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PROJECT TOPIC  : THE KNOWLEDGE AND PREVALENCE OF THE USE OF ORAL PILLS AMONG FEMALE UNDERGRADUATES

PROJECT PROPOSAL

BACKGROUND OF THE STUDY
There has been considerable concern in many countries about the sexual and reproductive health of young people, in part because of their perceived increased vulnerability to the risk of sexually transmitted infections (STIs), including acquired immune deficiency syndrome (AIDS), the potential risks to their health due to early pregnancy, and the negative consequences of early and non-marital childbearing to young people’s life prospects. Public concern over the reproductive health problems among Nigerian youth has drawn the attention of researchers, non-governmental organizations (NGOs) and policy makers to examining the driving force behind the upsurge in adolescent sexual activity.

Over the last decades, several researchers have identified unsafe abortion as an important challenge associated with women's reproductive health in Nigeria. Induced abortion currently accounts for 20,000 of the estimated 50,000 maternal deaths that occur in Nigeria each year (Akingba, 1977; and Okonofua and Ilumoka, 1992). It is thus the single largest contributor to maternal mortality. Numerous studies have documented the social, economic and health problems associated with early and unplanned pregnancies (Okonofua, 1994; and Ladipo, 1989).

The performance of an abortion is illegal under Nigerian criminal law, unless the woman's life is threatened by the pregnancy. As a result, induced abortions are usually obtained in secret, and are frequently unsafe. Unsafe abortion is often the end result of an unwanted pregnancy, which in turn is often the result of lack of contraceptive use. This trend is most profoundly demonstrated among adolescents. Hospital-based studies have shown that in Nigeria up to 80% of patients with abortion-related complications are adolescents (Adewole, 1992; Okonofua, Onwudiegwu and Odunsi, 1992; Anate, Awoyemi and Oyawoye, 1995 and Brabin L et al., 1995). Similarly, a community-based study of abortion prevalence found that one-third of women who obtained an abortion were adolescents (Okonofua et al, 1996)

In contrast, the utilization of modern and traditional methods of contraception has always been shown to be poor among Nigerian adolescents. Studies from western and southern Nigeria have found rates of contraceptive use among sexually active adolescents to be low, about 30% (Arowoju and Adekunle, 2000; Okpani and Okpani, 2000). The 1990 Demographic and Health Survey found that only 11% of sexually active women aged 15-19 ever used any modern contraceptive method. Such rates of contraceptive use are much lower than levels seen in similar age-groups in many Sub-Saharan African countries, or than levels in industrialized countries. Given the increasing adolescent sexual activity and decreasing age at first sex in developing countries (Nnko and Pool, 1997; Adedoyin and Adegoke, 1995, and Oladepo and Brieger, 1994), the use of contraceptives to prevent unwanted pregnancy and unsafe abortion is especially important.

Among the various forms of contraception, emergency contraceptives are the only one that can be used after sexual intercourse, offering a second chance to prevent unwanted pregnancy (Gold, Schein and Coupey, 1997; Barnhart and Sondheimer, 1994). Levonorestrel-only pills and combined oral contraceptives are the most common emergency contraceptive methods available in Nigeria; they can be obtained over the counter from patent medicine and pharmacy shops. The aim of this study is to determine the knowledge and prevalence of the use of oral pill among female undergraduates in Nigeria. In addition, I shall evaluate factors the influence their knowledge and perceptions to enable the development of strategies that will improve use of oral pill by Nigerian female undergraduates.

STATEMENT OF RESEARCH PROBLEM
The promotion of effective contraceptive use among Nigerian adolescents is a major challenge if their reproductive health is to be improved. Given that Nigerian youths are now marrying later, are increasingly interested in acquiring a formal education and are increasingly having premarital sex, it is clear that allowing the existing gap between contraceptive need and contraceptive utilization to be left unfilled will result in a dramatic rise in the prevalence of unsafe abortions. This will further compound overall levels of maternal mortality in Nigeria.

Other than identifying at-risk groups that are often unaware of contraception, a comprehensive study of the knowledge and prevalence of the use of oral pill and of societal views on risks associated with abortion is highly needed. In particular, social and cultural barriers to contraceptive utilization among adolescents need to be analysed and this is one of the main thrust of this research work.

LITERATURE REVIEW
Societal acceptance or rejection of any private behavior, including contraception, is likely to affect that behavior profoundly. According to Hall (1990), some instructional books and women's magazines provide contradictory messages regarding condom use. Specifically, they portray the condom either as a symbol of pleasure and of a life associated with responsible sexual intercourse, or as a symbol of promiscuity and disease.

Given the fact that the target population here is primarily college undergraduates, a relevant question is whether providing contraceptives to unmarried youth is socially accepted. Several investigators, including Bardis (1982), Bulatao and Lee (1973), and Carballo et al. (1983), have studied the issue of acceptability in different countries. Overall, the findings indicate that a negative attitude toward contraception is not limited to specific age groups.

The family of origin plays an important role in contraceptive decisions (Hornick, Devlin, Downey, & Baynham, 1986). For example, parental suggestion to use condoms has been found to be significantly related to condom use among male African-American adolescents (Wilson, Kastrinakis, D'Angelo, & Getson, 1994). Hanson, Myers, and Ginsburg (1987) found that a significant reduction in adolescents' chances of out-of-wedlock pregnancy was associated with having been raised according to family values stressing responsibility. Further, unstable or deprived family environments have been found to characterize adolescent runaways who engaged in unsafe sex (Kaliski, Rubinson, Lawrance, & Levy, 1990). To be raised in a "problem family" appears to be one of the strongest correlates of contraction of the human immunodeficiency virus (HIV) in teenagers (Helge, 1989).

Stiffman, Earls, Robins, Jung, and Kulbok (1987) pointed out that birth control availability and education should be supplemented by family-oriented interventions in order to reduce teenage pregnancies. Tucker (1989) suggested that more intergenerational communication is necessary, identifying the mother as the best potential agent of sexual socialization for teenagers. Yalom, Brewster, and Estler (1981) found that 80% of college-educated mothers would help their daughters obtain contraceptives. The high level of education of the mothers might have contributed to their open-mindedness; nevertheless, it shows that some mothers are indeed supportive of contraceptive use by their daughters.

OBJECTIVES OF THE STUDY
The issues that underline low contraceptive use by female youths in Nigeria as confirmed by some contemporary literature have not been given serious attention. Some of such issues can be summarized by the following research questions, which translate into the objectives of the study.
1. To determine the knowledge of oral contraceptives amongst female undergraduates.
2. To determine the prevalence of the use of oral contraceptives amongst female undergraduates.
3. To determine the most prevalent contraceptives used by female undergraduates.
4. To determine the knowledge of female undergraduates about the common side effects of the use of oral contraceptives.
5. To evaluate the factors the influence their knowledge and perceptions of oral pill usage

RESEARCH QUESTIONS AND HYPOTHESES
RESEARCH QUESTIONS
1. What necessitated for oral contraceptive use among female undergraduates students?
2. What factors influence their knowledge and perceptions of oral pill?
3. What are the psychological and other correlates of contraceptive practices among female undergradute students in Nigeria
4. What strategies could be developed to improve use of oral pill by Nigerian female undergraduates?
RESEARCH HYPOTHESES
The research hypotheses to be tested in the course of this research work are stated below:
1. Female undergraduates are knowledgeable about oral pill
2. That the knowledge of contraceptives determines its usage amongst female undergraduates.
3. Oral pills are effective among female undergraduates in Nigeria.

RESEARCH METHODOLOGY AND DATA COLLECTION INSTRUMENT
Primary data shall be the basis of this research wok. The data shall be generated by means of a structured questionnaire instrument. Data required for the study include certain relevant socio-cultural characteristics of respondents, their knowledge of oral contraceptives and health implications, sexual relationships etc.

The questionnaire to be used shall be self-administered and a total of three hundred (300) undergraduates students would be selected from the higher institutions in Lagos State, for the purpose of this study. The sampling shall be done randomly such that the respondents shall cut across the University of Lagos, Lagos State University, Yaba College of Technology and Lagos State Polytechnic. The data, which would be collected from the questionnaire, will be presented and analysed using the simple percentage and chi-square methods.

SAMPLING DESIGN
The target population is the female undergraduate students in the University of Lagos. The population of female students in the University is estimated at about 15,000 students comprising of new and returning students. The sample is designed to accommodate all categories of female students in the University. In the whole school 300 respondents would be interviewed.
The sampling technique to used would be simple random sampling since one respondent would be selected from every second room in all the female students’ halls of residence. The main purpose of using the simple random sampling is to give every member of the population equal chance of being selected.

SCOPE OF THE STUDY
This project work shall discuss the prevalence of the use of oral pill among undergraduate female students in Nigeria, focusing mainly on the awareness of female youths on contraceptives usage and the health implications associated with it. The psychological and other correlates of contraceptive practices shall also be discussed in the course of the research.
The gathering of views on the subject matter shall be restricted to Lagos State with particular focus on female undergraduate students of University of Lagos, Lagos State University, Yaba College of Technology and Lagos State Polytechnic.

SIGNIFICANCE OF THE STUDY
This study would help to determine the knowledge of oral contraceptive and the extent of its use amongst female undergraduates. This will enable us to know the modalities for further educating the students on different forms of contraceptives, proper use of such contraceptives, side effects and suitability of the oral contraceptives on individual basis.

PLAN OF THE STUDY
This research work shall commence by providing a background of the subject matter justifying the need for the study, followed by related literature on contraceptive usage and practices by female undergraduates. The research method shall then outline before results are presented and discussed. Concluding comments shall reflect on limitations of the study and identify implications of the findings.

REFERENCES
Adedoyin M. and Adegoke A. A. (1995), Teenage prostitution-child abuse: a survey of ilorin situation, African Journal of Medicine and Medical Science, 24(1):27-31.

Adewole I.F, (1992) “Trends in postabortal mortality and morbidity in Ibadan, Nigeria”, International Journal of Gynaecology and Obstetrics,38(2):115-118.

Anate M, Awoyemi O and Oyawoye O. (1995), “Induced abortion in Ilorin, Nigeria”, International Journal of Gynaecology and Obstetrics,49(2): 197-198.

Akingba J.B, (1977) “Abortion mortality and other health problems in Nigeria”, Nigeria Medical Journal, 7(4): 4465-4471.

Araoye M.O. and Adegoke A. (1996), “AIDS-related knowledge, attitude and behaviour among selected adolescents in Nigeria”, Journal of Adolescence, 19(2): 179-181.

Arowoju A.O. and Adekunle A.O.(2000), “Perception and Practice of emergency contraception by post-secondary students in South West Nigeria”, African Journal of Reproductive Health, 4(1):56-65;

Barnhart K. T. and Sondheimer S.J. (1994), Emergency contraception, current opinion in obstetrics and Gynecology, 6 (6): 559 – 563.

Brabin L et al. (1995), Reproductive tract infections and abortions amongst girls in rural Nigeria, Lancet, 345(8945):300-304.

Federal Office of Statistics, Nigeria Demographic and Health Survey (DHS), Lagos, Nigeria: Office of Statistics, and Institute for Resource Development/Macro International, 1990.

Feyisetan B. and Pebley A.R. (1989), Premarital sexuality in urban Nigeria, Studies in Family Planning, 20(6):343- 354.

Gold M.A, Schein A. and Coupey S.M.(1997), Emergency contraception: a national survey of adolescent health experts, family planning perspectives, 29(1): 15 – 19;

Nnko S. and Pool R.(1997), Sexual discourse in the contexts of AIDS: dominant themes on adolescent sexuality among primary school pupils in Magu district, Tanzania, Health Transition Review, 7(Suppl.): 85-90;

Ladipo O.A, (1989) “Preventing and managing complications of induced abortion in third world countries”, International Journal of Gynaecology and Obstetrics, Supplement 3, pp. 21-28.

Oladepo O. and Brieger W. R. (1994), “AIDS knowledge, attitude and behaviour patterns among university in Ibadan, Nigeria”, African Journal of Medicine and Medicine and Medical Science, 23(2):119-125.

Okpani AOU and Okpani J.U.(2000), “Sexual activity and contraceptive use among female adolescents: a report from Port Harcourt, Nigeria”, African Journal of Reproductive Health, 4(1):40-47.

Okonofua F.E and Ilumoka A, (1992) Prevention of Morbidity and Mortality from Unsafe Abortion in Nigeria, Critical Issues in Reproductive Health, The Robert H. Ebert Program, New York: Population Council, 1992.

Okonofua F.E, (1994) “Induced abortion: a risk factor for secondary infertility in Nigeria women”, Journal of Obstetrics and Gynaecology,14(2):272-276.

Okonofua F.E, Onwudiegwu U. and Odunsi O.A, (1992) Illegal induced abortion: a study of 74 cases in Ile-Ife, Nigeria, Tropical Doctor, 2(2):75-78.

Okonofua F.E et al.(1996), Women's Experiences of Unwanted Pregnancy and Induced Abortion in Nigeria, Critical Issues in Reproductive Health, The Robert H. Ebert Program, New York: Population Council.

Okonofua F.E. et al. (1999), Assessment of health services for treatment of sexually transmitted infections among Nigerian adolescents, Sexually Transmitted Diseases, 26(3):184-190.

United Nations Population Fund (UNFPA), The State of the World Population, New York: UNFPA, 1997.

Keywords: oral pill, contraceptives, reproductive health, female undergraduates