Let’s talk about sex: What do Nigerian adolescents know about sexual reproductive health?

Editor’s Note: Nigeria Health Watch in collaboration with Education As A Vaccine (EVA) recently conducted two Focus Group Discussions (FGDs) in Nyanya and Kuje areas of the Federal Capital Territory, amongst adolescent. The objectives of the FGD was to gauge the perceptions of adolescents about sexual and reproductive health, identify the key issues they face in accessing sexual and reproductive health services in Nigeria, and make recommendations for sexual and reproductive health and rights (SRHR) for adolescents. Nigeria Health Watch Team members, Chibuike Alagboso and Atinuke Akande share key findings from the FGD.
 
Have you ever wondered what the young people around you know about their bodies, especially their sexual and reproductive health? If you think they do not know enough about sexual health, you may be right. Many adolescents are curious about sex and will take advantage of any opportunity to find out more about it. The fact that they are not talking to you, doesn’t mean they are not getting the information somewhere else. Their peers are more than willing to share the knowledge they have gained, and the information they provide is often inaccurate. This is a problem that requires urgent action, as other researchers within and outside Nigeria have made similar findings. Research conducted by Amelia Odo and others to determine the availability and accessibility of sexual and reproductive health services (SRHS) among adolescents in Enugu State, Nigeria concluded that youth-friendly clinics were not available and this could make it difficult for young people to access services. The authors also agreed that it’s important to make these services available to help prevent and control sexual and reproductive health problems.

Two FGDs were conducted among in-school and out-of-school adolescents aged 15–25 years in Nyanya and Kuje, Abuja. The Nyanya group consisted of 7 females and 6 males while the Kuje group consisted of 6 females and 7 males. The discussion explored adolescents’ sexual and reproductive health knowledge and choices, the types of choices they make and the factors that influence those choices. Here are some interesting findings from the FGD.

The Sex Talk: Most Girls are left out
“If a man touches you, you will get pregnant and die”. This is the only sex education that many of the adolescents ever received from their parents or guardians. While it can be uncomfortable and awkward for many parents and children to have the sex talk, open communication between both parties about sexuality and other risky behavior is crucial. A 15-year old female respondent said, “I have never said anything about sex to my parents, but they always tell me that sex is not a good thing. They say that sex can get you pregnant and cause infection and I can only have sex when I get married”.
 
Of all the female adolescents, only one mentioned that she recently started talking to her dad about sex. “I would say because I got bolder and because of the knowledge I have now. It (sex) is something that is happening, and he cannot just close his eyes and say it’s not”.

When asked if their parents discussed puberty, including menstruation, with them, their responses weren’t very different. The majority of the girls learnt about their changing bodies from one or two biology classes in school, which often falls short, as well as conversations with their peers, which most times includes inaccurate information and myths. Therefore, it’s even more important for parents to fill the knowledge gaps by giving age-appropriate information to their children. Nigerian parents need to understand that helping their children understand their bodies will help them make more informed decisions about their health.

Sex education for the male participants was a bit different, more boys had the sex conversation with their parents. This provides a glimmer of hope because the usual belief is that parents find it difficult, if not impossible to have these discussions with their children. While this is arguable, the FGD provided evidence that it is not always the case. Some enlightened parents are now being more proactive in providing their children correct and age-appropriate information about their bodies before they acquire the information from wrong sources.

A male respondent said that on his 15th birthday, his father simply told him, “You are old enough to get a girl pregnant. You should be careful”. According to the respondent, that was the first and last conversation he ever had about sex with his father. “If you get any girl pregnant, you will face it. Your education will suffer,” was the clear message one of the respondents received when he was just nine years old.
 
From the FGD, it was quite clear that our adolescents especially girls do not receive adequate sex education. Girls should be taught about sex as much as boys are taught. Most importantly, we need to realise that sex education is beyond the act of sexual intercourse, but helping young people understand their bodies beyond the academic approach in school curriculums, what to expect as they grow, how to handle physical changes and how they can stay safe and healthy.

Alternative sources of information
When asked about the source of their sexual health information, a 19-year old girl said, “When I got to JSS3 I had my first sexual intercourse experience with someone older than me, so let me say I didn’t learn it from anybody. But I have also learnt from the movies”.
 
Some of the boys also got educated about sex from their teachers in school. “Our teacher told us back then that even touching a girl can get her pregnant,” one of the boys said. A majority of the respondents learned about sex from the experiences of their friends, most times, older friends. For example, a male respondent found out about sexually transmitted infections (STIs) after his friend had a nasty experience with Gonorrhoea. For one of the respondents, his first knowledge and experience was at age of four when a female family friend, then in her final year in high school, had sex with him. Recognising and discussing what constitutes inappropriate behaviour by adults towards children is also something that parents need to discuss with their children. 
 
Friends, books and the internet, were other common sources of sexual information for the adolescents. From the FGD, it was clear that our society has not created s safe environment for providing SRH information and services to adolescents. “My parents do not have time to sit down and discuss sex with me so I learnt from my friends that got some girls pregnant”, a male respondent said. We need to change the narrative. Parents and caregivers should be the primary source of information for young people at the family level as they influence their growth. Likewise, teachers should be more influential through health education in schools. But it’s important to give information with openness and not shroud facts in mystery to avoid losing the trust of these young people.

Misinformation and DIY Contraceptives
Saltwater. 7Up. Sprite. Schweppes. Coca Cola. Andrews liver salt. Ampiclox. Tetracycline. Alum. Diluted filtrate from firewood ash. Squad 5 — a local drink, mixed with seven cubes of sugar. Eating an excess amount of pineapple immediately after sex. These are contraceptive alternatives that the adolescents listed, some of which they have used. We have written about the use of antibiotics as contraceptives but what many Nigerians do not know or talk about are the other strange alternatives. Convinced that these ‘contraceptives’ are highly effective, a 22-yeard old female said, “They work. You just need to know how to use them”. All these point to a lack of proper sex education — because of their poor knowledge of ovulation cycles, they reach conclusions that these ‘contraceptives’ work.

While misinformation was common among them, the adolescents were also knowledgeable about approved emergency contraception pills like Postinor II. They also knew that condoms can prevent unintended pregnancies and STIs. When he was in Primary 5, one of the boys said he saw a condom for the first time when his father brought it home and told him it was used to prevent STIs and unintended pregnancies. While they understand the risks, a respondent said one of his peers prefers unprotected sex because it takes too long to climax when he uses a condom. So he resorts to buying self-test kits, having unprotected sex with only one partner and using withdrawal method to prevent unintended pregnancy.

So, what do they really want?
Nigerian adolescents want a judgement-free zone! They do not want to be judged when they ask questions about sex in class. They do not want to be judged when they visit health facilities to seek sexual health advice, counselling and services. Nigerian adolescents want to walk into any pharmacy or health facility to buy contraceptives without being called prostitutes, gossiped about or labelled promiscuous. They want contraceptive dispensers in public places including schools, hotels and restaurants.

One of the female respondents said, “When people see us going for contraceptives, they judge us. The day my sister saw a female condom in my bag, she said I am sleeping around. I had to lecture her that having condoms doesn’t mean I’m promiscuous”.

Amongst the female adolescents, there was a consensus that there should be more youth-friendly health centres with health workers between the ages of 17 and 24.

The male respondents had varying answers for where they would prefer to get their contraceptives. Some preferred pharmacies because of the likelihood of their proximity to wherever they were than youth-friendly centres. In addition, some respondents also said they preferred visiting pharmacies because there was a low chance of meeting familiar faces and they render services without asking questions. However, a youth-friendly centre was the preferred choice among male respondents.
 
The adolescents had a few ideas on how to make information and services more accessible to them. They want outreaches organised to reach their peers who are out of school and living in areas where access to information and services is very limited or non-existent. They want their teachers to go beyond just teaching them to pass examinations, to giving them quality information that can help them make more informed decisions.
 
They also have issues with health workers who often make distasteful comments when they go to access information or services and believe that this can be remedied by engaging more youth-friendly health workers in health facilities. “My friend had an unsafe abortion. She went to the clinic because she was seriously bleeding. When she got there, the health personnel was like ‘Stupid children. When they have gone to do what they do and they are almost dying they’ll now come back and be looking for help and expect us to help them.’ My friend left the clinic and went to a pharmacy where she was given a small remedy. Till today, no matter how ill she is, she never visits a health facility. This is why many young people do not visit health facilities to have such services”, a female respondent narrated.
 
The evidence is here to guide anyone who works with or is interested in working with young people on matters pertaining to their sexual and reproductive health. It is important that we all — parents, school proprietors, religious leaders, policymakers, and officials tasked with the responsibility of developing youth policies and education curricula like the Family Life and HIV Education curriculum used across the country — understand that young people must be empowered to protect their reproductive futures. That is the only way we can reap the potential they possess.