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Adolescence is the transitional phase of life from childhood to adulthood during which biological and major social role transitions occur (Sawyer etal, 2018). This is a critical time of formative growth when adolescents make decisions that can affect their health now and for their life time and influence the country‘s sustainable development (Centre for Infectious Disease Research in Zambia [CIDRZ], 2018). Risky behaviours among adolescents such as engaging in sexual activity without using contraception result in unwanted pregnancies, unsafe abortions and risk of contracting sexually transmitted infections (STIs), Human Immuno Deficiency Virus (HIV) / Acquired immune Deficiency Syndrome (AIDS) inclusive. All these adverse consequences can be averted by consistent use of family planning. Family planning prevents unintended pregnancies, reduces the need for unsafe abortion and delays pregnancies for adolescent girls who are at increased risk of health problems resulting from child bearing. Further, family planning methods such as condoms do not only protect girls from unplanned pregnancy but from HIV and other STIs (World Health Organisation [WHO], 2018). In Zambia, a variety of contraceptive methods are available ranging from long-acting reversible contraception, such as the implant or intra uterine device (IUD), hormonal contraception, such as the pill or the Depo Provera injection, barrier methods, such as condoms, emergency contraception, fertility awareness, permanent contraception, such as vasectomy and tubal ligation Ministry of Health [MOH], 2017). However, adolescents frequently encounter significant barriers to accessing contraceptive information and services, leading to high rates of unintended pregnancy and increased risk of contracting HIV and STIs (United Nations population Fund [UNFPA], 2018). Parents can potentially improve utilization of family planning services yet many are uncomfortable talking to adolescents or may have inaccurate contraceptive information (Hartman, 2012). Furthermore, parents represent a resource for providing clear messages about the use of contraceptives among adolescents (Guilamo-Ramos, 2016).This can enrich adolescents with lifelong sexual health information needed in good decision making in sexual and reproductive health. It is for this reason that the researcher wishes to explore the perceptions of adolescent‘s parents on family planning services in Lusaka, Zambia.
Of the 7.2 billion people world-wide, 1.2 billion are adolescents aged between 10 and 19 years. This means 1 in approximately 6 people is an adolescent (WHO, 2018). Among these adolescents, about 21 million girls aged 15 to 19 years become pregnant in the developing regions every year while 2 million of these are girls less than 15 years. The World Health Organisation (2018) observed that 23 million adolescents would like to use contraception but are not. This results in unplanned pregnancies and sexually transmitted infections including HIV/AIDS. Sadly, most of these unplanned pregnancies end as unsafe abortion.
Globally, 3 million girls aged 15 to 19 undergo unsafe abortion while 1 million girls under age 15 give birth every year (WHO, 2020). Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls worldwide (WHO, 2016). This is because young girls have immature reproductive organs predisposing them to complications associated with early child birth such as obstetric fistulae, post-partum haemorrhage (PPH), , puerperal endometriosis, pelvic inflammatory disease, prolonged and difficult labour, hypertensive disorders, cephalo pelvic disproportion, severe anaemia, disability and maternal death (WHO, 2016). Providentially, utilisation of family planning services among adolescents prevent deaths resulting from unsafe abortion, helps prevent Infant mortality and Human Immuno deficiency Virus/AIDS. Furthermore, effective and consistent utilisation of available family planning services can help reduce such complications by preventing unplanned pregnancies among adolescents (WHO, 2018) .The benefits of using family planning services are having improved quality of life, better health, less physical and emotional stress of life, better education, job and economic opportunities .It follows that most adolescent girls who become pregnant have to leave school with subsequent long-term consequences for them as individuals, their families and communities (Dutta, 2013). Overall, Family planning helps slowing unsustainable population growth. A high population has an adverse impact on the environment, economy, and national development efforts (WHO, 2018).
Therefore, if the need is met of increasing the use of contraception by adolescents at risk of unintended pregnancies, 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths could be averted each year world-wide (Darroch etal, 2016).
In the developing region, about, 252 million women are aged between 15 -19 accounting up to one sixth (1/6) of the reproductive age group of 15 to 49 years. Twenty-four percent of these adolescents live in Africa and nearly two thirds (2/3) live in rural areas (ibid). Adolescents in rural areas mostly lack education and wealth which has a relationship with non-utilization of family planning services (Central Statistical Office [CSO], 2014). The total fertility rate in Africa is the highest in the world as it is estimated at 4.6 children per woman. Likewise, the state of women report (2018), observed that 1 out of 3 women use modern contraception with 1 in 5 women with unmet need for family planning. The report further states that adolescent pregnancy rates are highest in sub-Sahara Africa with estimation that 1 in 4 girls in West Africa is pregnant and 1 in 18 girls before turning 15 years. The adolescent pregnancies are strongly resulting from early marriage. Generally, the adolescents are not ready to handle these pregnancies and resort to abortion that is mostly unsafe. In the Sub-Sahara African region, 1 in 4 abortions are among adolescents aged 15 to 19 years of which nearly four fifth (4/5) are unsafe (WHO, 2020).
The Declaration on human rights state that every woman has control over her fertility, the number, timing or spacing of pregnancies and her method of contraception (UNFPA, 2014). However, this is not the case as many adolescents are uncomfortable to discuss sex with older people about family planning resulting in unplanned pregnancies. Other challenges are unavailability of preferred method, and lack of community leader’s involvement in family planning programmes (Lorna, 2018).
In 2018, in East and Southern Africa (ESA) region, there were 160.2 million adolescents and young people aged 15-24 years representing 33% of the population (ESA Report, 2018). The region is experiencing early and unintended pregnancies sustained by poverty, social norms, sexual coercion, poor access to Sexual and Reproductive Health (SRH) services and information, low self-efficacy and peer pressure. As a result, the ESA commitment was signed by Ministers of Health in the region to increase access to SRH services, reduce unplanned pregnancies and increase coverage to comprehensive sexuality education in the region by 2020 (ESA Commitment, 2013).
Zambia is implementing the ESA commitment through the Adolescent Technical Working Group (ATWG) led by the Ministry of Health. The ATWG comprise non-governmental organisations and Line Ministries such as Ministries of General education, Youth Sport and Child development and United Nations (UN) partners such UNICEF, UNFPA and UNESCO.
The population of Zambia is estimated to be 17.86 million and ranks at number 8 for its fertility rate of 5.63 children per woman (Zambia Population review, 2019). Adolescents constitute 27% of Zambia‘s population (Central Statistical Office (CSO), 2010). According to the 2017-2021 Adolescent Strategic Plan, the priority for adolescents and youths in Zambia is to serve them with quality accessible sexual and reproductive health information and services. This is to reduce the unmet need for family planning in Zambian adolescents from 21% to 14 % by 2020 (UNFPA, 2018). This is hoped to be achieved by attending to health system bottle necks such as rights based family planning and information and service in every part of Zambia .
According to the Zambia Demographic Health Survey (ZDHS), (2018), the Maternal Mortality Ratio in Zambia is estimated to be 252 deaths per 100 000 live births. The decline from 398 per 10 000 live births in 2013/2014 ZDHS to 252 deaths per 100 000 live births has been aided by improved use of contraception for birth spacing, prevention of early marriages, systems access to emergence obstetrics services and the use of trained Midwives (MOH, 2018). The target is to further decrease the maternal mortality to 100 deaths per 100 000 live births by 2021 according to the 2017-2021 Zambia National Health Strategic Plan. This demand addressing the imbedded gender inequalities that manifest in early marriages, adolescent pregnancy, and inadequate access to sexual and reproductive health services and other interventions. Subsequently, the Ministry of Health (MOH) adopted the Youth Friendly Space (YFS) Model, previously known as youth friendly corner to attend to the health needs of adolescents in Zambia. The YFS is a well-advertised space which functions as an entry service point for adolescents visiting the health facility (Zambia Adolescent Health Strategy [ADHS], 2018). These YFS are manned by trained peer educators to provide a mix of services. The services offered by the peer educators include sexual and reproductive health information; provide health education materials, condom distribution and providing guided referrals to the health services offered by health workers trained to adolescent health standard. However, the Ministry of Health is transiting from adolescent friendly programmes approach to mainstreaming capacity in all health facilities to have an adolescent responsive system (ADHS, 2018). Further, the Ministry of Youth, Sport and Child Development with support from UNFPA in Zambia is involved in activities meant to support the delivery of comprehensive sexuality education to out of school youth who are mostly left out in the programmes being provided in schools.
From these statistics (ZDHS, 2018; WHO, 2020), adolescents are having sex from an early age resulting in unplanned pregnancies that mostly end in unsafe abortion or early child bearing with its associated complications. Adolescents in school may also end up dropping out of school due to pregnancy, yet a small percentage are accessing and utilizing family planning services. In Zambia, the family planning services are provided through youth friendly spaces, family planning clinics and outreach services (MOH, 2017). To access these services, parental attitudes have been shown to influence adolescent girls’ sexual decision making and attitudes towards contraception (O’Rourke-Suchoff, etal, 2017). The parents have potential to influence utilisation of contraceptives to sexually active young people by helping them discuss contraception options and appreciate their effectiveness (Adolescent Health strategy, 2017-2021). This would help avert the unplanned pregnancies, unsafe abortion, sexually transmitted infections and STIs. Therefore, preventing early, unplanned pregnancies among adolescents is critical as they are more likely to encounter more complications associated with child bearing. According to Vwalika and Kumwenda (2017), first degree perineal trauma, pregnancy induced hypertension, preterm or low birth-weight baby complications were observed to be higher among adolescents than older women. Furthermore, adolescent girls who become pregnant mostly have to leave school resulting in long-term economic implications for them as individuals, their families and communities (ZDHS, 2018; Nasilele, 2019).
The causes of teenage pregnancy in Zambia are poverty, peer pressure, desire for high life, distance from school, lack of knowledge about contraceptive use led by lack of communication between parents and children over sexual related issues (Restless development, 2019). Therefore, MOH targets to increase awareness and utilisation of available health services to promote healthy living by developing and adopting adolescent sexual and reproductive health and rights package for community leaders, church leaders, school teachers and parents (Zambia Adolescent Health strategy, 2017-2021). This would warranty health promotion and demand creation for family planning services among adolescents.
Zambia has adopted strategies such as facilitating access for young girls to all types of health services specifically family planning without consent of spouses, parents or guardians as allowed by current laws (MOH, 2017). The Ministry of Higher Education, Ministry of Health and partners launched the programme on adolescents, young people’s health to mitigate the impact of health issues of public concern among young people such as unplanned pregnancy. This is to be realized through multi sectorial approach through health promotion, demand creation, health service provision and strengthening leadership. This would help the adolescents have the necessary information about their sexuality, access and utilise the facilities as a fundamental right (CIDRZ, 2019).
Conversely, adolescents in and out of school continue to be sexually active and participate in sexual risk behaviours despite efforts of comprehensive sexual education programmes (Caroline etal, 2014). The sexual risk behaviours include having multiple sexual partners, lack of contraceptive use such as condoms and other methods. However, a high level of parental involvement is associated with lower levels of risky behaviours during adolescence (Regnerus, 2006).
The impact of modern contraceptive method use is its key role in preventing unintended pregnancy. However, some unintended pregnancies would still occur even if all adolescent women were using contraception because of inconsistent or incorrect use such as forgetting to take oral contraceptive pills, incorrect use of condoms and method failures. This explains the need for a shift in the method mix toward long-acting, reversible methods due to its cost effectiveness (Biddlecom etal, 2018). Where abstinence fails family planning services play a crucial role in adolescent sexual and reproductive health (ASRH, 2017; WHO, 2018).
For that reason, the researcher seeks to explore perception of parents on of utilisation of family planning services among adolescents in Lusaka, as there is currently limited information available in this area in Zambia.
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