Knowledge and Awareness Level of Contraceptive Usage Among Adolescents in Mankranso of Ahafo-Ano South District

Objectives: There is a major health and social problem in Ghana as a result of high levels of teenage pregnancy. Contraceptive use in Ghana among the adolescents is low and few studies have researched into it. The purpose of this study was to assess the level of knowledge, awareness and attitude towards the practice of contraception of the adolescents’ in Mankranso, Ghana. This is a cross-sectional study with a structured questionnaire. The responses were scored and analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: This study revealed that most of the adolescents lack knowledge about modern contraceptives such as jadelle and implanon. Majority of the respondents (94%) indicated that they have never used any contraception before. The main contraceptive device observed to have been used by respondents was condom (10%).Most of them strongly agreed that the use of contraceptive by a girl before her first birth can lead to infertility and use of condom does not make sex enjoyable. Religious doctrine and stigmatization were strongly agreed with index of 85% and 84% respectively as challenges faced by adolescents in seeking contraceptive services. Conclusion: This study showed that the level of knowledge on contraceptives usage among the adolescent was low. The usage of modern contraceptives was not preferred based on the negative attitude they have about contraceptives.


Background to the Study
Adolescence may constitute a period of both disorientation and discovery. The transitional duration may portray matters of freedom and self-identity; many adolescents and their peers face tough choices with respect to school activity, sex life, drugs, alcohol, and social life. Age groups, romantic looks and outward appearances normally tend to rise during teen's journey toward adulthood.
Motivating adolescent persons to find and use contraception is a universal public health concern. There is a great vacuum for contraception need and thus transforms into increased numbers of unplanned pregnancies and also a rise in maternal mortality in nations with poor maternal health delivery schemes. Therefore, bridging the great vacuum for contraception need is a vital focus in millennium development goal five. Internationally, plans are far advanced to cover up the great vacuum for contraception need; however, some countries see the progress in a very slowest pace [1].
In Ghana, there is a low patronage of contraceptive in adolescents because sexual maturity and introduction of sexual actions start at a younger age. This situation results in increase number of teenage pregnancies that constitute a huge health and social challenge in Ghana [2]. In spite of government policies to decrease the number of unintended pregnancies by ensuring contraception as a primary human right, the figure of adolescent pregnancies in Ghana remains increased. It is worth to note that a society with a great percentage of sexually active adolescents may possibly result into serious threat of pregnancies. The junior and senior high school pupils who engage in unprotected sexual activities as a result of risk-engaging conducts are becoming susceptible to Sexually Transmitted Infections (STIs), Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and unintended pregnancies. Most of the females at the age of nineteen (19) and below constitute thehuge-risk group of poor pregnancy outcomes in some part in Africa [3]. The rates of unsafe sexual practices and pregnancies are mainly great in junior and senior high school students in the villages in Ghana in which the use of contraception is still connected to religion. Huge number of adolescents is unable to access contraceptive, even though the services are freely accessible in the entire country.
Most pregnancies in senior high schools are unintended and as a result aborted unlawfully. This may be as a result of ignorance, lack of information and panic in adolescents' stage. This establishes a need to create awareness on adolescent sexual health reproduction. Adolescent pregnancy may be disadvantageous to individuals as well as the Country. Adolescents are of a higher peril than the adults in respect to infant birth weights, pre-term births, and infant deaths. Adolescent mothers are expected to record more of low level school achievements and high school dropout. Teenage mothers' children are obvious to continue a cycle of disadvantage where the likelihood of giving birth as teenagers will be high [4,5].
In Mankranso most adolescents are not able to complete the basic level to the senior high level due to unwanted pregnancies. In 2013, out of the total Antenatal Care (ANC) attendance, 772 were adolescent from the district, 28 had both unsafe and safe abortion.
Another data obtained from the district education office concerning school enrolment revealed that, many of the junior high pupils drop out at the primary level. All the four (4) basic schools in Mankranso have a total population of 1304 pupils at the primary level but have 471 pupils at the junior high school level, the number continue to reduce at the Senior High School (SHS ) level [6]. Adolescents are likely to be at peril for unplanned pregnancies, so identifying their level of information on contraceptives and conveying information to them is essential to prevent such pregnancies and underscores the need to carry out this study in Mankranso, Ghana.

Methodology
This study used a descriptive cross sectional study design and was carried out at Mankranso of AhafoAno-South District. This study was conducted at Mankranso because it has a lot of recorded cases of teenage pregnancies. The target population of this study was made up of adolescents from both public and private Junior Secondary Schools in Mankranso. We selected two hundred (200) pupils from the JHS 1 and 2 in four different schools using stratified and simple random technique. Fifty (50) pupils were selected from each school, they were grouped into two distinct classes, males and females, and were selected randomly by labelling 25 pieces of papers 1 and 0 .Those who selected the Figure 1 were selected for the study. A structured questionnaire was used to collect the data. The questionnaires were divided into six (6) Table 1 presents the results of the demographic data of the respondents. It was observed that 52% were in the age group of 12-14 years, 42% were in the age group of 15-17 years and 6% were in the age group 18-20 years. The study covered 50% male and 50% female which showed gender balance. All the respondents were singles. The study observed 50% representing charismatic/ Pentecostal Christians, 41%representing Catholic/Anglican Christians and 9% representing Islam. The study investigated the age respondents had their menarche first menstruation or spermarche (first ejaculation). It was observed that 73% representing majority of the respondents had their menarche first menstruation or spermarche (first ejaculation) at the age between 12-14 years. It was revealed 18% had it between age group of 15-17 years, 6 % also had it at age group 18-20 years and those who had it below 12 years were 5 %. It was observed that about 97 % of the respondents had no children. However, 2.5 % indicated they have 1-2 children.

Attitude Towards Contraception
It was observed from the results in Table 3   Use of contraception is important for adolescent having sex was also strongly agreed by 41% of the respondents and 20% agreed.
The mean scores and the standard deviation of each measure of agreement have been presented in Table 4, as well as the relative index. It was observed that the use of contraceptive by a girl before her first birth can lead to infertility had a mean score of 4.43 with low standard deviation showing averagely students agree to the statement. The relative index was observed to be high, thus 89 % being ranked first among the variables. The second ranked among the variables was People who insist on condom use are promiscuous with index of 83 % and mean score of 4.17. Sex is not enjoyable when I use condom was also significantly agreed by respondents with index of 82 % and mean score of 4.1. This means that averagely respondents agreed to the statement "sex is not enjoyable when I use condom".

Challenges the Adolescents Face in Seeking Contraceptives Services
The results in Table 5, demonstrated the challenges adolescents face a lot in seeking contraceptive services. The most challenges observed among them were challenges ranked from one to four. for especially adolescent girl who are in school were indicated by respondents averagely agreed, with indexes ranging from 76% to 72% and mean scores from 3.82 to 3.61. Statements ranked from 9 to 13 were observed that averagely respondents were uncertain about them. Their mean scores ranged from 3.31 to 3.09 and indexes ranged from 66% to 62%. radio and television and among the people who were exposed to radio message on family planning, 75% approved of the message.
Results from GDHS [12] also showed that less than half of adolescent males and females have heard or seen family planning in the mass media via community forum. Previous studies [13][14][15][16] have indicated that the commonest source of information about contraception was through friends, health institution and family planning clinics despite the fact that these are dedicated specifically to such duties. Information obtained from friends about the use and practice of contraception is often misleading as they contain a lot of misinformation, distortion, falsehood and misconceptions, and often at times self-centered [15,17].
The relative index of 'use of contraceptive by a girl before her first birth can lead to infertility' was observed to be high, thus was ranked first among the variables in this study. This finding was consistent with an article published in The Guardian: Global Development Professionals Network in 2014 that examined contraception use among adolescent girls, Venkatraman Chandra-Mouli and Karlien Braet [11] found out that erratic availability, cost, laws and policies prevent unmarried adolescents in low and middle income countries from accessing contraceptives.
Even when there were no legal restrictions, health workers often refused to provide unmarried adolescents with contraceptives because they did not approve of premarital sex. And when they did provide contraceptives, they often limit these to condoms, wrongly believing that long-acting hormonal methods and intra-uterine devices were inappropriate for all young women and those who had no children. Even when adolescents were able to obtain contraceptive methods, social pressure might prevent their use. In the same study they found out that adolescents in many places have misconceptions about health effects of contraceptives, including their future ability to bear children. Again, this study revealed that people who insist on condom use are promiscuous with index of 83 % and mean score of 4.17 was ranked second among the variables.
This finding tallied with Adinma et al. [18] who apparently made a similar observation that girls who did carry condoms around might be perceived as being sexually available; a situation that would reduce their eligibility as potential wives. Such beliefs have been found to produce a strong negative influence on condom use among University Nigerians. Some girls feel that a partner's wish to use condom suggests that, they are not clean and that they are commercial sex workers or that they are involved in more sexual relationship. This study revealed that most of the respondents agreed to the fact that sex is not enjoyable when they use condom.
This finding was also consistent with a study by Agyei and Epema

Conclusion
This study found out that the level and attitude towards the use of contraceptives among adolescents is very low and only few of them have ever used or currently using effective contraceptive methods. Their main source of getting information on contraception is their teachers, followed by television and others. Very few of them get information on contraception from the internet. Most of them are not using modern contraceptives due to the negative attitude they have about contraceptives, they strongly agreed that the use of contraceptive by a girl before her first birth can lead to infertility and the use of condom does not make sex enjoyable.