important because it is a major source of knowledge. The level of education of the respondents varied though they all were very knowledgeable in reproductive matters. Some of them were degree holders and others no degree. It then was considered necessary to find out if level of education affected their opinion regarding the life skills items designed
Modern technologies have brought a lot of differences in terms of amenities (in communication) in the urban and rural communities. Modern means of communication have greatly bridged the gap between urban and rural dweller. This is because of easy means of transportation, radio, T. V., among others, which pass information to all areas no matter where one dwells. So the researchers felt that it was necessary to know whether where the experts worked had any influence on their opinion regarding life skills programme.
Length of service has to do with experience. It is believed that the longer one services the more knowledge and experience the individual acquires. Following from this, length of service was included as one of the independent variables to see if it had any influence on the responses of the experts on reproductive health regarding life skills programme.