Over the years the idea of contraceptives as means of birth control in the Republic of South Africa (RSA) has changed, with some totally opposed and others accepting it. Traditionally it was not acceptable to fall pregnant before marriage, but cultural norms have shifted and having a teenage pregnancy is now not seen as immoral. Ziyani and Ehlers (2006) indicate that the attitudes of healthcare providers also contribute to the non-use of contraceptives by adolescents, since they are denied access by being ridiculed, and despite having knowledge about contraceptives they end up becoming pregnant.

Cultural beliefs within Black communities also prevent young people from gaining more information about sexuality, because culturally parents could not discuss sexual information with their children. Concrete sexual education and related information were not made available to the youth until they were faced with the trauma of unwanted pregnancies, birth complications and Sexually Transmitted Infections (STIs) due to wrong decisions and misconceptions about contraceptives (Sapire 1988; Kau 1988). Ziyani and Ehlers (2006) also reported that adolescent girls saw it as ideal to have given birth by the age of 18 years, since contraceptives would delay childbearing and cause sub-fertility – an indication that within African culture families and childbearing are highly valued.

The South African Demographic Survey 1998 showed that sexual behaviour starts as early as at 13 years of age in boys and 15 years in girls; furthermore, teenage pregnancy was more prevalent amongst Coloured and rural girls (Berry & Hall 1998). Peltzer’s (2001) study in Limpopo found that the mean age of sexual debut was 15.4 years, and moreover knowledge and use of contraceptive methods seemed to be poor in the province (Ritcher & Mlambo 2005). Oyedeji and Cassimjee (2006) also reported that rural and Coloured girls experience some form of oppression when it comes to contraceptive use.

Despite government intentions to provide free contraceptive services, there is still a high proportion of adolescents being exposed to the risk of pregnancy. Teenagers in the RSA are exposed to the risks of unwanted and unintended pregnancies as a result of ineffective use of contraceptives and non-utilisation of contraceptive services. Mwaba (2000) underscores the significance of statistics released in 1997 by the Medical Research Council which indicated that 17 000 babies were born to mothers of 16 years and younger. Furthermore, Ehlers et al. (2000) indicate that the rising incidence of adolescent mothers is expected to exceed 1 million in 2010, in spite of free contraceptive services.

Bisika et al. (2007) also indicated that in Africa more adolescent girls die due to pregnancy-related conditions, and unsafe abortions account for a great deal of adolescent morbidity. Over 60% of all unsafe abortions occur amongst women under the age of 25 years. Furthermore, half of all new Human Immunodeficiency Virus (HIV) infections occur in people of 15–24 years of age, most of them sexually active young girls – who are thus in even greater need of contraception and the dual protection it offers.

On balance, there is a high probability that within Black cultures parents, teachers and church leaders might be failing to communicate information about sexuality freely with their children as they feel embarrassed and awkward and think it is immoral. Various studies reported that adolescents in the RSA had some knowledge of one or other method to prevent pregnancies, but never as much as tried to use these methods. This finding was supported by Setiloane (1990), Ehlers et al. (2000) and Ehlers and Khoza (2001), who found that all pregnant teenage girls interviewed knew some contraceptive methods. Furthermore, Ehlers (2003) reported in a study done in Tshwane, RSA, that 60% of adolescent mothers knew about contraceptives but only 43 used injectables, condoms and the pill. In most studies teenagers gave many reasons for non-use of contraceptives, such as fear of parents and of infertility.

An unknown number of unwanted pregnancies continue to be terminated legally or illegally, and it has been reported that in the RSA between 30% and 50% of women requesting TOP were not using contraceptives at the time of conception. Similar percentages of unplanned pregnancies were reported, and the situation continues unabated despite availability of free contraceptives, emergency contraceptives and choice of TOP services (Maja & Ehlers 2004). Similar findings were reported by Yako and Yako (2007), that a large proportion of adolescents were exposed to the risk of pregnancy due to lack of contraceptive knowledge.

There is a need for adolescents to protect themselves from unintended pregnancies, and effective knowledge and contraceptive use can prevent unplanned pregnancies as well as the need for TOP.

• assess the knowledge of secondary school girls about contraceptives
• determine attitudes of secondary school girls towards use of contraceptives
• determine factors contributing to non-use of contraception by secondary school girls.

The population included girls of all types of socio-economic status, irrespective of parity, who might be practising or not practising family planning, were in Grades 10–12 and attending secondary schools in the Vhembe district of Limpopo Province. Non-probability convenience sampling was used to obtain a sample of 273 secondary school girls from the six sampled secondary schools. Convenience sampling entails using the most conveniently available people as study participants (Polit & Beck 2004).

Systematic probability sampling of education circuits was conducted. Systematic sampling refers to the process of selecting every Kth element on the sample list (Burns & Grove 2001). Malamulele Central was included purposively based on reports of high rates of teenage pregnancies, and simple random sampling was used to achieve the desired sample of six schools each from an education circuit.

The questionnaires were distributed by the researcher and an assistant and collected on the same day in order to enhance the return rate.

The majority (54%) of the adolescent girls were aged 15–17years, and most (76%) were residing in rural areas and were of Christian denomination. Forty-six per cent were staying with both parents, whilst 41% were staying with their mothers and siblings; 67% of their mothers were unemployed. The community of Thulamela Municipality is characterised by poor socio-economic conditions and most people rely on government grants.

The majority of respondents did not know the frequency of taking oral contraceptives; of those who responded, 35% said daily, 14% sometimes, 22% before sex, 13% after sex, and 16% didn’t know. The findings indicate that although they had knowledge of some forms of contraceptives, understanding thereof was usually superficial.

Of the 63% of respondents who reported negative attitudes towards contraception, 4% reported that they were abstaining, whilst others made statements such as: ‘boyfriend may leave me’, ‘can damage my womb’, ‘get fat’, ‘my mom will be angry’, ‘may never have children’, ‘it’s dangerous’, ‘long menstruation’, ‘not involved’, ‘not having sexual relations’, ‘not ready for family’, and ‘not necessary’. This indicates that adolescents need to receive information on contraceptives and sexuality.

Khoza (2004) reported similar findings, that group conformity, competition, curiosity, unemployment and irresponsible parents could lead to early initiation of sexual activities. Concerning information regarding sexuality and contraceptives, sexuality knowledge was poor as the majority could not specify the natural method or relate facts about menstruation and the safe period. Contraceptive knowledge was low as they engaged in unprotected sex, and some did not even know how often a contraceptive pill should be taken. These findings resonate with those of Maja and Ehlers (2004), who reported that 44.6% of adolescents were not using contraceptives consistently, implying that they were still at risk of unwanted pregnancy. Consistent and correct use of contraceptives is important to prevent unwanted pregnancies.

Regarding the adolescents’ source of information on sexuality and contraceptives, nurses and the media were cited equally, but the schools were also found to be a source of information; however, this information was not sufficient, since the teachers are from the same cultural background and feel uncomfortable discussing contraception and sexuality. The Alan Guttmacher Institute (2001) and Burgess, Dziegieeski and Green (2005) found that sex education in public schools often missed the target by dwelling on abstinence and denying students the information they really needed when they became sexually active.

This is supported by Bam (1994), who is also of the opinion that sexual education is not an event but a process. Information given should consist of information on anatomy, physiology, sexual behaviour, STIs, sexual development, conception and contraception. The study indicated that respondents had some knowledge of methods of contraception. These findings are supported by other studies like that by Ehlers and Maja (2001), which also reported that 64% of mothers could mention pills and injections – but these were adolescent mothers, who in spite of knowing about contraceptive methods ended up becoming pregnant. These findings are also supported by the Department of Health (2001) study, where it is indicated that to mention the method does not necessary imply its use.

The condom was cited by the majority as their preferred contraceptive method, whereas the hormonal contraceptives (the injection and the pill) were least preferred. However, the low condom use is a disturbing factor, since most were not actually using them even though condoms are widely distributed and easily available. Other contraceptive methods like emergency contraceptives, IUDs and femidoms were generally not known about, due to the fact that Vhembe is a rural district and the socio-economic conditions of the respondents mean they are not able to access them, since the public health facilities do not cater for such services.

These results reflect a serious omission on the part of the government and health care providers to make female condoms available in public places in order to encourage their use by women. Among their female adolescent sample, Moore and Parker (1999) similarly reported that their participants were unaware of the female condom. Those who knew about female condoms reported that condoms were purchased by some relatives at their homes. Regarding emergency contraception, the majority had no knowledge of it. This finding is further supported by Maja and Ehlers (2004), who reported that whilst 31.3% had heard about the morning-after pill, only 12.8% could provide information on it.

The adolescents displayed negative attitudes towards contraceptives as they could not engage in a discussion with their boyfriends and parents, and cited as reasons for this immorality, fear of parental authority and peer recognition and looking cool, some also indicating that they were using cultural methods. Kitsnasamy, Reddy and Jordan (2009) also concur with the fact that students across ethnic groups have a myriad of concerns related to religion and morality, as Christian participants viewed contraceptive use as morally wrong and promoting premarital sex, whilst Indian students indicated that it was demeaning and embarrassing to ask for them.

Forty-nine per cent of the adolescents were not using contraceptives and cited negative perceptions about contraceptives. Of those who were using contraceptives, 60% preferred condoms, 19% preferred injections and 5% preferred pills. Adolescents have easy access to condoms as they are usually distributed in public places, but still are not using them consistently or frequently, which results in unintended pregnancies and STIs. Kistnasamy et al. (2009) also indicated that sexually active students preferred condoms as a contraceptive method over the pill or injection. However, Mashegoane et al. (2004) reported that students did not use condoms during sexual intercourse, which supports the fact that preference does not relate to actual use.

Adolescents in the study could not even discuss contraceptives with their parents (most of them were from single-headed households) or boyfriends, and lack of open communication increases risky sexual behavior. Short and Rosenthal (2003) indicated that parents are the earliest models of sexuality, and mostly children from single-headed households were likely to indulge in sexual activities at an early age, and that is why adolescents could not open discussion with their parents.

Contraception can be a threat to cultural values and norms. In African cultures there is a notion that a man will not marry a woman until she has demonstrated her fertility, and women are considered inferior partners that cannot communicate about contraception with their partners. These findings are supported by Sukati (1998), cited in Ziyane, Ehlers and King (2003), in a study aimed at understanding men’s lack of commitment in family planning practices, which reported the need for health providers to target men on health-related issues including family planning so that they can support adolescent girls to use contraceptives.

Sixty per cent of the respondents were not utilising the health care services, and gave different reasons for this including health workers who denied them access to contraceptives since they perceived them as too young to engage in sexual intercourse. Adolescents need to be provided with information about contraception so that they are able to make an informed decision. Kellner, Jooste and Jacobs (2010) indicate that family planning services should be in line with clients’ expectations, put clients first, and treat the clients as they want to be treated.

Community health care services should foster collaboration with schools to address matters such as sexuality, contraception and contraceptive education and to strengthen life skills.

Health workers should receive regular in-service training in order to be able to provide a detailed contraceptive service and contraceptive counselling.

Peer educational programmes should be initiated. These influence in positive ways, promote norms, attitudes and behaviour, and will enable those involved to make decisions about safe sex or negotiate safe sex. Youth centres should be developed to a point where adolescents can be empowered about life skills to be self-sufficient.

Stereotypical thoughts and behaviour should be eliminated through proper contraceptive counselling and enlightening adolescents about the benefits of contraceptives in reduction of morbidity and mortality. Males and /or partners should be involved in understanding contraceptive practices through educational programmes to prevent negative attitudes, gender and patriarchal systems of behaviour.

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