A dissertation submitted in partial fulfillment of the requirement for the award of Master of Arts in Demography and Population Studies, University of the Witwatersrand, 2017 / BACKGROUND: Nigeria has a very low level of modern contraceptive use; with resultant effects of high fertility, and maternal and child mortality. It is Africa’s most populated country, and with a rapid growth rate. Modern methods of contraception is a crucial strategy to reduce the high fertility rate, halt population growth, lessen child mortality, and enhance maternal health. This study aims to assess partner’s economic and demographic asymmetries as barriers contributing to the uptake of modern contraceptives among young married and cohabiting women aged 15-24 years in Nigeria. METHOD: This study used data from the Nigerian Demographic and Health Survey 2013, with a sample of 4,981 young (15 – 24 years) married and cohabiting women. The Health Belief Model was used to explain partner’s socio-economic and demographic differences as barriers to the utilisation of modern contraceptives. Frequency distributions and binomial logistic regression were carried out using STATA v12 to answer the research questions. RESULTS: Only 6% of young married and cohabiting women use modern contraceptives. In the unadjusted analyses, women who were in less homogamous unions were less likely to practise modern method contraception. Respondents younger than their partners by 6-10 years and respondents younger by 11 or more years were less likely to use modern contraceptives (UOR= 0.357, CI 0.135-0.943; UOR= 0.223, CI 0.084-0.595). Respondents whose partners want more children were less likely to use modern contraceptives while respondents whose partners want fewer number of children compared to them were more likely to use modern contraceptives (UOR= 0.325, CI 0.240-0.439; UOR= 1.812 CI 1.1082.963 respectively). However, these associations were no longer significant after adjusting for women’s age, highest level of education, place of residence, religion, and region of residence and other differences. CONCLUSION: This study concluded that socio-economic and demographic differences between married partners are not associated with young women's contraceptive use in Nigeria, after adjusting for women’s characteristics. Further studies, especially qualitative studies, are needed to understand this finding. Keywords: Modern contraceptives, young married women, partner asymmetries, Health Belief Model, Nigeria / GR2018

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.

Thesis (MPH.) -- University of Limpopo, 2014 / Background The use of contraceptives among sexually-active teenagers in South Africa is known to be very poor and is currently estimated to be at a rate of 25% (DoH 2002). Teenagers who have unprotected sex are at a high risk of reproductive Health problems, such as Sexually Transmitted Infections (STIs) and HIV/AIDS, and unsafe abortion, amongst others (DoH 2002). Contraceptive use progressively declined between 2002 and 2004 among girls under 18 years in the Kwa-Zulu Natal Province as a whole (Health Statistical Bulletin, 2004). Aim The aim was to determine knowledge, attitudes and perceptions of pregnant teenagers with regard to usage of contraceptives at the Pietersburg Hospital, Limpopo Province, South Africa. Method of data collection and analysis A cross-sectional descriptive survey was used in this study. A self-administered questionnaire was used to collect data from pregnant clients aged 13-19 years of age. Data analysis was carried out by using the computer software called Statistical Program for Social Sciences (SPSS). The findings revealed that lack of knowledge, attitudes and perceptions of pregnant teenagers was a problem. Findings The findings of this study indicated that culture and attitude of nursing personnel were not the barriers. Barriers were “not having enough time to choose the method and just not being serious about contraception”. Thirty-six ix per cent (36%) of the participants said they had enough time to choose the method, but they did not choose. Sixty per cent (60%) said they were not serious about contraception, 40% said they were serious but did not use contraception. Married participants who did not hear about emergency contraception, the percentage was small, 6%, while the percentage of single women was higher (94%). Conclusion The study revealed that the participants had knowledge of contraceptives, both single and married; however, married women seemed to have negative attitudes towards contraceptives, based on the culture and the believe that, once married, the usage of contraception was not necessary. Based on the findings of the study, it is recommended that there should be effective ways of information giving to the public regarding family planning.

The researcher observed a high incidence of pregnancy, sexually transmitted infections and abortions, including illegal abortions among adolescents in the Maluti Sub-District in the Eastern Cape Province. The researcher noted when speaking to the adolescents about contraceptives that they appeared to have a lack of knowledge as well as some misconceptions about contraceptives. The study therefore explores the knowledge, attitudes and practices of adolescents regarding contraceptives. To achieve the purpose of this study, a quantitative, explorative and descriptive survey was used to conduct this study. The research population in this study comprised all Grade 11 and 12 female adolescents enrolled at the selected senior secondary schools in the Maluti Sub-District. Simple random sampling was used to select the research sample. A structured self-administered questionnaire was used as a data collection tool. Descriptive and inferential statistics were used with the help of a statistician to analyse the data. A pilot study was conducted prior to the actual study being conducted, using the same design and research methods. The study findings revealed that participants had a low level of knowledge about contraceptive methods and there were some misconceptions regarding contraceptives prevailing among the participants. More than half (54%) of the participants are currently sexually active and less than a third of the participants indicated that they were using contraceptives The study concludes with recommendations for nursing practice, education and research. Ethical principles have been maintained throughout the study.

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters. / Health Studies / M.A. (Health Studies)

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters. / Health Studies / M.A. (Health Studies)

Abortion is a highly controversial subject that has again come into the spotlight in South Africa due to the legalisation of abortion on demand in 1996. The results of various studies conducted since the Choice on Termination of Pregnancy Act 92 of 1996 was implemented, have indicated that abortion providers have met with a great deal of negativism and ostracism. This study focused on the implications of abortion work on nurses' social relationships with family, friends, colleagues and their communities. Recent literature was reviewed on the subject. The researcher however, found little information on this specific aspect of abortion. The study was conducted with abortion nurses from two government designated hospitals in the East London area responsible for abortion services. Thus, results cannot be generalised. This is a qualitative study that aimed at obtaining firsthand information regarding the personal experiences of abortion nurses. A non-probability sampling technique was used viz. criterion sampling. The Interview Guide Approach was used whereby in-depth, semi-structured interviewed were conducted with the guidance of a set of questions in the form of an Interview Schedule. The ten respondents were asked to share their recommendations as to possible measures that could address the challenges mentioned during their interviews. The researcher came to the conclusion that nurses' social relationships and lives are definitely impacted by abortion work. This impact is largely negative as the majority of respondents experience labelling, stigmatization and ostracism from family, friends, and their colleagues. Abortion nurses also experience a lack of social support, ambivalent feelings with regard to abortion, and a range of negative emotions ranging from stress and depression to frustration and anger. A number of repeat abortions are being done and there seems to be a general lack of contraception. The need exists for nurses to go to Value Clarification Workshops and also to get support in terms of compulsory, continuous, counselling. Separate wards should be set up for abortions whilst sex education should be included in school curriculums at both primary and secondary schools. Family planning and facts about the abortion process should also be included in these sex education programmes. Overall. the need exists for family planning initiatives to promote contraception and deter women from using abortion as a means of contraception. As this study reveals, conducting abortions has come at a great cost for the majority of nurses who lack social support and bear the brunt of anti-abortion sentiment expressed by significant others in their lives. The latter being the people who would normally be the one's they would turn to for help, counsel, support and assistance

Department of Advanced Nursing Science / MCur

MPH / Department of Public Health / Multiple sexual partners, unprotected sex and transactional sex are considered risky sexual behaviour worldwide and continue to pose risks of sexual transmitted infections, unwanted pregnancy as well as increased termination of pregnancy amongst young people. The reported study was aimed at describing factors associated with risky sexual behaviour amongst students at Vhembe Technical Vocational Education and Training College. Within the quantitative paradigm, the study adopted a descriptive, cross-sectional survey design to describe factors associated with risky sexual behaviour amongst students. The targeted population were all the registered students at Vhembe Technical Vocational Education and Training College, Mashamba Campus. Self-administered questionnaires with close ended questions were administered to 307 students whom were sampled using a simple random technique. Out of 307 students, 217(70.3%) were females and 90 (29.3%) were males. The Statistical Package for Social Sciences version 23.0 was used to manage and analyse data. The study results revealed that demographic factors such as gender, age and sexual orientation contributed to students in engaging in risky sexual behaviour. A majority of the male students 64 (61.2%) were found to be having multiple sexual partners as compared to 107(54.2%) female students. Students aged 21-24 years 98(31.9%) were having multiple sexual partners. The study further revealed that sexual orientation contributes to students engaging in risky sexual behaviour. The students who reported that they were bisexual, gay or lesbian 33 (84.6%) were not using condoms. Environmental factors such as staying alone in a rental place contributed to students engaging in risky sexual behaviour. A majority 97(51.2%) of college students who were staying at a rental place were engaging in unprotected sex. In this study, socio-economic factors such as depending on National Financial Aid Scheme have been identified as the main driver of transactional sex. About 131(49%) students who depend on National Financial Aid Scheme reported were found to be prone to engaging in transactional sex. The study recommends that the Department of Health and Department of Education initiate strategies such as having a clinic inside the Technical Vocational Educational and Training College and peer educators to expand knowledge of students on risky sexual behaviour and on lesbian, gay, bisexual transgender and intersex.

MCur / Department of Advanced Nursing Science / See the attached abstract below