Assessing Comprehensive Sexuality Education Programs in the Democratic Republic of the Congo: Adolescents’ and Teachers’ Knowledge, Attitudes and Practices towards Contraception — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Assessing Comprehensive Sexuality Education Programs in the Democratic Republic of the Congo: Adolescents’ and Teachers’ Knowledge, Attitudes and Practices towards Contraception
School of Public Heath of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa I, Democratic Republic of the Congo
,
School of Public Heath of Lubumbashi, Faculty of Medicine,University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
,
Centre de connaissances santé en RDC (CCSC), Kinshasa, Democratic Republic of the Congo
,
School of Public Heath of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa I, Democratic Republic of the Congo
,
School of Public Heath of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa I, Democratic Republic of the Congo
1 School of Public Heath of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa I, Democratic Republic of the Congo
2 School of Public Heath of Lubumbashi, Faculty of Medicine,University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
3 Centre de connaissances santé en RDC (CCSC), Kinshasa, Democratic Republic of the Congo
4 School of Public Heath of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa I, Democratic Republic of the Congo
5 School of Public Heath of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa I, Democratic Republic of the Congo
Introduction : Improving teenagers’ knowledge on sexual and reproductive health (SRH) is important to prevent unintended pregnancies. We aimed to assess comprehensive sexuality education (CSE) programs and knowledge, attitudes and practices of adolescents and teachers towards contraception. Methods : Based on the reasoned action theory and CSE guidelines, a qualitative study was conducted with seven teachers and 62 adolescents aged 15 - 19. The data were collected through six focus groups (FG) of adolescents and seven semi-structured interviews of teachers. The program of the family life education course (FLEC) was assessed. The Atlas Ti software helped to analyze the data, using a deductive approach. Results : The periodic abstinence, male condoms and pills were the most known contraceptive methods. Adolescents and teachers were reluctant to use artificial contraceptive methods, apart from the male condom which they used irregularly. Girls especially prefer red natural contraceptive methods, fearing side effects, such as the risk of infertility. Almost all adolescents wanted to be informed on SRH and family planning in school. However, they estimated that the content of the FLEC was insufficient and criticize d the teachers ’ lack of openness. Their main sources of information were peers, siblings and the internet. Mothers were an important source of information for girls, unlike fathers considered to be indifferent or even frightening. Conclusion : Adolescents’ and teachers’ knowledge are weak; and their attitude s unfavorable towards contraception. Misconceptions about contraception lead to the use of ineffective practices to prevent unwanted pregnancies. To improve knowledge, a teacher training program should be developed and the content of the FLEC improved , formalized and regulated.
Munakampe, M.N., Zulu, J.M. and Michelo, C. (2018) Contraception and Abortion Knowledge, Attitudes and Practices among Adolescents from Low and Middle-Income Countries: A Systematic Review. BMC Health Services Research, 18, Article No.: 909. https://doi.org/10.1186/s12913-018-3722-5
Guillaume, A. and Rossier, C. (2018) L’avortement dans le monde. état des lieux des législations, mesures, tendances et conséquences. Population-F, 73, 225-322 https://doi.org/10.3917/popu.1802.0225
Kennedy, E., Gray, N., Azzopardi, P. and Creati, M. (2011) Adolescent fertility and family planning in East Asia and the Pacific: A Review of DHS Reports. Reproductive Health, 8, Article No.: 11. https://doi.org/10.1186/1742-4755-8-11
Sedgh, G., Ashford, L.S. and Hussain, R. (2016) Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. Guttmacher Institute, New York, Report, 1-93.
Taghizadeh, M.H, Bahreini, A., Ajilian, A.M, Fazli, F. and Saeidi, M. (2016) Adolescence Health: The Needs, Problems and Attention. International Journal of Pediatrics, 4, 1423-1438.
Tsui, A.O., Brown, W. and Li, Q.F. (2017) Contraceptive Practice in Sub-Saharan Africa. Population and Development Review, 43,166-191. https://doi.org/10.1111/padr.12051
Blanc, A.K., Tsui, A.O., Croft, T.N. and Trevitt, J.L. (2009) Patterns and Trends in Adolescents’ Contraceptive Use and Discontinuation in Developing Countries and Comparisons with Adult Women. International Perspectives on Sexual and Reproductive Health, 35, 63-71. https://doi.org/10.1363/3506309
Undie, C.-C., Birungi, H., Odwe, G. and Obare, F. (2015) Expanding Access to Secondary School Education for Teenage Mothers in Kenya: A Baseline Study Report. Strengthening Evidence for Programming on Unintended Pregnancy, Nairobi, 1-27. https://doi.org/10.31899/rh4.1041
Gottschalk, L.B. and Ortayli, N. (2014) Interventions to Improve Adolescents’ Contraceptive Behaviors in Low- and Middle-Income Countries: A Review of the Evidence Base. Contraception, 90, 211-225. https://doi.org/10.1016/j.contraception.2014.04.017
Birungi, H., Undie, C.-C., MacKenzie, I., Katahoire, A., Obare, F. and Machawira, P. (2015) Education Sector Response to Early and Unintended Pregnancy: A Review of Country Experiences in sub-Saharan Africa. STEP UP and UNESCO Research Report, Nairobi, 1-44. https://doi.org/10.31899/rh4.1047
UNFPA (2016) Facing the Facts: Adolescent Girls and Contraception in 2015. Brochure, UNFPA, New York, 1-24.
Panova, O.V., Kulikov, A.M., Berchtold, A. and Suris, J.C. (2016) Factors Associated with Unwanted Pregnancy among Adolescents in Russia. Journal of Pediatric and Adolescent Gynecology, 29, 501-505. https://doi.org/10.1016/j.jpag.2016.04.004
Kennedy, E.C., Bulu, S., Harris, J., Humphreys, D., Malverus, J. and Gray, N.J. (2014) “These Issues Aren’t Talked about at Home”: A Qualitative Study of the Sexual and Reproductive Health Information Preferences of Adolescents in Vanuatu. BMC Public Health, 14, Article No.: 770. https://doi.org/10.1186/1471-2458-14-770
Yode, M. and LeGrand, T. (2014) Association between Family Environment and Sexual Behaviour of Adolescents in Burkina Faso. Advances in Reproductive Sciences, 2, 33-45. https://doi.org/10.4236/arsci.2014.22005
UNESCO, UNICEF, UNFPA, UN Women, WHO and UNAIDS (2018) International Technical Guidance on Sexuality Education—An Evidence-Informed Approach.
Yu, J. (2012) Teenage Sexual Attitudes and Behaviour in China: A Literature Review. Health & Social Care in the Community, 20, 561-582. https://doi.org/10.1111/j.1365-2524.2011.01054.x
Hawkins, J.D., Catalano, R.F., Kosterman, R., Abbott, R. and Hill, K.G. (1999) Preventing Adolescent Health-Risk behaviors by Strengthening Protection during Childhood. Archives of Pediatrics & Adolescent Medicine, 153, 226-234. https://doi.org/10.1001/archpedi.153.3.226
Capurchande, R., Coene, G., Schockaert, I., Macia, M. and Meulemans, H. (2016) “It Is Challenging… Oh, Nobody Likes It!”: A Qualitative Study Exploring Mozambican Adolescents and Young Adults’ Experiences with Contraception. BMC Women’s Health, 16, Article No.: 48. https://doi.org/10.1186/s12905-016-0326-2
Chae, S., Kayembe, P.K., Philbin, J., Mabika, C. and Bankole, A. (2016) The Incidence of Induced Abortion in Kinshasa, Democratic Republic of Congo. PLoS ONE, 12, e0184389. https://doi.org/10.1371/journal.pone.0184389
Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité (MPSMRM), Ministère de la Santé Publique (MSP), ICF International (2014) Enquête démographique et de santé en République Démocratique du Congo 2013-2014. MPSMRM, MSP, and ICF International, Rockville, 91-112.
Vodiena, G.N., Coppieters, Y., Lapika, B.D., Kalambayi, P.K., Gomis, D. and Piette, D. (2012) Perception des adolescents et jeunes en matière de santé sexuelle et reproductive, République Démocratique du Congo. Santé Publique, 5, 403-415. https://doi.org/10.3917/spub.125.0403
Muanda, F.M., Gahungu, N.P., Wood, F. and Bertrand, J.T. (2018) Attitudes toward Sexual and Reproductive Health among Adolescents and Young People in Urban and Rural DR Congo. Reproductive Health, 15, Article No.: 74. https://doi.org/10.1186/s12978-018-0517-4
Muanda, M.F., Ndongo, G.P., Messina, L.J. and Bertrand, J.T. (2017) Barriers to Modern Contraceptive Use in Rural Areas in DRC. Culture, Health & Sexuality, 19, 1011-1023. https://doi.org/10.1080/13691058.2017.1286690
Fishbein, M. and Ajzen, I. (2011) Predicting and Changing Behavior. The Reasoned Action Approach. Psychology Press, Taylor & Francis Group, New York, 1-527.
Ho, L.S. and Wheeler, E. (2018) Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo. Global Health: Science and Practice, 6, 161-177. https://doi.org/10.9745/GHSP-D-17-00365
Yoost, J. (2014) Understanding Benefits and Addressing Misperceptions and Barriers to Intrauterine Device Access among Populations in the United States. Patient Preference and Adherence, 8, 947-957. https://doi.org/10.2147/PPA.S45710
Onokerhoraye, A.G. and Dudu, J.E. (2014) Perception of Adolescents on the Attitudes of Providers on Their Access and Use of Reproductive Health Services in Delta State, Nigeria. Health, 9, 88-105. https://doi.org/10.4236/health.2017.91007
Parks, C. and Peipert, J.F. (2016) Eliminating Health Disparities in Unintended Pregnancy with Long-Acting Reversible Contraception (LARC). American Journal of Obstetrics & Gynecology, 214, 681-688. https://doi.org/10.1016/j.ajog.2016.02.017
Krugu, J.K., Mevissen, F.E.F., Prinsen, A. and Ruiter, R.A.C. (2016) Who’s That Girl? A Qualitative Analysis of Adolescent Girls’ Views on Factors Associated with Teenage Pregnancies in Bolgatanga, Ghana. Reproductive Health, 13, Article No.: 39. https://doi.org/10.1186/s12978-016-0161-9
Challa, S., Manu, A., Morhe, E., Dalton, V.K., Loll, D., Dozier, J., Zochowski, M.K., Boakye, A., Adanu, R. and Hall, K.S. (2018) Multiple Levels of Social Influence on Adolescent Sexual and Reproductive Health Decision-Making and Behaviors in Ghana. Women Health, 58, 434-450. https://doi.org/10.1080/03630242.2017.1306607
Unis, B., Johansson, I. and Sällström, C. (2015) Rural High School Students’ Sexual Behavior and Self-Esteem. Open Journal of Nursing, 5, 24-35. https://doi.org/10.4236/ojn.2015.51004
Anderson, D.M. and Pörtner, C.C. (2014) High School Dropouts and Sexually Transmitted Infections. Southern Economic Journal, 81, 113-134. https://doi.org/10.4284/0038-4038-2012.195
Rosenberg, M., Pettifor, A., Miller, W.C., Thirumurthy, H., Emch, M., Afolabi, S.A., Kahn, K., Collinson, M. and Tollman, S. (2015) Relationship between School Dropout and Teen Pregnancy among Rural South African Young Women. International Journal of Epidemiology, 44, 928-936. https://doi.org/10.1093/ije/dyv007
Campbell, C. (2015) The Socioeconomic Consequences of Dropping Out of High School: Evidence from an Analysis of Siblings. Social Science Research, 51, 108-118. https://doi.org/10.1016/j.ssresearch.2014.12.011
Chandra-Mouli, V., Svanemyr, J., Amin, A., Fogstad, H., Say, L., Girard, F. and Temmerman, M. (2015) Twenty Years after International Conference on Population and Development: Where Are We with Adolescent Sexual and Reproductive Health and Rights? Journal of Adolescent Health, 56, S1-S6 https://doi.org/10.1016/j.jadohealth.2014.09.015
Resnick, M.D., Bearman, P.S., Blum, R.W., Bauman, K.E., Harris, K.M., et al. (1997) Protecting Adolescents from Harm: Findings From the National Longitudinal Study on Adolescent Health. JAMA, 278, 823-832. https://doi.org/10.1001/jama.1997.03550100049038
Département Santé et Recherche génésiques de l’Organisation Mondiale de la Santé (OMS/RHR) et l’Ecole de santé publique de l’Université Johns Hopkins/Centre pour les programmes de communication (CCP), projet Knowledge for Health (Mise à jour en 2011) (2011) Planification familiale: Un manuel à l’intention des prestataires de services du monde entier. OMS, Baltimore et Genève, 1-388.
Mpunga Mukendi, D., Musalu, E.M., Muanda, F.M., Lutumba, G.-O., Mukalenge, F.C., Mapatano, M.A. and Utshudienyema, G.W. (2020) Assessment of Policies, Laws, and Regulations Affecting the Contraceptive Needs of Adolescents in the Democratic Republic of the Congo. Health, 12, 1241-1261. https://doi.org/10.4236/health.2020.129090