CHAPTER ONE
Introduction
Background to the Study
The environment in which young people grow and make decisions related to reproductive and sexual health is becoming more challenging than ever before. This is so for many obvious reasons. Today’s adolescents are being bombarded with erotic stimuli and messages through movies, music, novels and magazines. Basen-Engquist and Parcel (1992) affirmed this and noted that adolescents from their earliest years watch television shows and movies that insist that “Sex appeal” is a personal quality that people need to develop to the fullest. Haffiner (1999) opined that TV movies and music are not the only influence; the internet also provides the adolescents with seemingly unlimited access to information on sex as well as steady supply of people willing to talk about sex with them.
Specifically, as it relates to secondary school students who are also adolescents, Action Health Incorporated, AHI, (2003) stated that, today’s adolescents live in a world that may give conflicting messages about what is expected of adolescent’s sexual activity. On the other hand, they are told to abstain or “just say no” without knowing why, for how long, or even knowing exactly how to go about it. In addition, adolescents may see sexual relationships as extremely desirable. For instance music, movies, television, magazines and advertisements present sexuality in a way that glorifies and normalizes sexual behaviour of young people. In line with the above, Gail, Slap, Lucy, Bin, Confort, Theresa and Paul (2000) opined that sexual thoughts, feelings and behaviours present throughout life are often accentuated during adolescence. Dong (2001) further opined that just as sexual preferences are learned behaviour, most of all adolescent’s sexual deviations are learned behaviours with pornography having the power of conditioning them into sexual deviancy. For these reasons adolescents and indeed secondary school students find themselves in an environment of varied sexual attitudes and practices which is challenging.
Ademola (2005), disclosed that some young people have poor understanding of reproductive process, while others harbour misconceptions such as beliefs that pregnancy cannot occur during first sexual episode, and that the use of contraceptives can cause infertility. Some of these misconception and beliefs may lead to abortion (AHI, 2003), elevated risks of sexual transmitted infections-STIs (Aderibigbe & Aroaye, 2008) and unwanted pregnancy (Ekanem, 2010). These preventable problems may have prompted the Guidelines for Comprehensive Sexuality Education (2003) in Nigeria to lament that more and more Nigerian are beginning to realize that if the problems of unwanted teenage pregnancy, STIs and sexual abuse are to be effectively addressed, it is important that people develop accurate, rational and responsible attitudes and behaviours regarding issues concerning reproductive and sexual health. Though the two concepts (reproductive and sexual health) seem to be similar, they are not identical.Thus the need to examine the two concepts.
Reproductive health is now recognized as a crucial part of general health and central feature of human development. As such, National Conference of General Practitioners (1995) stated that, reproductive health covers the entire life Span of an individual. They further believe that it is reflection of health during childhood, adolescence and adulthood and therefore sets the stage for health beyond the reproductive years for both women and men and affects the health of next generation. Vaughar and Abouzahr (2000) associate reproductive health with prevention and treatment of diseases and supporting normal functions such as pregnancy and child birth. Elaborating further, they stated that reproductive health has to do with reducing the adverse outcomes of pregnancy, including maternal deaths and disabilities, complications of abortion, miscarriages, still births and neonatal deaths.
WHO (2008) defined reproductive health as a state of complete physical, mental and social wellbeing in all matters related to reproductive systems, functions and processes. This implies that, people are able to have a satisfying and safer sex life and they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed (about) and have access to safe, effective, affordable and acceptable methods of their choice for regulation of fertility, as well as other methods of birth control which are not against the law and the right access to appropriate health care services that will enable women go safely through pregnancy and childbirth.
For the purpose of the present study, reproductive health is a concept that describes how secondary school students should view and practice their sexuality to remain free from STIs, unwanted pregnancies, regulate their fertility, avoid abortion and its complications and effectively bear and rear healthy children. This definition implies achievement of general reproductive well being.
ICPD (1994) affirmed that reproductive health in the context of primary health care should include: family planning, counseling, information, education, communication and services for prenatal care, safe delivery and post natal care, especially breast feeding and infant and women’s health care. They further stated that it also include prevention and appropriate treatment of infertility; prevention of abortion and the management of the consequences of abortion, treatment of reproductive tract infections; Sexually transmitted infections (STIs) and other reproductive health conditions; and information, education and counseling as appropriate on human sexuality and responsible parenthood. Furthermore, studies (Benagiano 1994; Vaughan & Abouzahr, 2000) corroborating ICPD’S reproductive components and multi-dimensional nature of reproductive health listed various components of reproductive health to include Family planning, maternal mortality, sexual behaviour, maternal care, safe motherhood, abortion, unwanted pregnancy, early child bearing, STIs, HIV and AIDS prevention, infertility and certain reproductive tract malignancies such as cervical cancer.
Reproductive health components as summarized by Benagiano (1994) are responsible reproductive sexual behaviour, available family planning services, effective maternal care and safe motherhood, effective control of reproductive tract infections, prevention and management of infertility, elimination of unsafe abortion, unwanted pregnancy, sexual abuse and prevention and treatment of malignancies of reproductive organs and sound adolescent health and sexuality. Effective reproductive health depends largely on the state of sexual health.
WHO (1975) described sexual health as the integration of the somatic emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication and love. The WHO report in-corporating this forward looking description of sexual health laid the groundwork for a comprehensive understanding of human sexuality and its relationship to health outcomes. Also, terms such as sex, sexuality and sexual rights, were integrated as composite of sexual health.
Reproductive Health Matter-RHM (2001) described sexual health as having the freedom to choose how to express one’s sexuality (or how not to). The RHM report noted that sexual health also involves understanding one’s body, being comfortable with oneself and her sexual desires, having desirable sexual relationships with others; learning to identify and doing away with violent or abusive behaviours and learning to cope with the aftermath effects of such relationships. According to Federal Ministry of Health-FMOH (2005), sexual health is part of reproductive health which includes healthy sexual development, equitable and responsible relationship, sexual fulfillment and freedom from illness. Healthy sexual development is built on the acceptance of one’s self and good communication with his/her partner. People who develop healthy intimate relationships believe in themselves and in people around them. Equitable and responsible relationships according to Insel and Roth (2006) include open, honest communication, agreed on sexual activities, sexual privacy, using contraceptives, safer sex practices like use of condom and hugging, sober sex and clear discussion on sexual consequences. Sexual fulfillment entails that in sexual relationship love making must be with the primary aim of satisfying both sexual and psychological needs. Satisfaction of sexual desires and the quality of the relationship are more important to overall sexual satisfaction than sophisticated or erotic sexual techniques.
On the issue of freedom from illness, Insel and Roth (2006) maintained that both partners should be aware of and practice safer sex to guide against STIs. They further stated that partners should be honest about their health and any medical condition and work out plan for protection. For the purpose of this study, sexual health refers to a state of complete physical, mental and social well being in all matters related to the way students view and express their sexuality. It represents situations and conditions where secondary schools students derive sexual pleasure and satisfaction through a variety of sexual activities such as hugging, kissing and caressing.
CDCP (2010) stated that sexual health also encompasses problems of HIV and STIs, unintended pregnancy and abortion, infertility, cancer resulting from STIs, and sexual dysfunction. These components are also embedded in reproductive health. Robinson, Bockting, Rosser, Miner and coleman (2011) identified components of sexual health to
include, talking about sex in relation to culture, sexual identity, sexual anatomy and body functioning, Sexual health care, safer sex, body image, masturbation, fantasy, positive sexuality, intimacy and relationships and spirituality.
WHO (2010) noted that, while sexual health is often subsumed within reproductive health, it is in fact a wider term as sex does not always involve reproduction. Most policies of programmes on reproductive health are aimed at women of reproductive years. Yet older people, for example, require information that responds to their sexual health needs rather than to reproductive health. Some of these aspects of sexuality they explore are masturbation, fondling/caressing, oral sex, kissing and hugging. Adolescents, including those in Udenu Local Government Area secondary schools, also explore their sexuality and engage in sex without necessarily wishing to reproduce. People in the same-sex relationships may have specific sexual health needs that have nothing to do with reproduction. The use of the two terms together, as reproductive and sexual health could contribute to resolving this problem. In conclusion WHO (2010) further affirmed that health experts and experts in health related disciplines agreed that the two concepts are inseparable, reproductive and sexual health (RSH) and that they are integral components of any Nation’s Primary Health Care (PHC).
From the foregoing definitions and components of reproductive and sexual health, there appear to be areas of commonality. WHO (2010) listed the six components of reproductive and sexual health to include improving safe motherhood-antenatal, perinatal, postpartum and neonatal care; providing high quality service for family planning including infertility services; eliminating unsafe abortion, combating sexually transmitted infections (STIs); prevention and management of cervical cancer and other reproductive and sexual health morbidities, promoting sexual healthcare and safer sex, increasing capacity for strengthening research and programme development. Therefore, this study should refer to the two concepts as reproductive and sexual health (RSH).
In the present study, reproductive and sexual health will be used as a concept that describes how secondary school students should view, practise and express their sexuality to remain free from STIs, unwanted pregnancy, regulate their fertility, avoid abortion and its complications, effectively bear and rear healthy children and have a satisfying sexual life. Since the common components are many, this study will be restricted to such components as sexual behaviour, family planning, safe motherhood, safer sex and sexually transmitted infections (STIs) which are common to both of them. These components which form the bedrock of the present study are highlighted below.
Sexual behaviour is the totality of normal and abnormal, conscious and unconscious, overt and convert sensations, thoughts, feelings and actions related to sexual organs and other erogenic zones, including masturbation, heterosexual and homosexual relations, sexual deviations, goals and techniques (Wolman 1975). It is any physical activity that is connected with sex (Sally, 2000).
Family planning, according to Onuzulike (2005), is a way of thinking and living that is adopted voluntary upon the basis of knowledge attitude and responsible decisions by individuals and couples in order to promote health and welfare of the family and the group thus contributing effectively to the social development of the country. Through the teaching of family planning, individuals are assisted to decide on how to limit, space their births and avoid unwanted pregnancies.
Safe motherhood on the other hand has been defined as a means of saving the lives of women and improving the health of million mothers (safe motherhood Newsletter, 1993). It is aimed at preventing maternal and prenatal mortality and morbidity. The above source added that safe motherhood does not only mean saving the lives of mothers, but it also has to do with assuring women and their babies a better quality of life.
Safer sex entails that both partners should be aware of and practices sex safely to guide against sexually transmitted infections (Insel and Roth, 2006). They further stated that sexual activity has many potential consequences, including pregnancy, disease and emotional changes in the relationship. They added that safer sexual behaviours mean discussing these consequences openly and honestly. Safer sex is not limited to safer sex behaviours. Its broad perspectives encompasses knowing one’s body, obtaining regular exams for sexually transmitted diseases and cancer, and responding to physical changes with appropriate medical intervention, thus lowering the chances of HIV transmission (Robinson et al, 2011).
STIs, on the other hand, include all those diseases that result from sexual intercourse. While Ahi (2003) maintains that they are infections transmitted during unprotected sexual intercourse or genital contact among people. Samuel (2010) opined that STIs are infections that are transmitted by way of direct contact. This study will attempt to examine the reproductive and sexual health attitude and behaviours of secondary school students in Udenu Local Government Area, Enugu State.
Attitude according to Okafor (1991) is concerned with one’s feeling towards an objects, person or thing. Obioha (2004) defined attitude as a state of readiness organized through experiences upon individual response to all objects and situations. Attitudes that are related to RSH are termed reproductive health attitude and sexual health attitude respectively (RHA and SHA). Reproductive health attitude in the present study refers to opinions, and feelings that secondary school students usually have towards sexual behaviour, family planning, safe motherhood, safer sex and STIs. SHA are beliefs and opinions about sex. For example, sex education encourages young people to have sex, abortion should be personal private choice for a woman, condoms should not be made available to teenagers, access to pornography should not be restricted to adults and masturbation is a healthy expression of sexuality. In the present study SHA refer to beliefs and opinions secondary school students usually have towards sexual behaviour, family planning, safe motherhood, safer sex and STIs. The type of attitudes secondary school students have towards the above RSH components can be positive or negative. Positive attitudes can lead to safe sex and responsible sexual behaviour while negative attitudes can also lead to STIs, unwanted pregnancies as well as irresponsible sexual behaviours.
Behaviour, according to Kann (1995), refers to actions of a system or organisms, usually in relation to its environment, which include the other systems or organisms around as well as the physical environment. According to Houghton (2009) behaviour is the actions of a person or animal in response to external or internal stimuli. When behaviuor happens so regularly, it becomes a practice. Practice according to Webster’s (2000) is defined as the act of doing something customarily or habitually or to do or perform often. Practice also refers to a way of doing something regularly (Hornby, 2005). Thus behaviour and practice can be used interchangeably in this study.
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