By Angela Iwuagwu and Benjamin Uzochukwu
 
“Researchers can be surprised at their data …” This was said by one of the authors of this blog, who due to Nigeria’s conservative cultural outlook, was surprised at how almost 50% of surveyed secondary school students affirmed sexual activeness. It was even more surprising that some of the sexually active secondary school students were involved in sexual intercourse with the same gender.
In Nigeria, the typical age for secondary school students should be between 10 and 18 years. Those within this age bracket are considered to be adolescents. It is an age of experienced puberty, marked by changes in bodily organs and hormones, early sexual urges, and exuberance.
In typical Nigerian families, parental vigilance increases as soon as children begin to mature into adolescents because they will for the first time be exposed to new feelings, inclusive of sexual feelings and manifestations of exuberance, which could go against laws and moral principles. In fact, vigilance over adolescents in a typical Nigerian setting extends beyond the home to include vigilance by adult figures in schools, neighbourhoods, markets, and worship places. Such scale of vigilance reflects the popular parlance, ‘it takes a community to train a child’.
Adolescents are expected to be steadfast in their training in school, acquire skills, and grow into becoming contributing members of society. Even in societies that support the sexualization of adolescent women, there is an increasing number of intense campaigns against such. Unfortunately, despite the many emphases of small- and large-scale vigilance over adolescents, many do not keep to the expectations of morality society has placed on them or even to the ideals of the diverse campaigns protecting adolescents from sexual engagements.
 
Sexual behaviours among adolescents in Nigeria pose a significant public health problem
For adolescents, there is just a thin line between risky and non-risky sexual behaviours. This is due to the inability of adolescents to regulate and bear the overall consequences of sexual engagements. It is for this reason, that sexual-related campaigns targeting adolescents mainly advocate abstinence. The most popular one in Nigeria for the past decade is the ‘Zip-UP!’ campaign. However, available statistics indicate that Nigerian adolescents tend not to heed such campaigns, and it is important to understand why and seek alternative approaches.
The fertility rate of 104 births per 1,000 Nigerian adolescent women is among the highest in the world. A study reported that among 428 adolescents in northern Nigeria, condomless sexual intercourse was found to be prevalent in one-third. Besides the spread of sexually transmitted infections (STIs), other concerns being witnessed as a result of this high prevalence of sexual intercourse among adolescents include unplanned pregnancies, truncated schooling, unsafe abortion, psychological worries for both adolescents and their carers, and death. The health challenges posed by sexual behaviours among adolescents extend to their carers, which is why this subject has remained of significant interest to a broad range of stakeholders.
 
Figures for adolescents’ sexual behaviours in southern-Nigeria are becoming scary
We surveyed 880 adolescents in secondary schools in the south-eastern part of Nigeria. They were between 10 and 19 years of age, drawn from rural and urban divides. We went ahead to conduct group discussions with another 80 adolescents in the region to seek more insights into the results from the survey.
Almost half (47.7%) of the surveyed adolescents confirmed participation in sexual intercourse, and some of them mentioned sexing the same gender, while others claimed to have more than one sexual partner. Substance misuse during sexual intercourse was found to be common at 93%. The misused substances in particular order are alcohol, marijuana, cigarettes, codeine, tramadol, methamphetamine, cocaine, and heroin. Of those who are sexually active, 86% never used condoms, and 75% said they had oral sex after misusing a substance. This group of adolescents also used sex as a means of exchange for drugs.
After sexual activity, less than 25% of the adolescents had confirmed pregnancies. However, adolescents in rural areas were less likely to have an abortion than those in urban areas. The study found poor parenting, exposure to uncensored videos, peer pressure, and limited knowledge of sexual and reproductive health as key factors driving up the numbers. A significant finding was that adolescents from poor homes could engage in sex for basic survival.
We discovered that primary health centres within the adolescents’ neighbourhoods were designed to provide sexual and reproductive health tips and services. Schools were also prepared to offer similar services. Disappointingly, while a good number of adolescents were unaware of such services around them, those that have ever utilised the services complained about stigmatisation and breaches of confidentiality.
 
A call to action
For several people, the scale of sexual engagement and risky sexual behaviours among adolescents in a typical conservative society like Nigeria may be surprising. The consequences are too significantly destructive, hence the need to take critical actions. First, the availability of sexual and reproductive health services in primary health centres and schools should be widely communicated, and those who are responsible for these services should be trained on the vital skills needed to work in such spaces.
Five important skills would be empathy, non-judgemental attitude, acceptance, respect for confidentiality, and case management. We reckon that these skills are home to the social service disciplines like social work and psychology, and it would be appropriate to begin to take dramatic and urgent measures to strengthen the operations of the social service professionals in health centres and schools.
The relationship between substance misuse and risky sexual behaviours among adolescents has been established. A firm approach should be in place to regulate and criminalize adolescents’ exposure to such substances. This should also include community-led awareness campaigns against substance misuse in relation to risky sexual behaviors.
Finally, we recommend community-led recreational and extracurricular activities that will keep adolescents engaged, and will serve as platforms for targeted health education content. Overall, for sustainable interventions to address these scary figures, government, non-government, and community actors will have significant and concerted roles to play. Efforts should also be made to improve sexual and reproductive health rights among adolescents in Nigeria.
 
Authors Bio
Dr. Angela Chiebodi Iwuagwu is a Nigerian medical doctor with the Community Medicine department of the University of Nigeria Teaching Hospital, and Fellow of the West African College of Physicians with expertise in public health, particularly endemic and epidemic diseases. With years of experience in sub-Saharan Africa, she has worked in various roles, including senior registrar, implementing public health programmes, and providing healthcare services to mothers and children. She has also worked as a health policy researcher and participated in various health projects.
 
Prof. Benjamin Uzochukwu is a public health physician and professor at the University of Nigeria, Nsukka. He is a renowned figure in Nigeria and Africa in health policy, systems research, and analysis. He has advised various organisations on implementation research, healthcare financing, and realistic evaluation of health programs. Professor Uzochukwu is a member of several committees, including the Ministerial Expert Advisory Committee on COVID-19 Health Sector Response in Nigeria. He is a Fellow of the National Academy of Science (FAS) and the Academy of Medicine Specialists of Nigeria (FAMedS).
 
Correspondence: Dr. Angela Iwuagwu
+234 803 528 6369
angelaiwuagwu@gmail.com
 
Acknowledgment: We thank Dr Prince Agwu for expert review.

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