CHAPTER 4

Analysis and presentation of data

4.1 INTRODUCTION

This chapter discusses the data analysis and findings from 34 questionnaires

completed by nurses in Eastern Samar Provincial Hospital. The purpose of this

study is to assess the knowledge, attitude and practices on disaster risk

reduction and management of the nurses in ESPH during covid-19.

Specifically, it aims to find the following:

 The demographic profile of the respondents in terms of age, gender,

civil status, and work experience

 The level of knowledge of ESPH nurses on disaster risk reduction

and management during covid-19.

 The attitude level of ESPH nurses towards disaster risk reduction

and management during covid-19.

 The relationship of the demographic profile of ESPH nurses to the

level of knowledge on disaster risk reduction and management during

covid-19.

 The relationship of the demographic profile of ESPH nurses to their

attitude towards disaster risk reduction and management during covid-

19
47
The researchers coordinated with the head of the Eastern Provincial Hospital

(ESPH) for the permission to conduct the study among the respondents. Upon

approval, the researchers will then be coordinating with the Department Heads of

every departments to be notified and be well-informed regarding the research

study to be conducted. The questionnaires will be administered through

distribution of forms to the respondent as the domain to gather and tally

information.

A total of one hundred and seven (107) adolescent mothers completed

questionnaires at the two participating well-baby clinics between 12 July 2004

and 3 September 2004.

The data from the questionnaires were statistically analysed by a statistician. The
SPSS version 11 program was used for the data analysis. The findings are
discussed according to the sections of the questionnaire and then with reference
to the three components of the HBM. The four sections of the questionnaire were:

• Section A: Personal (biographical) data

• Section B: Sex education
• Section C: Knowledge of contraceptives
• Section D: Termination of pregnancy

48
The HBM was used to contextualize the literature review (see chapter 2). The
three main components of the HBM, namely individual perceptions, modifying
factors and variables affecting the likelihood of adolescent mothers’ utilisation of
contraceptives were used to summarise the findings (Onega 2001:271).

4.2 PERSONAL (BIOGRAPHIC) DATA

This section of the questionnaire covered the respondents’ age, race, home
language, highest school qualification and household monthly income. Though
not central to the study, the personal data helped contextualise the findings and
the formulation of appropriate recommendations to enable more adolescents to
utilise contraceptives to prevent unplanned pregnancies.

4.2.1 Respondents’ ages

The respondents were asked how old they were at their previous birthdays.
Table 4.1 depicts the respondents’ ages.

Table 4.1Respondents’ ages at the time of completing the questionnaires

AGE FREQUENCY PERCENTAGE
14 years 2 1,87
15 years 20 18,69
16 years 24 22,43
17 years 22 20,56
18 years 20 18,69
19 years 19 17,76
TOTAL 107 100,00
The adolescent mothers’ ages ranged from 14 to 19, with the majority being 16 as
24 (22,43%) respondents were at this age. It should be borne in mind that
adolescent mothers aged 14 probably became pregnant while they were only 13
years old, indicating that sex education and knowledge about contraceptives
need to be attained by the age of 12 or even earlier.

49
4.2.2 Race

Of the 107 respondents, only one was Coloured, one was White and 105 were
Black hence only Black adolescent mothers were well represented in the sample.
This means that the research results might not be generalisable to adolescents of
all racial groups in the Piet Retief (Mkhondo) area.

4.2.3 Home language

Of the respondents, 101 (94,39%) were Zulu-speaking. Only Zulu-speaking

adolescents were well represented in the sample, which means that the research
results might not be generalisable to adolescents with home languages other
than Zulu. These findings correlate with the fact that almost all the respondents
were Black. It also indicates that most of the Black adolescent mothers were
Zulu-speaking, probably because the two participating clinics were in areas where
predominantly Zulu-speaking people live. The implication of this finding is that
sex education and knowledge about contraceptives should be conveyed in Zulu
to reach the majority of adolescent women.

4.2.4 Highest school qualification

Table 4.2 represents the highest level of school education that the adolescent
mothers had obtained. Of the respondents, 59 (55,14%) had passed Grades 10
to 12 and only 2 (1,87%) had passed Grades 1 to 3, corresponding with the small
number of adolescent mothers aged 14 (as indicated in table 4.1). This implies
that with more knowledge and better accessibility to contraceptives, more
adolescent mothers might have been able to complete their schooling prior to
commencing childbearing.

50
Table 4.2 Highest school qualification

GRADE FREQUENCY PERCENTAGE

1-3 2 1,87
4-6 11 10,28
7-9 35 32,71
10-12 59 55,14
TOTAL 107 100,00
In a study of adolescent mothers’ utilisation of reproductive health services in
Gauteng Province, RSA, Ehlers et al (2000:46) reported that the majority had
passed Grades 10 to 12. If the respondents had used contraceptives effectively,
more could have completed their schooling (passed Grade 12) prior to becoming
mothers. Having completed their schooling would have afforded the mothers
more opportunities to continue with post-school education or training and earn
better salaries. Better education would benefit not only the adolescent women
but also their children.

4.2.5 Household income

The monthly household income revealed that 72 (67,29%) of the respondents

were from lowincome groups. Four (3,74%) respondents did not answer this
question. Adolescent mothers can use contraceptives to prevent unplanned
pregnancies and thus improve their educational and/or economic status prior to
commencing with childrearing responsibilities. Hatcher et al (1997:2-22)
emphasise that “family planning helps nations develop.
Table 4.3 Monthly household income
RANDS FREQUENCY PERCENTAGE
R0-R999 72 67,29
R1 000-R1 14 13,08
999
R2 000-R2 7 6,54
999
R3 000-R3 3 2,80
999
R4 000-R4 3 2,80

51
999
R5 000-R5 2 1,87
999
R6 000 2 1,87
and
more
No response 4 3,74
TOTAL 103 100,00
In countries where women are having far fewer children than their mothers did,
people’s economic situations are improving faster than in most other countries.”
Although contraceptives are available free of charge at clinics in the Piet Retief
(Mkhondo) area, the adolescent mothers could still require funds for transport
costs should the clinics not be within walking distance from their homes.

4.2.6 Summary of personal data

Section A revealed the respondents’ age distribution, racial group, home

languages, highest school qualification, and monthly (30 days) household
income. Most of the respondents were 16 years old (22,43%), mostly African
(98,13%), Zulu-speaking (94,39%), had passed Grades 10 to 12 (55,14%) and
had a low monthly household income (67,29%).

4.3 SEX EDUCATION

This section consisted of six questions about sex education received by the
participating adolescent mothers at different stages of their lives, in relation to
potentially significant events in their lives, such as their age at their first sex
encounter (sometimes referred to as “sexual debut” in the literature review).

52
4.3.1 Age at first sexual encounter

This question was asked to identify whether or not the respondents had received
sex education prior to their sexual debut.

Table 4.4 Age at first sexual encounter

AGE FREQUENCY PERCENTAGE
12 3 2,80
13 9 8,41
14 20 18,69
15 29 27,10
16 25 23,36
17 16 14,95
18 4 3,74
19 1 0,93
Knowing the age at which they had their sexual debuts should indicate before
what age sex education as well as contraceptive information should be provided.
This is important to enable adolescent women to make informed decisions prior
to embarking on sexual intercourse. Learning about contraceptives only after
becoming pregnant might deprive many young women of the opportunity to make
informed decisions about their own and their children’s futures.

35

30 Age in
years
25
Frequency

20

15

10

12 13 14 15 16 17 18 19

53
 Figure 4.1 Age at first sexual encounter

Table 4.4 and figure 4.1 reveal that of the 107 adolescent mothers, 102 (95,33%)
had engaged in sexual intercourse by the time they reached the age of 17. It is
important to study the age at first sexual intercourse to identify adolescents at risk
before they engage in unprotected sexual intercourse. Measures could then be
taken to prevent or delay pregnancy through education about sexual intercourse,
pregnancy and contraception, before the age of 12. From tables 4.1 and 4.4
there appears to be a correlation between “age at time of data collection” and
“age at time of first sexual encounter”. The modal age when they had sex for the
first time was 15 (table 4.4) and the modal age of the respondents at their
previous birthdays was 16 (table 4.1). These findings could mean that there are
possibly factors contributing to adolescent mothers’ non-utilisation of
contraceptives at their sexual debut.

4.3.2 Reasons for sex for the first time

This question aimed to identify reasons why the respondents engaged in sexual
intercourse for the first time. Four reasons and a space for other reasons, which
respondents could specify, were provided. Only one respondent did not reply to
this question but the other 106 chose from the reasons provided as depicted in
table 4.5.

Table 4.5Reasons for respondents’ sexual debut

REASON FREQUENCY PERCENTAGE

Did not 62 57,94

know
Loved 32 29,91
partner
Requested by 4 3,74
partner
54
Peer 8 7,48
pressure
No 1 0,93
response
TOTAL 107 100,00

Although the 62 (57,94%) respondents who indicated that they did not know why
they had sex for the first time did not elaborate on this, it can be assumed that
sex education and contraceptive knowledge might have enabled them to make
better informed choices about their own and their children’s futures, by either
using contraceptives effectively themselves or insisting that their partners use
condoms effectively – avoiding both unplanned pregnancies and STIs.

4.3.3 Number of children the respondents had

The respondents were asked to indicate how many children they had. Figure 4.2
represents the number of children. Of the respondents, 96 (89,72%) had one
child and 11 (10,28%) had two children. Being an adolescent mother aged 19 or
younger with one child could be a challenge, but with two children it could
become a major challenge to cope physically, emotionally and financially. The
finding that 11 adolescent mothers had two children indicates the urgent need to
continue to provide health education and contraceptive information to adolescent
mothers – even after the birth of their babies.

55
 96.00 %

One child each

Two children
each

11.00 %

Figure 4.2 Number of children each adolescent mother had

4.3.4 Age at birth of first child

The respondents were asked how old they were when their first child was born.
The modal age was 17 (n=41; 38,32%). These findings seem to correlate with
those portrayed in table 4.4, which indicates that they were 15 and 16 at their
sexual debut (see bimodal distribution in table 4.4).

Table 4.6Respondents’ ages when their first children were born

AGE FREQUENCY PERCENTAGE

Up to 14 4 3,74
15 16 14,95
16 24 22,43
17 41 38,32
18 13 12,15
19 8 7,48
No response 1 0,93
TOTAL 107 100,00
The implication of this finding is that at the age of 17 the respondents could not
have progressed beyond Grade 10 or 11 in their schooling. If they could have
been empowered to postpone their childbearing for one or two years, should they
have desired to do so, they might have successfully completed their schooling
(passed Grade 12) thereby enhancing the possibility of finding gainful
56
employment and perhaps pursuing post-secondary education pursuits – even
after the birth of their children. However, an incomplete school career may imply
greater hardship for adolescent mothers and their children than a successfully
completed school career.

Figure 4.3 presents a comparison of the respondents’ ages at their previous

birthdays, their sexual debut and the birth of their first child. Ages 15 and 17
seem to be significant in the lives of these adolescent mothers. This supports
Stanhope and Lancaster’s (2001:810) finding that many pregnant teenagers fell
into the 15 to 17 years old age group.

45

Had sex
40
for the
35 first
time
30 Age at
last
Frequency

25 birthday Age
when first
20 child was born

15

10

12 13 14 15 16 17 18 19 19
Figure 4.3
Adolescent mothers’ significant ages

(Combination of facts from tables 4.4, 4.1 and 4.6).

57
4.3.5 Age at which sex education was provided

Table 4.7 depicts the ages at which the respondents received information about
menstruation, sexual intercourse, conception (pregnancy) and contraceptives.

Table 4.7 Age at which information was received about menstruation,

sexual intercourse, pregnancy and contraceptives
AGE IN MENSTRUATION SEXUAL PREGNANCY CONTRACEPTIVES
YEARS INTERCOURSE
FREQUENC PERCENTAG FREQUENC PERCENTAG FREQUENC PERCENTAG FREQUENC PERCENTAG
Y E Y E Y E Y E

up to 12 26 24,30 11 10,28 13 12,15 7 6,54

13 20 18,69 8 7,48 2 1,87 2 1,87
14 21 19,63 28 26,71 13 12,15 8 7,48
15 16 14,95 16 14,95 20 18,69 18 16,82
16 10 9,35 17 15,89 26 24,30 21 19,63
17 4 3,74 12 11,21 14 13,08 15 14,02
18 1 0,93 3 2,80 4 3,74 7 6,54
19 - - - - 2 1,87 4 3,74
No 9 8,41 12 11,21 13 12,15 25 23,36
respons
e
MENSTRUATION SEXUAL PREGNANCY CONTRACEPTIVES
INTERCOURSE
TOTAL 107 100,00 107 100,00 107 100,00 107 100,00
Table 4.7 as well as figure 4.4 indicate that of the respondents, 21 (19,63%)
received information about menstruation at 14; 28 (26,71%) on sexual intercourse
at 14; 26 (24,30%) about pregnancy at 16; and 21 (19,63%) on contraceptives at
16 years of age. Figure 4.4 indicates that very few adolescent girls knew about
sexual intercourse, pregnancy or contraceptives if they started menstruating at
the age of 12. Although most respondents were reportedly informed about sexual
intercourse at the age of 14, few were informed about pregnancy and even fewer
about contraceptives. In order to make informed decisions adolescent girls
seem to need information about menstruation, sexual intercourse, pregnancy and
contraceptives before they reach the age of 12. Thereafter this information might
need to be provided at repeated intervals in order to enhance their knowledge
and understanding about sexual issues and thus their capability to make informed
decisions affecting their own lives but also the lives of their families and their
children.

58
 Information received at specific ages

30

25

20
Menstruation
Age in years

Sexual intercourse
15
Pregnancy
10 Contraceptives

0
13

14

15

16

17

18

19
12

e
ns
to

o
sp
up

-
re
no

Types of information

Figure 4.4

Ages at which adolescent mothers received specific types of sexual

information

4.3.6Sources providing sex education

The respondents indicated that they received information about menstruation,

sexual intercourse, pregnancy and contraceptives from the sources/persons
specified in table 4.8.

Of the respondents, 80 (74,77%) received information from their mothers. Other

sources in order of frequency were clinic nurses, friends, teachers,
magazines/newspapers, television, radio, fathers and sisters. This question
allowed the respondents to indicate more than one source and to specify other

59
sources that were not on the list. However, only two specified “other: sister” as
indicated in table 4.8.

Table 4.8 Sources providing sex education

SOURCE O FREQUENC PERCENTAG

INFORMATION F Y E
Mother 80 74,77

Father 7 6,54

Teacher 18 16,84

Friend 20 18,69

Clinic nurse 25 23,36

Television 14 13,08

Radio 12 11,21

Magazine/ 16 14,95
newspaper
Other: sister 2 1,87

Although information about menstruation, sexual intercourse, pregnancy and

contraceptives was received mostly by the time they had reached 14 to 16 years
of age, all the respondents fell pregnant. From the findings, then, sex education
failed to prevent the adolescents from engaging in unprotected sexual
intercourse. This is shown in table 4.4 where 29 (27,10%) of the respondents
had had sex for the first time at the age of 15. Of the respondents, 28 (26,71%)
received information on sexual intercourse at 14 years old as illustrated in figure
4.8, indicating that many of the respondents had received sex education prior to
their sexual debut, yet failed to use effective contraceptives effectively. As the
majority of the adolescent mothers received sex education from their mothers, it
might be worthwhile to update the mothers’ knowledge about contraceptives for
them to impart knowledge to their daughters about the effective utilisation of
contraceptives to prevent unplanned pregnancies. This may be a constructive

60
and valuable effort to help adolescents to make better informed decisions about
preventing unplanned pregnancies.

4.3.7 Ways in which sex education was presented

Respondents could indicate that they received sex education in different ways.
As each respondent could tick a number of presentations, these totals do not add
up to 107.

Table 4.9 Sex education presentations

SOURCE OF FREQUENCY PERCENTAGE

INFORMATION
Book 14 13,08
Video 6 5,61
Lecture 25 23,36
Personal discussion 78 72,90
Other: no response 107 100,00
Table 4.9 reveals that 78 (72,90%) of the respondents received information about
menstruation, sexual intercourse, pregnancy and contraceptives through personal
discussion. Personal discussion makes the adolescent feel comfortable about
asking questions and encourages participation in such discussions. However, as
the majority of the respondents received this sex education from their mothers,
some information about the effective utilisation of contraceptives to prevent
unplanned pregnancies may have been lacking, because all these adolescents
became mothers despite sex education from their mothers.

4.3.8Summary of sex education

The results in section B indicate that of the respondents, 29 (27,10%) had had
sex for the first time at the age of 15, 62 (57,94%) did not provide specific
reasons for their sexual debut, 96 (89,72%) had one child, and 41 (38,32%) gave

61
birth to their first child at the age of 17. Information about menstruation, sexual
intercourse, pregnancy and contraceptives was mostly received at the age of 14
to 16 and chiefly from mothers through personal discussion. The findings
indicate that there may be a lack of accurate contraceptive information/knowledge
to enable adolescent women to use contraceptives to delay childrearing should
they so wish.
4.4 KNOWLEDGE OF CONTRACEPTIVES

This section of the questionnaire consisted of 26 questions on contraceptive

knowledge. Most of the questions were closed items requiring the respondents to
reply “yes” or “no”, but spaces were provided for them to specify, explain or state
reasons in their own words should they wish to do so.

4.4.1 Clinic visits for contraceptives

The respondents were asked whether they ever visited a clinic to acquire
contraceptives.

Table 4.10Clinic visits for contraceptives

RESPONSE FREQUENCY PERCENTAGE

Yes 50 46,73
No 56 52,34
No response 1 0,93
TOTAL 107 100,00
Of the respondents, 50 (46,73%) had visited clinics for contraceptives, 56
(52,34%) had never done so and only one did not reply to this item. Adolescents
would appear to need more information about contraceptives and clinics
providing contraceptives free of charge in the Piet Retief (Mkhondo) area.
However, as 50 (46,73%) of the respondents reported visiting clinics for
contraceptives, and nevertheless fell pregnant, the services and health education

62
actually provided to adolescents at these clinics might be suspect of failing to
provide effective contraceptive services and education.

Every adolescent who visits a clinic is entitled to receive health education and
contraceptives free of charge. If this were the case, and if the respondents had
used the contraceptives effectively, then they should not have fallen pregnant.
Furthermore, if the services and health education provided at the clinics had been
effective, the pregnant adolescents should have been able to access and utilise
ECs and/or TOP services should they have wished to do so in order to postpone
their childbearing until they had completed their schooling or until deciding to
have children.

4.4.2 Utilisation of contraceptives

The respondents were asked to indicate whether or not they had ever used
contraceptives.

Table 4.11Utilisation of contraceptives

RESPONSE FREQUENCY PERCENTAGE

Yes 54 50,47
No 53 49,53
TOTAL 107 100,00
From tables 4.10 and 4.11 it appears that 50 (46,73%) of the respondents had
visited clinics to obtain contraceptives, but 54 (50,47%) had, in fact, used
contraceptives. The fact that three of the respondents reported that they had
never visited a clinic for contraceptives and one did not answer the question, but
had used contraceptives could mean that the contraceptives were obtained from
their friends, mothers or private sources, such as pharmacies. However, the last
possibility might be unfeasible in view of the low monthly family household

63
incomes reported by the respondents, making it unlikely that they would be able
to afford to pay for contraceptives provided by private suppliers.

4.4.3 Contraceptives used

Table 4.12 presents the contraceptive methods used.

Table 4.12Contraceptives used

CONTRACEPTIVE FREQUENCY PERCENTAGE

METHOD
Pills 6 5,61
Injections 28 26,71
Intra-uterine - -
contraceptive
device
Condoms 32 29,91
Other methods 1 0,93
(unspecified)
Multiple methods 2 1,87
No response 38 35,51
TOTAL 107 100,00
Of the respondents, 32 (29,91%) used condoms, 28 (26,17%) used injections, 6
(5,61%) used contraceptive pills, 0 indicated using an IUCD, and 38 (35,51%) did
not reply to this question, which could indicate their non-utilisation of
contraceptives. No reasons for making limited use of contraceptive pills and no
use of IUCDs could be derived from the questionnaires.

4.4.4Choice of contraceptive methods at clinics

The respondents were asked whether they were allowed to choose a

contraceptive method at their clinics.

It could not be determined why 32 (29,91%) of the respondents reported not

being able to choose a contraceptive method at their clinics. Such a choice

64
should be encouraged, as the same method might not necessarily be suitable for
all adolescents.

Table 4.13Ability to choose a contraceptive method at clinics

RESPONSE FREQUENCY PERCENTAGE

Yes 68 63,55
No 32 29,91
No response 7 6,54
TOTAL 107 100,00
Of the respondents, 68 (63,55%) reported that they were allowed to choose a
contraceptive method at their clinics and 7 (6,54%) failed to reply to this question,
probably because they did not know whether or not their clinics allowed a choice
of contraceptive methods. Despite the adolescent mothers’ ability to choose a
contraceptive method, they failed to use contraceptives effectively and still had
children. It was noted that 54 (50,47%) of the respondents (see table 4.11)
indicated that they had ever used contraceptives, while 68 (63,55%) reported that
they would be allowed to choose a contraceptive method at their clinics. These
numbers might indicate that some of the respondents were aware that they would
be allowed to choose a contraceptive method at their clinics, even if they
themselves had never used contraceptives. They may have obtained such
information from their peers.

4.4.5 Utilisation of traditional contraceptives

The respondents were asked whether they had used any traditional contraceptive
methods.

Table 4.14Use of traditional contraceptive methods

RESPONSE FREQUENCY PERCENTAGE

Yes 9 8,41
No 95 88,79

65
No response 3 2,80
TOTAL 107 100,00
Table 4.14 indicates that 95 (88,79%) of the respondents had reportedly never
used traditional contraceptive methods, while 9 (8,41%) had used traditional
methods such as tying a rope around the waist, mixing medicines with menstrual
blood, drinking traditional medicines. Only one respondent specified a traditional
contraceptive method that was not listed, namely “double bay”.
Table 4.15 illustrates the traditional methods used.

Table 4.15 Types of traditional contraceptives used

TRADITIONAL METHOD FREQUENCY PERCENTAGE

USED
Tying a rope around the 2 1,87
waist
Mixing medicines with 1 0,93
menstrual blood
Drinking traditional 7 6,54
medicines
Other methods 6 5,61
Specified other: double 1 0,93
bay
No response 90 85,05
TOTAL 107 100,00
Table 4.15 reveals that 17 (15,89%) of the respondents used traditional methods
and this could have contributed to their pregnancies since the effectiveness of
these methods has not been scientifically proven. This argument could not be
supported nor refuted from the information available from the completed
questionnaires because an unknown number of adolescents might have
successfully avoided pregnancies by using traditional contraceptive methods,
who would thus not be adolescent mothers and who would thus be excluded from
participation in this study. Moreover, the other 90 respondents, who did not report
that they had used traditional contraceptives, also became pregnant. It could not
be explained why in table 4.14, 95 respondents said they had not used traditional
contraceptive methods, while in table 4.14 only 90 claimed this to be the case.
However, the respondents might have encountered some difficulty in
66
understanding all the questions, and the alternative answers supplied as they
completed the questionnaires by themselves. If the respondents could have
been traced for follow-up interviews, then this apparent discrepancy might have
been resolved. However, as the questionnaires were completed anonymously
such follow-up investigations could not be done and the data had to be accepted
as indicated by the respondents on the questionnaires. A possible explanation
might be that some adolescent mothers might have been unfamiliar with the term
“traditional contraceptives”.

4.4.6 Problems with receiving contraceptives or information

The respondents were asked whether they experienced any problems with
receiving contraceptives and/or family planning information.

Table 4.16Problems with receiving contraceptives or information

RESPONSE FREQUENCY PERCENTAGE

Yes 10 9,35
No 84 78,50
No response 13 12,15
TOTAL 107 100,00
Table 4.16 indicates that of the respondents, 84 (78,50%) did not experience
problems with obtaining contraceptives or family planning information. The
respondents were asked to explain any problems they encountered with receiving
contraceptives or family planning information.

Table 4.17 Description of problems with receiving contraceptives or

information

PROBLEMS FREQUENCY PERCENTAGE

Draining water per 1 10,0
vagina
Prolonged 5 50,0
menstruation
Varicose veins 1 10,0
Swollen legs 1 10,0

67
Lower abdominal 1 10,0
pains
No explanation of 1 10,0
problem
10 100,0
TOTAL
From table 4.17 it is clear that the problems stated by 10 (9,35%) of the
respondents were not related to receiving contraceptives or information per se
but were due to side effects of some contraceptives. The respondents may have
misunderstood this question.

4.4.7 Knowledge about contraceptives before pregnancy

The respondents were asked whether they had known about

contraceptives/family planning before they started menstruating, had sexual
intercourse or became pregnant.

Table 4.18Knowledge about contraceptives before pregnancy

CONTRACEPTIVE MENSTRUATION SEXUAL PREGNANCY

METHOD INTERCOURSE
FREQUENCY PERCENTAGE FREQUENCY PERCENTAG FREQUENCY PERCENTAGE
E
Emergency 19 17,76 74 69,14 14 13,08
contraceptives
Oral contraceptives 23 21,50 55 51,40 29 27,10
Injections:Depo-provera 34 31,78 47 43,93 26 24,30
Nur-Isterate 28 26,17 52 48,60 27 25,23
Intra-uterine 14 13,08 61 57,10 32 29,91
contraceptive device
Condoms 57 53,27 22 20,56 28 26,17
From table 4.18 it is evident that the respondents had known about a number of
different contraceptives/family planning methods before they became pregnant.
The data in table 4.19 about contraceptives used does not correlate with data in
table 4.18 because knowledge about contraceptives did not result in the
respondents’ utilisation of contraceptives to prevent unplanned pregnancies.
Factors other than knowledge may have contributed to the respondents’ non-
utilisation of contraceptives prior to their pregnancies. Table 4.18 indicates that

68
57 (53,27%) of the respondents had knowledge about condoms before they
started menstruating. However, they did not use condoms because they had
children despite their knowledge. Similar results about other contraceptive
methods are found in table 4.19, which indicates that although the respondents
knew about different contraceptives, they failed to use contraceptives effectively
to prevent unplanned pregnancies.

4.4.8 Contraceptive use before pregnancy

The respondents were asked whether they had actually used contraceptives
before becoming pregnant.

Table 4.19Contraceptive use before pregnancy

RESPONSE FREQUENCY PERCENTAGE

Yes 17 15,89
No 88 82,24
No response 2 1,87
TOTAL 107 100,00
Although most of the respondents knew about different contraceptives prior to
their pregnancies, only 17 (15,89%) had actually used contraceptives prior to
conception. The respondents were asked to indicate what contraceptive method
was used.

Table 4.20Contraceptive method used before pregnancy

CONTRACEPTIV FREQUENC PERCENTAG

E USED Y E
Emergency 2 11,76
contraceptive
Oral 1 5,88
69
 contraceptives
(pills)
Condoms 10 58,82
Multiple methods 4 23,53
TOTAL 17 100,00
From tables 4.19 and 4.20 it is evident that only 17 (15,89%) of the respondents
used contraceptives before pregnancy and that the contraceptive methods used
were condoms, ECs and oral contraceptives. No further deductions could be
made about the four respondents who reported using multiple methods. It is not
known whether they used different methods at different times or concurrently.
Although 10 of the respondents reported having used condoms before their
pregnancies, they nonetheless became pregnant, which might indicate that the
condoms had not been used properly or that they had insufficient knowledge
about condom usage. However, if condoms had been used effectively, the 10
respondents may have been able to postpone their pregnancies until they had
completed their schooling. The two respondents who used ECs did not indicate
what methods were used or why the ECs did not prevent the pregnancies.
Further exploration of adolescents’ actual knowledge about ECs and condoms
might help to reduce the number of unplanned adolescent pregnancies in the Piet
Retief (Mkhondo) area in future.

Of the respondents, 88 (82,24%) indicated that they did not use contraceptives
before pregnancy (see table 4.19). However, it should be borne in mind that
there may be perceived benefits of the non-utilisation of contraceptives (see
chapter 2, section 2.4), such as enhanced sexual pleasure by not using condoms.
The few adolescent mothers who actually reported using contraceptives prior to
their pregnancies might have discontinued such use because they encountered
side-effects.

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4.4.9 Side effects of contraceptives

The respondents were asked whether they had experienced any side effects
when they used contraceptives.

Table 4.21Side effects of contraceptives used

SIDE EFFECTS FREQUENCY PERCENTAGE

Headaches 1 5,88

Weight gain 1 5,88

Amenorrhoea (absence of 3 17,65

menstruation)
Multiple side effects 4 23,53

No response 8 47,06

TOTAL 17 100,00

Table 4.21 indicates that all 17 respondents who had used contraceptives
experienced side effects. These side effects may have caused them to
discontinue using contraceptives since they subsequently fell pregnant and gave
birth. If contraceptive methods have known side effects, clients need to be
informed about these side effects before they choose a contraceptive method and
if a method hardly ever has any side effects or complications, then clients need to
know that too (Hatcher et al 1997:3-5). Adolescents need to know about all the
side effects of all contraceptive methods available in order to be satisfied and
continue using contraceptives and reduce the number of adolescent mothers.
However, merely knowing about potential side effects might not be sufficient to let
women persevere with any specific method. Contraceptive users need to have
recourse to clinic staff should they encounter side effects. The clients need to
have open communication lines to raise any concerns with appropriately qualified
staff members. However, all clients should be educated never to discontinue a
contraceptive method when they encounter side effects, as that would make them

71
vulnerable to unplanned pregnancies. Should any side effect be encountered,
then they should consult clinic staff, and perhaps change their contraceptive
method but they should be duly warned about any unsafe contraceptive period
with such changes.

4.4.10 Reasons for discontinuing contraceptive methods

The respondents were asked to state the reasons for stopping to use
contraceptives. The following reasons were given:

• Do not know; no specific reason for stopping contraceptives. (10)

• Dislike using contraceptives. (10)
• Had general, non-specific side effects. (3)
• Boyfriends did not want them to use contraceptives. (3)
• There was peer pressure. (3)
• Had amenorrhoea as a specific side effect. (2)
• Lacked knowledge. (1)
• It was a mistake to use contraceptives. (1)

From the reasons given for having discontinued contraceptive use, it may be
assumed that their sexual education did not deal with the effects of adolescent
pregnancy for the adolescent mother, adolescent father and child as well as the
adolescents’ own families. These reasons were some of the factors that
contributed to the respondents’ non-utilisation of contraceptives and led to their
pregnancies. According to the respondents, peer pressure, side effects of
contraceptives, lack of knowledge, boyfriends’/sexual partners’ disapproval, and
their dislike of contraceptives contributed to their non-utilisation of contraceptives,
leading to their adolescent motherhood.

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4.4.11 Contraceptive use after babies’ births

The respondents were asked whether they had used contraceptives since their
babies’ births.

Comparing contraceptive use in table 4.22 with table 4.19, there was an increase
in contraceptive use from before pregnancy (15,89%; n=17) to after their babies’
births (59,81%; n=64). However, the fact that only 59,81% of these adolescent
mothers used contraceptives after their babies’ births implied that the other
40,19% might have been susceptible to further pregnancies within the
foreseeable future. The adolescent mothers did not indicate why did or did not
use contraceptives after the birth of their babies. The respondents were asked to
indicate the contraceptive method used after their babies’ births.

Table 4.22Contraceptive use after babies’ births

RESPONSE FREQUENCY PERCENTAGE

Yes 64 59,81
No 39 36,45
No response 4 3,74
TOTAL 107 100,00
Table 4.23Contraceptive methods used after babies’ births

CONTRACEPTIVE FREQUENCY PERCENTAGE

METHOD
Emergency 1 1,56
contraceptives
Oral contraceptives 3 4,69
(pills)
Injections: Depo- 20 31,25
Provera
Nur- 9 14,06
isterate
Condoms 17 26,56
Multiple methods 14 21,88
TOTAL 64 100,00

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According to table 4.23, the 64 (59,81%) respondents who indicated using
contraceptives after their babies’ births used the following methods:

• depo provera (20)

• condoms (17)
• multiple methods (14)
• nur-isterate (9)
• oral contraceptives/pills (3)
• emergency contraceptives (1)

It could not be determined why only 64 of the respondents were using

contraceptives and why the other 43 apparently used no contraceptives, thereby
risking further pregnancies and possibly jeopardising their own and their
children’s chances of a more secure future to an even greater extent than in the
case of their first pregnancies. Concerted education drives should be directed at
adolescent mothers to enable them to make informed decisions about their own
and their children’s futures. The 17 respondents who reported using condoms
as a contraceptive method may have been in particular need of education about
the effective use of condoms as 10 of them had reported using condoms prior to
their pregnancies. If they could not prevent pregnancy using condoms prior to
their pregnancies, it would seem doubtful whether they could do so after their
babies’ births. ECs should not be seen as a contraceptive method, but should
only be used in cases of unprotected sexual intercourse to prevent unplanned
pregnancies. It can be generally accepted that any woman who requires an EC
should, in fact, use contraceptives regularly and effectively subsequent to the
utilisation of the EC.

74
4.4.12 Knowledge about side effects of contraceptives

The respondents were asked whether they had received any information about
the side effects of contraceptives.

Table 4.24Knowledge about side effects of contraceptives

RESPONSE FREQUENCY PERCENTAGE

Yes 50 46,73
No 54 50,47
No response 3 2,80
TOTAL 107 100,00
Of the respondents, 54 (50,47%) indicated that they had not received information
about contraceptives’ side effects (see table 4.24) although 64 (59,81%) indicated
that they had used contraceptives (see table 4.23). Some of the respondents
apparently used contraceptives without knowing about their side effects. This
could be a particularly serious situation as some of the respondents indicated
side effects as the reason for discontinuing contraceptive use (see section
4.4.10). Information about contraceptives’ side effects should be provided to
adolescents in order to increase their knowledge, thus improve contraceptive
compliance. However, they should also know what to do and where to seek help
should any side effects be encountered. Above all, they should be informed
never to discontinue any contraceptive without consulting the clinic staff, and that
should they decide to change to another contraceptive, there might be an unsafe
period during which they could become pregnant even if they had no break in
contraceptive use. During this period, condoms should be used in addition to any
other contraceptives to avoid unplanned pregnancy.

75
4.4.13 Sources of information about side effects

The respondents were asked to indicate who provided information about

contraceptives’ side effects.

Table 4.25Sources of information about contraceptives’ side effects

SOURCE OF FREQUENCY PERCENTAGE

INFORMATIO
N
Mother 11 22,00

Father 1 2,00
Teacher 2 4,00
Friend 10 20,00
Clinic nurse 12 24,00
Television 1 2,00
More that one 12 24,00
No response 1 2,00
TOTAL 50 100,00
Of the 50 (46,73%) respondents who knew about side effects, 12 obtained this
information mostly from the clinic nurses, 11 from their mothers, 10 from their
friends, 12 from more than one source, 1 from her father, 1 from television, 2 from
a teacher, and 1 did not reply to the question. It could not be determined why the
50 respondents who knew about contraceptives’ side effects, failed to use
contraceptives effectively to prevent unplanned pregnancies. Again, it appeared
that knowledge alone did not enable the respondents to postpone their
pregnancies until they had completed their schooling. It might be valuable to find
out what clinic nurses and mothers actually tell adolescents about contraceptives’
side effects in order to provide them with further information, should that be
indicated by research results.

4.4.14 Availability of contraceptives

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The respondents were asked about the availability of contraceptives at their
clinics.

Table 4.26Availability of contraceptives

AVAILABILITY FREQUENCY PERCENTAGE

Always 68 63,55
Sometimes 33 30,84
Unknown 5 4,67
No response 1 0,93
TOTAL 107 100,00
From table 4.26 it appears that contraceptives were only “always” available to 68
(63,55%) of the respondents. This question was asked to evaluate whether the
unavailability of contraceptives was one of the factors contributing to adolescent
mothers’ non-utilisation of contraceptives in the Piet Retief (Mkhondo) area.
Contraceptive services should always be available at all health facilities so that
adolescents can access contraceptives when needed. In a study on the
accessibility of adolescent health services, adolescents indicated that the service
should be available throughout the week, including Saturdays (Richter 2000:81).

4.4.15 Advice received at clinics

The respondents were asked to indicate what advice they had received at their
clinics visited for contraceptives. According to table 4.27, most of the
respondents received advice about condoms and/or HIV/AIDS.

Table 4.27Advice received at clinics

ADVICE FREQUENCY PERCENTAGE

Condoms 83 77,57
HIV/AIDS 64 59,81

77
Other 9 8,41
The respondents had to indicate all the advice received and each respondent
could indicate more than one, hence the total frequency exceeded 107. Of the
respondents, 83 (77,57%) received advice about condoms, and 64 (59,81%)
about HIV/AIDS. Table 4.27 indicates that 77,57% of the respondents were
advised about condom usage, correlating with table 4.20 where 58,82% of the
respondents indicated condom use, and table 4.18 where 53,27% indicated
knowing about condoms. More extensive condom use should be promoted,
especially for adolescents since condoms protect against both pregnancy and
STIs, including HIV/AIDS. However, something may be lacking with regard to
condom use as all these respondents became pregnant in spite of this
knowledge, and 10 had used condoms prior to their pregnancies.

4.4.16 Distance from home to the nearest clinic

The respondents were asked to estimate the distance from their homes to the
nearest clinic.

Table 4.28Distance from home to the nearest clinic

DISTANCE FREQUENCY PERCENTAGE

0-5 km 73 68,22
5-10 km 20 18,69
10-20 km 10 9,35
20 km and more 1 0,93
No response 3 2,80
TOTAL 107 100,00
Of the respondents, 73 (68,22%) travelled less than 5 km from their homes to
their nearest clinic, which meant that these clinics should have been within the
respondents’ geographical reach. However, the geographical accessibility of
living up to 5 km from clinics did not prevent the 73 respondents from becoming
pregnant. The 10 (9,35%) respondents who had to travel more than 10 km could

78
experience problems of accessibility. Only 3 (2,80%) respondents did not reply to
this question.

4.4.17 Type of clinic visited by respondents

The respondents were asked to indicate the type of clinic used. Table 4.30
indicates that of the respondents, 73 (68,22%) used fixed clinics that operate
from 07:00 to 16:00, 20 (18,69%) used mobile clinics visiting their areas once a
month and 10 (10,28%) used community health centres.
Only one respondent (0,93%) did not reply to this question.

Table 4.29 Type of clinic

TYPE OF CLINIC FREQUENCY PERCENTAGE

Fixed clinic (07:00-16:00) 73 68,22
Mobile clinic (once a 20 18,69
month)
Community health centre 10 9,35
(24 hours)
No response 1 0,93
TOTAL 107 100,00
From table 4.29 it is clear that contraceptive services are available to 99,07% of
the respondents because they indicated a type of health service used. However,
the distance the respondents have to travel may influence the type of health
service used since 73 (66,22%) of the respondents travel less than 5 km to the
nearest clinic as indicated in table 4.28. Hence for the majority of the
respondents, utilisation could not be affected by accessibility in terms of
geographical distance from their homes to the nearest clinic.

4.4.18 Clinic operating days

The respondents were asked to indicate their clinic operating days.

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Table 4.30Clinics’ operating days

DAY FREQUENCY PERCENTAGE

Monday 103 96,26
Tuesday 102 95,33
Wednesday 102 95,33
Thursday 105 98,13
Friday 34 31,78
Saturday 1 0,93
Of the respondents, 105 (98,13%) indicated clinic operating day on Thursdays
because contraceptive services were previously offered on Thursdays although
contraceptive services had been available from Monday to Friday (from 07:00 to
16:00) in the Piet Retief (Mkhondo) area for months prior to the current study.
This aspect needs to be stressed during health education sessions with
adolescents so that they know about contraceptive services’ availability at the
fixed clinics and daily (24 hours) at community health centres. Only 34 (78,0%)
respondents indicated that contraceptive clinics operated on Fridays, implying
that 72 believed contraceptive services were not available on Fridays. This
perception might have been attributable to past clinic operations in the Piet Retief
(Mkhondo) area, when Fridays were used only for administration and in-service
duties, and not for providing services to clients. Although this has changed, and
services are available to clients on Fridays, some respondents did not perceive
Fridays as clinic days.

4.4.19 Clinic operating times

The respondents were asked to indicate the times during which contraceptive
services were available from their clinics.

Table 4.31Clinic operating times

OPERATING FREQUENCY PERCENTAGE

TIMES
All the time 63 58,88

80
On specific 35 32,71
days
At specific times 5 4,67
No response 4 3,74
TOTAL 107 100,00
Table 4.31 indicates that only 63 (58,88%) of the respondents reported that
contraceptive services were available at all times while the clinics were open.
This could mean that the respondents’ perceptions were that they could not
access contraceptive services at all times, even if these services were, in fact,
available. Merely extending the consulting hours and days did not succeed in
enhancing adolescents’ accessibility nor utilisation of the services because they
lacked the appropriate knowledge.

When comparing tables 4.30 and 4.31, it is evident that contraceptive services
were not perceived to be available every day when the clinic was open. These
perceptions might have impacted negatively on the perceived accessibility of
contraceptives, compromising their decision-making on whether or not to become
pregnant. Accessibility seems to have been compromised when comparing
tables 4.31, 4.30 and 4.28.

Of the respondents, 98,13% accessed clinics only on Thursdays, 68,22%

travelled less than 5 km to the clinics and 58,88% could access their clinics for
contraceptive services at all times. (Table 4.30 indicates that some adolescents
continued to believe [erroneously] that contraceptive services were offered only
on Thursdays.) Only 1 (0,93%) respondent could access contraceptive services
on Saturdays and travel more than 20 km to their clinics. The findings indicate
that accessibility could contribute to the respondents’ non-utilisation of
contraceptives. More information about longer clinic hours and about the
availability of contraceptives at clinics on all weekdays in the Piet Retief
(Mkhondo) area might help adolescents, including adolescent mothers, to make
better informed decisions about the utilisation of contraceptives. Moreover,

81
merely extending the clinic hours and days for providing contraceptives did not
seem to benefit the adolescent mothers who were apparently uninformed about
these changes that could have benefited them.

4.4.20 Clinic staff’s attitudes towards adolescent clients

The respondents were asked to rate their clinic staff’s attitudes towards
adolescent clients.

Table 4.32Clinic staff’s friendliness towards adolescent clients

FRIENDLINESS FREQUENCY PERCENTAGE

Very friendly 37 34,58
Friendly 51 47,66
Unfriendly 9 8,41
Extremely 4 3,74
unfriendly
No response 6 5,61
TOTAL 107 100,00
Table 4.32 indicates that of the respondents, 51 (47,66%) found clinic staff
members friendly, 37 (34,58%) found them very friendly, but 9 (8,41%) found
them unfriendly and 4 (3,74%) indicated that clinic staff members were extremely
unfriendly.

The respondents were asked to rate the clinic staff members’ respect towards
adolescents at clinics when they requested contraceptives.

Table 4.33Clinic staff’s respect towards adolescent clients

RESPONSE FREQUENCY PERCENTAGE

Yes 83 77,57

82
No 18 16,82
No response 6 5,61
TOTAL 107 100,00
Tables 4.32 and 4.33 indicate that clinic staff members were mostly perceived to
show respect and to be friendly towards their adolescent clients. There was a
similarity between tables 4.32 and 4.33 because 6 (5,61%) respondents did not
respond to both questions. The positive responses to tables 4.33 and 4.34
indicated that 82,24% of the adolescent mothers perceived clinic staff to be
friendly and 77,57% to show respect to the adolescent clients. This data did not
indicate that lack of friendliness or respect from clinic staff members could be
regarded as factors contributing to the respondents’ non-utilisation of
contraceptives.

4.4.21 Beliefs about contraceptives

The respondents were asked to state their beliefs about contraceptives and
stated the following:

• Contraceptives prevent pregnancy (45,79%; n=49)

• Condoms protect from both pregnancy and STIs (13,08%; n=14)
• Contraceptives stop menstruation pains (0,93%; n=1)
• Weight gain occurs when contraceptives are used (0,93%; n=1).

Of the respondents, 42 (39,25%) did not indicate their beliefs about

contraceptives. This could mean that they lacked knowledge about
contraceptives. Of the 65 (61.75%) respondents who responded, 49 (45,79%)
believed contraceptives do prevent pregnancies; 14 (13,08%) believed that
condoms do prevent both pregnancies and STIs, and two (1,89%) believed that
contraceptives caused side-effects of weight gain and amenorrhoea, respectively.

83
Whether or not these two adolescent mothers also believed that contraceptives
prevent unplanned pregnancies could not be ascertained from the available data.

4.4.22 Summary of contraceptive knowledge

In section C the adolescent mothers responded to 26 questions on their

knowledge about contraceptives. The findings in this section indicate that
knowledge about contraceptives, side effects and accessibility could contribute to
the adolescent mothers’ non-utilisation of contraceptives.

4.5 TERMINATION OF PREGNANCY SERVICES (TOPs)

This section consisted of eight questions on termination of pregnancy and one

last part where adolescent mothers could provide comments or state
contraceptive problems in their own words.

4.5.1 Termination of pregnancies (TOPs)

The respondents were asked whether they had heard about legally available TOP
services.

Table 4.34Knowledge about termination of pregnancy (TOP) services

RESPONSE FREQUENCY PERCENTAGE

Yes 25 23,36
No 78 72,90
No response 4 3,74
TOTAL 107 100,00
Of the respondents, 78 (72,90%) indicated that they had not and 25 (23,36%) had
heard about TOPs while 4 (3,74%) did not reply to this question. It could be
surmised that if more of the respondents had known about TOP services in their

84
areas, and if they could have accessed these services, fewer of them might have
been adolescent mothers at the time of collecting data for this study.

4.5.2 Knowledge about termination of pregnancy services (TOPs)

The respondents stated that they knew that TOPs

• were legal in South Africa (8,41%; n=9)

• were dangerous (4,67%; n=5)
• implied killing babies (1,87%; n=2)
• constituted a sin before God (0,93%; n=1)

As only 8 (7.48%) respondents reported negative perceptions of TOPs, it could

not be established why the others had failed to obtain TOP services and became
adolescent mothers, assuming that the other 99 respondents did not harbour
similar negative attitudes towards TOPs. However, as only 25 (23,36%) of the
respondents indicated that they knew about TOP services in the Piet Retief
(Mkhondo) area, this aspect might deserve greater attention from the health
educators in this area.

4.5.3 Utilisation of termination of pregnancy services (TOPs)

The respondents were asked whether they had ever undergone an abortion or
utilised TOP services.

Table 4.35Previous abortions (TOPs)

RESPONSE FREQUENCY PERCENTAGE

Yes 4 3,74
No 97 90,65
No response 6 5,61

85
TOTAL 107 100,00
Of the respondents, 97 (90,65%) reported that they had never used TOPs or
undergone abortions. Only 4 (3,74%) respondents had had abortions while 6
(5,61%) did not reply to this question. It is not known whether the 4 adolescent
mothers had used TOPs prior to or after the birth of their babies, nor whether the
TOP had failed for some reason.

4.5.4 Reasons for abortions/TOPs

The reasons given by the 4 respondents for using TOPs were poverty (2), rape
(1) and not being ready to bear and raise a child (1). Regular information
regarding TOPs should be provided for adolescents to enable pregnant
adolescent women to make informed decisions on whether or not to use the
service in the first twelve weeks of conception. Only two of the respondents
procured TOPs at a hospital or from a doctor, while one did so at home and the
other one failed to indicate where she obtained TOPs. Although only 4
respondents responded to this item, it might indicate that TOPs are not freely
accessible to adolescents at clinics in the Piet Retief (Mkhondo) area. Such non-
accessibility of TOPs could be a factor influencing the respondents’ and other
adolescent mothers’ non-utilisation of TOPs, contributing to the number of
unplanned adolescent pregnancies in the area.

4.5.5 Willingness to use TOPs

The respondents were asked whether they would use TOPs if they could access
them. Of the respondents, 82 (76,64%) indicated that they would not use TOPs
even if they could access them; 11 (10,28%) indicated that they would use TOPs

86
and 14 (13,08%) did not respond to this question. More factual information could
be provided to adolescents on TOP issues, procedures and legal aspects.
Although many of the respondents would refrain from using TOPs, only 2 had
experienced problems with these services. One these respondents explained her
problem as feeling guilty and like a murderer after the TOP. Thus her problem
concerned her own psychological experiences, rather than the TOPs as such.

These results supported those of Myburgh et al (1998:18) who found that

adolescents experienced psychological pain and were depressed subsequent to
procuring TOPs. Myburgh et al (1998:19) stress that counselling should focus on
the girl’s termination of pregnancy as a long-term issue, possibly incorporating
spiritual and psychological pain. The finding that a few respondents would use
TOPs indicates a need for more abortion clarification workshops and awareness
campaigns.

4.5.6 Comments or problems

The questionnaire concluded with an open question requiring the respondents to

comment on contraceptives. The following responses were received:

• The questionnaire should be re-administered at a later stage as they enjoyed

completing it (8)
• They had no problems with clinic staff (7)

• Adolescents should be taught to use condoms effectively as condoms prevent

both pregnancy and STIs (5)
• Clinic staff members do not treat adolescents well (2)

• Adolescents should use contraceptives and not TOPs (1) • It was a mistake to
have a child (1)
• Stronger condoms should be supplied as they “burst” (1)
87
• Young people, not adults, should be appointed to teach and render
contraceptive service to adolescents (1)

The respondents’ comments may not be generalisable because of the small

number of responses. However, their concerns about condoms should be dealt
with to enable more adolescents to prevent unplanned pregnancies in the Piet
Retief (Mkhondo) area.

4.5.7 Summary of TOPs

Section D covered nine questions on TOPs. Of the 107 respondents, 78

(72,90%) indicated that they had not heard about TOPs and only 9 knew that
TOPs were legal in South Africa. This information may indicate that adolescents
require more information about TOPs.

4.6 FINDINGS IN TERMS OF THE HEALTH BELIEF MODEL (HBM)

The researcher used the HBM to contextualise factors contributing to the

adolescent mothers’ nonutilisation of contraceptives. According to Onega
(2001:271), the HBM provides a framework for understanding why some people
(in this study, adolescent mothers) take specific actions to avoid illness (in this
study, pregnancy instead of illness), whereas others fail to protect themselves (in
this case, become adolescent mothers). The findings are discussed in terms of
the three main components of the HBM, namely individual perceptions, modifying
factors, and variables affecting initiating action.

88
4.6.1 Individual perceptions

The study found that of the adolescent mothers, 74 (69,14%) did not know about
emergency contraceptives and 88 (82,24%) did not use any contraceptives prior
to their pregnancies. Negative perceptions about TOPs may have prevented
them from procuring these services to terminate unplanned pregnancies.
Perceptions that contraceptives cause weight gain may have been a deterrent to
using contraceptives.

4.6.2 Modifying factors

The adolescent mothers were aged between 14 and 19 years of age. The
majority (94,39%) were Zulu- speaking. Of the respondents, 72 (67,29%) were
from a low social class as the household monthly income was below R1 000,00.

4.6.3 Variables affecting the initiation of actions

Although the respondents knew about contraceptives, namely condoms,

injections, oral pills, ECs and IUCDs, this knowledge did not enable them to use
contraceptives effectively to prevent their pregnancies. Of the respondents, 88
(82,24%) did not use contraceptives before pregnancy, 17 (15,89%) used
contraceptives before pregnancy and 2 (1,87%) did not reply to this question.

The adolescent mothers in this study indicated the following perceived barriers to
contraceptive use:

• prolonged menstruation due to contraceptives

• accessibility of contraceptive services was more limited than the actual
accessibility as a large number of respondents were unaware of the extended

89
 clinic hours and days during which contraceptives can be obtained in the Piet
Retief (Mkhondo) area
• lack of knowledge about contraceptives, ECs and TOPs.

4.7 CONCLUSION

This chapter discussed the data analysis and interpretation with reference to the
literature review. The aim of this study was to identify factors contributing to
adolescent mothers’ non-utilisation of contraceptives. The main findings of the
investigation were summarised in each section.

Chapter 5 concludes the study, discusses its limitations and makes

recommendations for practice and further research.

90