The use of contraceptives in schools

Backgrounder

Introduction 

 
Why is this topic important to listeners?

• Contraceptive methods prevent unwanted pregnancies in schools.
• They minimize the risk of dropping out of school.
• They allow young girls to develop to their fullest potential by sparing them the stigma associated with school pregnancy.
• They prevent clandestine abortions.
• Condoms prevent sexually transmitted infections.
• Young people start having sex at an early age.
• It’s a highly relevant subject, particularly in the context of Burkina Faso’s national health program, which has a sexual and reproductive health component.

Some essential facts

• The EMDS 2015 (Demographic and Health Multiple Indicator Survey) indicates high unmet needs for FP (19.4%) and for improvements in the use of modern contraceptive methods, which are still low (22.5%). In view of these needs, Burkina Faso has developed a National Action Plan to Accelerate Family Planning (2017-2020).
• More than 6,000 school pregnancies were recorded in Burkina Faso in 2016.
• The Centre-East alone had 600 cases, including 176 cases of girls aged 10-15 years old.
• There were about 300 cases in primary schools between 2012 and 2017 in Burkina Faso. The girls who had unwanted pregnancies were 9-14 years old.
• In 2016, 30 girls became pregnant in two classes in Orodara, Kénédougou, western Burkina Faso, according to the Bobolese daily newspaper L’express du Faso.
• A recent study showed that the rate of unwanted pregnancies among school-age girls is high in a number of cities in Burkina Faso.
• In Burkina Faso, contraceptive methods are becoming increasingly popular. In schools, high schools, and universities in Bobo-Dioulasso, several initiatives are being taken to promote contraception in order to reduce unwanted pregnancies and their consequences in schools. These include setting up listening centres and introducing peer educators.

Key information on contraceptive methods in schools

1. Definitions

What is contraception?

Contraception refers to the use of methods to ensure that sexual intercourse does not result in pregnancy. It is defined by the World Health Organization as “the use of agents, devices, methods or procedures to reduce or avoid the likelihood of conception.”

Contraceptive methods are defined as the set of means and methods aimed at preventing sexual intercourse from leading to pregnancy.

Contraception helps women avoid unwanted pregnancies, many of which end in unsafe abortions; prevents early pregnancies; reduces school dropouts; and improves women’s socio-economic and occupational status.

Contraceptive methods include:

• Natural methods: fixed-day method (necklace), lactation and amenorrhea method (LAM), calendar, temperature, cervical mucus, abstinence, coitus interruptus.
• Mechanical barrier methods: male condom, female condom, intrauterine device (IUD).
• Hormonal methods: combined or progestin-only pills, injectables, subcutaneous implants.
• Voluntary surgical contraception (VSC): vasectomy, tubal ligation.
• Emergency contraception: the morning-after pill.

The contraceptive methods that the Community-Based Health Worker can distribute in Burkina Faso include:

Mechanical and chemical barrier methods:

• Male condom
• Female condom
• Spermicides
• Hormonal methods (for renewal)
• Combined pill
• Progestogen-only pill

Contraceptive methods for which the Community-Based Health Worker should refer include:

• Injectables
• Pill for first use
• Subcutaneous implants
• Intrauterine device (IUD)
• Voluntary surgical contraception (VSC): vasectomy, tubal ligation.

Modern contraceptive methods include:

• Injectables
• The pill
• The morning-after pill
• The IUD
• The implant
• The male or female condom
• The contraceptive patch

The traditional (natural) methods are:

• Withdrawal (or coitus interruptus)
• Periodic continence

The necklace method: (a natural family planning method based on using a necklace of beads of different colours that represent the days of a woman’s menstrual cycle, showing the days when the woman can become pregnant).

• Abstinence for six months after birth
• Temperature curve method
• Cervical mucus method

2. What are the barriers to contraceptive use by school-age children in Burkina Faso?

The rate of contraceptive use in Burkina Faso is estimated at 22.8%. This low rate is mainly due to:

• Lack of accurate information on contraceptive methods and unfamiliarity with family planning services.
• Non-use of family planning services.
• Poverty is also a significant factor, as well as early marriages. Young girls are sometimes forced to accept advances from boys for cash to meet their needs because they come from poor families. Because of poverty, some parents force their daughters to marry into wealthy families, hoping to receive support from the in-laws.
• Women are generally poorer than men, and mothers who are supposed to provide for their teenage girls carrying an unwanted pregnancy are generally poor.
• Socio-cultural factors can prevent the use of family planning services. For example, family planning centres are perceived as places that promote sexual misconduct. Husbands believe that no one should see their wives’ private parts and that birth control is unnatural.
• Health financing is confronted with many difficulties.
• The generally low level of education results in a lack of positive attitudes to adolescent sexuality.
• Lack of availability and accessibility of contraceptive products.

3. What are the consequences of unwanted pregnancies?

• Unwanted pregnancy can occur at an early age, with consequences for the health of both mother and child. According to the World Health Organization, 194 girls die every day around the world as a result of early pregnancy.
• Marginalization: Girls who are pregnant out of wedlock are marginalized and stigmatized, including:
  • By their classmates with remarks and mockery (for example, by calling them whores).
  • By parents who feel dishonored and therefore banish the girl from the family and psychologically traumatize the girl with insults.
  • By society that accuses the girl of being perverse and condemns her as a social failure.

4. Different contraceptive methods and their uses

• Injectables: a safe and effective injectable hormonal contraceptive for the prevention of unwanted pregnancies.
• The pill: An oral hormonal contraceptive for birth spacing and prevention of unwanted pregnancies (its main action is to prevent the ovary from releasing the eggs).
• Male and female condoms: The condom is a thin rubber sheath. It prevents the sperm from penetrating the egg.
• The diaphragm: A very flexible latex stopper that is fixed in the vagina before intercourse.
• Implants: Capsules placed just under the skin in the woman’s arm.
• Withdrawal (coitus interruptus): This involves the man withdrawing from the woman’s vagina just before ejaculation (not reliable because it requires the serious involvement of the partner, especially the man).
• Periodic continence: Avoiding sexual intercourse during periods close to the woman’s ovulation.
• Temperature curve method: A method of periodic abstinence based on the calculation of the fertile period by measuring the woman’s basal body temperature and abstinence from sexual intercourse during the fertile period.
• Contraceptive patch: A patch that sticks to the skin and releases hormones through the skin. Its action is similar to that of pills.
• Surgical methods (vasectomy and tubal ligation). These procedures are regulated by specific laws in Burkina Faso, which provide guidelines on when and how they can be used.

5. Behaviours to encourage in young people to avoid unwanted early pregnancy

• Control menstrual cycle by distinguishing the fertile period (or “risk period”).
• Abstinence
• Attend youth counselling centres
• Distinguish between messages conveyed by television and the real world. Television stories can portray and even glorify or sensationalize promiscuous, irresponsible, and inappropriate sexual behavior.
• Use contraceptive methods from first intercourse, the very first moment of sexuality.
• Have only one partner.

6. The consequences of non-use of contraception on society:

• Increased school drop-out rates
• Population increase
• Higher maternal and infant mortality rates than among older mothers due to the poverty and/or the immaturity of the mother
• Malnutrition of children and often of the mother
• Child abandonment
• Family conflict
• Infanticide
• Increased rate of STIs

Editor’s note: Many of these consequences are common regardless of a person’s social and economic status in all societies Young women should not be blamed for all this: some of the consequences are due to negative social attitudes and stigmatization. Strong family and social support and awareness among young people in general and women in particular could reduce these risk factors, although not eliminate them.

Conclusion

Directors of counselling and education services for adolescents in Burkina Faso stress that, in order to minimize unwanted pregnancies and their negative consequences, efforts should focus not only on increasing knowledge, but also on everyday practices related to sex and on addressing specific barriers to change. In addition, young people must enjoy confidentiality and free and accessible contraception.