Contraceptive literacy among school-going adolescents in Botswana

Aim

To examine adolescent contraceptive literacy and condom knowledge in Botswana.

Background

In Botswana, adolescent HIV infection rates remain high and unintended pregnancies are the predominant reason girls drop out of school. Despite a national mandate for comprehensive sexuality education and youth‐friendly health services, access to accurate sexual and reproductive health information for adolescents remains limited.

Methods

Two hundred forty adolescents attending secondary schools in Maun, Botswana, completed cross‐sectional surveys in 2020. Bivariate and logistic regression examined factors associated with contraceptive literacy and self‐reported condom knowledge.

Findings

Although 90% of students were aware of one or more forms of contraception, only 67% could name a method for which they knew a source and only half of sexually active respondents had used birth control during their last sexual experience. Respondents reported that teachers and family members were the most important sources of information; only 8.2% of respondents identified health professionals in that role. Adolescents who consulted nurses had eight times greater odds of reporting correct condom‐use knowledge than those who consulted teachers.

Implications for Nursing Policy

The positive association between adolescents’ condom‐use knowledge and nurses as information resources supports a call to expand nurses’ role in health education in secondary schools and clinics in Botswana. Education and training programs for health professionals that build communication skills for working with adolescents should be promoted as an essential step in youth‐friendly service provision.

Conclusion

Contraceptive literacy among adolescents in Botswana is low and may contribute to risk behaviors that drive rates of HIV and pregnancies in this population. Interventions to reduce adolescent HIV risk behaviors and unintended pregnancy may prove more effective if they involve nurses as communicators and educators.

Sexual and reproductive health knowledge and behaviour of adolescent boys and girls aged 10-19 years in western Kenya: evidence from a cross-sectional pilot survey

This paper reports findings of a pilot survey of adolescent sexual and reproductive health (ASRH) knowledge and behaviour in Homabay County of western Kenya. The study was based on a cross-sectional survey of 523 male and female adolescents aged 10-19 years from 32 Community Health Units (CHUs). Bivariate analysis of gender differences and associations between ASRH knowledge and behaviour was followed with two-level logistic regression analysis of predictors of ASRH behaviour (sexual activity, unprotected sex, HIV testing), taking individual adolescents as level-1 and CHUs as level-2. The findings reveal important gender differences in ASRH knowledge and behaviour. While male adolescents reported higher sexual activity (ever had sex, unprotected last sex), female adolescents reported higher HIV testing. Despite having lower HIV/AIDS knowledge, female adolescents were more likely to translate their SRH knowledge into appropriate behaviour. Education emerged as an important predictor of ASRH behaviour. Out-of-school adolescents had significantly higher odds of having ever had sex (aOR=3.3) or unprotected last sex (aOR=3.2) than their in-school counterparts of the same age, gender and ASRH knowledge, while those with at least secondary education had lower odds of unprotected sex (aOR=0.52) and higher odds of HIV testing (aOR=5.49) than their counterparts of the same age, gender and SRH knowledge who had primary education or lower. However, being out of school was associated with higher HIV testing (aOR=2.3); and there was no evidence of significant differences between younger (aged 10-14) and older (aged 15-19) adolescents in SRH knowledge and behaviour. Besides individual-level predictors, there were significant community variations in ASRH knowledge and behaviour, with relatively more-deprived CHUs being associated with poorer indicators. The overall findings have important policy/programme implications. There is a need for a comprehensive approach that engages schools, health providers, peers, parents/adults and the wider community in developing age-appropriate ASRH interventions for both in-school and out-of-school adolescents in western Kenya.