CHAPTER ONE

INTRODUCTION

1.1 Background of Study

Unintended pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviours during pregnancy that are associated with adverse effects. For example, women with an unintended pregnancy may delay prenatal care, which may affect the health of the infant. Women of all ages may have unintended pregnancies, but some groups, such as teens, are at a higher risk.

The use of modern contraceptive methods has greatly reduced the incidence of unintended pregnancy, particularly in more developed countries and provision of family planning services and modern contraceptives to those who do not have access to them would prevent a large proportion of unintended pregnancies and abortions, as well as many maternal and infant deaths. It is reported that despite of the availability of different modern methods of contraceptives, ranging from short, long term to permanent methods, as well as natural methods of contraception, the problem of unwanted pregnancies is very big worldwide but still underreported in many communities due to its sensitive nature. This is so said due to the high incidence of pregnancy termination which contributes to high maternal mortality and morbidity. About 80 million of unintended pregnancies are estimated to occur worldwide annually. In developing countries more than one-third of all pregnancies are considered unintended and about 19% will end up in abortion, which are most often unsafe accounting for 13% of all maternal death globally (Guttmacher institute 2007, Marston 2004).

Unwanted pregnancies are affected by number of factors including personal beliefs, social services, religious and cultural values as well as the existing laws in the community. Most of the time unwanted pregnancies started as unplanned pregnancy, but occasionally the planned pregnancy may end up into being unwanted pregnancy (Baginsk, 2007).It is also shown that out of 210 million pregnancies occurring in the world annually, about 79 million are estimated to be unintended, of these more than 50% end up in abortion.(Bongarts & West off, 2000). The World Health Organisation estimates that at least 33% of all women seeking hospital care for complications related to abortions are less than 20 years of age. This may be explained by the fact that adolescents’ fertility rate is very high, this affects not only these young women but also their children’s health; because birth to women aged 15-19 years have the highest risks of infant and child mortality as well as high risk of maternal mortality (WHO). In Nigeria there are 139 reported births per 1000 women aged 15-19 years (WHO, Adolescent fertility statistics 2000). Even if all contraceptives users were too use their methods correctly at all time, still there will be nearly six million accidental pregnancies annually which may end up into unwanted pregnancy (WHO 2003). Countries were contraceptive use is very high, the rate of unwanted pregnancy as well as abortion has declined to a very great extent, that is contraceptive use is inversely proportional to the rate of abortion (Bongaarts and Westoff, 2000).

In Nigeria, the contraceptive use is still very low. The Contraceptive Prevalence rate is 34% among married women, so this low contraceptive use gives us the reflection of the magnitude of unplanned pregnancies which is most likely to be unwanted compared to the planned pregnancies. This is much of a problem among the youths , because majority of them are facing various problems with regards to their reproductive health needs including contraceptive use i.e. services are not protecting the youths from infections as well as unplanned pregnancies, this is due to the fact that there is limited access to contraceptive to this vulnerable group, the barriers may include lack of information, misinformation, fear of side effects as well as social, cultural and economic barriers in accessing the family planning services (PRB 2000).

Despite the social and cultural importance of child bearing in many African communities, unwanted pregnancies are the source of problems in the families. This is more severe for young girls who often fall pregnant out of wed lock. The best option for them is to go for an abortion just to avoid facing the judgment from their families and the community in general.

Adolescents aged 15-19 years accounts for 25% of all the unsafe abortions in Africa, According to (Olukoyo et al 2001) women in developing countries who were admitted to the hospital for the treatment of unsafe abortion complications 38-68% were under the age of 20 years. These complications include cervical or vaginal lacerations, sepsis, haemorrhage, bowel or uterine perforation, tetanus, pelvic infections or abscesses, chronic pelvic inflammatory disease and secondary infertility. For Nigeria 23 % of all maternal deaths are among young pregnant girls. Unmarried adolescent girls are far more likely to become pregnant unintended and thus pregnancies are more likely to end in induced abortion (THMIS 2007/08). This is also much contributed by Premarital sexual activity which is very common in many parts of the world and is reported to be on the rise in all parts of the world. In many countries, young women and men are under strong social and peer group pressure to engage in premarital sex (PRB, 2000). Surveys have shown that, on average 43 percent of women in sub-Saharan Africa has had premarital sex before age 20, for instance median age at first intercourse among young women in Ethiopia, Cameroon, Kenya and Niger is 16, 15.9, 16.8 and 15.3 respectively from Africa (PRB, 2000).In Nigeria it is shown that 13 % of women had sex by the age of 15 years and 59 % of women have had sexual intercourse by age 18 years (TDHS 2010), this increase in sexual activity puts young people at a great risk of unintended pregnancies as well as other STI’s including HIV/AIDS (Negussie et al, 1999).

Despite of all these alarming statistics, only 13 percent of married adolescent age 15-19 use contraception in sub-Saharan Africa (PRB, 2000). In South Africa, 61 percent of sexually active women used a modern contraceptive method, yet 53 % of all births were reported as mistimed or unwanted and 78 percent of births to women aged 19 or younger were unplanned (Blanchard et al, 2005).

The major consequence of unwanted pregnancy worldwide is induced abortion, this can be performed in health care services where by the abortion is provided by a skilled health care provider with proper equipment, correct technique as well as under sterile environment as part of the reproductive health services. According to WHO standards these services are provided to any woman in need of the services in countries were abortion is legalised, But for the countries were abortion is illegal except under life threatening conditions (medical grounds), majority of the women go for unsafe abortion despite all the complications that may arise, ranging from immediate to lifelong complications and even deaths. Adolescents have the highest risk of serious complications from the unsafe abortion, this is worse in countries were abortion is restricted by law. It is estimated that 46 million abortions are performed each year, 20 million of which occur in countries where abortion is prohibited by law (WHO 2006). Globally maternal deaths due to complications of unsafe abortion is on the rise from 13 to 20 %(WHO,2003, World Health Report 2005), women are still risking their life as well as criminal consequences to terminate their pregnancies, this explains their need of avoiding or delaying having a child at a particular time in their lives, for Nigeria specifically considering Low contraceptive rate i.e. 34% and the restricted law on Abortion, addressing the problem of unwanted and induced abortion especially to the youths will help in dealing directly with maternal mortality and morbidity. This will be achieved by exploring the extent of unwanted pregnancies and induced abortion among youths, together with their knowledge and practice of contraceptive as well as assessing their sexual behaviour in general.

 

1.2       Problem statement

In Nigeria studies on unwanted pregnancies and induced abortion among youths at the community levels are few, with a lot of studies done at the health facility level. This point out to the need of more community-based studies, because most of the maternal deaths due to abortion complications occur outside the formal health system. The problem of unwanted pregnancy and induced abortion at the community is very big but much underreported; Women are not open to discuss on the sensitive issue of abortion and unplanned pregnancies. So this study will provide information on the real situation at the community level. Several studies have been conducted to determine factors contributing to the unwanted pregnancies and induced abortion in Sub Saharan Africa , Reasons includes :- poverty, no support from the partner, disruption of education and employment, family building preferences i.e. need to post pone childbearing or to achieve health spacing between births, relationship problems with the partner/husband, risk to maternal or foetal health, pregnancy resulting from rape or incest, most of the time it is poor access to contraceptives or contraceptive failure.( Bankole A, Singh S, Haas T 1998). Most of the unwanted pregnancies and induced abortions occur among the youths e.g. a study done in Nigeria among youths showed that 27.1% of pregnancies were unplanned (Urassa et al 2008) and another hospital based study done in Enugu state hospital in Dar es salaam showed that 60% of patients admitted with an incomplete abortion stated that it had been induced and among these women 88% of them were less than 24 years, and 55% were less than 20 years (Vibeke R 2000). Statistically it is shown that at the turn of the 21st century, there will be 1.7 billion people – more than one- fourth of the world’s six billion people are between the ages of 10 and 24, and the vast majorities 86 % live in less developed countries (PRB, 2000 and Ipas, 2005). In many countries, young women and men are under strong social and peer group pressure to engage in premarital sex (PRB, 2000).Surveys have shown that, on average, 43 % of women in sub Saharan Africa started to have sex before the age of 20, when this is coupled with limited accessibility of effective and modern contraceptives, then the problem of unintended pregnancies as well as induced abortion is bound to rise.

It was important to conduct this study because of the limited community data on the prevalence of unwanted pregnancies and induced abortion among female youths, many of the studies in Nigeria are hospital based .Information from this study will be used by the policy makers and program managers in addressing the needs of young people today and come up with effective interventions to help in the reduction of unwanted and induced abortion among the youths hence reduction in maternal mortality and morbidity. This is very important because the actions of young people will shape the size, health, and prosperity of the world’s future population.

Therefore the main research question in this study was to analyze the increase in mortality rate s a result of abortion among young women in Nigeria.

 

1.3       Research Objectives

The broad objective of this research work was to analyze the increase in mortality rate s a result of abortion among young women in Nigeria. The specific objective

1. To determine the proportion of female youths aged 15-24 years reported to have unwanted pregnancies in Enugu state
2. To determine the proportion of female youths aged 15-24 years reported to have abortion in Enugu state
3. To establish factors that influence female youths aged 15-24 years in having induced abortion in Enugu state.
4. To assess the knowledge of contraceptives among female youths aged 15-24 years in relation to unwanted pregnancies in Enugu state

 

1.4       Research questions

The study had the following research questions:-

1. What proportion of female youths in Temeke has ever had unwanted pregnancies?
2. What proportion of female youths in Temeke has ever had an abortion?
3. What is their level of contraceptives use among female youths in Enugu state?
4. What are the factors influencing female youths in Enugu state to go for an abortion?

 

1.5       Significance of Study

The problem of mortality rate, unwanted pregnancy and induced abortion at the community is very big, but much underreported this is due to the fact that majority of people mainly because of the social and cultural norms are not open to discuss on the sensitive issue of abortion and unplanned pregnancies.

An understanding of the magnitude of unwanted pregnancy , induced abortion among youths as well as the factors that are associated with them at the community level is very crucial in designing and implementing interventions that could be tailored to youths needs there by contributing in the attainment of the MDG 5( Reduction in maternal mortality)

Therefore the results will be useful in developing or reviewing the national policy and guidelines regarding the prevention of unwanted pregnancies and induced abortion.

 

1.6       Definition of Terms

Abortion: this is the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus. An abortion that occurs spontaneously is also known as a miscarriage.

Mortality Rate: A mortality rate is the number of deaths during a particular period of time among a particular type or group of people. Insurers base the premiums for life insurance in part on the mortality rate for a proposed insured’s age group.