Sexual and reproductive health (SRH) for adolescents and young adults is a vital component of health policy and is included in the United Nations Sustainable Development Goals (WHO, 2015). Adolescents and young adults are particularly vulnerable to the consequences of poor knowledge of SRH and inadequate protection during sexual encounters. Sub-Saharan Africa, with only 12% of the global population, accounts for about 71% of the global burden of HIV infection (Kharsany & Karim, 2016). Although there has been an increase in awareness and personal knowledge of HIV status, this is not consistent across countries (UNAIDS, 2019). Young adults (15-24 years) are also at risk of unintended pregnancies and unsafe abortions, partly due to their low levels of SRH knowledge (Bearak, Popinchalk, Alkema, & Sedgh, 2018). It is estimated that 44% of pregnancies worldwide are unplanned which is attributed to low usage of contraceptives (Bearak et al., 2018; Grindlay et al., 2018; Sutton, Zhou, & Frazier, 2018). Of the 25.1 million unsafe abortions reported globally, 95% occur in lower-middle-income countries in Africa, Asia and Latin America (Ganatra et al., 2017).
Africa lags behind other continents with respect to knowledge of SRH, particularly among young people (Govender, Naidoo, & Taylor, 2019; Ivanova, Rai, & Kemigisha, 2018; Lince-Deroche, Hargey, Holt, & Shochet, 2015) This could be attributed to societal construction which inhibits open discussions about SRH between parents and children (Kusheta, Bancha, Habtu, Helamo, & Yohannes, 2019; Mekonen, Dagnew, Yimam, Yimam, & Reta, 2018; Yadeta, Bedane, & Tura, 2014). Such discussions are considered a taboo in many African families, hence many young adults learn about SRH from their peers which could be detrimental (Ayehu, Kassaw, & Hailu, 2016; Department of Health South Africa, 2012).
Many South African adolescents and young adults engage in unprotected sexual intercourse. Richter et al reported a median age of sexual debut for young adults as 16 years for girls and 15 years for boys (Richter, Mabaso, Ramjith, & Norris, 2015). 5.8% of the male respondents in this study reported having impregnated a girl at least once (Richter et al., 2015). A number of studies have reported high risk-taking behaviours (multiple sexual partners and infrequent condom use) among young adults in South Africa (de Jager & Naudé, 2018; Yaw Amoateng & Kalule-Sabiti, 2013).
Unwanted pregnancies can negatively affect the health of individuals, families and society at large. Women have an increased risk of morbidity and mortality from abortions and the process of childbirth (Beksinska, Pillay, Milford, & Smit, 2014; Department of Health South Africa, 2012). Most health promotion programs focus mainly on adolescents below 16 years (Dreyhaupt et al., 2012; Mistry et al., 2012), however unwanted pregnancy rates are higher among university students (Chima Anyanwu, Ter Goon, & Tugli, 2013; Wang et al., 2015; Zenebe & Haukanes, 2019). In Kwa-Zulu Natal, South Africa, 19.2% of youths were reported to have experience unwanted pregnancies (Mchunu, Peltzer, Tutshana, & Seutlwadi, 2012).
The majority of university students fall into the adolescent and young adult group. In South Africa, as in countries around the world, university students possess low levels of knowledge about SRH (Adinew, Worku, & Mengesha, 2013; Furry, Mashalla, & Tshweneagae, 2019; Govender et al., 2019), but indulge in high-risk behaviours (Caetano et al., 2010; Somba, Mbonile, Obure, & Mahande, 2014). In a study of sexually active first year university students at a university in the Western Cape, South Africa, Abels and Blignaut reported that 62% of the respondents had not used condoms during every sexual encounter (Abels & Blignaut, 2011). A longitudinal study (2007- 2012) among students at the same university reported that 44% and 51% respectively, were sexually active prior to enrolment (Blignaut, Jacobs, & Vergnani, 2015). A survey of university students in KwaZulu-Natal, South Africa, noted that 218 of 576 students reported a vaginal sexual encounter with inconsistent contraceptive use in the previous two months (Hoffman et al., 2017). A study among male students at the University of Venda, South Africa reported that the majority of the respondents had a negative attitude towards contraceptive use (Raselekoane, Morwe, & Tshitangano, 2016).
Existing studies in the area of SRH knowledge have mainly focused on undergraduate students, highlighting limited knowledge and low uptake of SRH services among students (Caetano et al., 2010; Mchunu et al., 2012; Protogerou, Flisher, Wild, & Aarø, 2013; Somba et al., 2014). Although the postgraduate student numbers in most universities in South Africa have increased over the last decade, there is limited published information on SRH knowledge among postgraduate students. The aim of the study was to determine the SRH knowledge of postgraduate students in a university in South Africa, with specific exploration of students’ knowledge and use of contraceptives, Pap smear, clinical breast examination and knowledge of STIs and HIV.