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CHAPTER TWO
REVIEW OF RELATED LITERATURE
This chapter will present the review of related literature on the topic, Impact of family life and sex education on the prevention of teenage pregnancy among secondary school student in Lagos state. This chapter will be discussed under the following sub-headings.
- Concept of Sex Education
- Concept of family life education
- Concept of teenage pregnancy
- Causes and prevention of teenage pregnancy
- Effect of teenage pregnancy
- Good communication among family members and teenage pregnancy
- Growth and development of teenagers
- Sex education on abstinence and contraception use and teenage pregnancy
- Inclusion of sex education in secondary schools curriculum and teenage pregnancy
- Summary of related literature review
CONCEPT OF SEX EDUCATION
Sex education which sometimes is referred to as sexuality education, is a sex and relationship education of acquiring information and forming attitude and belief about sex. It is about developing, young people skill so that they make informed choices about their behaviour and feel confident and competent about acting on their choices. It is widely accepted that young people have a right to sex education, partly because, it is a means by which they are helped to protect themselves against abuse, exploitation, unwanted pregnancy, sexually transmitted diseases and HIV/ AIDS (Ikpe, 2004)
Young people today are being exposed to wide range of attitude and beliefs in relation to sex and sex nullity. This sometime appears contradiction and confusing. For example, some health magazine emphasized the risk and danger associated with sexual activity while some media coverage promotes the idea that being sexually active make a person more attractive subjects, young people and sex education can have story view on what attitude that should govern peoples interest in ‘the moral and cultural frame work that binds sex and sexuality by talking about strong issues like abortion, pre-marital sex, lesbian and contraception without minding the implications (Moronkola and Fakeye, 2008).
However, the youths need to have information about the physical and emotional changes associated with puberty and sexual reproduction, including fertilization conception and about sexually transmitted diseases with AIDS. They also need to know about the relationship they make like love and commitment, marriage and patronizing and the law reality to sexual behaviour as well as the range of religious and cultural view on sex and sexuality and also sexual diversity (Lloyd, 2005). Sex education that works start early before young people reach puberty and before they can develop patterns of behaviour. Maintained that a child receives sex education from many sources and at an early age, especially through mass media. To counter it the impact of bad experience received through those media, the combined effort of parents, schools, mosques, churches and youth with scientific information sound sex attitude and desirable standard of conduct (AHI, 2003).
In Nigeria, today sex education is becoming more and more important as we feel its impact in our various schools with the inclusion of sex education in the schools curriculum, student are being furnished with various information on sexual matter, and this make them knowledgeable about the effect of abortion, in discrimination sexual intercourse venereal diseases, prostitution and homosexuality (Lena, 2000).
Content of Sex Education
Sex education has been given various definitions by various schools of thought. AHI (2003) described sexuality education as “a planned process of education that fosters the acquisition of factual information, the formation of positive attitudes, beliefs and values as well as the development of skills to cope with the biological, psychological, socio-cultural and spiritual aspects of human sexuality.” That is, learning about the anatomy, physiology and bio- chemistry of the sexual response system which determines identity, orientations, thoughts and feelings as influenced by values beliefs, ethics and moral concerns. It is the interactive relationship of these dimensions that describes an individual’s total sexuality. Also, sexuality education teaches us that, religious principles, beliefs, rules and regulations and ethical considerations affect our everyday interactions just as our culture, role models in our families and our friends impact us as well. Sexuality education is simply the art of learning how to conform to a certain art of living by being able to reason, examine and monitor oneself in clearly defined terms (Ikpe, 2004).
Longman dictionary define sex as the condition of being either male or female or act of sexual intercourse between people. Thomas (2000) however sees it as the biological force that compels people to look for a male or female and the incest taboo ensure that this male comes from outside the family circle.
Education on the other hand, has been defined by Fashiku, Ajayi, Talabi and Adetayo (2004) is a social mechanism designed to make one to be useful to himself the society and humanity as whole. Also, encyclopaedia Britannica defined education as the transmission of the values and accumulated knowledge of a society. The term sex education was adopted by the international congress hygiene in 1912 to describe indication which seeks to develop understanding of the physical, mental, social, economic and physiological phase of human relationship they are affected by male and female relationship (Abudu, 2000). Sex education carries with itself the widest social imported asserted the production but rather with every sphere of our sex life. From the scope education, it is observed to be a major concern with male and female issue how secondary school students choose girlfriend and boyfriends and the effective qualities they should look at when choosing are neglected. Olusanya (2003) contented that many girls never put any factor into consideration before going out with boys except for money. The moment they fall in love while playing in the real act of sex. This is why the awareness of sex education must be created for secondary school student.
Challenges / Prospects of Sex Education
Sex education like other intervention programmes in Nigeria has suffered many setbacks. Its prospects and challenges are found in the various dimensions of sexuality education as highlighted below; Society, Culture and Sexuality Interactively, complex sets of biological, psychological and socio-cultural issues influence the human sexuality. The way we feel about our worth, the way we think and our body image play important roles in our sexuality (Ikpe, 2004). Most of the time, we judge our looks and behaviour with what our culture dictates. For example, the idea of what is attractive with respect to height, weight, hairstyle and skin tone are all socio- cultural ideas. Society and culture go hand in hand. Society can simply be defined as a group of people living in an area, regenerating its members through reproduction and sharing the same culture as in knowledge, habits, belief, art, morals, law and custom. Both society and culture are dynamic and prone to change. The goal and significance of what is and could become of the population (i.e. people) in the future occupy a very vital place in the philosophy and the history of traditional African societies (Nigeria in particular), hence, great emphasis is placed on the importance of life, the eternity of the human being and the immortality of the community. These are constantly preached and reinforced through family formations, kinship systems and initiation ceremonies (Dailard, 2006). Sexuality education debunks ideologies and social constructs that regard certain words as dirty and wrong, that certain parts of the body are unmentionable and that sometimes we should hide our feelings and other myths and taboos that influence the human sexuality negatively. In Nigeria cultural heterogeneity, multiculturalism, ethics, social status and other traditions perpetuate rules and norms that affect the perceptions of parents, teachers and others and therefore serve as catalysts against the successful implementation of sexuality education in the country (Thato and Jenkins, 2008).
Invariably, religion continues to pose a daunting challenge to the successful implementation of sexuality education in Nigeria. While Christianity is seen as less rigid and highly adaptable to societal change, Islam is very rigid and not receptive to any subject whose content is at variance with its ideals. The idea of intermingling of people of the opposite sex, half-naked dressing and female assertiveness is seriously frowned at by Islam. Christianity tolerates the idea of protective sex as a measure of avoiding “sinful” abortions, but frowns at masturbation and covetousness (Thato, 2009).
Selingo (2008) argued that sexual experience does not necessarily bring wisdom or skill in sexual decision making. Lack of value clarification restricts our understanding of the many social and cultural factors that influence our sexuality, undermines our understanding of our feelings and jeopardizes our sexuality. How we respond to ethical questions about our sexual behaviour differentiates what is wrong from what is right and could depend on our type of personality and how skilled we are in handling our emotions and actions. Ethical decision-making underscores the importance of taking responsibility for one’s sexual wellbeing. Our reproductive health, sexually relationships, use of contraceptives, drug abuse, sexual coercion etcetera are issues that call for appropriate use of ethical decision-making.
Aims of sex education
Sex education aims to reduce the risk of personally negative outcomes from sexual behaviour, such as unwanted or unplanned pregnancies and infection with sexually transmitted diseases including HIV. It also aims to contribute to young people’s positive experience of their sexuality by enhancing the quality of their relationships and their ability to make informed decisions over their lifetime. Sex education also help young people to be safe and enjoy their sexuality (Naachi 2003)
CONCEPT OF FAMILY LIFE EDUCATION
The premier professional organization in the United States for Family Life Educators – the National Council on Family Relations (NCFR, 2020) explains Family Life Education (FLE) as the educational effort to strengthen individual and family life through a family perspective. The objective of the FLE is to enrich and improve the quality of individual and family life .FLE is not a new terminology. It has existed informally throughout mankind’s history, and passed on from generations to generations since ancient times. Unlike “Family Therapy” which intervenes primarily after problems set in, FLE works primarily on a prevention approach helping family members to enrich family life and prevent problems before they occur.
Research from the Rand Corporation (the Rand research report Early Childhood Interventions: Proven Results, Future Promise by Lynn A. Karoly, M. Rebecca Kilburn, and Jill S. Cannon) and the Federal Reserve Bank of Minneapolis (in its report Early Childhood Development: Economic Development with a High Public Return) proves that family problems would be less damaging for people, and less expensive for society, when they can be tackled by prevention. FLE recognizes that all families can benefit from education and enrichment programs not only those families experiencing difficulties. The definitions of FLE vary across countries and nations. Currently, an array of FLE programmes and related activities are provided through service units under the Education Bureau (EDB), Labour and Welfare Bureau (LWB), Department of Health (DH), Social Welfare Department (SWD) and non-governmental organizations (NGOs), including the Family Life Education Units (FLEUs), Integrated Family Service Centres (IFSCs) / Integrated Services Centres (ISCs) and Integrated Children and Youth Services Centres (ICYSCs) as well as the school social work service. Through a wide range of educational and promotional activities such as seminars, talks, groups, and exhibitions, they seek to prevent family and social problems, promote harmonious interpersonal relationships and help families function effectively.
Family life education (FLE) is any effort to strengthen family life through education or support, and can include anything from teaching about relationships in schools to providing a parent’s day out. The objective of all family life education is to enrich and improve the quality of individual and family life. Rather than define what constitutes a family, FLE emphasizes processes that help people develop into healthy adults, work together in close relationships, and bring out the best in others. Unfortunately, only a small percentage of Americans are ever reached by family life education. This is a painful reality since there is no enterprise that is as complex as being a human. There may be no arena of life in which education may be as valuable as in family life. Family life educators share information related to family life with families, couples, parents, youth, or students by teaching, writing, coordinating, speaking or creating products. Anyone who teaches others about family life could be considered a family life educator. Initially, it was not clear who qualified to be a family life educator, and sometimes physicians and nurses were used–people with professional training but no specific training in family life education.
Family life educators, using many methods and innumerable settings, provide valuable training to people who want to be more effective family members. Family life education is done by many different groups of people in many different ways. Delivery methods include print materials, mass media, classes, workshops, newsletters, mentoring and cultural change. The organizations that deliver family life education range from universities to entrepreneurs, from health organizations to government and military, from public schools to faith communities. Family life education focuses on healthy family functioning, recognizing that one member of the family impacts all members of the family. Research is clear that the basic skills and knowledge needed for healthy functioning are:
- strong communication skills,
- knowledge of typical human development,
- good decision-making skills,
- positive self-esteem, and
- healthy interpersonal relationships.
The goal of family life education is to teach and foster this knowledge and these skills to enable individuals and families to function optimally.
CONCEPT OF TEENAGE PREGNANCY
Teenage pregnancy is pregnancy in a female under the age of 20 (when the pregnancy ends). A pregnancy can take place as early as two weeks before menarche (the first menstrual period), which signals the possibility of fertility, but usually occurs after menarche. In healthy, well-nourished girls, menarche normally takes place around the ages 12 or 13. Whether the onset of biological fertility will result in a teenage pregnancy depends on a number of personal and societal factors. Teenage pregnancy rates vary between countries because of differences in levels of sexual activity, general sex education provided and access to affordable contraceptive options. Worldwide, teenage pregnancy rates range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea (Franckie, 2008).
Pregnant teenagers face many of the same obstetric issues as women in their 20s and 30s. There are however, additional medical concerns for mothers younger than 15. For mothers between 15 and 19, risks are associated more with socioeconomic factors than with the biological effects of age. However, research has shown that the risk of low birth rate is connected to the biological age itself, as it was observed in teen births even after controlling for other risk factors (such as utilization of antenatal care etc.). In developed countries, teenage pregnancies are associated with many social issues including lower educational levels, higher rates of poverty, and other poorer life outcomes in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures.
Many studies and campaigns have attempted to uncover the causes and limit the numbers of teenage pregnancies. Among OECD developed countries, the United States, United Kingdom and New Zealand have the highest level of teenage pregnancy, while Japan and South Korean have the lowest in 2001. The latest data from the United States shows that the states with the highest teenage birth-rate are Mississippi, New Mexico and Arkansas while the states with the lowest teenage birth-rate are New Hermsphere , Massachusetts and Vermont
Teenage pregnancy is formally defined as a pregnancy in a young woman who has not reached her 20th birthday when the pregnancy ends, regardless of whether the woman is married or is legally an adult. In everyday speech, the speaker is usually referring to unmarried minors who become pregnant unintentionally. The average age of the first menstrual period is 12 years old, though this figure varies by ethnicity, and ovulation occurs only irregularly before this. Whether the onset of fertility in young women leads to pregnancy depends on a number of factors, both societal and personal. Worldwide, rates of teenage pregnancy range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea. Pregnant adolescents face many of the same obstetrics issues as women in their 20s and 30s.
However, there are additional medical concerns for mothers age 14 or younger, especially if they live in a developing country. For mothers between 15 and 19, age in itself is not a risk factor, but additional risks may be associated with socioeconomic factors. In developed countries, teenage pregnancies are associated with many social issues, including lower educational levels, higher rates of poverty, and other poorer “life outcomes” in children of adolescent mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. Many studies and campaigns have attempted to uncover the causes and limit the numbers of teenage pregnancies. In other countries and cultures, particularly in the developing world, teenage pregnancy is usually within marriage and does not involve a social stigma.
CAUSES AND PREVENTION OF TEENAGE PREGNANCIES:
In some societies, early marriage and traditional gender role are important factors in the rate of teenage pregnancy. For example, in some sub-Saharan African countries, early pregnancy is often seen as a blessing because it is proof of the young woman’s fertility. The average marriage age differs by country, and in countries where teenage marriages are common, one can expect to also experience higher levels of teenage pregnancies. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities compared to the rate in cities. The lack of education on safe sex, whether it is from parents, schools, or otherwise, is a cause of teenage pregnancy. Many teenagers are not taught about methods of birth control and how to deal with peers who pressure them into having sex before they are ready. Many pregnant teenagers do not have any cognition of the central facts of sexuality. Some teenage girls have said to be pressured into having sex with their boyfriends at a young age, and yet no one taught teens how to deal with this pressure or to say “no”.
In societies where adolescent marriage is less common, such as many developed countries, young age at first intercourse and lack of use of contraceptive methods (or their inconsistent and/or incorrect use; the use of a method with a high failure rate is also a problem) may be factors in teen pregnancy. Most teenage pregnancies in the developed world appear to be unplanned. In an attempt to reverse the increasing numbers of teenage pregnancies, governments in many Western countries have instituted sex education programs, the main objective of which is to reduce such pregnancies and STDs. Countries with low levels of teenagers giving birth accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality. The various causes of teenage pregnancies in Kenya are as listed below;
- Peer pressure
- Drug and substance abuse leading to compromised decisions
- Irresponsible sexual behaviour that frequently occurs in youth who do not have basic information about sex and contraception.
- Traditional values, gender roles and strict social taboos that once regulated sexual behaviour among unmarried youth have broken down.
- Early marriage and child bearing among adolescent females.
- Problems in parent-child relationship, which may encourage the adolescent to seek comfort, acceptance and consolation through sexual activity.
- Poverty and material deprivation that may push young people into survival sex in exchange for money and food.
- Exposure to suggestive or explicit media, films, magazines, music that may influence adolescent sexual behaviour, causing them to engage in sexual activity before they are ready.
- Failure to comply with religious principles and commandments, as prescribed by religious ethics, may lead to sexual permissiveness. Early pregnancy may be seen as a normal occurrence, the outcome of adolescent fertility and an indication of one’s manhood.
Mensch et. al (2001), also found out that girls who attended schools where girls felt they received equal treatment with boys were less likely to have engaged in sex than those who attended schools where fewer girls reported equal treatment. It thus appears that school environment is also a factor affecting the likelihood that a girl will be at risk of pregnancy.
The great majority of sexually active girls do not want to become pregnant. Teenage pregnancy can usually be attributed to abundance of sexual mythology that they have learned from their peers and lack of factual information that they have received from their parents. This causes them to believe that their sexual practices are safe and will not result in pregnancy.
Prevention of Intended Pregnancy
Prevention includes comprehensive sexual education availability of family planning services, abstinence and increased access to a range of effective birth control methods. Most unwanted pregnancies result from not using contraception, and many result from using contraceptives inconsistently or incorrectly. Though, increased rates of sexual activity are also a factor. Increasing use of long acting reversible contraceptive (such as IUD and contraceptive implant) decreases the chance of unwanted pregnancy by decreasing the chance of incorrect use. Method failure is relatively rare with modern, highly effective contraceptives, and is much more of an issue when such methods are unavailable or not used. (comparion of contraceptive). In the United States, women who have an unwanted pregnancy are more likely to have subsequent unplanned pregnancies. Providing family planning and contraceptive services as part of prenatal, postpartum and post abortion care can help reduce recurrence of unwanted pregnancy (Haddad & Nour, 2009).
Providing contraceptives and family planning services at low or no cost to the user helps prevent unwanted pregnancies. Many of those at risk of unwanted pregnancy have little income, so even though contraceptives are highly cost-effective, up front cost can be a barrier. Subsidized family planning services improve the health of the population and saves money for governments and health insurers by reducing medical, education and other costs to society. Providing modern contraceptives to the 201 million women at risk of unwanted pregnancy in developing countries who do not have access to contraception would cost an estimated US$3.9 billion per year. This expenditure would prevent an estimated 52 million unwanted pregnancies annually, preventing 1.5 million marternal and child deaths annually, and reduce induced abortions by 64% (25 million per year). Reduced illness related to pregnancy would preserve 27 million healthy life cycle, at a cost of $144 per year of healthy life. It is theorized that reducing unwanted pregnancies could help break the cycle of poverty (Templeton & Grimes, 2011).
EFFECTS OF TEENAGE PREGNANCY
Medical Effect
Maternal and prenatal health is of particular concern among teens who are pregnant or parenting. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers. In a rural hospital in West Bengal, teenage mothers between 15–19 years old were more likely to have anaemia, preterm delivery, and low birth weight than mothers between 20–24 years old. Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all. The Guttmacher Institute reports that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to suffer from health issues in childhood or be hospitalized than those born to older women. Young mothers who are given high-quality maternity care have significantly healthier babies than those that do not. Many of the health-issues associated with teenage mothers, many of whom do not have health insurance, appear to result from lack of access to high-quality medical care (Guttmacher Institute, 2008)
Many pregnant teens are at risk of nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals food faddism , snacking, and consumption of fast food. Inadequate nutrition during pregnancies is an even more marked problem among teenagers in developing countries. Complication of pregnancies result in the deaths of an estimated 70,000 teen girls in developing countries each year. Young mothers and their babies are also at greater risk of contracting HIV. The World Health Organization estimates that the risk of death following pregnancy is twice as great for women between 15 and 19 years than for those between the ages of 20 and 24. The maternal mortality rate can be up to five times higher for girls aged between 10 and 14 than for women of about twenty years of age. Illegal abortion also holds many risks for teenage girls in areas such as sub-Saharan Africa.
Risks for medical complications are greater for girls 14 years of age and younger, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labour is normally dealt with by caesarean section in industrialized nations however, in developing regions where medical services might be unavailable, it can lead to eclampsia, obsteric fistula,, infant mortality or maternal death. For mothers in their late teens, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology.
Psychological Effect
Several studies have examined the socio-economical, medical and psychological impact of pregnancy and parenthood in teens. Life outcomes for teenage mothers and their children vary; other factors, such as poverty or social support, may be more important than the age of the mother at the birth. Many solutions to counteract the more negative findings have been proposed. Teenage parents who can rely on family and community support, social services and child-care support are more likely to continue their education and get higher paying jobs as they progress with their education.
Effect on the mother
Being a young mother in an industrialized country can affect one’s education. Teen mothers are more likely to drop out of high school. Recent studies, though, have found that many of these mothers had already dropped out of school prior to becoming pregnant, but those in schools at the time of their pregnancy were as likely to graduate as their peers. Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers. Professor John Ermisch at the institute of social and economic research at Essex University and Dr Roger Ingham, director of the centre of sexual health at Southampton University – found that comparing teenage mothers with other girls with similarly deprived social-economic profiles, bad school experiences and low educational aspirations, the difference in their respective life chances was negligible.
Effect on the child
Early motherhood can affect the psychosocial development of the infant. The children of teen mothers are more likely to be born prematurity and low birth weight predisposing them to many other lifelong conditions. The hardships do not stop at birth for these children. The children are at higher risk and are usually plagued by intellectual, language, and socio-emotional delays. Development disabilities and behavioural issues are increased in children born to teen mothers. One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviour such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs. Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment.
Poor academic performance in the children of teenage mothers has also been noted, with many of them being more likely than average to fail to graduate from secondary school, be held back a grade level, or score lower on standardized test. Daughters born to adolescent parents are more likely to become teen mothers themselves. A son born to a young woman in her teens is three times more likely to serve time in prison.
Effect on the family
Teen pregnancy and motherhood can influence younger siblings. One study found that the younger sisters of teen mothers were less likely to emphasize the importance of education and employment and more likely to accept human sexual behaviour, parenting, and marriage at younger ages; younger brothers, too, were found to be more tolerant of non – marital and early births, in addition to being more susceptible to high-risk behaviour. If the younger sisters of teenage parents babysit the children, they have an increased risk of getting pregnant themselves.
GOOD COMMUNICATION AND PREVENTION OF TEENAGE PREGNANCY
Teaching the adolescent about how to make ethical decisions concerning their sexuality and sexual behaviour is an important attribute of sexuality education which promotes rational thinking and positive decision- making. Communication and Sexuality Communication can simply be defined as an act of transmitting and receiving messages one of the most important elements for living in a society is communication or language because it provides the society with a means of socialising its members and a mechanism for role-taking and role-playing.
Communication can be verbal or non-verbal, and involves a lot of negotiations between the sender and the receiver. Our personality traits can easily be determined, most of the time, through the ways we communicate. The way we talk or walk, our facial expressions and our other body gestures are in different ways by which we communicate. That is why it is generally easy to differentiate an extrovert from an introvert (Adepoju, 2005). Our communication style may lead to a sexual or non-sexual relationship.
Effective sexual communication has remained difficult, elusive and almost unattainable in Nigeria. This has remained a great constraint against the effective implementation of sexuality education in Nigeria because free, open and relaxed communication about sexual topics between adults and the youth (particularly parents and children) have been left to only specific occasions such as traditional initiation ceremonies that alert boys of their coming of age and girls of their readiness for marriage and procreation. Little or no reference is made to reproductive health and/or reproductive rights. Most of the time Nigerian children resort to books, films etc. to learn sexual communication only to be criticized by the adult populace; this act of criticism makes the youth feel threatened and sometimes impairs their ability to function normally. Criticism has been known to affect sexuality with regards to sexual functioning and denigration of self-esteem. It is therefore imperative that criticism, when given, should be constructive and non-destructive. For criticism to be effective, the environment, time and attention are pertinent. There is also a need for positive approach, specificity of the situation and awareness of limitations of the person being criticized. On receiving criticism, non-defensive attitude should be adopted with less justification of actions and understanding and appreciation of the criticism (Finer & Zolna, 2011). It is a well-known fact that the ability to give and receive criticism is difficult but specific suggestions should lead to actual change. In this vein, the sexuality education teaches the youths how to open up their relationship to discussion of problems, how to foster a style of communication that will enhance all aspects of their relationship and enable them to discuss freely matters that bother them through free expression of their emotions and behaviour. This is one of the great gains of sexuality education (Hoffman & Maynard, 2008).
Information and Sexual well-being one of the major concerns of sexuality education in Nigeria is the sexual health and well-being of its populace, particularly the youth. Ample research findings have revealed that, sexual activities (especially among teenagers) are on the increase globally. Emergence of new cultures has led to acculturation and a redefinition of ‘sex’ among the youth (Adepoju, 2001). Sexual matters have become permissive and liberal among members due to exposure to media both foreign and local and the abandonment of important traditional virtues. It is therefore believed that, knowledge that wanton sexual activities with multiple partners can result in unwanted pregnancy, unsafe abortion, HIV/AIDS and even death, can contribute to the practice of safer sexual behaviour among the youth.
In Nigeria, young persons’ inability to access sexuality information either through the home or school has contributed immensely to high prevalence of sexually transmitted diseases and other adolescents’ sexuality problems. Sexuality education in Nigeria is about providing vital information on reproductive health needs of the adolescent in relation to the inculcation of good practices and reinforcement of values and group norms against unprotected sexual behaviour. Whether this information is accurately provided by the various institutions is another challenge for sexuality education in Nigeria. Gender and Sexuality Gender can simply be defined as masculinity or femininity, taking into consideration biological, social and cultural norms. A person’s self-image as a male or female and the roles the person is attached to and can be used as gender identity. It is a common assumption that, society and cultural factors exert more influence on gender identity than to define its roles for males and females and reinforces behaviour through gender roles socialization. Any deviation from societal expectation of gender roles is labelled inappropriate (Adepoju, 2005). Gender roles differ from society to society and each society has different socialization process designed for their children.
GROWTH AND DEVELOPMENT OF TEENAGERS
Human development is a lifelong process of physical, behavioural, cognitive, and emotional growth and change. In the early stages of life from babyhood to childhood, childhood to adolescence, and adolescence to adulthood enormous changes take place. Throughout the process, each person develops attitudes and values that guide choices, relationships, and understanding .Sexuality is also a lifelong process. Infants, children, teens, and adults are sexual beings. Just as it is important to enhance a young person’s physical, emotional, and cognitive growth, so it is important to lay foundations for an adolescent’s sexual growth. Adults have a responsibility to help young people understand and accept their evolving sexuality. Each stage of development encompasses specific markers. The following developmental guidelines apply to most young people in this age group. However, each adolescent is an individual and may reach these stages of development earlier or later than other teens the same age. When concerns arise about a specific teen’s development, parents or other caregivers should consult a doctor or other adolescent development professional.
Physical Development
Most teens ages 13 to 17 will:
Complete puberty and the physical transition from childhood to adulthood
Reach nearly their adult height, especially females [Males continue to grow taller into their early twenties.]
Cognitive Development
Most teens ages 13 to 17 will:
Attain cognitive maturity—the ability to make decisions based on knowledge of options and their consequences continue to be influenced by peers [The power of peer pressure lessens after early adolescence.]
Build skills to become self-sufficient
Respond to media messages but develop increasing ability to analyze those messages
Develop increasingly mature relationships with friends and family
Seek increased power over their own lives
Learn to drive, increasing their independence
Emotional Development
Most teens ages 13 to 17 will:
Have the capacity to develop long-lasting, mutual, and healthy relationships, if they have the foundations for this development—trust, positive past experiences, and an understanding of love
Understand their own feelings and have the ability to analyze why they feel a certain way
Begin to place less value on appearance and more on personality
Sexual Development
Most teens ages 13 to 17 will:
Understand that they are sexual and understand the options and consequences of sexual expression
Choose to express their sexuality in ways that may or may not include sexual intercourse
Recognize the components of healthy and unhealthy relationships
Have a clear understanding of pregnancy and of HIV and other sexually transmitted infections and the possible consequences of sexual intercourse and have the ability to make reasoned choices about sex based on knowledge
Recognize the role media play in propagating views about sex
Have the capacity to learn about intimate, loving, long-term relationships
Have an understanding of their own sexual orientation [This is different than sexual behavior]
What Families Need to Do to Raise Sexually Healthy Adolescents
To help teens ages 13 to 17 develop as sexually healthy youth, families should:
The family and religious values regarding sexual intercourse. Express that, although sex is pleasurable, young people should wait to initiate sex until they are in a mature, loving, and responsible relationship.
Express that we all have a variety of options for experiencing intimacy and expressing love.
Discuss together the factors, including age, mutual consent, protection, contraceptive use, love, intimacy, etc., that you and your teen believe should be a part of decisions about sexual intercourse.
- Reinforce teens’ ability to make decisions while providing information on which they can base those decisions.
- Discuss contraceptive options and talk about the importance of condom use.
Discuss teens’ options, should unprotected intercourse occur—including emergency contraception and STI testing and treatment. Discuss teens’ options, should pregnancy occur, including abortion, parenting, and adoption. - Discuss exploitive behavior and why it is unhealthy and (in some cases) illegal.
Help youth identify various physical and verbal responses to avoid/get away from sexual situations that make them feel uncomfortable. - Acknowledge that teens have many future life options that some may marry and/or parent while others may remain single and/or childless.
- Use inclusive language that recognizes that some youth may be gay, lesbian, bisexual, or transgender.
SEX EDUCATION ON ABSTINENCE AND CONTRACEPTION USE AND TEENAGE PREGNANCY
Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information. (Slater, 2000). Contraception for teenagers presents a huge challenge for the clinician. In 1998, the government set a target to halve the under-18 pregnancy rate by 2010. The Teenage Pregnancy Strategy (TPS) was established to achieve this. The pregnancy rate in this group, although falling, rose slightly in 2007, to 41.7 per 1000 women. The 2010 target is currently looking highly ambitious. Young women often think of contraception either as ‘the pill’ or condoms and have little knowledge about other methods. They are heavily influenced by negative, second-hand stories about methods of contraception from their friends and the media. Prejudices are extremely difficult to overcome. Over concern about side-effects, for example weight gain and acne, often affect choice. Missing up to three pills a month is common, and in this age group the figure is likely to be higher. Restarting after the pill-free week, having to hide pills, drug interactions and difficulty getting repeat prescriptions can all lead to method failure (Adams & D’Souza, 2009).
In the United States, according to the 2002 National Surveys of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10.7% average for women ages 15 to 44). More than 80% of teen pregnancies are unintended and Over half of unintended pregnancies were to women not using contraceptive, (James Trussell & Wynn, 2008). 23% of sexually active young women in a 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who did not use a condom, while 70% of girls in a 1997 parade laimed it was embarrassing to buy birth control or request information from a doctor (Joseph, 2008).
According to Besharov, Douglas and Gardiner (1997), reversible longer term methods such as intrauterine devices, subcutaneous implants, or injections (Depoprovera, Combined injectable contraceptive), require less frequent user action, lasting from a month to years, and may prevent pregnancy more effectively in women who have trouble following routines, including many young women Besharov, Douglas and Gardiner(1997) . The simultaneous use of more than one contraceptive measure further decreases the risk of unplanned pregnancy, and if one is a condom barrier method, the transmission of sexually transmitted disease is also reduced. Joseph, Cynthia & co, 2008). A study of more than 4,000 sexually active adolescents showed that condom use at sexual debut is associated with a twofold increased likelihood of subsequent condom use (Shafii, 2004). In fact, adolescents who use condoms the first time they have vaginal intercourse do not have more partners, are more likely to protect themselves and their partners, and are less likely to get an STI than adolescents who don’t use condoms the first time they have vaginal intercourse (Shafii, 2007). And teens need protection more than 60 percent of young women and men in the United States have had sexual intercourse by the age of 19 (Hebernick et al., 2010).
Methods of Contraception
Birth control according to Medicine Net (2012) is also known as contraception and fertility control, which refers to methods or devices used to prevent pregnancy, such as the use of male or female condoms, can also help prevent transmission of sexually transmitted infections. Contraceptive use in developing countries has been reported to have cut the number of maternal deaths by 44% (about 270,000 deaths averted in 2008) but could prevent 73% if the full demand for birth control were met (Ahmed, 2012). According to Joseph (2012) effective birth control methods include barriers such as condoms, diaphragms, and the contraceptive sponge; hormonal contraception including oral pills, patches, vaginal rings, and injectable contraceptives; and intrauterine devices (IUDs). Emergency contraception has also been reported by (Trussell, James,Schwarz, Eleanor &Bimla 2011) to prevent pregnancy after unprotected sex. Some people regard sexual abstinence as birth control, but abstinence-only sex education often increases teen pregnancies when offered without contraceptive education (Duffy, Lynch&Santinelli, 2008). Non-penetrative sex and oral sex are also sometimes considered contraception (Feldmann, 2002).
Types of Contraceptives
Barrier
Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus. They include: male condoms, female condoms, cervical caps, diaphragms, and contraceptive sponges with spermicide. The condom is most commonly used during sexual intercourse to reduce the likelihood of pregnancy and of spreading sexually transmitted infections (STIs/STDs—such as gonorrhea, syphilis, and HIV). It is put on a man’s erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Modern condoms are most often made from latex, but some are made from other materials such as polyurethane, polyisoprene, or lamb intestine. A female condom is also available, most often made of nitrile. Male condoms have the advantage of being inexpensive, easy to use, and having few side effects. Contraceptive sponges combine a barrier with spermicide. Like diaphragms, they are inserted vaginally prior to intercourse and must be placed over the cervix to be effective. Typical effectiveness during the first year of use is about 84% overall, and 68% among women who have already given birth (Hatcher, 2000).
Hormonal
Hormonal contraceptives according to Shulman (2011) include oral pills, subdermal implants, and injectable contraceptives as well as the patch, hormonal IUDs and the vaginal ring. The most commonly used hormonal contraceptive is the combined oral contraceptive pill—commonly known as “the pill”—which includes a combination of an estrogen and a progestin. Combined hormonal contraceptives are associated with a slight increased cardiovascular risk, including an increased risk of venous and arterial thrombosis, blood clots that can cause permanent disability or even death. However, the benefits are greater than the risk of pregnancy, because pregnancy also increases those risks (Brito, 2011).
Intrauterine devices
The contemporary intrauterine device (IUD) is a small ‘T’-shaped birth control device, containing either copper or progesterone, which is inserted into the uterus. IUDs are a form of long-acting reversible contraception, and reported to be the most effective type of reversible birth control (Winner, 2012). As of 2002, World Health Organization reported that IUDs were the most widely used form of reversible contraception, with nearly 160 million users worldwide. Evidence supports both effectiveness and safety in adolescent. Advantages of the copper IUD was identified by (Cleland, Zhu, Goldstruck , Cheng, & Trussel. 2012) as its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available (WHO, 2012). It contains no hormones, so it can be used while breast feeding, and fertility returns quickly after removal (Odlind, 1996). Disadvantages include the possibility of heavier menstrual periods and more painful cramps (Grimes, 2007). Hormonal IUDs do not increase bleeding as copper-containing IUDs do, rather, they reduce menstrual bleeding or stop menstruation altogether, and can be used as a treatment for heavy periods (Odlind, 1996).
Behavioral
Behavioral methods involve regulating the timing or methods of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present (Grimes, 2004).
Sterilization
Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men (Hurt, 2012). There are no significant long term side effects and tubal ligation decreases the risk of ovarian cancer (Hurt et al, 2012). Short term complications are less likely from a vasectomy than a tubal ligation (Hurt et al. 2012). Neither method offers protection from sexually transmitted infections (Hurt et al, 2012). Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the Fallopian tubes in females or a vasectomy reversal to reconnect the vasa deferentia in males. The rate of success depends on the original technique, tubal damage, and the person’s age (Womenshealth.about.com. 2009).
Lactational
From ancient times women have extended breastfeeding in an effort to avoid a new pregnancy. The lactational amenorrhea method, or LAM, outlines guidelines for determining the length of a woman’s period of breastfeeding infertility (Kennedy, 1998). Women who meet the criteria, LAM is highly effective during the first six months postpartum (Kennedy, 2002). This form of birth control is also recognized by the World Health Organization (WHO, 2005).
Fertility Awareness
This is calendar-based contraceptive methods such as the discredited rhythm method and the Standard Days Method estimate the likelihood of fertility based on the length of past menstrual cycles (Grimes & Gallo 2004). To avoid pregnancy with fertility awareness, unprotected sex is restricted to a woman’s least fertile period. The effectiveness of fertility awareness-based methods of contraception is unknown because of the lack of completed standardized and controlled scientific trials (Grime et al 2004).
Withdrawal
Withdrawal Coitus interruptus (literally “interrupted sexual intercourse”), also known as the withdrawal or pull-out method, is the practice of ending sexual intercourse (“pulling out”) before ejaculation. The main risk of coitus interruptus is that the man may not perform the maneuver correctly or in a timely manner. Despite older studies claiming that no sperm was found in preejaculatory penile secretion, a more recent study states that “41% [of subjects] produced pre-ejaculatory samples that contained spermatozoa and in 37% a reasonable proportion of the sperm was motile” (Kennedy, 2002).
Abstinence
Though some groups advocate total sexual abstinence, by which they mean the avoidance of all sexual activity, in the context of birth control the term usually means abstinence from vaginally penetrative sexual activity (Murthy, Harwood, & Bryna, 2007). Abstinence is 100% effective in preventing pregnancy, however, not everyone who intends to be abstinent refrains from all sexual activity, and in many populations there is a significant risk of pregnancy from nonconsensual sex (Fortenberry & Dennis, 2005). Teen pregnancy rates are higher in students given abstinence-only education, compared to comprehensive sex education (Ott 2007). Some authorities recommend that those using abstinence as a primary method have backup method(s) available (such as condoms or emergency contraceptive pills) (Kowal, 2007). Non-penetrative and oral sex will generally avoid pregnancy, but pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital rubbing, and the penis exiting from anal intercourse) where semen can be deposited near the entrance to the vagina and can itself travel along the vagina’s lubricating fluids.
INCLUSION OF SEX EDUCATION IN SECONDARY SCHOOLS CURRICULUM AND TEENAGE PREGNANCY
A study on the Nigeria scene have revealed that a high percentage of youth expressed the view that they should not engage in premarital sexual activity, 25%-50% disclosed that they were already sexually active. Then 25% of young girls interviewed revealed that their first experience of sexual inter-course was through rape or in a situation where consent was procured by force. There is early initiation of sexual activity. There is also high incidence of teenage pregnancy. Teenagers account for 80% of unsafe abortion complications treated in hospitals. Therefore there is need for young ones to establish and accept the role and responsibilities of their own gender by acquiring the knowledge of sex. This will help to setup a foundation for future development in their acquaintance with friends and lovers and their interpersonal relationship. Since it is a kind of holistic education, it will teach an individual about self-acceptance and the attitude and skills of interpersonal relationship. Sex education will also help to lessen or reduce risk behaviours in teenagers such as engaging in an unprotected sex which can result in unwanted pregnancy and sexually transmitted disease STD’s. The need for young people to cultivate a sense of responsibility towards others as oneself will also be fulfill. The need for sex education in the school can also be seen from the fact that many parents are shy about talking/teaching their children on this subject. Sex education impacted through schools can also prove to be a significant and effective method of bettering the youngster’s sex-related knowledge, attitude and behaviour. Also youngster’s usually derives information on sex and related subjects from sources like friends, books, the media comprising advertising, television, magazines and the internet. The problem with all these sources is that, they may or may not really provide them with correct and accurate information. As such, sex education in school will help to transfer authentic information and in the process, also correct any misinformation that they may have apart from adding to their already existing knowledge.
Importance of Sex Education for Teenager
While sex education is already part of a number of Western Countries such as the United States, its implementation in Nigeria schools recently kicked up a massive discussion. However, the proponents of sex education in schools usually underscore the following benefits advantages in support of their view.
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