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CHAPTER ONE

INTRODUCTION

Background of the Study

Over the world, family planning and contraception is among the pertinent issues been discussed. In the early days, human societies had creation of as many children as possible, a central value. Today however, relatively few societies can afford this perspective, resulting in increased attempts to limit and manage the birth rate of their families of which Ghana is no exception. The negative effect of high fertility rate on women and their children, and the benefits of fertility control are well known (Dona et. al., 2008). The situation in Africa is as low as 25 percent, the lowest among developing regions in the world (RAND, 1998; UNFPA, 2001).
In West Africa, about 36 percent of women are using contraceptives and this rate varies from a low percentage of 22 percent in Mali, 26 percent in Togo, 32 percent in Burkina Faso, and 33 percent in Ghana (Dona et. al., 2008, UNDP, 2008). In Ghana, a country with multiple ethnic sets and religious groupings, efforts made by the Ministry of Health (MOH) and other agencies on the use of contraceptives have resulted in a general increase over the last two decades (Ann et al 2002, UNDP, 2008). There has also been a drop in fertility rate from 6.4 percent in the 1970s to 4.4 percent in 2005 (UNDP, 2008). Currently, a national contraceptive use of 33 per cent has been estimated even though 43 percent of married women in the country desire to space their children and an additional 24 percent need to limit births. The disparity of use of family planning methods among the urban and rural, and rich and poor puts many women in most deprived settings at a disadvantage (GSS, 2003).
The use of contraceptives since 1960 have helped women worldwide to prevent about 400 million pregnancies ,as a result, women lives have been saved from high risk of pregnancies. Again, contraceptives methods do excellent double duty as prophylactics (disease preventer), latex rubber and polyethylene condoms provide a barrier against STIs and HIV/AIDS infection whose spread is alarming in the country (Harvey, 2000). The major concern here is about the factors that influence the use of contraceptives among teenagers. Even though contraceptives have emerged in the prevention of unwanted pregnancies and sometimes STI, it has not been fully accepted by the community for teenagers to use them. Other factors include age of the teenage boy or girl; the younger the teenager the less likely he or she is to use contraceptives .Also another factor is the decision of the teenager to abstain from sex for various reasons such as not wanting to get pregnant against religious or moral values (Linda-lowen, 2011). Becoming a parent as a teen can negatively impact young people's ability to achieve educational and personal goals; and in developing countries, complications from pregnancy including childbirth and unsafe abortion, are the leading cause of death for young women ages 15-19.
Teens around the world need information about contraception well before they become sexually active. They need to understand how various methods of birth control work, the benefits and challenges of using particular methods, and where to get them. They need support and encouragement from their peers, adults, and the media to increase their comfort levels with condoms and birth control. Importantly, they need full access to confidential, safe, and convenient family planning services. Parents, educators, health care providers, and pharmacy staff can play a critical role in helping teens learn about, obtain, and use contraception effectively (Wind, 2005). For countries that have achieved Millennium Development Goal 5 on improving maternal health, meeting women’s contraceptive needs has played an important role. MDG 5a aims to reduce the maternal mortality ratio by three-quarters between 1990 and 2015, and MDG 5b aims to achieve universal access to reproductive health, including family planning (United Nations 2012). According to the World Health Organization in 2012, satisfying the unmet need for family planning alone could cut the number of maternal deaths by almost a third.
However, an estimated 215 million women who would prefer to delay or avoid pregnancy continue to lack access to safe and effective contraception (WHO 2012). Thus along with providing skilled maternal care, offering family planning is crucial to averting maternal deaths.  Although many United Nations member countries, particularly those in the developed world, have strong family planning programs, this is not the case in sub-Saharan Africa, where despite a rise in contraceptive prevalence, many women continue to have unmet need for contraception (UNFPA 2012; Cleland et al. 2006). The resultant high fertility is associated with high levels of maternal mortality, especially among the poorest communities. Globally, the maternal mortality ratio remains high, at 287 maternal deaths per 100,000 births; a large proportion of these deaths occur among young women (WHO et al. 2010).
An estimated one-third of women who give birth in developing countries are below age 20, which exposes them to greater risk of illness and death related to maternal causes (WHO 2010). Major factors associated with contraceptive use are women’s age, education, and socioeconomic status. Women who are more educated and wealthier are more likely to use contraception compared with illiterate and less wealthy women (UBOS and Macro International 2007). Similarly, women who use contraceptives tend to have a better quality of life, higher social status, and greater autonomy. This association has been highlighted in a study in Nigeria by Osemwenkha, who emphasized that contraceptive use has the power to reduce fertility considerably and ultimately to improve maternal and child health (Osemwenkha 2004). According to Blanc et al. (2009), in developing countries, contraceptive use among young women, whether married or unmarried, involves a lot of experimentation and is inconsistent.
Additionally, young women face many barriers to the use of family planning services, which include fear, embarrassment, cost, and lack of knowledge (Blanc et al. 2009). In the Ugandan context, only 10% of all Ugandan women and 14% of married women age 15-24 are using any contraceptive method (UBOS and Macro International 2007). Whereas age at first marriage has generally increased around the world, several parts of sub-Saharan Africa are struggling with a significant proportion of girls being married off before their 18th birthday (UNICEF 2005). Early marriage exposes these women to frequent and unprotected sexual intercourse, which can lead to early and risky first birth (Mensch 1998; Haberland 2005). In Uganda, the median age at first marriage is 17.9 years, and young women are expected to prove their fertility soon after marriage (UBOS and ICF International 2012). In addition, these women have a limited chance to space their births, since contraceptive use within marriage is not expected. Many researchers have examined the determinants of contraceptive use, from both the providers’ and clients’ perspectives (Cleland et al. 2006). The customized conceptual framework builds on existing knowledge to analyze the socio-economic and demographic factors associated with contraceptive use among young married women compared with older women in Uganda. While the framework used is generalized for both the young women and older women, we hypothesize that the factors associated with contraceptive use may operate differently within each age group due to differences such as empowerment, education, and desire for children. This hypothesis is premised on the fact that, as in many of the least-developed countries, health services and policies in Uganda are not clearly streamlined to consider the special needs of young women (Healthy Action 2011).
Since individuals act and react within a society and culture, the analysis considers that these factors operate through intermediate factors that generally act as catalysts to increase or decrease contraceptive use among women. These factors are both societal and behavioral in nature. Factors measured include exposure to family planning messages in the mass media, women’s empowerment, women’s residence (rural or urban), wealth, and region of the country. To measure women’s empowerment, the DHS survey asked women about their decision-making, as a proxy indicator. Women were asked who makes decisions on: visiting a family relative, large family purchases, daily household purchases, and own health care. Harvey, (2000) thinks that, Laws limiting teenagers’ access to contraceptive services and information fail to reduce sexual activity and increase the risk of unintended pregnancy and sexually transmitted diseases (STDs).
Statement of the Problem
The adoptions of contraceptives among Ghanaian teenagers are still low at 10 percent largely due to limited access to contraceptive services especially in the growing urban areas. National plans and guidelines for Sexual and Reproductive Health encourage use of health workers within Health Teams to provide contraceptives, including the injectable, as a key intervention to promote access among underserved populations and the teenagers in particular. Even though the trends of family planning indicators, total fertility rate and contraceptive use in Ghana have been improving, there is a challenge of increasing access to many teenagers in school who desire to limit or avoid births. The non-use of contraceptives by these teenagers has a commensurate effect on their total well-being and that of their career and education development. The increase in maternal mortality rate from 210/100,000 live births in the 1990’s to a projected 560 in 2005 (UNDP, 2008) is an indication of the consequence of complication resulting in pregnancies usually unplanned and unintended. In addition, risk of Human Immune Virus (HIV) and Sexually Transmitted Infections (S.T.I) abound.
This trend is even higher in areas where there is largely limited access to quality care. Over, the past years, New Juaben municipal area has consistently been one of the lowest in terms of contraceptive use in Ghana. The district, predominantly urban, recorded below a regional average of 24.9 percent (Eastern Regional Health Report, 2007). However, Ford et al., (2001) believes that teenagers use contraceptives due to peer pressure influence and curiosity. They also use contraceptives to prevent unwanted pregnancy and its associated problems such as school dropout, contracting sexually transmitted infections (S.T.Is) and abortion. It is against this background that the present study is being conducted to determine the factors influencing teenage contraceptive use among students in the Koforidua senior high Technical School.  
Objectives of the Study 
The general objective of the study is to determine the factors influencing contraceptive use among teenagers in Senior High Schools in Koforidua in the Eastern Region. The specific objectives of the study are:
1)      To assess the knowledge on contraceptives use among teenagers in Senior High Schools in Koforidua.
2)      To determine the perception of teenagers on the use of contraceptives in Senior High Schools in Koforidua.
3)      To  determine the accessibility to the use of contraceptive  among teenagers in Senior High Schools in Koforidua.
4)      To determine the barriers to the use contraceptives among teenager in Senior High Schools in Koforidua.
Research Questions
1)      What is the knowledge of teenagers on the use of contraceptives?
2)      What is the perception of teenagers on the use of contraceptives?   
3)      How do teenagers in Senior High Schools in Koforidua get access to contraceptives?  
4)      What are the barriers to the use contraceptive among teenagers in Senior High Schools in Koforidua?  
Justification of the Study
Unplanned and unintended pregnancies account to a large extent the poor state of health of women and children in most developing nations. The choice of women to control their own health and that of their children is challenged by Social and environmental factors that mitigate their ability to decide independently and freely on their reproductive and sexual choices. Secondly, there are still unanswered questions based on local settings that have not been revealed and still worsens the situation of these vulnerable groups with regard to decision and choices to make in controlling child birth.  
This study will provide local and contextual expressions by deprived women that could be incorporated locally into the design, administration and implementation of contraceptive use programs in districts in Ghana and other urban settings. It would also inform policy makers and programme managers of the missed opportunities worthy of consideration in the implementation of programmes. Further, it would yield information that would add to the existing knowledge in research and in the field of contraceptive uses and related issues.
Organization of the Study
The study will be organized in five chapters as follows.  Chapter one is introductory chapter to the study. Sub topics discussed under this chapter include the background of the study the problem statement, research questions, the objectives of the study, significance and limitation of the study.  Chapter Two will review of literature relevant to the study. Chapter Three will deals with the study methodology  Chapter Four will discuss the results of the study and Chapter five will summarize the main conclusions drawn from the study and will make appropriate recommendations.

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