This study found a contraceptive prevalence of 28.9% among female undergraduates. This is similar to the NDHS prevalence for unmarried women of 28%.5 It is also similar to findings of Kana et al1 in North-eastern Nigeria and Ogboghodo et al9 in South-south Nigeria with a prevalence of 26% and 26.8% among current users respectively. This low level of contraceptive use among female undergraduates is worrisome, particularly when their literacy level about contraceptives was almost 100%, (NDHS 2018 found a literacy level of 98% among unmarried women in Nigeria)5. Reasons why most female undergraduates did not use contraceptives included fear of infertility in the future; refusal of their male partners; fear of the safety profile of the various methods as well as dislike for the use of modern contraception. These findings have been corroborated by other studies which found a low contraceptive use due to fear from the side effects of the contraceptives such as infertility, cancer etc.13 However, this finding is in contrast to what was reported in a study done in Southeast Nigeria,15 where a high prevalence of contraceptive use among female undergraduates was found.
In a study done by Akintayo et al,16 consistency in the use of contraceptives did not match the contraceptive knowledge, as only about 35% of the studied population consistently used contraceptive, while in about 31.2%, there was no consistency in the use of contraceptives during sexual intercourse. Sexual activity without consistent and proper usage of contraceptive will lead to unwanted pregnancy and PID with their attendant morbidity and mortality. Inconsistency in the use of contraception has been noted earlier, and it can be ascribed to ignorance, fear of side effects, poor access to contraception and spontaneity of adolescent sexual activities.17,18 In order to maintain and sustain healthy sexuality, attitudinal change in this area is inevitable.
In the same study as above,16 an outcome of unprotected intercourse is unwanted pregnancy which occurred in 27.4% of the sexually active students. Unwanted pregnancy among teens and young people account for about three million unsafe abortions worldwide and the incidence seems to be on the rise.19 Although abortion is illegal in our country, all the girls procured it somehow. Studies in Nigeria revealed that over 80% of adolescents who have an unwanted pregnancy, seek the option of induced abortion with many of them using dangerous and unsafe methods.6,20 The implications (both economic and otherwise) of treating complications of unsafe abortion is enormous, and this often stimulates the debate on review of our abortion legislation.
The study showed that respondents from low socioeconomic background (20.3%) were less likely to use contraceptives compared to those from middle (33.7%), and high (44.7%) socioeconomic backgrounds, and the higher the socioeconomic status, the higher the likelihood of using contraceptive. This is similar to findings by Ogboghodo et al7 and Ackerson et al.9 Poverty therefore is a major barrier to contraception as these poor ladies are not likely to have a say in their sexual life, as they are more likely to engage in sex for monetary gains. Previous studies16,21 showed that engaging in sexual intercourse for monetary gains is common among undergraduate students, and this puts them in a condition where they are less likely to negotiate sex and contraceptive use leading to reduced use.13
The mean age of sexual debut found in our study was 18 ± 2.2 years. this was similar to findings in previous studies.16,22 Also this finding is comparable with the findings in South Africa, Ireland and Albania where sexual debut was at 17.3 years, 17.6 years and 18.8 years respectively.23,24 However, this is in contrast to the findings by Adegbenga et al25 in their study in Northern Nigeria, where earlier age of sexual debut was reported. This finding may be attributed to religion and cultural factors in the area studied.
Only a very small percentage of the studied population (5.3%) had one sexual partner, while a very high percentage had more than one sexual partner. This high number of undergraduates with multiple sexual partners confirms the risky sexual practices among the adolescents and young adults. This is contrary to the expectation that the prevailing HIV/AIDS pandemic should exert some positive constraint on sexual exploitation by these undergraduates. However, this finding is in contrast to what was found in a previous study,26 where a decline in the prevalence of multiple sexual partners when compared to earlier trend among undergraduates was reported.
Age was found to significantly affect contraceptive use in our study. The older the respondent, the higher the likelihood of them using a modern contraceptive method – ages 15–19 (16.2%) while ages 30 and above (36.4%). This may be due to their ability to negotiate sex with maturity, and are able to overcome their partner’s insistence on not using contraceptive. Studies have shown that contraceptive use is affected by non-cooperation of the malepartner.13 Also, as the girl ages, she can resist coercion from male partners more. It was therefore not surprising that older respondents used contraceptives more than younger ones.
Marital status was also identified by the study as a determinant for contraceptive use among undergraduates. Unmarried respondents (30.1%) used contraceptives more than married ones (9.1%). This is in line with 2018 NDHS, which found a contraceptive use prevalence of 28% among unmarried women compared to 12% among married women.5 This is expected as married women look forward to having children and often have sex with their husbands only. They therefore use contraceptives for child spacing and when they have completed their family size. Unmarried women on the other hand commonly have multiple sex partners as found in this study and elsewhere, and are exposed to risks of unwanted pregnancies as well as STIs thus increasing the need for contraception in this category of young women.
The commonest method of contraception used by the respondents was male condom (63.3%). This is comparable to finding reported in a previous study,27 but is in contrast to what was reported in another study,28 where respondents who practiced natural methods such as rhythm and calendar methods were more. Also, another study in the United States29 reported predominant use of oral contraceptive pill. The preferred use of male condom found in our study is perhaps due to is availability, cheap price and ease of over-the-counter purchase of the condoms. Due to the fact that some other contraceptive methods require an expert input in their use, in addition to scarcity of adolescent friendly clinics, coupled with judgemental attitudes of health workers, the students are discouraged from accessing health facilities for other contraceptive methods in our environment.30