Determinants of contraceptive use and sexual activity amongst school-going adolescents in Lesotho.

Abstract

This study investigated factors that have an influence on sexual activity and subsequent contraceptive use among school-going adolescent girls in Lesotho, focusing on the districts of Berea, Maseru and Mohale’s Hoek. The factors under investigation from a reproductive health survey included demographic variables (age, district, rural urban residence, class and religion), behavioural variables (drinking alcohol, boyfriend status), and attitude and knowledge variables (including attitude toward sex before marriage, contraceptive use before marriage, and communication with a boyfriend about sex). The methodology comprised a secondary analysis of the 1999 Adolescent Reproductive Health Survey of Lesotho. Bivariate analysis and binary logistic regression were used to establish if significant relationships existed between sexual activity and contraceptive use and the independent factors. A limitation of the study is that the survey instrument contained a limited set of indicators. Thus a number of theories of sexual decisionmaking were excluded from the conceptual framework. Prevalence of sexual activity was lower than expected. This research confirmed that the likelihood of adolescents being sexually active increases with age. A somewhat surprising result was that Catholic adolescents were more likely to become sexually active than adolescents of other religions. Adolescents who live in rural areas, as well as those with a boyfriend were also found to be more likely to become sexually active. Contraceptive use was higher for this Lesotho sample than has been reported for research from other African countries. Nevertheless, the proportion of adolescents not using contraceptives is argued to be a matter of concern. Adolescents in the lowest school class were least likely to use contraceptives, which suggests a lack of control over decisionmaking in this group. Contraceptive use was found to be lower among adolescents who were coerced into their first sexual experience. Adolescents from Mohale’s Hoek, designated the least developed area for this research, were the least likely to use contraceptives. Those adolescents who reported having a boyfriend were more likely to use contraceptives, suggesting a regular partner allows the adolescent some control over decision-making. A positive view of use of contraceptives before marriage was associated with higher likelihood of use. Somewhat surprisingly, use of alcohol was associated with higher likelihood of contraceptive use. The findings suggest adolescent girls can be grouped into different risk categories. Some practice abstinence and some who are sexually active appear to have control over sexual decision-making, specifically in being able to negotiate use of contraceptives. However, there is a group which is sexually active but does not use contraception. This group has a higher rate of coercion as the reasons for sexual activity. The analysis suggests a multi-dimensional set of factors explain sexual activity and associated contraceptive use (or non-use) and that beliefs and attitudes do not always predict an expected behaviour. Interventions should target the most at-risk group and must take into account that belief and attitude does not necessarily predict behaviour.A