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

Sexual and reproductive health care have become key priorities both within developing and developed nations. Young people have been identified as particularly vulnerable to negative health outcomes. South Africa is one such example of a country that presently faces significant challenges in addressing the unmet sexual and reproductive health needs of young people. With the enormous burden of reproductive health problems and the accelerating HIV epidemic, the provision of sexual and reproductive health services remains a challenge. Though various studies highlight the importance of comprehensive services targeted at youth, there is a lack of adequate research in evaluating the extent to which health services are addressing the health needs of clients. This study aimed to address this gap by examining a health care facility for students at one of the largest tertiary institutions in KwaZulu-Natal. The core objective was to determine the extent to which the health services are responding to the sexual and reproductive needs of young people by, exploring the experiences and perspectives of service providers and young men and women in relation to comprehensive, youth-friendly sexual and reproductive health care. This was assessed using a revised version of the Bruce-Jain quality of care framework. Information for this study was obtained using quantitative and qualitative data collection methods including: an inventory of the facility and services, in-depth interviews with staff and exit interviews with 200 clients aged 18 to 24 years. The findings of the study reveal that logistical constraints hindered effective implementation of comprehensive, youth-friendly services by providers. Providers missed opportunities to provide clients with much needed information and services due to staff shortage, client overload, lack of infrastructure, and poor continuity mechanisms. HIV, STIs and unwanted pregnancies were some of the most important health issues among young people visiting the health facility. Very few young men utilised the services. Some of the key findings were that clients continue to experience barriers in interpersonal relations while many expressed the need for more information from providers. In addition, many young women still have an unmet need for contraception. Policy makers need to incorporate the needs of young clients within sexual and reproductive health initiatives. Ideally young people should be involved in the design and implementation process of comprehensive, youth-friendly health initiatives. This would form a platform for addressing the barriers that hinder health service provision. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

The increased rate of teenagers suffering from reproductive healthcare -related conditions is a global phenomenon. An estimated 16 million teenage girls aged between 15 and 19 years give birth every year with 95% of these births occurring in the developing countries. In South Africa one notes from recorded statistics that 20000 school going teenagers fell pregnant in South Africa during 2014. These statistics left many questions to be answered in terms of what information school going teenage girls do receive at school. Formally the current school curriculum in South Africa includes a subject around life skills orientation which is known as Life Orientation Programme and in which learners are introduced to reproductive healthcare from grade 7; but a persistent increase in the rate of pregnancies and sexually-transmitted infections amongst school going teenage girls is observed. The aim of the study was to explore and describe the knowledge of school going teenage girls regarding reproductive healthcare and services in the Eastern Cape Province. The objectives of this study were:-to determine and explore the knowledge of school going teenage girls regarding reproductive healthcare in the Eastern Cape Province; -to determine the nature of information given to school going teenage girls regarding reproductive healthcare through the school Life-Orientation programme; and,-based on the results of the entire study, develop guidelines that could assist the stakeholders in health and education professions in enhancing of knowledge regarding reproductive healthcare of school going teenage girls and improving their access to related services. A quantitative design with a descriptive, exploratory and contextual approach was used. A survey was conducted and the data -collection tool was a self-administered, structured questionnaire developed by the researcher with the assistance of the supervisor and the statistician. Validity and reliability were assured before data collection commenced. A convenience, non-probability sampling method was used to collect data from schoolgoing teenage girls that gave permission to participate and met the inclusion criteria of:- schools having school going teenage girls between the ages of 12 and 19 years in the Eastern Cape Province, - being within the Nelson Mandela Bay Municipality areaand the Sarah Baartman district and -the schoolgoing teenage girls being in grades 10 to 12. Data was collected in September 2016 from a total of 314 teenagers who participated and returned the completed questionnaires. The data was captured by the researcher and analysed using a Microsoft excel programme created by the statistician for data - analysis purposes. STATISTICA Version 12 computer software application was used. The study results revealed that learners received some reproductive healthcare related education in Life-orientationprogramme lessons; but the information was seen as insufficient. Parents were telling them about their body development; but were not discussing reproductive healthcare issues with them. Participants did not know how to use the different methods of contraceptives correctly though they knew about the methods. Participants did not know about other signs of complications of reproductive healthcare as they did not know how to identify sexually-transmitted infections, breast and vaginal infections and related problems. Based on the above study results guidelines wasdeveloped as the necessary tool to facilitate the enhancement of schoolgoing girls’ knowledge regarding reproductive healthcare in the Eastern Cape Province. The study adopted the Belmont Report principles, namely, respect for persons, beneficence and justice, to enhance ethical considerations.

The aim of this study is to explore the introduction of IsiXhosa (iintsomi) as an alternative method in the maternal health education in rural Primary Health Care in the Eastern Cape. An informal preliminary observation of a maternal health lesson by the researcher indicated a further need for maternal health educators to introduce storytelling into the health content themes. To re-inforce the maternal health educator lesson on the causes of teenage pregnancy, lifestyles for pregnant women, causes of miscarriage and termination of pregnancy, the Community Health Workers can undoubtedly use isiXhosa iintsomi in selected clinics and maternal waiting homes. As a readily available resource that cuts across all literacy barriers, iintsomi (isiXhosa) fosters a cross-cultural consultation which enables the healthcare worker to convey messages that make sense to the rural women. While the conventional methods of teaching have a tendency to create tension and lack of participation, use of folktale (iintsomi) have huge potential to bring lesson enjoyment; a meaningful interaction and story sharing by the maternal health educator, the pregnant women and greater community; access to important health messages; and strengthened utilisation of Primary Health Care. The study therefore suggests that there is a place for isiXhosa iintsomi: From the Fireplace into the Workplace.

A case study design was used to evaluate the National Adolescent-Friendly Clinic Initiative (NAFCI) programme in Greater Tzaneen Sub-District of the Limpopo Province, South Africa. An interview guide was used to collect data from adolescents who visited the health centre at Nkowankowa in Limpopo Province and from professional nurses who provided the services at the health centre. Records were also reviewed to check clinic attendance of adolescents for sexually transmitted infections (STIs), voluntary counselling and testing (VCT), teenage pregnancy and contraceptive services. According to the study, even though most adolescents made use of the NAFCI services especially those providing for contraception, pregnancy and STIs, the numbers of adolescents falling pregnant and contracting STIs did not decrease. Findings also indicated that VCT services were still not adequately used as indicated by the numbers in the registers. It is recommended that VCT, STI and pregnancy services be monitored and evaluated on a quarterly basis. / Health Studies / M.A. (Health Studies)

Teenage pregnancy is an ever increasing dilemma in South Africa. Dealing effectively with pregnant teenagers is a continuous challenge for the health care providers particularly the nursing staff. The present study focuses on the reproductive health care services in a Gauteng province clinic and pregnant teenagers' experiences of their interaction with the nursing staff. Six pregnant teenagers were included in the study. Data consistied of the participants' narratives regarding the health care services provided by the nursing staff. Themes from the narratives were identified and explored according to a Social Constructionism stance within the Postmodernist paradigm. Factors found to affect the experiences of the pregnant teenagers included acceptance, respect, effective communication, privacy, trust and the dedication and professionalism of the nursing staff. / Psychology / M.A. (Clinical Psychology)

A research report submitted to the School of Social Science, 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 2015 / Introduction: Early sexual debut remains a public health concern, and it continues to gather interest among researchers. In part interest is driven by the unchanging age at sexual debut and even though the age of sexual debut remains unchanged, the rate of early sexual debut keeps rising in many developing countries (Pettifor et al, 2009). Approximately 60% of young people in South Africa report to have had sexual intercourse by the time they are 16 years old (Peltzer, 2006). Furthermore early sexual debut has been identified as an indicator of risky sexual behaviour; as it exacerbates the individuals exposure to sexually transmitted diseases especially HIV, which is most prevalent among the youth in the ages 15-24 years old (Mchunu, 2012). Similarly, violence also remains a public health concern as it endangers the development of young people. Approximately 3.5 million people report injuries caused by violence every year, and violence accounts for 30% of mortality (Norman et al, 2010). A prevalent feature of violence is the dual role of young men as victims and as perpetrators of violence (Seedat et al, 2009). In some areas of South Africa homicide deaths of males outnumber those of females at a rate of 7 males to 1 female death (Seedat et al, 2009). Furthermore other reported consequences of violence among the youth are mental health problems, injuries and a negative education outcome among young people in South Africa. Young people are future leaders and parents of South Africa and it is therefore important to have a study that will examine the association between two factors that have been deemed as risk factors for the development of young people. The general objective of this study is to examine the association between violence and early sexual debut among youth in South Africa. The first specific objective of the study is to identify the level of early sexual debut among youth in South Africa, while the second specific objective of the study is to examine the association between violence and early sexual debut controlling for socio-economic and demographic variables. Methodology: Data was obtained from the National HIV communication survey with a sample of 1 873,956 females and 932,397 males. who are in their youth (15-24 years old). Data was managed using the STATA 12 and was analysed in a way that answers the objectives of the study. For descriptive analysis, frequency tables and graphs were used. A chi-square test was conducted, to test for an association between violence and early sexual debut and for multivariate analysis the study employed a multinomial logistic model / GR2017

A case study design was used to evaluate the National Adolescent-Friendly Clinic Initiative (NAFCI) programme in Greater Tzaneen Sub-District of the Limpopo Province, South Africa. An interview guide was used to collect data from adolescents who visited the health centre at Nkowankowa in Limpopo Province and from professional nurses who provided the services at the health centre. Records were also reviewed to check clinic attendance of adolescents for sexually transmitted infections (STIs), voluntary counselling and testing (VCT), teenage pregnancy and contraceptive services. According to the study, even though most adolescents made use of the NAFCI services especially those providing for contraception, pregnancy and STIs, the numbers of adolescents falling pregnant and contracting STIs did not decrease. Findings also indicated that VCT services were still not adequately used as indicated by the numbers in the registers. It is recommended that VCT, STI and pregnancy services be monitored and evaluated on a quarterly basis. / Health Studies / M.A. (Health Studies)

Teenage pregnancy is an ever increasing dilemma in South Africa. Dealing effectively with pregnant teenagers is a continuous challenge for the health care providers particularly the nursing staff. The present study focuses on the reproductive health care services in a Gauteng province clinic and pregnant teenagers' experiences of their interaction with the nursing staff. Six pregnant teenagers were included in the study. Data consistied of the participants' narratives regarding the health care services provided by the nursing staff. Themes from the narratives were identified and explored according to a Social Constructionism stance within the Postmodernist paradigm. Factors found to affect the experiences of the pregnant teenagers included acceptance, respect, effective communication, privacy, trust and the dedication and professionalism of the nursing staff. / Psychology / M.A. (Clinical Psychology)

Adolescent reproductive health services (ARHS) in Gauteng Province are not meeting the reproductive health needs of adolescents. There is also no formalised adolescent/youth policy laid down to assess the quality of care given to adolescents attending these clinics although the policy is currently in the process of being finalised. The purpose of the study therefore was to critically analyse the ARHS in Gauteng Province to determine which adolescents attended the clinics, whether the clinics were accessible and available and whether they provided comprehensive care, gave information and counselling to the adolescent and whether the clinics \\·ere adolescent-friendly. Using the quality care model as the conceptual framework for the study, the following research questions were asked to determine the quality of care in terms of the adolescent's needs at these clinics: Who is the adolescent using ARHS in Gauteng Province') Are the ARHS in Gauteng Province accessible and available to adolescents? Do the ARHS in Gauteng Province provide comprehensive care to adolescents? Are adolescents receiving information and counselling from the ARHS in Gauteng Province? Are the ARHS in Gauteng Province adolescent-friendly? A quantitative cross-sectional exploratory, descriptive research design using a self-administered, researcher­ designed questionnaire was used to collect data from a 203 nonprobability convenient sample, at selected ARHS in Gauteng Province. The analysed data indicated that females in the older age group. ie 18-19 years used the ARHS more than the female adolescents in the younger age group and males. Findings also indicated that the ARHS in Gauteng Province are geographically accessible and available to adolescents. However, there appeared to be a need to extend the days and hours of functioning of the ARHS so as to make them more accessible and available to adolescents. Comprehensive care is not given to adolescents attending ARHS. Adolescent gave contradictory mformation especially with regard to the attitudes of service providers. Recommendations made include management strategies that will attract the adolescent in the younger age group and in particular the male adolescent. This necessitated that service providers at ARHS be equipped with the appropriate information given in an outcome-based format in adolescent care. / Health Studies / D. Litt. et Phil. (Advanced Nursing Science)