Teenage pregnancy in Nigeria: professional nurses and educators’ perspectives

Study design

A qualitative approach using an exploratory research design was primarily used to explore professional nurses and educators’ perceptions and experiences of teenage pregnancy in the two communities in Nigeria.

Setting

The study was conducted in two selected secondary schools and primary health care centres in Kwara and Edo states in Nigeria. Kwara is a state located in the North-Central geopolitical zone while Edo is an inland state in the SS geopolitical zone.

Selection and description of participants

A purposive sampling technique was used to guide the recruitment of 80 participants who were professional nurses and secondary school teachers. In total, 10 of the participants dropped out due to time constraint and work schedule. Criteria for inclusion in the study were as follows:

Appointment were booked with participants both at the schools and clinics through physical visits and follow-up phone calls to confirm availability. All participants agreed to be interviewed at their workplace. Interviews were conducted at prearranged times at the clinic and school. Recruitment of participants was performed between August and September, 2016.

The sample size was determined by saturation of data, which was achieved when 70 participants had been interviewed. Data collection and analysis were done concomitantly. Transcription of recorded information was completed within 24 hours. Data saturation was attained when no new information was forthcoming from the participants. A total of professional nurses and 40 teachers were interviewed and each sample group saturated independently. A total of 70 interviews were analyzed with new categories and 10 interviews analyzed without new categories evolving. Referential adequacy was attained, partially fulfilling the requirement of trustworthiness.

Data collection

Data was collected from September to November 2016. The first author (O.A.A.) conducted and audiotaped the semi-structured interviews with professional nurses and secondary school teachers in each of the selected schools and clinics. The researcher explained the goals and reasons for conducting the research individually to all participants during the recruitment period. To guide the interviewer, an interview schedule was developed. The interview was guided by questions such as: knowledge of teenage pregnancy prevention programmes, occurrence, contributing factors and prevention of teenage pregnancy. Probing questions were asked so as to implore certain information from the participants. Follow-up questions were also asked in order to clarify participants ideas and thoughts. The interviews took an average of 45–50 minutes per participants. Furthermore, pretest interviews were conducted during the recruitment phase before the actual data collection with four interviewees (from each community) using participants who have similar characteristics to the study population (one teacher from a nearby school and a nurse from a different PHC centre), but who were not included in the final data. Categorical variables such as socio-cultural group, age and gender. The interviews were written and audio-recorded with participants’ permission and field notes were taken to complement the recorded information. No repeat interview was conducted.

Data analysis

The interviews were transcribed verbatim by OAA and samples of the transcripts were given to GTT for verification and coding. Data was analysed using a combination of three qualitative data analysis methods, namely, the template analysis style, Tesch’s content analysis approach using open coding and quasi-statistics^17,18. Quasi-statistic is used as a validating mechanism so as to confirm that the inferred themes and categories precisely echo the viewpoints of the participants involved in the study. Quasi-statistics are a tabulation of the frequency certain themes or categories are supported by the data^17,18. Themes were generated from the data, they were first identified by the first author and later confirmed by the second author. Software was not used in qualitative data analysis. Descriptive statistics were also used for the presentation of data.

Trustworthiness

To ensure trustworthiness, strategies such as interpersonal relationship and trust building, triangulation of data gathering methods, peer examination, member checking, authority of the researcher, dense description, consensus with independent coder and dependability audit were employed.

Ethical considerations

Before the commencement of the study, the research proposal was submitted to the Local Government Health Authority and permission to conduct the research was given (IRLG/CA/TC/6/T.1/96). An official letter was also written to the selected primary health care clinics as well as the secondary schools and permission letters were obtained from the Head of Nursing Services and the School Principals. Prior to the interview, each participant’s rights were explained and written informed consent was obtained, and also the permission to use audio recorder. To guarantee privacy, the interviews were conducted in a private room with only the participant and the researcher present.

Demographic profile

All eighty participants (N = 80) verbatim interviews were subjected to template analysis after initial data saturation was attained after 70 interviews and the template constructed according to the categories and sub-categories that emerged from the data. As shown in Table 1, the participants were grouped into four age groups; the majority (63.7) were aged 20–40 years. In terms of socio-cultural groups, the Yoruba socio-cultural group had the most participants with 52.5% (42 of 80) followed by the Benin with 15% (12 of 80). The majority (66.3%) of the participants (53 of 80) were females.

Qualitative findings

The qualitative findings of the study are presented according to the themes and various categories generated from the data (Table 2). Each theme is described with a summary of its categories it represents. This served as a template according to which accounts (interview data) from participants were considered after the initial data analysis and the point of data saturation. Complete de-identified interview transcripts are available on figshare¹⁹.

Theme 1: Values and beliefs

Knowledge of community teenage pregnancy prevention programmes. More than half (44 of 80) of the participants interviewed were not aware of any programmes, events or interventions that were currently in place at the community level focusing on the prevention of unplanned teenage pregnancies. About one-third (15/40) of the professional nurses mentioned different programmes such as School Sexuality Education (5/15), Society of Family Health Programme (6/15) and Church-Based Teen Programmes (5/15) but only 1 (1/15) was from the NC and mentioned Sexuality Education in the Family Planning Clinic. While more than half (21/40) of teachers from both regions mentioned various intervention programmes such as School Sexuality Education (14/21), HIV/AIDS programme on the Radio (2/21), State Family Support Programme (2/21), Church Based Teenage Programme (2/21) while one teacher from the NC mentioned School Health visit from the Ministry of Health. Notable in these findings is that the majority (34/40) of the participants from the NC region (19/20 of the professional nurses) were not aware of any teenage pregnancy prevention programme.

Meaning, acceptance and cultural beliefs about dating. Dating was viewed by all 80 participants as an intimate relationship between two parties, primarily of the opposite sex, who are supposed to have known each other before they get married or relationship that will result in marriage or a love affair. However, the majority (74 of 80) expressed that it must not involve sexual intercourse.

Majority (66 of 80) of the participants expressed during the interviews that dating is accepted. Of these, 44/66 believed it must only commence after the age of 20 years, while the remaining 22/66 assumed it can begin at 18 years. Notable in the findings was that all teachers from the NC opined that dating is acceptable.

Participants opinions were taken as regards their cultural belief about dating, the majority (54/80) of the participants expressed that dating is culturally acceptable in their communities. Almost half (8/20) of the professional nurses from both regions respectively, all (n=20) teachers from the SS and 18/20 of teachers from the NC. About one third (26 of 80) of the respondents emphatically stated that their culture does not support dating. The following is a citation from a professional nurse from the NC relating to cultural belief about dating:

Acceptance and expected age of teenage sexual experimentation. The interviewed participants were asked about acceptance and the age at which teenagers are expected to get involve in sexual relationship. Almost half (37/80) of the participants stated that sexual relationship is not accepted, nor expected from teenagers at whatsoever age they are, they must wait till after marriage. However, the majority (43 of 80) expressed that teenagers are only allowed to engage in a sexual relationship when they are well above 20 years of age. The followings are citations from the participants:

Teenage pregnancy: occurrence, acceptance and family support. During the interviews, participants were asked about the frequency of teenage pregnancies in their communities. A large number (54 of 80) of the respondents stated that they have witnessed cases of teenage pregnancy very often as it is frequent and rampant in their communities, more than two third (28 of 40) of the participants from the NC while more than half (26 of 40) from the SS. Notable from the findings was that more teachers (29 of 40) opined that teenage pregnancy was more rampart in their communities.

With regards to teenage pregnancy acceptability, the general perceptions (75 of 80) was that pregnancy among teenagers is absolutely not acceptable for whatever reason. Conversely, 5 of 40 of the professional nurses (3 from NC and 2 from SS) indicated that it is conditionally acceptable as the parents or guardians has nothing else to do rather than accept to avoid more complications.

During the interviews, participants were if there is family support for the pregnant teenager, the majority of the sampled participants (58 of 80) responded that no family in the community will accept and support a pregnant girl, they rather refute and treat her harshly; they resulted to the fact that it is sometimes depends on the moral and religious background of that family because in it real sense, it is uncultured and biblically it is wrong, and morally it is bad. While 22 of 80 of the participants opined that even if the girl’s family do not accept the case from the beginning, but later resolutions on the matter usually see the family supporting her. Some of the observed responses are as follows:

Theme 2: Health related to teenage pregnancy

Definition, knowledge, type and acceptance of contraceptives. Participants’ opinions were taken with regards contraceptives. All the professional nurses (n = 40) had adequate understanding of contraceptives. Contraceptives was defined by all 40 participants as material things, instruments or devices, or chemical substances used in prevention of pregnancy and sexually transmitted diseases (STDs). Likewise, all the teachers (n = 40) also had previous knowledge of contraceptives. Around two-thirds (27/40) explained that contraceptives are methods of preventing unwanted pregnancy.

Participants opinions were taken as regards the types of contraceptives that they know; the professional nurses mentioned different types of contraceptives, and the majority of the teachers (38/40) also mentioned various contraceptive methods, such as condoms, 32/40 stated contraceptives pills and injections; more than half (25/40) indicated IUDs and calendar methods; while only 18/40 mentioned implant, sterilization and emergency contraceptives.

Acceptance of contraceptive usage among teenagers. Participants’ also responded to the enquiry that seek to find out if they accept or can encourage teenagers to use contraceptives as a means to prevent unwanted pregnancies and STDs. Responses observed were categorized as follows; 9/20 of professional nurses from the NC and more than half (12/20) from the SS expressed that they accept and also encourage the use of contraceptives among teenagers. However, only 13/40 of teachers (6 from NC and 7 from SS) stated that they accept teenagers to use contraceptives. Significant in this was that despite the adequate knowledge of the professional nurses, only half (21/40) accept the use of contraceptives by teenagers. The following is a citation from a professional nurse from the SS relating to contraceptive usage:

Problems and benefits associated with teenage pregnancy. Perceived consequences of teenage pregnancy and child bearing as expressed by the participants were classified as health, economic and social consequences as indicated in Table 3. A notable finding was vesico-vaginal fistula that was mentioned by only the professional nurses from both regions as a possible consequence of teenage pregnancy and child bearing.

The interviewed participants were asked about the benefit of teenage pregnancy; all the participants unanimously opined that there is no benefit associated with teenage pregnancy, it is always found to pose one problem or the other. The following are examples of citations from a professional nurse from the SS and a teacher from the NC:

Theme 3: Risks and protective factors

Perceived risk factors, importance and existence of parent-child communication and preventive strategies for teenage pregnancy. As revealed in Table 4, perceived risk factors that might contribute towards teenage pregnancies were classified into six categories: personal, psychological, cultural, societal and media pressures, family and economic reasons. A notable difference from the findings was that only teachers from the NC mentioned religious belief of early marriage as a perceived cause of teenage pregnancy and polygamy was also mentioned by participants from the NC.

Importance and existence of parent-child relationship. On the issue of parent-child communication, participants were asked about its meaning and importance, all (n = 80) indicated that parent-child communication as an open relationship that exist between the parent and the child such that both parties express their thoughts, feelings and experience in a friendly manner, or an act of interaction between the parent and the child such that both parties discuss matters that are bothering them and as such, the parents can have a knowledge of what the child is up to.

All the participants stressed the importance of the parent-child communication as something every home must practice so as give their children the freedom to express themselves. Similarly, all the participants unanimously expressed the existence of parent-child communications in their homes. The followings are statements made by participants:

Preventive strategies for teenage pregnancy. With regards to teenage pregnancy prevention strategies, the participants’ responses were grouped into sex education, preventive health care, youth programmes and community engagement, personal and family life strategies (Table 5). A notable finding was that the use of contraceptives as a preventive strategy for teenage pregnancy was only mentioned by the professional nurses.