DETERMINANTS OF RISKY SEXUAL PRACTICES AND ACCESS TO SEXUAL REPRODUCTIVE SERVICES AMONG ADOLESCENTS IN SECONDARY SCHOOLS IN URBAN AND RURAL AREAS OF ENUGU STATE NIGERIA.

Abstract

Background: Adolescent risky sexual behaviors in Nigeria pose significant public health challenges, including unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs). Understanding the determinants of these behaviors in urban and rural contexts is crucial for effective intervention development.

Objective: This study explored the determinants of risky sexual behaviors and access to adolescent reproductive health services (ARHS) among in-school adolescents in Enugu State, Nigeria.

Methods: A descriptive cross-sectional design with mixed methods was utilized, involving 880 adolescents aged 10-19 years from eight schools (four urban, four rural) for quantitative analysis and 80 adolescents for qualitative analysis. Data were gathered through self-administered questionnaires and focus group discussions (FGDs). Statistical analyses included descriptive statistics, chi-square tests, and logistic regression with a significance level of p<0.05.

Results: Among respondents, 420 (47.7%) reported being sexually active, with similar figures in urban (212; 48.2%) and rural (208; 47.3%) areas. The mean age for the sexual debut was identical across groups: 14.62 years (SD 1.768). The majority (85.5%) had multiple sexual partners. Condom use was low in both groups: 18.9% in urban and 9.6% in rural areas. Almost half of both groups (46.2% urban, 49.0% rural) never used condoms. Substance use was strongly associated with risky sexual practices, particularly alcohol, followed by marijuana and cigarettes. Notably, 86% of adolescents who used substances before sex did not use condoms, and 47% reported forced sex. Key determinants of risky behavior included poverty, peer pressure, and poor parental supervision. Access to ARHS was limited, with concerns about stigma and confidentiality; 57.7% lacked access, with rural adolescents facing poorer access (66.3%) than their urban counterparts (47.5%).

Conclusion: The study underscores the need for increased awareness, parental involvement, and targeted interventions to improve ARHS access and reduce risky sexual behaviors among adolescents in Enugu State.