Youths and Reproductive Health- Important Next Steps for Nigeria

Promoting and protecting the reproductive health of young people is a key factor in developing their potentials and helping them grow to become healthy and responsible adults and parents. Globally, there has been a focus on addressing the needs of young people and more importantly in recent years, their sexual and reproductive health. Statistics show that 45% of the Nigerian population is under 15 years old, and a third of the Nigerian population between 10 - 24 years¹. With the Nigerian youth population projected to exceed 57 million by 2025², Nigeria is the envy of the world as a nation with a great future with its teeming, young vibrant population. However, the reproductive health of the Nigerian youth population is nothing to be envious about and this threatens the future of Nigeria.

It is well documented that young people are prone to risky sexual behaviours that may compromise their health and puts them at a high risk of infertility and death from unsafe abortion and contracting Sexually Transmitted Diseases (STDs). Meanwhile, the devastating effects of increasing rates of unprotected sexual activity, unwanted pregnancies, unsafe abortions and contraction of STDs not only affects the young person but also their families, the community and the nation. Nigeria has come a long way in the fight to improve the reproductive and sexual health of the younger population with some evident successes. This article discusses the current statistics and trends of reproductive health and sexual behaviours of young people in Nigeria and proposes the important next steps to preserve their future.

Sex Initiation & Early Marriage

Age at first sex or at marriage is an important factor because the age at which women initiate sex more precisely marks the beginning of their exposure to sexual health risks. Studies show that as much as 13% of girls have initiated sex by age 11.⁴ According to the National District Health Survey (NDHS, 2010), 24% of women report that they had sexual intercourse by age 15 and 54% by age 18. More so, 23% of women age 15-18 have already begun childbearing and about one-third (32%) of women age 20-49 have had a birth by age 18⁵. However, there is indication that there is a gradual increase in age at marriage among the younger generation with the median age at first marriage increasing from 17.3 years among women aged 45-49 to 19 years among women age 20-24⁶.

It is known that teenage mothers are also more likely than older women to suffer from serious complications during delivery, resulting in higher morbidity and mortality for both mother and infant. The social context of adolescents’ first sex is also of great concern. A research in Abia State reported that concerning ‘debut sex’, 5.4% of the girls were drugged, 4.1% were raped, 7.4% were coerced, and 14.2% were deceived into having sex with only about 34.6% of sexual debut by the adolescents being by mutual consent.⁷ In addition, the current trend is that most sexually active young people do not practice contraception which results in high levels of unwanted pregnancies and illegal abortion.

Early Unwanted Pregnancy And Unsafe Abortion

As at 1999, 80% of pregnancies of unmarried young girls in rural Nigeria were unintended compared to 6% for married girls.⁸ With the number of young people who are sexually active, and who are known to not consistently use contraceptives, the rate of unintended pregnancies are obviously high and under-reported. It is documented that girls aged 10-14 years are five times more likely to die in pregnancy or childbirth than women aged 20-24. Meanwhile, pregnancy-related complications remain the main cause of death in 15-19 year old girls worldwide.

In Nigeria, abortion remains illegal except if to save a woman’s life. However, as at 2001, it was estimated that more than 600,000 women obtain abortions each year with a study reporting that over 30% of these women were adolescents.⁹ This has since worsened with a  2003 report stating that young people constituted 55% of the 760,000 unsafe abortions annually in Nigeria.

STDs, HIV and AIDs

Young people are at a high risk  of contracting sexually transmitted  diseases (STDs) and common among them are syphilis, gonorrhoea, herpes and HIV/AIDs all of which if left untreated, makes the subject vulnerable to infertility and premature deaths. HIV & AIDS infection rates remain high among the young population with over 60% of new HIV cases  (20,334) occurring in youths aged 15 – 25 in 1998 alone.¹⁰ And 80% of HIV infections in Nigeria are contracted through sexual intercourse and 1 in 20 adolescents become infected with STDs.¹¹

Many young people remain vulnerable to contracting STDs because they do not value unprotected sex even though they are aware that STDs can be transmitted via sex. They often believe they are not vulnerable and therefore have no need for protection. When infected, they are also wary of seeking treatment due to fear of stigmatization. Significant among the causes of STD spread among young people is that they are often coerced into exploitative sexual relationships and some of them exchange sex for money.

The challenges and significant next steps.

One of the major challenges plaguing the reproductive health of young people in Nigeria has always been lack of appropriate education about reproductive health issues. Socio-economic conditions also exert more pressure on the youths and this generates negative health consequences.  The advertising and entertainment industries have not been helpful as they glamorize sex without equally highlighting the associated risks.

Age-appropriate comprehensive sex education have been incorporated into the educational curriculum but more work needs to be done in taking this education outside the walls of formal education. The population of Nigerian youths who are not in school is high and they cannot be left out. Young people below 18 years who are not yet sexually active need to be identified and supported with the knowledge and skills needed to delay sex.

Another challenge is the seemingly obvious gap in the knowledge of reproductive health of the youth and their behavior. Peer pressure does have a strong hold on the behaviour of youths. Specific interventions should address these. Interventions which use peer educators should be encouraged as this would be an effective behaviour change communication strategy.

Access to adolescent friendly reproductive health services is another challenge. Youths are likely to change behaviour positively when they have accessible and dedicated youth-friendly reproductive health service providers. There is a need for more provision to be made for such and for an improvement in service delivery of such facilities. Mobile and technology platforms can also be used to reach more young people and directly.

The ban on abortion in Nigeria makes young people seek and approach quacks putting themselves at risk. Some experts have argued that removing the ban on abortion will reduce abortion related deaths through increased access to safe abortion. Other countries such as Romania have taken this step and abortion related mortality have recorded a decline. More sustainably. if more effort is put into reducing unwanted teenage pregnancies through continuous education and interventions, then unsafe abortions will significantly be on the decline.

The National Adolescent Health Policy (2001) and other related reproductive health policies already in existence should be enforced by the appropriate government establishments. While some of them need a review to capture the current state of the nation, full implementation of these policies would show significant improvements in the health of the young population.

If Nigeria would indeed secure her future, the health of the young population and specifically, their reproductive health must move beyond policy formulation and continue to be a priority for the government and interventions that increase their access to good, quality youth-friendly healthcare and disease prevention strategies must be prioritized with more financial commitments.

References

*denote reference was used more than once.

1. National Population Commission, Nigeria Demographic and Health Survey 1999. Abuja, Nigeria: The Commission, 2000

2. National policy on the health & development of adolescents & young people in Nigeria, 2007 by Federal Ministry of Health, Nigeria

*3,6. Nigeria Demographic and Health Survey (NDHS) 2013 National Population Commission

Federal Republic of Nigeria, Abuja, Nigeria.

4. Anochie I.C and Ikpeme E.E prevalence of sexual activity andn outcome among female secondary school students in Port-harcourt,Nigeria. African Jou Repr Health, 2001; 5(2), 63-67s

5. Nigeria Demographic and Health Survey (NDHS) 2010 National Population Commission

Federal Republic of Nigeria, Abuja, Nigeria.

7. Chimaraoke Otutubikey Izugbara. Tasting the forbidden fruit: The social context of debut sexual encounters among young persons in a rural Nigerian community. Afri J Reprod Health 2001; 5(2): 22-29.

8. Okonofua F. E. .Factors Associated with Adolescent Pregnancy in Rural Nigeria.. [Ob/Gyn Obafemi Awolowo Univ., Ile-Ife, Nigeria], (1992): 8-9

9. Otoide VO et al. Why Nigerian adolescents seek abortion rather than contraception: evidence from focus-group discussions. International Fam Plann Perspect 2001; 27:77-81.

10. National AIDS and STDs Control Programme, 1999 HIV/Syphilis Sentinel Sero-Prevalence Survey in Nigeria. Abuja, Nigeria

11. Meeting The Sexual and Reproductive Health Needs of Young People in 
 Nigeria

About the Author 
Ebenezer Anifowose, is a nutritionist and public health specialist. He has developed Nigeria’s first and arguably, Africa’s first health and fitness education board game which helps children and adults, through his social enterprise, Healthucate Nigeria. Ebenezer is also the founder of the Centre for Productivity and Stress Management. He is a writer, leisure musician and lover of nature.