Factors Associated With the Use of Contraceptives among Girls Attending Secondary Schools in Kisumu East Sub-County, Kenya

Abstract

Pregnancy is one of the leading reasons for adolescent girls dropping out of secondary schools in Kenya. Teenage pregnancy presents several challenges to the teenage girl including: maternal mortality, negative outcome of the pregnancy and exposure to abortion. A teenagers’ contraceptive use is influenced by several factors at the individual, cultural and policy levels. This study was carried out in Kisumu East Sub-County in April 2016.The contraceptive prevalence rate (CPR) in the study site is 27%, compared to a National CPR of 50.1% among sexually active unmarried girls aged between 15-19 years. The main objective of this study was to determine the CPR and factors associated with contraceptive use among girls attending secondary schools in Kisumu East Sub-County. A total of 320 girls in secondary schools were recruited in to the study. Data was collected using self-administered questionnaires and focus group discussions (FGD). The data was then analysed using SPSS. Descriptive analysis was carried out to obtain descriptive statistics. Pearson’s chi-square test (P-value <0.05) and odds ratio with corresponding 95% confidence intervals were computed to establish the factors associated with contraceptive use. The mean age of the respondents was 16 years. It was established that among the sampled students 55% had experienced sexual contact. Of the 55% that had experienced sexual debut, 35% (accounting for 19% of the total respondents) were hitherto sexually active. Only 29% of the girls used a contraceptive method at their sexual debut. Approximately 40% of girls who reported to be sexually active (have sex regularly) were using at least a method of contraception-the common method mentioned being condom (mentioned by 76% of the sexually active users of contraceptives). The other methods mentioned include: oral contraceptive pills (16%), emergency pill (four percent) and withdrawal (four percent). After adjustment using logistic regression, the following were established to be independently associated with contraceptive use: girls in Form 3 were five times more likely to use contraceptives as compared to girls in Form 1 (Adjusted Odds Ratio (AOR) = 4.71; 95% Confidence Interval (CI) = 1.97 – 6.89; P < 0.001). Girls in the 18 – 19 age group were 3.4 times (AOR = 3.43; 95% CI = 1.16 – 12.43; P = 0.005) likely to use contraceptives as compared to the 15 – 16 years age group. The type of school was a predictor to contraceptive use with girls attending mixed day schools being 3.21 times (AOR = 3.21; 95% CI = 1.93 – 8.87; P = 0.014) likely to use contraceptives as compared to their girls-only boarding schools counterparts. Arising from the FGDs, barriers to contraceptive use included parental disapproval, peer influence, potential negative health outcomes of contraceptive use, inadequate knowledge of other modern methods apart from the condom. The study revealed that more than half of girls attending secondary schools in Kisumu East District had experienced sexual debut which poses a public health challenge to this group due to exposure to sexually transmitted diseases and teenage pregnancy. It further revealed that mothers are an important source of information on sex and contraceptives. Therefore, there is need for parents (especially mothers) and guardians to be provided with information relating to adolescent sexual and reproductive health within the school set up to complement, rather than contradict what is taught in schools, as they (mothers/parents) are an integral source of information on contraceptives to the girls aged between 15-19 years.