The Health Policy Research Group at the University of Nigeria Enugu, Campus, is implementing a four-year (48 months) project on sexual and reproductive health in six urban and rural local government areas in Ebonyi State Nigeria. It is estimated that about 2 in 10 young women will become pregnant before 18 years of age worldwide (Sedgh et al., 2015). The demand for family planning among young unmarried women in all regions is estimated at 90%, indicating that these women do not want to become pregnant. The gap between sexual intentions and contraceptive behaviour (unmet need for contraceptives) in this group is highest in West and Central Africa, an estimated 41.7% (MacQuarrie K.L.D, 2014). This unmet need is highest among the youngest women and declines with increasing age showing that adolescents have the highest unmet need for contraceptives. West Africa has the highest proportion of adolescent pregnancies (28%) (MacQuarrie K.L.D, 2014). There is a high unmet need for contraception and sexual reproductive health services in Nigeria resulting in high pregnancy rates.
    The project aimed to adapt, design, implement, and evaluate an inclusive community-embedded intervention program to address unmet contraceptive needs of adolescents in rural and urban areas in Ebonyi state, Nigeria. It focuses on 6 local government areas in Ebonyi State, South-East Nigeria. LGAs with the highest unmet need for contraceptives as evidenced by unwanted teenage pregnancies and abortions were selected. The LGAs are namely, Abakaliki (urban), Izzi (rural), Ezza south (semi-urban), Ikwo (rural), Afikpo south (rural), and Ohaozara (semi-urban). From each LGA, the community that is served by the youth-friendly primary health center (YFC) was purposively selected. This selection was based on the understanding that the YFCs were sited in communities that have been prioritized by the State government for adolescent SRH intervention, based on need.
    The first phase of the project involved a situational analysis (literature review and baseline survey) to understand the situation of adolescent sexual and reproductive health in Ebonyi state, and gain insights that would be used in designing components of the community-embedded intervention. Following the baseline survey, the study objectives were modified to encompass adolescents’ unmet needs for sexual and reproductive health information and services, rather than only their unmet needs for contraceptives. This was based on the finding that only 9.8% and 2.9% of the surveyed adolescents had access to SRH information and services, respectively, from health providers; and only 15% of the adolescents had access to SRH information from school teachers.
    The second phase of the project involved the design and implementation of interventions while the evaluation of the interventions was carried out in the final/third phase of the project. The project interventions aimed to increase access to needed sexual and reproductive health (including contraceptive) information and services by adolescents in Ebonyi State, Nigeria, by addressing specific barriers at individual, community, school, and health facility levels. During the design and implementation of interventions, several stakeholders were visited, and were later pulled together to participate in series of workshops where goals and strategies in three (3) core areas were finetuned – information, health services and advocacy. On advocacy, four major advocacy strategies were supported by the project, and these are:
    • Advocacy visits to influential decision-makers, community leaders, and youth influencers
    • Public panel discussion on adolescent SRHR
    • Radio phone-in program
    In the area of health services, formal and informal health services providers were trained and provided with supportive supervision to cascade sexual and reproductive health services to health facilities.
    And on information, the project supported the implementation of the following activities:
    • Training of secondary school teachers and peer educators
    • Establishment and Formal inauguration of school health clubs
    • Group awareness campaigns in communities
     
    Project research team
    Principal Investigator
    • Professor Chinyere Ojiugo Mbachu
    Co-Investigators
    • Professor Obinna Onwujekwe 
    • Professor Nkoli Ezumah
    Research staff
    • Dr Irene Eze
    • Ifunanya Clara Agu
    • Mrs Uchenna Ezenwaka
    • Dr Chibuike Innocent Agu
    • Dr Chinyere Okeke
    • Dr Ugenyi Iloabachie
    • Dr God’stime Eigbiremolen
    • Dr Ifeyinwa Akamike
    • Ms Ozioma Agu
    • Dr Prince Agwu (Research Uptake and Communication)

    Major project outputs

    Published research papers and access link   

    1. Stakeholders’ perceptions of adolescents’ sexual and reproductive health needs in southeast Nigeria – a qualitative study. BMJ Open 2022; 12:e051389., https://bmjopen.bmj.com/content/12/6/e051389
    2. Prevalence and sociodemographic determinants of risky sexual behaviour among unmarried adolescents in Southeast Nigeria. Int J Med Health Dev (2022). 27(2): 176-184. https://www.ijmhdev.com/article.asp?issn=2635-3695;year=2022;volume=27;issue=2;spage=176;epage=184;aulast=Eze
    3. Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria. Niger J Clinical Practice 2021; 24:1582-9. https://www.njcponline.com/article.asp?issn=1119-3077;year=2021;volume=24;issue=11;spage=1582;epage=1589;aulast=Agu
    4. Adolescents’ Perceptions About Dating and Sexual Permissiveness in Ebonyi State, Nigeria: What Can Be Done to Enhance Adolescents’ Sexual Health and Well-Being, Frontiers Reprod. Health (2021). 3:626931. https://www.frontiersin.org/articles/10.3389/frph.2021.626931/full
    5. Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria. Reprod Health 18, 7 (2021). https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-020-01062-y
    6. Socio-demographic and economic determinants of awareness and use of contraceptives among adolescents in Ebonyi State, South-east, Nigeria. Africa Journal of Reproductive Health 2021, 25(3). https://www.ajrh.info/index.php/ajrh/article/view/2774/pdf
    7. Collaborating to co-produce strategies for delivering adolescent sexual and reproductive health interventions: processes and experiences from an implementation research project in Nigeria. Health Policy and Planning, 2020. 35, suppl. 2: ii84-ii97. https://academic.oup.com/heapol/article/35/Supplement_2/ii84/5959267
    8. Misconceptions about transmission, symptoms and prevention of HIV/AIDS among adolescents in Ebonyi state, South-east Nigeria. BMC Research Notes, 2020. 13:244. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-020-05086-2
    9. Survey data of adolescents’ sexual and reproductive health in selected local governments in southeast Nigeria. Scientific Data (2020). https://www.nature.com/articles/s41597-020-00783-w
    10. Exploring issues in caregivers and parent communication of sexual and reproductive health matters with adolescents in Nigeria. BMC Public Health (2020). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-8058-5
    11. Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: an application of the socio-ecological model. BMC Public Health 2020, 20(1):1162. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09276-2
    Published reports
    1. Addressing unmet need for contraceptives among adolescents using community-embedded intervention: highlights of stakeholder engagement meeting, 2019. http://hdl.handle.net/10625/58193
    2. Cross-Sectional Survey Data of Adolescent Sexual and Reproductive Health in Nigeria 2018. [Data Collection]. Colchester, Essex: UK Data Service, 2020.   https://reshare.ukdataservice.ac.uk/854374/
    Policy and advocacy briefs
    1. Institutionalizing comprehensive sexuality education in secondary schools and non-formal education settings in Ebonyi state: The need for action
    2. Potential contributions of traditional & community leaders in promoting adolescents’ sexual and reproductive health in Ebonyi state
    3. Improving adolescents’ access to sexual & reproductive health information and services using community-embedded interventions in Ebonyi State, Nigeria
    Job aides
    • Counselling cards – The balanced counselling strategy plus: A toolkit for family planning service providers
    • Hand flyer on provision of sexual and reproductive health (SRH) information in Ebonyi state
    • Poster on adolescent sexual and reproductive health (SRH) and wellbeing
    • Poster on improving parent-adolescents communication of sexual and reproductive health (ERH) education