Contraception and prevalence of sexually transmitted diseases among adolescents and young adults in Uganda.

The study is aimed at (i) exploring the knowledge and attitudes of adolescents (15-19 years old) and young adults (20-24 years old) towards sex and contraception (condoms) and (ii) determining their level of knowledge and attitudes towards sexually transmitted diseases (STD) as well as the prevalence of the latter among the sexually active adolescents and young adults. A sample of 4510 respondents (1545 males and 2965 females) aged 15-24 years from urban and rural areas were interviewed. The majority of adolescents and young adults surveyed have a negative attitude towards the use of condoms although most of them agreed that they prevent STD. Over 95% of the respondents have heard about STD and their level of knowledge is relatively high; slightly higher for urban residents and for young males. Approximately 21% of the male and 8% of the female respondents admitted having ever contracted STD. The gap between contraceptive knowledge and practice is rather wide. Only a small proportion of the respondents were using condoms at the time of the survey.

PIP: Between 1988 and 1990, researchers conducted the Adolescent Fertility Survey in the districts of Jinja, Kampala, Masaka, Kabale, Hoima, and Mbale in Uganda among 4510 15-24 year old urban and rural youth to examine their knowledge and attitudes toward sex, contraception, and sexually transmitted diseases (STDs). Males were more likely to experience 1st sexual intercourse at an earlier age than females. Many youth experienced their 1st sexual intercourse before age 15 and they had had more sexual partners than females. 83.9% of males and 87% of females used no contraception. Overall knowledge of condoms was high (78.2% for males and 56.6% for females) except among rural females (31.1%), especially among urban males (85.8%). Almost everyone was knowledgeable about STDs (96.1% males, 93.5% females). They tended to agree that condoms prevent STDs (urban males, 80.2%; urban females, 76%; rural males, 89.8%; and rural females 83.7%). Despite these high knowledge levels and positive attitude toward condoms, condom use levels were low, e.g., only 12.7% of males and 0.4% of females who were familiar with condoms used them. 40% of all respondents knew about the 3 most common STDs: gonorrhea, syphilis, and AIDS. Urban males were a bit more knowledgeable about these 3 STDs than were the other groups (48.8% vs. 41.2% for urban females, 41.3% for rural males, and 41.6% for rural females). In addition, STD prevalence was quite high especially among males (21.4% for males vs. 7.8% for females). The unsafe sexual practices revealed in this study indicated the need for sex education earlier than it is presently being offered in the school system and the establishment of health clinics geared toward adolescent needs.

Fertility levels, patterns and differentials in Papua New Guinea.

PIP: On the basis of a survey conducted between November 1979 and March 1980, new evidence is presented on changes in fertility levels, patterns, and differentials in Papua New Guinea. A single-stage systematic sample designed was used to select respondents in both rural and urban areas. 3986 females in the childbearing age group of 15-49 years and 2297 males ranging in age between 20 and 54 years were interviewed. 1066 males and 1857 females lived in rural areas and 1231 males and 2129 females resided in urban areas. Information was collected on the following: births occurring in the 12 months prior to the survey; the number of children ever born of all female respondents; a complete pregnancy history of all female respondents; and the age structure of the female respondents. The results of the estimated fertility measures for the rural and urban areas of Papua New Guinea are high by world standards: adjusted estimates of total fertility rates of between 6-7, gross reproduction rates of 2.99 and 2.76, and net reproduction rates of 2.25 and 2.08 for the urban and rural areas. Fertility was higher for rural respondents in all age groups except in the 30-34 and the 45-49 age groups where the rates were slightly higher for urban respondents. These differences in the fertility rates were substantial, particularly among respondents under 25 years old. The rural total fertility rate was 8.5% higher than the urban rate; the differences in the gross reproduction rate and the net reproduction rate were 8.3% and 8.2%, respectively. In the rural sample, respondents with primary education had a slightly lower fertility than those with no education, but the respondents with secondary and tertiary education showed marked differences than those with primary education, especially in the 20-39 year age groups. The differences among the youngest (15-19) year age group and the older (40-44) and (45-49) age groups were not large. The pattern for the urban sample was similar to the rural pattern, except the differences for respondents 40-44 and 45-49 were relatively larger than for rural respondents in the same age group. In general, education serves to facilitate the acceptance of new ideas and practices. Papua New Guinea's high fertility may be interpreted in terms of social and cultural factors which favor high fertility, namely marriage is the norm and women marry young. There is some evidence of possible decline in fertility levels as indicated by the more refined measures, i.e., total fertility rate and gross and net reproduction rates.^ieng

Infant mortality levels, patterns, and differentials in Papua New Guinea.

PIP: This paper reports new estimates of infant mortality rates in Papua New Guinea and compares the estimates for sex of child, rural-urban residence, as well as for the 4 main geographical regions in order to detect similarities or differences in the rates. Estimates are based on a sample survey of 3986 females aged 15-49 carried out in 35 urban and 30 rural cluster units in 8 provinces. Indirect estimates revealed some sustantial declines in infant mortality over the past 15 years, but the levels are still high by world standards. The differentials of infant mortality levels observed in the rural and urban areas as well as in the 4 geographical regions strongly suggest a need for further implementation of the currently existing health care services, particularly those that focus on infant care.^ieng

Fertility and family planning in Papua New Guinea.

PIP: This paper examines some of the data on fertility, family size and family planning from a survey conducted between November 1979 and March 1980 in 8 provinces both in rural and urban areas of Papua New Guinea (PNG). The sample consisted of 6283 male and female respondents; a total of 3986 females in the age group 15-49 and 2297 males between the ages of 20 and 54 were interviewed. About 9% of the rural and 5.4% of the urban female respondents were pregnant at the time of the interview. The higher number of pregnancies recorded for the rural population, compared to the urban, is due to longer duration of marriage and higher mean age. Both rural and urban respondents have similar attitudes to the ideal number of children. 4 and 6 children were indicated as an ideal number for the urban and rural population, respectively. The results indicate that economic pressures are being felt within the family in both urban and rural areas, and that the costs of raising children are clearly perceived, at least among the educated. Nonetheless, the majority of the population desires large numbers of children, the main reason being economic security in old age. It is also evident that the people have a negative attitude to modern methods of contraception because they are not well informed about them. The most frequently stated reason, the harmful effects on the health of the mother and future offspring, is probably one of the obstacles to their more widespread use. Though there is physical accessibility to family planning services for most urban and about 1/2 of the rural dwellers, the problems of non-use are mainly of a sociological and psychological nature. The problems include the attitude of husbands to their wives' use of contraceptives, reinforcement of culturally acceptable behavior by the extended family and community members, and the desire for more children. Although the levels of contraceptive awareness are relatively high, the overall impression is that the practice of modern contraception in both the rural and urban areas is low. Despite the rural-urban differences in educational and income levels, living conditions, and the availability of family planning services, awareness and current use are only slightly higher among the urban respondents. For family planning programs to have more impact in reducing the high fertility levels, a much more intensive program of activites is needed for the country at large.^ieng

Breast-feeding and sexual abstinence in Papua New Guinea.

PIP: The practice of breastfeeding and sexual abstinence in Papua New Guinea (PNG) does not vary markedly between rural and urban areas. Data are drawn from a study of fertility, mortality, and contraception among the indigenous population of Papua New Guinea conducted between November, 1979 and March, 1980, in 8 provinces in both rural and urban areas. The sample is made up of 6283 respondents, regardless of their marital status: 3986 females in the childbearing age group (15-49 years) and 2297 males between the ages of 20-54 years. 1066 males and 1857 females lived in rural areas; 1231 males and 2129 females lived in urban areas. More than 90% of the rural and urban males believe that breastfeeding is nutritious for children. The mean period of breast feeding for the rural mothers is 21.8 months and 20.7 months for the urban mother. The literacy levels of both the rural and urban respondents is rather low, but the urban female respondents have a higher % of secondary education than their rural counterparts. Breastfeeding must fit in with the mother's lifestyle and work. The current rural-urban migraton patterns are given. 33.9% of the males and 28.7% of the females in urban areas were born in rural areas. The rural-born urban mothers breastfeed slightly less than rural mothers (21.4 and 21.8 months, respectively). An increasing number of women are going to the hospital to have their babies. Respondents were asked if they thought that a couple should go without sexual relations after a child is born, and for how long. About 63% of the rural males and 67% of the rural females responded affirmatively: approximately 34% of the rural males and 29% of the rural females responded negatively. 66% of urban males and 74% of females responding affirmatively; negative were 31% male and 22% female respondents. The duration of expected abstinence ranges from 1-36 months.^ieng

They yearn for freedom to read and write.

PIP: In spite of the expansion of educational systems and increasing enrollments of both boys and girls in primary, secondary, and tertiary institutions in many sub-Saharan African countries, females in this region still have limited education and training opportunities. Home economics is very popular among the women, although most courses are not entirely relevant to the sub-Saharan African conditions. Westernized courses like baking, weaving, knitting, and sewing are very popular. On the other hand, little attention is paid to African traditional courses like agriculture and trading. A number of UN agencies have tried to include traditional African courses. Literate women are more knowledgeable about nutrition, health, and contraceptive practices, and they are more likely to send their daughters to school. Illiterate women in sub-Saharan African countries, however, have not significantly improved their lives through literacy training. A wide variety of health and nutrition programs are designed for only women. Maternal and child care, disease prevention, hygiene, rehydration and proper use of sanitary services are among the most popular. Programs are usually offered by Ministries of Health but are often funded by UNICEF and WHO. Nutrition programs typically involve teaching the basics of nutrition and improvement of the family diet with the major aim of reducing infant and child morbidity and mortality rates. Income generating programs provide women with skills needed to help them earn income and gain status in the household. Agricultural training, in many cases, excludes women in spite of the fact that the majority of women in Sub-Saharan Africa are involved in agriculture and provide 60-80% of the agricultural labor and produce. Agriculture is the key to development in most countries of this region. Factors that influence sub-Saharan women's participation in nonformal education programs include program relevance, availability, distance to the training center, economic resources, and information. UNESCO and UN guidelines require program assessment, implementation, and evaluation.^ieng

Mortality estimates for South Kampala based on 1980 Uganda Population Census.

PIP: In the absence of vital statistics data, analysis of the 1980 Uganda Population Census for South Kampala was able to provide estimates of infant, child, and adult mortality. Indirect techniques yielded estimated 1q0 values of 0.0860 for male infants, 0.0680 for female infants, and 0.0774 for infants of both sexes. The infant mortality rate estimated for 1980 is somewhat higher than that estimated for Kampala city in 1969 (0.0750), supporting medical professionals' opinion that infant mortality increased during the 1970s due to political and economic factors in Uganda and the consequent deterioration of health services. Child mortality (4q1), estimated in this study as 0.0491, appears to have declined during the 1970s; however, this unexpected finding may reflect differences in coverage and content errors in the 2 sets of data for 1969 and 1980. Adult mortality, based on the estimated survival rates from paternal and maternal orphanhood data and those from adjusted 12 values, is slightly lower than those for infant and child mortality. Expectation of life at birth estimates from various techniques show clearly that females have lower patterns of mortality than males. The estimated life expectation is 54.7 years for males, 59.3 years for females, and 57.0 years for both sexes. Overall, these estimates indicate a need for further reductions in mortality in Uganda as part of the overall development effort.^ieng

Adolescent fertility in Kampala, Uganda: knowledge, perceptions and practice.

PIP: The Adolescent Fertility Survey of Kampala, Uganda in 1988 queried 1133 adolescents, 335 male and 798 female, aged 15-24, using methods drawn from those of the Demographic and Health Surveys. While 45% of the males were in school and 39% were working, it was noted that 57% of the females were not active. 51% of the women were single, 26% were married, 18% were cohabiting. 85% of both sexes were sexually experienced. Mean age of 1st coitus was 15.7 for males and 15.3 for females. By age 17 30% of the women had 1 or more pregnancies. 1 in 8 was currently pregnant. The respondents had an average of 2.15 pregnancies. 23% of those who had been pregnant stated that they had 1 or more abortions, 38% of single and 19% of married women. By age 22-24 40% of the men and 80% of women had children. Information about reproductive health was obtained from friends, school and relatives. 87% could name a MOH approved contraceptive. 69% believed that unmarried people should use contraceptives. 24% use or had used contraceptives, but 2/3 were not using any method. The stated reasons for not using were the belief that contraceptives are unsafe, objections by the male partner or insufficient knowledge. Ugandan institutions generally oppose provision of contraceptives to young people.^ieng

Determinants of cumulative fertility in Kenya.

This paper analyses the effects of age at first marriage, level of education, place of residence, marriage disruption, religion, contraceptive use, and work status on cumulative fertility in Kenya, using data from the 1977-78 Kenya Fertility Survey. Age at first marriage is the main determinant of cumulative fertility, but there are significant effects of level of education and marriage disruption. Place of residence is only significant for the Coast province. The implication of the findings is that to promote any real decline in fertility, emphasis should be placed on providing higher education and work opportunities for young women as an alternative to early marriage.

Demographic and sociocultural factors influencing contraceptive use in Uganda.

Bivariate and multivariate analyses of the influence of demographic and sociocultural factors on contraceptive knowledge, attitudes and practice among currently married respondents in Uganda show that: (1) contraceptive knowledge is widespread, even among women with no education; (ii) the majority of the respondents have favourable attitudes towards contraceptive use; (iii) the level of contraceptive use is low in comparison with knowledge and attitudes. Post-primary education, ethnicity, residence, the presence of the spouse in the household and discussion of family planning with spouse were strong predictors of knowledge and favourable attitudes towards contraception. Secondary or higher education, discussion of family planning with spouse and urban residence strongly influenced contraceptive use, but child mortality did not. The use of condoms as a behavioural change to avoid contracting HIV/AIDS was low. The results suggest that, particularly in rural areas, family planning services are not meeting the needs of potential clients.

PIP: Data from the 1988/89 Uganda Demographic and Health Survey was used to examine contraceptive knowledge, attitude, and usage among 3055 currently married Ugandan women. An estimated 20% of total population were not included in the sample due to areas of civil disorder. Greater knowledge about contraception was found among women with a secondary or higher education, among women with three or more surviving children, among urban women, and among women with husbands absent. Catholic women had less knowledge than Protestants and Muslims. More favorable attitudes toward contraceptive use were found among women aged 20 years and older. Women with a secondary or higher education were more likely to approve of contraceptive use. The Bantu, Nilo-hamites, and Hamites highly approved of contraception compared to Lilotics. Approval was greater among women who desired no more children. Women whose husbands lived away from home were more likely to approve of contraceptive use. 26.4% of women who had never had a child die had ever practiced family planning. 21.6% who had experienced a loss of a child had ever practiced family planning. Women who had married at the age of 20 years and older were more likely to have practiced family planning. Contraceptive use was 26.2% among women with three or more surviving children. 19.0% of women with no surviving children used contraceptives. Higher contraceptive use was associated with higher educational level, ethnicity (Banti and Nilo-hamite), women with husbands absent, and urban women. In the multiple classification analysis, findings showed that knowledge of contraceptive methods was strongly predicted by a woman's ethnic origin, educational attainment, discussion of family planning with a partner, place of residence, and age at first marriage. Significant determinants of approval of contraceptive use included husband-wife discussion of family planning, a woman's ethnic origin, educational level, fertility preference, religious affiliation, and number of surviving children. Ever use of contraception was significantly related to having secondary or higher education, ever discussed family planning with a spouse, urban residence, and the desire to stop childbearing. Traditional method use was related to women with no or only primary education. 22.0% of men in Kampala and 11.0% of rural men had ever used condoms, but only 8.4% used condoms as a prevention for AIDS.

Sexual behaviour, reproductive health and contraceptive use among adolescents and young adults in Mbale District, Uganda.

Results from a survey of adolescents and young adults in Mbale District in Uganda are presented. First sexual experience among female and male respondents occurs at quite an early age, 15 years for males and 16 years for females. Most respondents claimed to have received information on reproductive health. The accuracy of these self-assessments was rather poor as a relatively small proportion of the respondents could identify the safe period in a woman's menstrual cycle. The incidence of adolescent pregnancy is generally high and slightly higher in rural than in urban areas. A relatively large proportion of pregnancies occur out of wedlock. The respondents' contraceptive knowledge was quite good but many still engaged in unprotected sexual relations. The most commonly used methods were the condom and the pill. The main reasons given for non-use were lack of knowledge about contraceptives, beliefs that they were not safe, and their non-availability. This calls for improvements in family planning education and in accessibility of contraceptives.

PIP: A 3-phase adolescent fertility survey was carried out in Uganda starting in 1988. This report presents data from household and individual questionnaires collected in Mbale District for the third phase in August 1990. 1357 adolescent and young adult respondents (15-24 years old) comprised the sample (146 urban males, 330 urban females, 356 rural males, and 525 rural females). Information was solicited on education, religion, employment, marital status, age at first intercourse, frequency of intercourse, number of partners, pregnancy, abortions, and childbearing, sexually transmitted disease experience and knowledge, and contraceptive knowledge and use. It was found that most of these young people were sexually active, and many initiated sexual activity before age 15 years. Most reported having received information about reproductive health, but few could identify the safe period in a woman's menstrual cycle. There were contradictions between behavior and attitudes, with many more young people reporting that they engaged in sexual behavior than reporting that they approved of premarital sex. Whereas levels of contraceptive knowledge were quite high, actual usage was very low. The condom, oral contraceptives, and rhythm method were most often used, but many respondents stated that they lacked enough knowledge to use contraceptive, they believed contraceptives were not safe, or contraceptives were not accessible to them. It is recommended that more educational programs be devised to counter the factors which will encourage high fertility in this population.

Sexual behaviour and contraception among unmarried adolescents and young adults in Greater Accra and Eastern regions of Ghana.

A fertility survey of unmarried adolescents and young adults (953 males and 829 females) in Greater Accra and Eastern regions of Ghana revealed that a substantial proportion of the respondents were sexually experienced. Overall, 66.8% of the males and 78.4% of the females were sexually experienced. The mean ages (+/- SD) of the males and females were 15.5 +/- 2.5 and 16.2 +/- 2.0 years, respectively. Most respondents claimed to have received adequate information on reproductive health and sexually transmitted diseases (STDs), including AIDS. However, 20% and 30% of the respondents in peri-urban and rural areas, respectively, did not know that a girl could get pregnant the first time she has sexual intercourse. The incidence of pregnancy among the unmarried female respondents was relatively high (37%), and was higher in urban than in rural areas. Approximately 47% of those who had ever been pregnant reported that they had had an abortion. Levels of contraceptive awareness were high (98.2% among males and 95.5% among females) but many still engaged in unprotected sexual relations. The most commonly used methods were the condom and the pill. The main reasons given for non-use were that they did not think about contraception, were concerned about the safety of contraceptives, and partner objection. These findings point to the need for targeting of unmarried adolescents and young adults with information on reproductive health and family planning to increase their awareness of the risks of pregnancy, STDs and HIV infection.