Knowledge of contraceptives, attitudes towards contraceptive use, and perceptions of sexual risk, among university students at a South African university.

Abstract

University students form a high-risk group in relation to unplanned pregnancy and sexually transmitted infections such as chlamydia, gonorrhoea, hepatitis B, syphilis and HIV/AIDS, due to sexual exploration, unsafe sexual practices and involvement in risky behaviours in their environment. The use of contraceptives such as the male condom, the female condom, the contraceptive pill, the loop, implants, the injectable contraceptive, and contraceptive practices such as the rhythm method and withdrawal, potentially prevent conception; while proper use of the male condom and the female condom protect against the risk of sexually transmitted infections (STIs). An unplanned pregnancy can negatively impact on a student’s university education due to the challenges following childbirth. Students with children may find it difficult to attend to their studies and the needs of their young ones; while financial difficulties may constrain others. STIs, on the other hand, can severely damage a woman’s fallopian tubes leading to infertility, ectopic pregnancy and miscarriage. The STIs can cause genital cancers in both men and women and death of an infant following transmission of infection during pregnancy. Pregnant students and those with STIs are at higher risk of dropping out of college, becoming depressed or anxious. To inform interventions targeting change in behaviour, a qualitative study was conducted at the University of KwaZulu-Natal, on the Pietermaritzburg campus. The aim of the study was to understand students' knowledge of contraceptives, their attitudes towards contraceptive use, their perceptions of sexual risk, and factors influencing their decision-making processes about contraceptive use. The theory of planned behaviour was used to understand contraceptive use among university students. Convenience, purposive and snowball sampling techniques were used to access 25 sexually active students (13 men and 12 women) from all races, religions, levels of study and nationality. Ten in-depth interviews and four focus group discussions were conducted and, the findings were analysed using thematic analysis. The findings show that participants knew about the process of conception, the right time for contraceptive use, therapeutic benefits of contraceptive use, and sources of contraceptives on campus. The participants demonstrated knowledge of contraceptives such as the male condom, the female condom, the contraceptive pill, emergency contraceptives, injectable contraceptives, the loop, implants, and contraceptive practices such as the rhythm method, withdrawal and abstinence. There were inconsistencies and low use of contraceptives by the participants in the study, and contraceptives preferred were injectable contraceptives, emergency contraceptives and the male condoms. Participants knew about sexual risk and behaviours that can expose students to the risk of pregnancy and STIs. These behaviours were perceived to be mainly socially defined, like peer interaction, boredom, use of alcohol, drug abuse and watching pornographic movies. Contraceptive use was perceived as a woman’s responsibility because women are directly affected by pregnancy and they have access to more methods of contraception than men. Most of the participants were of the opinion that women have little say in negotiating safer sex practice and contraceptive use in relationships. Sexual activity was thought to be primarily for a man’s enjoyment. Men are not easily judged for their sexual behaviours if they are in possession of male condoms, while women are if they prepare for sexual activity. Peer interaction, parents’ expectations of their children’s behaviour and health care service providers’ attitudes towards sexual activity and contraceptive use influenced decisions about contraceptive use. The participants identified the cost of buying a good quality male condom and insufficient time to prepare for sexual activity as structural barriers to contraceptive use. This study concludes that contraceptive use is not a spur of the moment decision, but one guided by beliefs about likely outcomes of their use, beliefs held by significant others about their use, and availability of resources and opportunities that facilitate their use. Although knowledge of contraceptive use may be necessary for their use, it does not influence actual use. Knowledge is likely to influence the formation of intentions to contraceptive use by working mainly through attitudes towards their use. This information could help individuals in sexual and reproductive health centres in designing interventions to create awareness, change in sexual behaviours and promote contraceptive use. The study recommends interventions targeting men on attitudes change particularly in relation to condom use and responsibility for condom use in order to foster respect and shared responsibilities on reproductive health decisions; expansion of methods of contraception for men to widen their choices; and further national research on contraceptive use to inform new programming in higher institutions of learning.