A research report submitted to the Faculty of Health Science, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 11 December 2018 / Background: Women with mental illness are at increased risk of unplanned pregnancy and adverse pregnancy outcomes for themselves and their offspring. Aim: This study described patterns of contraceptive use, family planning education and contraceptive preferences in female mental health care users of childbearing age at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto. The study also aimed to determine associations between demographic and clinical characteristics and contraceptive choices and to assess perceived barriers to contraception. Methods: A convenience sample of 190 women aged 18-49 were recruited from outpatients and inpatients. A structured interview using a questionnaire was administered and diagnosis and treatment were obtained from patients’ files. Results: Consistent contraceptive use was 44.7%. Total contraceptive use was 60%. Family planning education had been done with 26.8% of participants. The commonest reason for not using contraception was not being in a relationship (21.6%). The commonest form of contraception was the male condom and 28.9% participants used barrier methods of contraception. Family planning education (p=0.87) and teratogen use (p=0.56) were not associated with contraceptive utilisation. Positive associations were found between contraceptive use and depression (p=0.0068); and between employment and family planning education (p=0.015) Conclusion: Despite contraceptive use being similar to that of the general South African population, there were low levels of family planning education. Participants may be at risk of teratogen exposure during pregnancy. They may also be at risk of unplanned pregnancy and sexually transmitted infections due to inconsistent contraceptive use and low rates of barrier contraception use. / E.K. 2019

The attitude of the African male to contraception and the role he plays in the acceptance of contraceptives by his racial group is presented. Over a period of one month the researcher interviewed 220 African males at a primary care private practice. In this study 186 (85%) were aware of contraceptives and 34 (15%) had no knowledge of contraception; 111 (60%) were married and 75 (40%) were unmarried. The 26 - 35 year age group were the most familiar with contraception (57%). The unemployed were the least users of contraceptives (8%), whereas 69% of the professional group were using contraceptives. The average ideal family size of the group was 4 children. No significant cultural barriers to contraception were found. Religion was found to have little effect on contraceptive practice by the African male. Fifty-three percent of the Urban dwellers were using contraceptives compared with only 30% of the Rural inhabitants. Modern methods of contraception are not yet sufficiently known by the African male to be useful to him. Health workers should educate the African male in matters of contraception to achieve the desired objectives of family planning campaigns among this racial group. / Thesis (M.Prax.Med.)-University of Natal, Durban, 1986.

This study adopted a case study design to understand women and contraceptive use in the Diepsloot community, an impoverished urban informal settlement, north of Johannesburg. It was guided by feminist and critical theory, and made use of the qualitative research paradigm. The history of the provision of reproductive health services in South Africa has been discussed as a process that has both marginalised the participation of previously disadvantaged communities and also limited the opportunities for effective contraceptive use in the post-apartheid era. The main objectives were to understand reproductive health experiences of women and their knowledge of modern contraception in relation to the ecological environment in which they are embedded. I used the non-probability purposive and theoretical sampling methods. The sample size was theory driven and largely determined by the type of data acquired after a series of interviews with twenty women over a five month period. Data collection ceased when data saturation was reached. Individual interviews and focus group discussions were conducted with twenty primary respondents. For triangulation purposes, primary health care service providers from the two local clinics were interviewed. Also one focus group discussion was done with a group of eight men; two traditional healers and the manager at the local Marie Stopes clinic were also interviewed for the same purpose. I used thematic analysis as the method of analysing the data. Thematic analysis moves beyond merely describing the data but identifies both the unspoken and obvious ideas within data. It was the intersectionality of contraceptive use and the unique lived experiences of disadvantaged women that had inspired the study and all methods employed were aimed at a deeper understanding of the effects of the cultural, social and economic environment on the reproductive health choices of the women. The data were analysed according to the seven themes that emerged from the study and these were: empowerment and reproductive health decision making, level of education as a determining factor in contraceptive use, contraceptive knowledge, contraceptive dialogue as a contributing factor to contraceptive use and choice, opinions on the prevention of pregnancy, spacing versus limiting the number of births and the availability and accessibility of modern contraceptive methods. The inextricable link between education, poverty and gender inequality highlighted the need to empower women in marginalised communities. Due to poverty and lack of education, most women were powerless and not independent to make favourable reproductive health decisions. Knowledge of modern contraceptive methods was limited and the most popularly used method was the contraceptive injection. The circumstances of the women in this study and those of the Diepsloot community speak to the broader economic issues of the country and reflect the need to prioritise women’s education; to create economic opportunities for women and to enhance the participation of the poor and marginalised communities. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

M.Cur. (Community Health Nursing Science) / The surgical contraceptive services of any population programme play an extremely important part in the quest to attain the proposed socio-economical health and demographic goals. Being a permanent contraceptive method, the promotion and acceptance of sterilization poses a problem in pro-natalistic communities. This study was aimed at gaining insight into problems, perceptions. knowledge and attitudes of the nurses involved in the National Family Planning programme. In an exploratory, descriptive study, 408 nurses in the RSA partook in a postal survey. The knowledge, attitudes and activities of nurses were assessed. It can be concluded that the attitudes are positive and the level of knowledge very low.

This research report is submitted to the School of Social Sciences at the University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies for the year 2016, September 2017 / Background: South Africa has some of the most progressive legislation when it comes to sexual and reproductive health rights. However, contraceptive use amongst this segment of the population group remains distorted. From a public health perspective, investing in the sexual and reproductive health needs of young people translates into an improvement in the sexual health status of the population at large. As such this paper makes use of the Health Belief Model to investigate the factors associated with the choice of type of contraceptive methods used by sexually active young women to prevent a pregnancy. Methodology: Data for this study was obtained from Wave 2 of the Transitions to Adulthood survey. The weighted sample size is 464. Analysis on the weighted data was conducted in STATA 13.1 in survey mode in order to achieve the objectives of this study. Descriptive statistics were used to analyse the data at the univariate level. The Chi-squared test was conducted to examine the relationship between the variables under investigation and the outcome, contraceptive use. The multinomial logistic regression model was used to analyse the data at the multivariate level. The results of which were provided in terms of relative risk ratios. Findings: Approximately 41% of sexually active young women in KwaZulu Natal did not use contraception to prevent a pregnancy with their most recent sexual partner. Results from the multinomial logistic regression model revealed that sexually active young women who were single were 77% less likely to make use of hormonal and other contraceptive methods to prevent a pregnancy compared to their who were counterparts in a relationship (p-value= 0.00001). Young women who have been pregnant at least once were approximately 60% less likely to utilise hormonal and other contraceptive methods to prevent a pregnancy with their most recent sexual partner. Conclusion: By using the Health Belief Model as a theoretical basis this study highlighted the complex non-linear relationships between the variables selected to constitute the health beliefs as well as the health-related behaviour of contraceptive use. The findings of this study demonstrate two key realities related to contraceptive use of sexually active young women in KwaZulu Natal. Firstly, relatively low rates of contraceptive uptake. Secondly, amongst sexually active young women who utilised contraception, there are even lower usage rates of long-acting reversible contraceptive methods. As such, it is important for healthcare facilities in KwaZulu Natal and South Africa at large to support young women in their decision to protect themselves from unintended pregnancies and from infections of HIV and others STIs. / XL2018

The purpose of this study was to explore and describe the contributory factors to the high teenage pregnancy rate within a district hospital in the Ehlanzeni district of the Mpumalanga Province, South Africa. Quantitative, non-experimental, descriptive and exploratory research was conducted to explore the contributory factors to the high teenage pregnancy rate. Data collection was done using a self-designed structured interview schedule. The findings of the study supported the assumptions that there are factors related to biography, individual perceptions, knowledge and awareness of; and practices, perceptions regarding the use of contraception. Perceived seriousness and barriers to the use of safeguards that could have prevented pregnancy contribute to the high teenage pregnancy rate thus emphasise the need to develop strategies to prevent teenage pregnancies / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore and describe the contributory factors to the high teenage pregnancy rate within a district hospital in the Ehlanzeni district of the Mpumalanga Province, South Africa. Quantitative, non-experimental, descriptive and exploratory research was conducted to explore the contributory factors to the high teenage pregnancy rate. Data collection was done using a self-designed structured interview schedule. The findings of the study supported the assumptions that there are factors related to biography, individual perceptions, knowledge and awareness of; and practices, perceptions regarding the use of contraception. Perceived seriousness and barriers to the use of safeguards that could have prevented pregnancy contribute to the high teenage pregnancy rate thus emphasise the need to develop strategies to prevent teenage pregnancies / Health Studies / M. A. (Health Studies)

This study explored knowledge, perceptions and attitudes regarding contraception and contraceptive practices among secondary school learners in the Limpopo Province. Self-administered questionnaires were completed by 612 Grade 8 and 332 Grade 12 learners from 24 randomly selected secondary schools. The study found that permissive attitudes prevailed towards sex, characterised by casual sexual activities commencing at 12 years of age. The availability of contraceptive and termination of pregnancy (TOP) services did not enable learners to utilise them, because of social, cultural, financial and service barriers. Most learners were sexually active without being knowledgeable about contraceptives, emergency contraceptives and TOP services. Two workshops conducted with learners produced similar results to those obtained from the completed questionnaires. Semi-structured interviews conducted with nurses, providing contraceptive and TOP services in the Limpopo Province, also substantiated the findings from the questionnaires. Secondary school learners in the Limpopo Province require more knowledge about and ready access to contraceptives to enable them to delay child bearing until they are emotionally, financially and physically ready for these responsibilities. Nurses and teachers in this province can enhance the learners' contraceptive knowledge and utilisation to help learners make better informed decisions about their own and their future children's lives. / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this study was to investigate sexual activity as well as contraceptive knowledge and use among termination of pregnancy (TOP) clients at Prince Mshiyeni Memorial Hospital’s TOP clinic in the province of KwaZulu-Natal (KZN). This was a non-experimental quantitative study in the form of a cross sectional study. Self-administered questionnaires were used for collecting data from 61 respondents selected non-randomly. The majority of the respondents were single young women between 18 and 27 years of age. Sexual intercourse frequency was mostly once a month (91.8%). Most were unemployed and dependent on government grants and had heard of both contraception in general and emergency contraception. Only 44 (78.6%) had used contraceptives before and the most frequently used method of contraception was the injection (36.6%). Despite the respondents having heard of contraception, the median score of the knowledge of contraception was only 16%. The distribution of knowledge was very wide, but on the whole the level of knowledge of contraception was very low / Health Studies / M.A. (Public Health)

This Dissertation is submitted in partial fulfilment of the Master of Arts in Demography and Population Studies at the University of the Witwatersrand, 2017 / Background: In South Africa, poor choice of contraception method or contraceptive failure has been noted as one of the key contributors to high rates of unwanted pregnancy and HIV/AIDS. Contraceptive use is highly correlated with pregnancy and fertility intention. While research knows the role of contraceptive use in delaying conception and/or childbearing, what remains unknown is an understanding of whether the methods of contraception used by young women match their fertility intentions. The objective of this study is to determine the relationship between fertility intention and method of contraception among young women (20-24 years old) South Africa. Methods: This study provides a secondary data analysis on cross-sectional data from the 19992002 Transition to Adulthood in the Context of HIV/AIDS survey. Given that the survey involved two waves of data collection in 1999 and 2002, the two respective datasets are pooled together to achieve a representative sample of 8 370 adolescents aged 14 – 24. However, because the population of interest is young women, further sample restrictions are performed and a weighted sample of 1,020 sexually active young women aged 20-24 years old is attained. A multinomial regression is adopted for this study because the outcome variable-method of contraceptioncomprises of three categories: (1) modern method (2) traditional (3) no method. As such, in establishing the relationship between fertility intention and method of contraception, three levels of analysis are carried out. Firstly, is a univariate analysis of the variables in the study, followed by a bivariate analysis using Chi2 to examine the association between predictor variables and method of contraception. Finally, a multivariate analysis producing the adjusted and unadjusted associations is conducted to examine whether a statistical relationship exists between fertility intention and method of contraception. Results: Of the 1,020 sexually active young women 20-24 years old years old in the sample, 77.8% do not use any method of contraception while 13.9% make use of modern methods and only 8.1% use traditional methods of contraception. There was no significant association found between fertility intention and method of contraception. Among young women that intend to have three or more children in their lifetime compared to those that intend to have 1-2 children, the relative risk of using a modern method of contraception compared to not using any method of contraception is expected to decrease by a factor of 0.620 (95% CI=0.351,1.095; P>0.05). However, positive associations were found between relationship status and method of contraception as well as between place of residence and method of contraception. Among young women that have steady partners compared to those that are single/not in a relationship, the relative risk of using a traditional method of contraception compared to not using any method is expected to decrease by a factor of 0.274 (95% CI=0.122, 0.617; P<0.05). Furthermore, among young women living in rural areas compared to those in urban areas the relative risk of using a modern method of contraception compared to not using any method is expected to decrease by a factor of 0.499 (95% CI=0.300, 0.831; P<0.05). Conclusion: This study has demonstrated that fertility intention cannot be used as the sole predictor of the choice of contraception used by young women. Rather, there are prevailing and contextual demographic and socio-economic factors that intervene this relationship and influence women’s adoption of any method of contraception. Notably, the limited access to healthcare centres; ambivalent feelings about pregnancy as well as misconceptions and perceived side effects of contraception influence the poor use of modern methods of contraception. To address the high rate of unwanted pregnancy among youth in South Africa, it is advisable that policies and programmes assist young women to become decisive about their fertility intentions and provide them with the necessary support and resources to access contraceptive methods that will assist them in achieving their fertility goals. / XL2018