Why Nigerian Adolescents Seek Rather than Contraception: Evidence from Focus-Group Discussions By Valentine O. Otoide, Frank Oronsaye and Friday E. Okonofua

on risks associated with abortion. In par- Context: Nigerian adolescents generally have low levels of contraceptive use, but their reliance ticular, social and cultural barriers to con- on is high, and results in many abortion-related complications. To determine traceptive utilization among adolescents why, it is important to investigate adolescents’ perceptions concerning the risks of contracep- need to be analyzed. tive use versus those of induced abortion. This article reports on a qualitative Methods: Data were collected through focus-group discussions held with adolescents of di- study of the social perceptions of risks as- verse educational and socioeconomic backgrounds. All were asked what they knew about abor- sociated with abortion and contraception tion and contraception, and each method of contraception was discussed in detail. In particu- among adolescents in Benin City, . lar, youths were asked about contraceptive availability, perceived advantages of method use, Twenty focus-group discussions were un- side effects and young people’s reasons for using or not using contraceptives. dertaken to obtain an understanding of the reasons for the current discrepancy be- Results: Fear of future infertility was an overriding factor in adolescents’ decisions to rely on in- tween levels of contraceptive use and duced abortion rather than contraception. Many focus-group participants perceived the adverse abortion prevalence in Nigeria. effects of modern contraceptives on fertility to be continuous and prolonged, while they saw The focus-group discussion had two abortion as an immediate solution to an unplanned —and, therefore, one that would purposes: to explore local attitudes and have a limited negative impact on future fertility. This appears to be the major reason why ado- beliefs concerning abortion, and to explore lescents prefer to seek induced abortion rather than practice effective contraception. adolescents’ attitudes and beliefs con- Conclusions: The need to educate adolescents about the mechanism of action of contracep- cerning the use of contraceptives. We be- tive agents and about their side effects in relation to unsafe abortion is paramount if contracep- lieve that the findings may have profound tive use is to be improved among Nigerian adolescents. implications for the formulation of poli- International Perspectives, 2001, 27(2):77–81 cies for improving adolescents’ utilization of contraception.

ver the last decades, several re- and traditional methods of contraception Background searchers have identified unsafe has always been shown to be poor among Benin City was the capital of the old Benin Oabortion as an important chal- Nigerian adolescents. The 1990 Demo- Empire, a kingdom whose borders ex- lenge associated with women’s repro- graphic and Health Survey found that tended as far as to the modern-day Da- ductive . Induced abor- only 11% of sexually active women aged homey, in the neighboring Republic of tion currently accounts for 20,000 of the 15–19 ever used any modern contracep- Benin. In keeping with the national trend, estimated 50,000 maternal deaths that tive method. Such rates of contraceptive Benin City has experienced phenomenal occur in Nigeria each year.1 It is thus the use are much lower than levels seen in growth in population: In the 1960 popu- single largest contributor to maternal mor- similar age-groups in many Sub-Saharan lation census, the city’s population was tality. Numerous studies have docu- African countries, or than levels in in- put at about 200,000; today, it is estimat- mented the social, economic and health dustrialized countries.5 ed to total more than one million residents. problems associated with early and un- The promotion of effective contracep- This rapid population growth is the re- planned .2 tive use among Nigerian adolescents is a sult of several factors, foremost being the The performance of an abortion is ille- major challenge if their reproductive population’s high fertility rate, with an av- gal under Nigerian criminal law, unless health is to be improved. Given that erage of five or more children per house- the woman’s life is threatened by the preg- Nigerian youths are now marrying later, hold.7 The polygamous culture of the in- nancy. As a result, induced are are increasingly interested in acquiring a digenous inhabitants (monogamy being usually obtained clandestinely, and are formal education and are increasingly the exception in most households) has also frequently unsafe. Unsafe abortion is often having premarital sex,6 it is clear that al- contributed to this trend. Moreover, the the end result of an unwanted pregnan- lowing the existing gap between contra- cy, which in turn is often the result of lack ceptive need and contraceptive utilization Valentine O. Otoide is a senior registrar in the Depart- ment of Obstetrics and Gynecology, University of Benin of contraceptive use. This trend is most to be left unfilled will result in a dramat- Teaching Hospital, Benin City, Nigeria, and is an associ- profoundly demonstrated among ado- ic rise in the prevalence of unsafe abor- ate of the Women’s Health and Action Research Centre, lescents. Hospital-based studies have tions. This will further compound over- Benin City. Frank Oronosaye is a program officer with shown that in Nigeria up to 80% of pa- all levels of maternal mortality in Nigeria. the Women’s Health and Action Research Centre, Benin City. Friday E. Okonofua is a professor in the Department tients with abortion-related complications Other than identifying at-risk groups of Obstetrics and Gynecology, University of Benin Teach- 3 are adolescents. Similarly, a community- that are often unaware of contraception, ing Hospital, Benin City, Nigeria, and is executive director based study of abortion prevalence found an effective strategy for increasing the uti- of the Women’s Health and Action Research Centre, that one-third of women who obtained an lization of contraception must also include Benin City. The authors would like to thank Abiodun 4 Osawaru and James Falaiye, both of the Women’s Health abortion were adolescents. an understanding of patterns of contra- and Action Research Centre, who helped to type and edit In contrast, the utilization of modern ceptive utilization and of societal views the draft of this article.

Volume 27, Number 2, June 2001 77 Why Nigerian Adolescents Seek Abortion Rather than Contraception

Table 1. Occupation, education, age range and number of young women aged 15–24 who The groups ranged in size from six to 10 participated in focus groups, Benin City, Nigeria, 1999 participants per session (Table 1). Each dis- cussion generally lasted between 45 and Occupation/group Education Age range No. of participants 90 minutes. Total Not sexually Sexually To elicit a comprehensive understand- active active ing of abortion among adolescents, we Student Tertiary 16–19 8 0 8 adopted an operational definition of abor- Student Tertiary 16–20 7 1 6 Student Tertiary 17–19 8 3 5 tion during the discussions as being ter- Student Secondary 16–18 8 4 4 mination of an existing pregnancy or the Student Secondary 16–19 10 6 4 use of any medium to “bring back a Student Secondary 16–18 7 3 4 missed period.” Similarly, we defined con- Food vendor Primary 18–21 7 0 7 traception as anything used before or after Food vendor None/primary 17–22 7 0 7 intercourse with the aim of preventing a Seamstress Primary/secondary 17–19 6 1 5 pregnancy. These wide-ranging defini- Seamstress Primary/secondary 19–23 6 0 6 tions gave participants an opportunity to Seamstress Primary/secondary 15–20 7 1 6 provide unbiased views of abortion and Out-of-school youth Secondary 15–20 7 2 5 contraception. Out-of-school youth Secondary 19–21 8 0 8 Out-of-school youth Secondary 18–24 8 2 6 Focus-group participants were gener- Out-of-school youth Secondary 18–19 8 3 5 ally allowed to express what they knew about abortion and contraception. There- Food vendor None 19–21 6 0 6 after, a detailed discussion of each sug- Hair weaver None/primary 15–17 8 1 7 gested method of contraception was elicit- Church member Secondary 17–19 7 3 4 ed. This often concerned availability, Church member Secondary 18–21 7 2 5 perceived advantages, side effects and rea-

Youth club member Secondary 19–22 9 1 8 sons for use or nonuse among adolescents. Questions on fertility control, regarding the use of abortion or contraception, were city’s strategic location as a gateway to all prevalence of reported experience of sex- asked in the third person, to maintain dis- major regions of Nigeria has contributed ually transmitted diseases (STDs) and crete and confidential reporting by the immensely to its rapidly growing migrant poor health-seeking behavior. adolescents. population. The focus-group discussions were con- Postindependence, Benin City was one Materials and Methods ducted in English or in pidgin English, a of Nigeria’s four regional capitals, bring- Focus-group participants were selected local corruption of the English language ing about rapid urbanization and the de- geographically from within Benin City on that is widely spoken and understood. (The velopment of several educational institu- the basis of their current vocation or pur- language used depended on the group’s tions. Thus, Benin City has one of the three suit. We adopted this approach to ac- educational status.) All interviews were au- universities in Edo State, as well as sever- commodate the heterogeneous structure diotaped. In addition, extensive notes were al other secondary and postsecondary in- of the adolescent populace, so we could taken during the discussions, and these stitutions funded by the public sector. obtain a representative pattern of social were subsequently employed when the More recently, as the demand for educa- interaction. To this end, we organized the tapes were reviewed and transcribed. tion far outstrips the public sector’s capa- focus groups by occupation and by par- bility of meeting it, the number of privately ticipants’ place of residence, thus encom- Results funded educational institutions in Benin passing a broad range of socioeconomic Knowledge of Abortion City has risen steeply. Educational enroll- and educational strata. However, there In general, participants were forthcoming ment in the city is about the highest in the was considerable overlap in demograph- in their opinions about adolescents’ beliefs country, cutting across diverse socioeco- ic characteristics between groups. on abortion and contraception. Sexually nomic divides, thus providing unique op- To help generate relevant information, active female youths gave more lengthy portunities for cross-exchanges among interviewers asked participants confi- responses and more detailed information those of widely differing backgrounds. dentially if they had had sexual activity than those who were not sexually active. Despite the foregoing, the sexual and re- prior to the focus-group session.* The in- More educated discussants tended to give productive behavior of adolescents in vestigators thus knew which focus-group more correct explanations. Benin City does not appear to differ re- participants reported being sexually ac- There was often a diversity of opinion markably from reports of adolescents’ sex- tive and which had not initiated sexual ac- in the understanding of the term “abor- ual behavior in other areas of Nigeria. In tivity. The former tended to be older than tion.” While the majority defined abortion general, this has been characterized by the latter. This information was not dis- as the act or process of terminating an un- early initiation of sexual activity, nonuse closed to other focus-group participants, wanted pregnancy, a minority felt that of contraceptives at first sexual intercourse however. abortion referred to the termination of and poor overall utilization of contracep- The focus-group discussions were con- pregnancy after 3–4 months with the use tives. In tandem with this is the high ducted by a team of researchers from the of a “sharp metal instrument” or a “drip.” Women’s Health and Action Research Termination of pregnancy at less than 3–4 *Focus groups could not be formed solely on the basis Centre, led by the first author. Twenty months was referred to as “D and C” with of sexual experience, as few participants reported that focus-group sessions were conducted with the use of “sucking” (suggestive of vacu- they had not initiated sexual activity. a total of 149 young women aged 15–24. um aspiration for termination of early

78 International Family Planning Perspectives pregnancy). For instance, a 19-year-old ticipants often mentioned modern med- Fertility Control secondary student said that “D and C is ications, such as APC (a brand of aspirin) Focus-group participants identified sev- when you miss your period for 1 to 2 and antibiotics, that are not contraceptives. eral sources of contraception, most often months.” Another focus-group participant Although the less-educated were more the patent medicine store. According to a (a 22-year-old tertiary student) interrupt- likely to mention ineffective contracep- 17-year-old out-of-school youth, “If you go ed a discussion of abortion to express her tives, similar patterns were also observed any chemist, just tell the person… them go opinion that abortion meant termination among those who were more educated. give you something” [If you go to any of an advanced pregnancy, in contrast to a For example, a 17-year-old uneducated patent medicine store, the attendant will D and C: “Wait…you keep talking of D hairdresser said: “How woman fit prevent readily provide contraception on request]. and C, it is abortion, when it is advanced, belle? Na many ways. She fit use qui- Likewise, a 16-year-old out-of-school that is dangerous.…” Menstrual regula- nine…” [How can a woman prevent get- youth commented “How person go dey go tion and early drug use were some other ting pregnant? There are many ways. She UBTH because of family planning, if you terms used to differentiate early recourse can take quinine…]. Medications dis- enter any chemist you will get family plan- to pregnancy termination. cussed included aspirin, quinine, parac- ning” [Why would someone go to a ter- When asked how they recognized a etamol, tetracycline, indocid and ampi- tiary care center in the city because of con- pregnancy, youths most often mentioned cillin. They also mentioned menstrogen traception? If you enter any patent a missed period or a failure to see the (a combination of ethinyl estradiol and medicine store you will get contraceptives]. monthly menstrual flow. Few educated ethisterone) and “apiol and steel” (pars- The use of patent medicine stores was participants gave other means, such as ley oil marketed for correction of female seen as discrete and confidential. Youths early morning vomiting or recognition of menstrual irregularity). generally agreed, though, that patent body changes. In general, other than for the condom, medicine dealers provide minimal or no The major reasons given for why ado- there was poor knowledge of the mecha- information on the exact nature, known lescents seek termination of pregnancy nism of action for modern methods, as side effects or benefits of these methods. were (in order of frequency): the need not well as poor knowledge of any noncon- Focus-group participants generally to interfere with schooling; not being old traceptive benefits. In contrast, partici- agreed that adolescents often try to pre- enough to get married; fear of family pants often gave a list of adverse effects vent pregnancy. However, they disagreed members knowing; not planning to marry arising from the use of these methods. For greatly about what is generally done. The the partner; being jilted by a fiancé; fol- example, reported problems associated least common choice, especially among lowing rape or incest; and not knowing with the pill included infertility, frequent older and less-educated youths, was the the actual father. Less-common reasons periods and “frequent dosing.” Partici- use of an effective modern contraceptive were the need to test fertility and, in some pants argued that “the oral contraceptive method. Thus, a 17-year-old secondary cases, as a means of making financial de- pills entered into the blood stream and as student commented that “many of my mands on male partners. This last reason such directly contaminated the blood, in- friends try to prevent getting pregnant, was often mentioned by the less-educat- terfering with future fertility” (22-year-old they use safe period or sometimes they ed participants, although it was also given food vendor). (Such views often were ex- use gynaecosid [a hormonal prepara- by more-educated respondents. pressed even by educated participants.) tion].” A 23-year-old tertiary student re- The IUD was associated with being “miss- marked that “many girls are doing some- Knowledge of Contraception ing” and possibly requiring an operation thing to prevent getting pregnant. They In general, participants were aware that for removal or interfering with fertility. use safe period or sometimes drugs like something could be done to prevent a Focus-group participants associated in- ergometrin or ampicillin.…” woman from getting pregnant. The re- jectables with abscess, paralysis and in- The major reasons given were the sponses on what could be done differed fertility, while condoms were seen as not known side effects of modern methods. substantially among focus-group partic- being reliable. For example, a 17-year-old secondary stu- ipants, however. Young people who re- Focus-group participants also men- dent said that “as for the pill, many girls ported that they had not initiated sexual tioned a large variety of traditional con- don’t like it; it makes them to put on activity often had little information on spe- traceptive methods,* and were quick to weight.” Side effects were of special con- cific means of contraception. In contrast, give details of their uses and sources. Sex- cern to the focus-group participants when the other participants were more knowl- ually active adolescents were particular- they were seen as potentially affecting fu- edgeable about specific methods. ly likely to give an in-depth list of tradi- ture fertility. As a 20-year-old out-of- Participants mentioned a large variety tional methods. This pattern was also school youth recounted, “I know of one of modern contraceptive methods—the common among the educated groups. pill, the IUD, injectables, the male condom Participants often did not mention any *Among the methods mentioned were caustic substances such as alum, potash or snuff (ground-up tobacco); home- and emergency contraception (the prod- adverse effects from natural methods made mixtures such as salt and water, salt and sugar uct Postinor). However, participants often (withdrawal and safe periods) or from tra- solutions, Omo (a detergent solution) and limewater; did not mention the condom as a contra- ditional methods of contraception. They hormonal preparations such as menstrogen (methy- ceptive method. When they were asked noted that these methods are used only at loestrenolone and methyloestradiol) and gynaecosid why, youths’ major reason for this obser- times when unprotected exposure occurs (ethinyl estradiol and ethisterone); nonhormonal drugs such as white quinine (an antimalarial treatment) and vation was that they thought of the con- at the most fertile period or when periods Andrew’s liver salt (magnesium sulphate); physical dom more as a means of preventing are missed. However, focus-group mem- materials or charms, such as a waistband, a padlock or infections than as a way of preventing a bers often disagreed on what period con- a ring; and other miscellaneous methods, such as apiol pregnancy. stituted the safe period. Often, only a mi- and steel pills (parsley oil marketed for correction of men- strual irregularity), Krest (a nonalcoholic mineral drink), However, when asked to name effective nority of the educated participants Chelsea (an alcoholic drink), brandy (an alcoholic drink) methods of modern contraception, par- provided correct responses. and Conquer mixture (which is marketed as a laxative).

Volume 27, Number 2, June 2001 79 Why Nigerian Adolescents Seek Abortion Rather than Contraception woman, she took pills when she was a stitute contraceptive use when they initi- tive methods should be more widely ac- young girl, when she got married and ate sexual activity, so recourse to abortion cepted in Nigeria, as they only need to be wanted a child she could not, they told her may be their first attempt at controlling used when contraceptive failure is feared, it is because of the pill.” their fertility. for example, or when the monthly periods A recurring theme in the discussions Youths who have initiated sexual ac- have not returned. Reliance on such meth- was the view that “women who use con- tivity, on the other hand, know about both ods tends to mirror that of abortion as a traceptives will find it difficult to conceive contraception and abortion. Our findings means of controlling fertility. This is con- when they eventually get married” (20- suggest that low levels of contraceptive sistent with results from the 1990 Demo- year-old youth club member). In contrast, utilization among such young people arise graphic and Health Survey showing side effects from abortion were thought from their perceived risk of side effects. greater acceptance of traditional methods to be few, with the possibility of damage In particular, they understand contracep- than of modern methods. Unfortunately, to the womb and infertility being most fre- tives (other than the condom) to mean adolescents’ lack of understanding of these quently mentioned. Participants often per- something that interferes with fertility, traditional methods, as well as the types ceived these risks as remote, however, es- while abortion has a similar, but more of methods mentioned, point to these pecially when doctors perform the short-lived, effect. Fertility and infertility methods’ inefficacy in preventing un- abortions. For example, according to a 23- would appear to be central issues in wanted pregnancies. In any case, young year-old tertiary student, “many girls do youths’ decision to use contraceptives or people tend to use these methods as early D and C and don’t have problems; these practice abortion. Thus, a plausible po- abortificients rather than as contraceptives. problems (complications of unsafe abor- tential explanation for the low use of mod- In general, adolescents did not feel that tion) is when you go to quacks, they will ern contraceptive methods among Niger- having to obtain contraceptives was a use all kinds of things.…” ian adolescents is the perceived threat of major hindrance to use. This is contrary to When asked whether she knew of a sustained interference with fertility. Such findings from several published studies.9 friend who had died from abortion and if a concern is in keeping with the fact that Youths generally felt that the services of- mortality from abortion is common in their such modern methods as the pill, injecta- fered by patent medicine dealers were suf- community, a 20-year-old tertiary student bles and IUDs are used continuously over ficient to meet their contraceptive needs. responded: “No… well maybe it happens a lengthy period of time. As these dealers are located on street cor- [a young person dying from an abortion], Nevertheless, if a threat to future fer- ners, such a finding is not a surprise, as but who will tell you somebody died from tility were an overriding concern in ado- they provide confidential services. This abortion? If someone dies, they [the fam- lescent sexual behavior, the expected trend may also explain adolescents’ knowledge ily] will say it is from a brief illness.” in the community would be a decreased and use of modern antibiotics and other In addition, focus-group participants prevalence of premarital sex, illegal abor- medications as contraceptives, as these held the opinion that as abortion may be tions and teenage births. The fact that this likely were recommended by and pro- required only occasionally, it poses no real is not the case suggests that a pregnancy cured from patent medicine dealers. Pre- or immediate threat. This belief was re- may not be entirely unwanted. A con- vious studies have shown that patent med- flected in the views of a 22-year-old un- ception proves a woman’s fertility and is icine dealers often are not trained and have dergraduate who drew a relationship be- sometimes seen as a bargaining instru- diverse educational backgrounds, with a tween the use and ease of abortion and the ment through which to obtain favor from significant number of them not literate.10 continuous, daily use of oral contracep- the male partner, and possibly also to From our results, we can draw several tives: “One D and C is safer than 16 packs demonstrate the capacity to have a child. conclusions regarding the design of a com- of daily pills….many girls say this.” Our findings suggest that a plausible ex- prehensive policy on contraceptive mar- In general, participants believed that planation for the prevalence of and resort keting and distribution to adolescents. abortion-related deaths and other com- to abortion among sexually active youths Crucial among these is the need for a com- plications arose only when an abortion is is that illegal abortion is not perceived as prehensive policy on adolescent repro- performed late in the pregnancy or is done an immediate threat to fertility. Rather, the ductive health. Such a policy must clear- by a quack. Yet focus-group participants complications of abortion and their po- ly outline a strategy for educating both could reach no consensus on how a quack tential impact on fertility are seen as re- in-school and out-of-school adolescents can be identified. The majority suggested mote, occurring only when several steps about reproductive health before they ini- that adolescents associate a competent have failed. This attitude may be strong- tiate sexual activity. Information about provider of abortion services with any pri- ly reinforced by peers who have had abor- and knowledge of contraception will be vate clinic or a “male doctor,” or a service tions without noticing any outward com- important in adolescents’ acceptance of that has been used successfully by a peer. plications. However, since Nigerian law modern methods and their use of such prohibits abortion, services are generally methods at first intercourse. Such a poli- Discussion and Recommendations of poor quality. The absence of any out- cy must also fully address the social myths We set out to provide a social explanation ward complications in the vast majority and perceptions limiting the use of mod- for the gap between adolescents’ use of of induced abortions does not necessari- ern methods, especially with regard to abortion in Nigeria and their contraceptive ly imply that such procedures are safe. their effect on fertility. use. It is evident that in terms of sexual ac- Several previous studies also have shown Similarly, there is an urgent need for ad- tivity and contraceptive uptake, there are a high prevalence of a equate documentation and understand- essentially two groups of adolescents. and a strong association between such a ing of the roles of informal contraceptive Adolescents who are not sexually active history and infertility, as well as ectopic delivery points—in particular, patent tend to know less about contraception, al- pregnancy.8 medicine dealers. Such findings will be though they are aware of abortion. Ar- Consistent with earlier explanations, it crucial towards determining training guably, such youths are not likely to in- would appear that traditional contracep- needs. These providers can act as an im-

80 International Family Planning Perspectives portant link in providing in-school and 1990; United Nations Population Fund (UNFPA), The State cia, que tenía un impacto negativo limitado out-of-school adolescents with appropri- of the World Population, New York: UNFPA, 1997; and Pop- sobre la futura fecundidad. Aparentemente, ulation Reference Bureau (PRB), Adolescent Women in Sub- ate information, counseling and mecha- Saharan Africa: A Chartbook on Marriage and Childbearing, esta es la razón principal por la cual los nisms for contraceptive continuation. Washington, DC: PRB, 1992. adolescentes prefieren recurrir a un aborto Our findings further illustrate the need 6. Feyisetan B and Pebley AR, Premarital sexuality in inducido en lugar de usar un método anti- to review the existing . It is ob- urban Nigeria, Studies in Family Planning, 1989, 20(6):343– conceptivo eficaz. vious that adolescents resort to abortion, 354; and Araoye MO and Adegoke A, AIDS-related Conclusiones: Si se desea mejorar el uso de and a large proportion will continue to do knowledge, attitude and behaviour among selected anticonceptivos entre los adolescentes de Ni- so. What is not obvious, however, is the adolescents in Nigeria, Journal of Adolescence, 1996, 19(2): geria, es de primordial importancia educar a 179–181. quality of the services that are provided este grupo acerca del mecanismo de acción de and who provides these services. Under 7. Federal Office of Statistics, 1990, op. cit. (see reference 5). los agentes anticonceptivos y sobre sus efec- present conditions, health care providers 8. Orhue AA, Unuigbe JA and Ogbeide WE, The contri- tos secundarios, y compararlos a las conse- generally deny their involvement in or bution of previous induced abortion to tubal ectopic preg- cuencias de los abortos realizados en condi- nancy, West African Medical Journal, 1998, 8(4):257–263; practice of illegal abortion. This may have Olatunbosun OA and Okonofua FE, Ectopic pregnancy: ciones no seguras. contributed to the ambiguity reported the African experience, Postgraduate Doctor Africa, 1986, 8(3): among adolescents in accessing a com- 74–78; and Okonofua FE, 1994, op. cit. (see reference 2). Résumé petent abortion care provider. A revised 9. Nare C, Kate K and Tolley E, Adolescents’ access to Contexte: Les adolescentes nigérianes pré- abortion law would allow for proper doc- reproductive health and family planning services in sentent généralement de faibles niveaux de pra- umentation of trained abortion care Dakar (Senegal), African Journal of Reproductive Health, tique contraceptive, mais leur recours à l’avor- providers and for information about them 1997, 1(2):15–24; and Olowu F, Quality and cost of fam- tement à risques est élevé et source de ily planning as elicited by an adolescent mystery client to be disseminated to the community. It trial in Nigeria, African Journal of Reproductive Health, 1998, nombreuses complications. Pour en détermi- would also allow for statutory regulation 12(1):49–60. ner la raison, il est important de comprendre and for the monitoring of such services. 10. Okonofua FE et al., Assessment of health services for les perceptions que se font les adolescentes des These could go a long way toward re- treatment of sexually transmitted infections among risques de la contraception par rapport à ceux ducing the needless morbidity and mor- Nigerian adolescents, Sexually Transmitted Diseases, 1999, de l’avortement provoqué. tality arising from induced abortion. 26(3):184–190. Méthodes: Les données ont été recueillies In conclusion, an effective educational dans le cadre de discussions de groupe orga- strategy on the process of fertility and con- Resumen nisées avec des adolescentes de souches so- traception is needed for Nigerian adoles- Contexto: Los adolescentes de Nigeria gene- cioéconomiques et niveaux d’instruction di- cents. Such a comprehensive policy will ralmente presentan bajos niveles de uso de an- vers. Toutes ont été interrogées sur ce qu’elles be crucial in correcting misconceptions ticonceptivos y al mismo tiempo recurren con savaient de l’avortement et de la contraception, that limit the uptake of modern methods mucha frecuencia al aborto no seguro, lo cual et toutes les méthodes de contraception ont été of contraception among adolescents. presenta muchos casos de complicaciones. Para discutées en détails. En particulier, les jeunes conocer la causa de este fenómeno, es importante ont été invitées à parler de questions de dispo- References investigar las percepciones de los adolescentes nibilité contraceptive, des avantages perçus 1. Akingba JB, Abortion mortality and other health con respecto a los riesgos del uso de anticon- de la pratique contraceptive, des effets secon- problems in Nigeria, Nigeria Medical Journal, 1977, 7(4): ceptivos y compararlas con sus percepciones daires de la contraception et des raisons de sa 4465–4471; and Okonofua FE and Ilumoka A, Prevention of Morbidity and Mortality from Unsafe Abortion in Nigeria, sobre los riesgos del aborto inducido. pratique ou non. Critical Issues in Reproductive Health, The Robert H. Métodos: Se recopilaron datos por medio de Résultats: La peur du risque de stérilité fu- Ebert Program, New York: Population Council, 1992. grupos focales llevados a cabo con adolescen- ture s’est révélée un facteur primordial de la 2. Okonofua FE, Induced abortion: a risk factor for tes de diversos antecedentes educativos y so- décision prise par les adolescentes de recourir secondary infertility in Nigeria women, Journal of Ob- cioeconómicos. Se les preguntó a todos los par- à l’avortement provoqué plutôt qu’à la contra- stetrics and Gynaecology, 1994, 14(2):272–276; and Ladipo ticipantes acerca de sus conocimientos sobre el ception. Beaucoup de participantes aux grou- OA, Preventing and managing complications of induced abortion in third world countries, International Journal of aborto y la anticoncepción, y se examinó en pes de discussion percevaient les effets anti- Gynaecology and Obstetrics, 1989, Supplement 3, pp. 21–28. forma detallada cada método anticonceptivo. conceptionnels de la contraception moderne comme continus et prolongés, tandis que 3. Adewole IF, Trends in postabortal mortality and mor- En particular, se les preguntó a los participantes bidity in Ibadan, Nigeria, International Journal of Gynae- acerca de la disponibilidad de anticonceptivos, l’avortement leur offrait une solution immé- cology and Obstetrics, 1992, 38(2):115–118; Okonofua FE, las ventajas o desventajas que percibían del uso diate au problème d’une grossesse non plani- Onwudiegwu U and Odunsi OA, Illegal induced de un método, sus efectos secundarios y las ra- fiée, l’approche étant par conséquent perçue abortion: a study of 74 cases in Ile-Ife, Nigeria, Tropical zones por las cuales los jóvenes usan o no usan comme ayant une incidence négative limitée Doctor, 1992, 22(2):75–78; Anate M, Awoyemi O and Oyawoye O, Induced abortion in Ilorin, Nigeria, Inter- los métodos anticonceptivos. sur la fécondité à long terme. Il semble s’agir national Journal of Gynaecology and Obstetrics, 1995, 49(2): Resultados: El factor mencionado por la gran là de la raison principale pour laquelle les ado- 197–198; and Brabin L et al., Reproductive tract infections mayoría de los adolescentes para no usar an- lescentes préfèrent recourir à l’avortement plu- and abortions amongst girls in rural Nigeria, Lancet, 1995, ticonceptivos y recurrir al aborto inducido fue tôt que de pratiquer une méthode contracep- 345(8945):300–304. el temor a la futura infecundidad. Muchos de tive efficace. 4. Okonofua FE et al., Women’s Experiences of Unwanted los participantes de los grupos focales consi- Conclusions: La sensibilisation des adoles- Pregnancy and Induced Abortion in Nigeria, Critical Issues in Reproductive Health, The Robert H. Ebert Program, deraron que los efectos adversos sobre la fe- centes au mécanisme des agents contraceptifs New York: Population Council, 1996. cundidad de los anticonceptivos son continuos et à leurs effets secondaires par rapport aux risques de l’avortement à risques est in- 5. Federal Office of Statistics, Nigeria Demographic and Health y prolongados. Al mismo tiempo, considera- Survey (DHS), Lagos, Nigeria: Office of Statistics, and In- ron que el aborto era una solución inmediata dispensable si l’on veut améliorer la pratique stitute for Resource Development/Macro International, a un embarazo no planeado y, en consecuen- contraceptive parmi les jeunes Nigérianes.

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