AFRO-NETS> Perspectives in adolescent reproductive health in Nigeria

["A. Odutola" <chpss_abo2@yahoo.com>]

Perspectives in adolescent reproductive health in Nigeria
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The Punch
Published: June 18, 2003
By: Samuel Shofuyi
 
A professor of community health at the College of Medicine, Univer-
sity of Lagos, Mrs. Muriel Oyediran, has indicted the society for 
double standards in dealing with issues that bother on sexuality of 
adolescents.
 
She made this indictment while presenting a paper titled, ?Reproduc-
tive health of adolescents?, during a conference on the ?Public 
health challenges of adolescent sexuality? organized by the Depart-
ment of Community Health, College of Medicine, University of Lagos, 
held last Wednesday, June 11, 2003 at the New Great Hall, Idi-Araba.
 
According to her, these double standards have made it difficult for 
adolescents to obtain proper guidance and information on sexual mat-
ters, especially with regard to contraception.
 
?This has resulted in adolescents using their peers as a support and 
resource group, a despairing case of the blind leading the blind,? 
Oyediran said.
 
She said a study of students attending Nigerian tertiary institutions 
showed that pieces of advice given by peers were based on folklores, 
myths or traditional methods mixed with modern contraception like the 
use of condom.
 
?It was amazing to find in another Nigerian study that many adoles-
cents thought abortions were more likely to protect their fertility 
than contraceptives. There was the misguided belief that the use of 
modern contraception could cause prolonged infertility whereas a 
abortion was a short term solution to unwanted pregnancies,? she 
said.
 
She said that abortion had been proven to be unsafe and adolescents 
using them as an alternative to contraception ran greater risks of 
infertility and death.
 
According to her, the risk of infection with sexually transmitted in-
fections is very high among adolescents because of their risky sexual 
behaviours and tendency to have multiple sexual partners.
 
Oyediran said 60 percent of AIDS cases reported in the country in 
1998 were within the age group of 15 ­ 24 years and that the a preva-
lence rate of 8.1 percent was found in the 20-24 yeas age group in 
1999, while adolescents aged 15 ­ 19 were found to have an average 
AIDS prevalence of 4.9 percent.
 
?One of the important new strategies to combat HIV/AIDS in young peo-
ple is voluntary counselling and testing. Some of the challenges to 
be faced however, are confidentiality and the importance of parental 
consent,? she said.
 
Oyediran pointed out that another commonly occurring sexually trans-
mitted infection in adolescents, which is related to the development 
of cancer of the cervix according to her, is human papillomavirus 
(HPV) infection. According to her, a British study had found that 46 
percent of a group of adolescents aged 15-19 years had acquired HPV 
within three years after their first intercourse, and all of them re-
ported having only one sexual partner. 
 
?It has also been shown that HPV prevalence rises as the number of 
sexual partners increases. Sexual practices that increase the risk of 
exposure to HPV include: having sex before the age of 17 years, hav-
ing six or more lifetime sexual partners, and having sex with prosti-
tutes,? she said.
 
According to her, concerns about adolescent reproductive health 
should not just start at adolescent but from childhood.
 
?This is because there are several cultural practices with detrimen-
tal effects on the future reproductive health of these children,? she 
said.
 
She said foremost about the harmful cultural practices was the prac-
tice of Female Genital Mutilation, which caused various complications 
such as failure of the excision area to heal, abscess formation and 
urinary tract infections among others.
 
?There is also the risk of becoming infected with the Human Immunode-
ficiency virus, hepatitis B and other blood­borne infections and 
death from haemorrhage. The risk of sexually transmitted infections 
(STIs) becomes greater when group procedures occur as part of puberty 
rites because in some cultures, FGM is not done immediately after 
birth,? Oyediran said.
 
According to her, one of the worrying trends about FGM practice is 
that, in some countries, ?it is becoming increasingly practiced by 
health professionals and no longer by traditional birth attendants. 
This is despite the fact that FGM is recognized by the United Nations 
as an act of gender violence, following the 1989 Convention on the 
Rights of the Child, and the 1993 Declaration of the Elimination of 
Violence against Women,? she said.
 
Oyediran said another cultural practice harmful to the reproductive 
health of adolescents was early marriage. She said marriage at the 
age of seven, in some parts of Africa, was not uncommon and in some 
parts of Northern Nigeria, average age of marriage was estimated to 
be 11 years.
 
?It is estimated that more than 27 percent of Nigerian adolescents 
have given birth before they are 18 years, and 8.5 percent before 
they are 15 years old. A study in 1999 revealed that 22 percent of 
adolescents aged 15-19 years, were already mothers or undergoing 
their first pregnancy. These figures were much higher in the rural 
areas and in the North,? she said.
 
According to her, a study in Niger State has found that 80 percent of 
all cases of fistula (vesico-vaginal) occur in adolescents aged 15-19 
years. In addition, women under 17 years are more likely to experi-
ence premature labour, miscarriage and still birth as well as being 
up to four times as likely to die from pregnancy-related causes than 
women over 20 years old.
 
Oyediran said that the problem of adolescent pregnancy was further 
compounded by the place of delivery. She said a mere 37 percent of 
deliveries occurred at health facilities as against 58 percent of de-
liveries which occurred at home. 
 
?These percentages, however, vary according to the zones. The North-
East and North-West zones have the lowest percentages of deliveries 
taken in at health facilities with 85 percent and 91 percent respec-
tively of deliveries occurring at home, and these are the areas where 
early childhood marriage is practiced,? she said.
 
Oyediran said that it was a safe presumption that since most of the 
deliveries were taken at home, that traditional birth attendants took 
the deliveries. She said data had shown that trained health workers 
in the North-East and North-West assisted only 13 percent and 8 per-
cent of deliveries respectively.
 
She recommended that the population of adolescents should be classi-
fied into three. Those who had never had sexual experience; those who 
had had but suffered no ill effects, and those who had had sexual ex-
perience and had suffered or still suffering the consequences either 
through having been pregnant, experienced an abortion or becoming HIV 
positive.
 
?Intervention programmes should then be developed to meet the needs 
of these different groups of adolescents so that maximum cooperation 
is achieved and the reproductive health of Nigerian adolescents is 
improved,? Oyediran said.
 
She said that studies had shown that giving adolescents information 
about sexual health and contraception did not promote sexual activity 
but actually had the beneficial effect of decreasing sexual activity 
among them.
 
Source: Punch, Wednesday, June 18, 2003. Pg: 40. By Samuel Shofuyi. 
 
--
A. Odutola
Centre for Health Policy & Strategic Studies
34 Town Planning Way, Ilupeju
P.O. Box 7597, Ikeja, Lagos, Nigeria
Tel: +234-1-470-1255
Fax: +234-1-263-5285
mailto:chpss_abo2@yahoo.com
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