In this study, data was collected through face-to-face interview with participants. During the interview sessions conducted, participants communicated their thoughts using owns mother tongue and the voice records were translated verbatim to English.
Table 1 outlines a summary of demographic profile of participants.
Table 1 Demographic profile of participants
Participants
|
Age in years
|
Sexually active
|
Contraceptive in use
|
Participant1(Tshilwavhusiku CHC pre-test)
|
19
|
Yes
|
Medroxyprogesterone
|
Participant2(Tshilwavhusiku CHC pre-test)
|
16
|
Yes
|
Implant
|
Participant3(Tshilwavhusiku CHC pre-test)
|
17
|
Yes
|
Norethisterone injection
|
Participant1(Tshilwavhusiku CHC)
|
16
|
Yes
|
Implant
|
Participant2(Tshilwavhusiku CHC)
|
18
|
Yes
|
Implant
|
Participant3(Tshilwavhusiku CHC)
|
14
|
Yes
|
None
|
Participant4(Tshilwavhusiku CHC)
|
17
|
Yes
|
None
|
Participant 1(Tiyani CHC)
|
17
|
Yes
|
None
|
Participant 2(Tiyani CHC)
|
15
|
Yes
|
Medroxyprogesterone
|
Participant 3(Tiyani CHC)
|
18
|
Yes
|
None
|
Participant 4(Tiyani CHC)
|
14
|
Yes
|
None
|
Participant 1(Makhado CHC)
|
18
|
Yes
|
Condoms
|
Participant 2(Makhado CHC)
|
17
|
Yes
|
Condoms
|
Participant 3(Makhado CHC)
|
14
|
No
|
None
|
Participant 1(Bungeni CHC)
|
19
|
Yes
|
Medroxyprogesterone
|
Participant 2(Bungeni CHC)
|
19
|
Yes
|
Norethisterone injection
|
Participant 3(Bungeni CHC)
|
18
|
Yes
|
Norethisterone injection
|
Participant 4(Bungeni CHC)
|
13
|
No
|
None
|
Table 1 revealed that most participants (11) were between the ages of 17-25, followed by (6) who were between the ages of 13-16. The table further shows that (16) participants were sexually active, while only (2) were not sexually active. From all participants, (3) were using Medroxyprogesterone injection, (3) were using norethisterone enanthate injection, (2) were using implant, and (2) were using condoms only while (6) were not using any contraceptive.
Thematic analysis was used to analyse collected data. During data analysis, two
themes emerged, namely: (1) Lack of IUDs awareness among adolescents in Makhado Local Municipality; (2) Description of views and attitudes that contribute to the lack of utilisation of IUDs among adolescents in Makhado Local Municipality. Sub-themes that emerged include (1) Lack of existing general knowledge about IUDs in the community; (2) Lack of interest in IUDs among health professionals, (3) Existing rumours and myths mentioned as possible deterring effect to using IUDs.
Themes and their sub-themes are presented in Table 2 below:
Lack of IUDs awareness among adolescents
Two sub-themes emerged under theme 1, during data analysis. The sub-themes that emerged include lack of existing general knowledge about IUDs in the community and lack of interest in IUDs among health professionals. All these sub-themes were presented individually and supported by quotes from participants.
Lack of existing general knowledge about IUDs in the community
Majority of adolescents in all selected health centres, namely: Tshilwavhusiku CHC, Tiyani CHC, Makhado CHC and Bungeni CHC, reported that they do not know what IUD is. Among fifteen participants, including three participants that were interviewed for pre-test to the sum of eighteen, only three participants were aware of IUD.
Majority of participants when asked to share what they know about IUDs, they responded:
Participant 3 (Tshilwavhusiku CHC): “I know nothing about it”. When asking what the participant thinks loop or intrauterine device is used for. She said, “I think it helps when one is sick”.
Other participants said:
Participant 1 (Makhado CHC): “It is for the first time that I am hearing about it, I never heard about it”.
Lack of existing general knowledge about IUDs in the community was perceived in this study. When asking participants if they once heard any older women or girls of their age, talking about IUDs or using IUDs whenever a topic about contraception is discussed, most participants responded that they never heard any older women or girls of their age mentioning IUD or stating if they are using it. Some of their responses were:
Participant 3 (Tiyani): “there are those that only use Nur-Isterate to prevent; there is no one of my friends who use a different contraceptive”.
Participant 1 (Tiyani CHC): “My neighbour said she is using pills”.
Participant 3 (Tshilwavhusiku CHC): “they were saying that they were going to prevent with an injection so that they may not fall pregnant”.
Participant 1 (Tshilwavhusiku CHC pre-test 1): “I do not know anyone of my friend who is using loop”.
Only one participant mentioned that her sister who is now having a new-born baby had been using IUD and that she recommended it for her to use. Her response was:
Participant 2 (Tiyani CHC): “I heard it from my sister, she told me that it worked well for her, and she was using it. Her first born is 9 years old; her last born was born last month”.
This study also revealed that participants received knowledge about contraception which they were using during the time of study or which they know about from either relative or friends. When participants were asked who informed them about contraceptives which they know about, majority of participants responded as follows:
Participant 3 (Tiyani CHC): “I was told by one of my friends”.
Participant 3 (Makhado CHC): “By my classmate”.
Participant 4 (Tiyani CHC): “I was told by my friends”.
Participant 1 (Tiyani CHC): “There is my neighbour, she told me after telling her my problem of not seeing periods as I am using prevention”.
Participant 3 (Tshilwavhusiku pre-test): “I heard people talking about it”.
Participant 1 (Tshilwavhusiku CHC): “I was told by my older sister”.
Lack of interest in IUDs among health professionals
When asking participants who were using a form of contraception during the study, it was found that they were either using one of the short-acting contraceptives: Medroxyprogesterone injection, norethisterone enanthate injection and condoms. Participants who were using any form of short-acting contraceptive excluding condoms had visited a health facility for a contraceptive method, but during the study, the majority were not aware of what IUD is. Given that in all these health centres, that is, Tshilwavhusiku CHC, Tiyani CHC, Makhado CHC and Bungeni CHC, IUDs were available and offered during the time of the study, how come were they not informed?
When asking participants what happened the day they attended clinic requesting sexual and reproductive health services, it was evident that contraceptive counselling was not including all forms of contraceptives, especially LARCs. The following were their responses:
Participant 1 (Bungeni CHC): “no, they only told us about injection and pills and also that you can take and use condoms because they are available at the clinic including female condoms”.
Participant 3 (Tshilwavhusiku pre-test): “I was informed by nurses the time I came wanting to prevent asking me what contraceptive I want to use. Do I want to use contraception for school going youth or for three months or implant? They explained how it works”.
Participant 2 (Tshilwavhusiku CHC): “Uhm, last I came to the clinic, when I come to the clinic, I told them that I want implant. They started by explaining to me how it works, then I inserted it. They did not share with me any other contraceptive”.
However, most of participants knew about implant as one of LARCs and some had been found to be using it with good satisfaction. Nevertheless, when interviewing participants who were using implant during the time of the study, asking them who informed them about implant before inserting it, all responded that they heard about it either from a relative or a friend.
The following were their responses:
Participant 2 (Tshilwavhusiku Pre-test): “I heard another girl saying that she inserted it”.
Participant 1 (Tshilwavhusiku CHC): “I was told by my sister”.
Participant 2 (Tshilwavhusiku CHC): “Ahh, I came on own, no one advised me to use implant. I decided to use implant because I realised that using injection after two months or three months, you may find yourself forgetting follow-up dates. I thought that implant last for three years. I did not know that loop last for five years”.
Although most participants knew about implant during the time of study, some of them were mistaking loop for implant. When asked what loop is? Some of their responses were:
Participant 2 (Makhado CHC): “loop is something you use to prevent pregnancy. It is inserted on the hand, and it is used by youth under 18 years”.
Participant 1 (Tshilwavhusiku CHC): “Loop is something like a pipe which is inserted in the left hand”.
Participant 4 (Tshilwavhusiku CHC): “I know the one that is inserted when one wants to prevent. I saw a video of it being inserted in the hand”.
Descriptions of the views that contribute to the lack of IUDs awareness by adolescents of age 12-19years.
Existing rumours and myths mentioned as possible deterring effect to IUDs.
Few myths and misconceptions toward IUDs were mentioned in this study maybe because IUDs were generally not known and as a result not utilised irrespective of its availability in all sampled health care facilities. These were their responses when they were asked why they did not choose IUD for contraception:
Participant 2 (Tiyani CHC): “Another day I came here to health centre wanting to insert it and they said that it will hurt me because I am still young, and they will insert me implanol”.
Tshilwavhusiku (CHC 2): “No, the way they explain it, it is like it is dangerous because it is inserted underneath, and it is not like an implant”.
Myths and misconception create a situation where women cannot see the value, use, and purpose of the device in terms of safety, efficacy, and convenience [45]. Debunking persisting IUD myths and misconceptions remain the most valuable venture to pursue and achieve to promote IUD use among adolescents and childbearing mothers.
This study also revealed a depressing reality, there were participants who were not using any modern contraceptive methods, but who were sexually active and fully aware that engaging in unprotected sexual intercourse may result in teenage pregnancy. The result of all these, they mentioned, it is due to myths and misconceptions toward contraceptives. When asked why they were not using any contraceptive while they were sexually active, and knowing that there is a possibility of them falling pregnant, they said:
Participant 3 (Tshilwavhusiku CHC): “Because, ehh, I sometimes believe that using prevention have bad consequences when growing up. I think when I am grown up and when I want to have babies, it might happen that I will not be able to have babies because my eggs would have forgotten and used to prevention, which is what I believe”.
Participant 4 (Tiyani CHC): “I am afraid, and others say that when you inject, injections may damage you and you may be unable to have children”.
Participant 1 (Makhado CHC): “Laughing, I was afraid that they were not going to work well in my body if using injections because I heard that injection have the possibility of causing one to gain too much weight and bulge depending on what one eats or what your body require. I never thought of pills”.
However, it was refreshing to learn that three participants were using one type of LARC, that is, the implant although they were a small fraction.
The extent of the role of Love Life and school-based education on contraception was also revealed. Only few participants mentioned that they were informed by Love Life ground breakers on which contraception to choose from. All participated health facilities were accredited Youth Friendly clinics during the time of study. All participants who knew IUDs at the time of study did not mention Love Life as their informant of IUDs. It was evident that they were not following tiered-effectiveness contraceptive model for counselling and informing adolescents of available contraceptives.
It was also revealed that some participants acquired knowledge about contraceptives from school. When they were asked of the one who informed them, they responded:
Participant 3 (Tshilwavhusiku CHC): “We were taught at school”.
Participant 1 (Makhado CHC): “I heard about them at school when we were being taught Life Science”.
Participant 4 (Tiyani CHC): “No, at school they only told us about pills”.
Majority of participants mentioned that they were never taught contraceptives at school revealing inconsistency in the provision of sexual and reproductive health education among educators.
Among participants, two were sexually active but using condoms only. Condoms are regarded as less effective, and adolescents are encouraged to use dual protection. None among participants was using IUD as contraception during the time of study.