Sexual behaviour, contraceptive knowledge and use among female undergraduates’ students of Muhimbili and Dar es Salaam Universities, Tanzania: a cross-sectional study

Adolescent sexual behaviour has been recognized as an important health, social and demographic concern in the developing world [1]. Adolescent pregnancy is associated with adverse maternal, fetal and neonatal outcomes [2, 3]. Teenage girls who get pregnancy suffer from social and economic consequence and they are more likely to drop out of school. Furthermore, unwanted pregnancy poses a big problem among young adult in developing countries [4].

Majority of students who join universities in Tanzania are aged between 19 and 29 years [5]. Most of female students are enrolled to university at their young age, this expose them to unplanned and unprotected sexual intercourse leading to unintended pregnancies, abortions and sexual transmitted infections [6]. The increased sexual risky behaviours of female University student has been attributed to movement from a restricted rural to a more liberal urban environment, age and marital status [7].

A recent study in Tanzania reported a 34.4% contraceptive prevalence rate among women of reproductive age (15–49 years) [8]. Results from Demographic and Health Survey in Tanzania also reported contraceptive prevalence use rate of 19% among female aged between 20 and 24 years, and the teenager pregnancy rate of 44% [9]. Previous studies conducted in sub Saharan Africa have reported on risky sexual behaviours among African youths, particularly University students. For example, a study among university students in Madagascar by Rahamefy and colleagues revealed that 29% of the students reported to have 2 or more sexual partners and only 13.5% were consistently using the condom [10]. However, a slightly higher proportion (48.9%) of condom use was reported among university students in Kampala [11].

Low level of utilization of contraceptives has been associated with high rates of unwanted pregnancies and unsafe abortions among Sub-Saharan Africa youth [12]. A study conducted among nursing female students at Calabar University in Nigeria revealed that 55% of students who were sexually active had knowledge of family planning especially condom use (37%) [13]. In a similar study, more than half (51%) of the students who had unwanted pregnancy ended to abortion [13]. Low utilization of contraception has also been attributed to limited capacity of the health care system and structure within which family planning services are offered [14]. Furthermore, individual factors such as risk perception, fear of side effects, opposition from male partners, health service limitations and insufficient knowledge needed to make informed choices have been reported as barriers for utilization of contraception [15, 16].

As an attempt to curb the problem, Tanzania government policy on family planning has made an effort to ensure the availability of contraceptives services in its health Centres for men and women who are ready for and in need [17]. In line with the government policy, the University of Dar es Salaam and Muhimbili established a project to target students and other youths in the surrounding communities by providing reproductive health services including contraceptives. However, the effectiveness of this program has not yet evaluated.

Previous studies in sub Saharan Africa have demonstrated that University female students are at high risk of sexual transmitted infections including HIV, and they have high rate of unwanted pregnancy which results to high abortion rate. Despite this fact, there is limited information about sexual behaviours, contraceptive knowledge and use among female University students in Tanzania. This underscores the need to understand the sexual risk behaviour, knowledge and pattern of contraceptives use among this high risk group in order to promote proper use of contraception. Therefore this study aimed to examine sexual behaviour, contraceptive knowledge and use among female undergraduates’ students of Muhimbili and Dar es Salaam Universities in Tanzania. The study also explored factors associated with use of contraception.

Although majority of the respondents in this study had knowledge of contraception, but we found that the utilization of contraception is still low. Majority of the students were sexually active and started sexual activity at young age. We also found that marital status, age at first sex, ever had sex, ever been pregnancy and unwanted pregnancy were independent associated with use of contraception.

Knowledge about fertility control is an important step towards access to and use of an appropriate contraceptive methods in a timely and effective manner [9]. In the present study all the respondents were aware about contraceptive. Our findings are consistent with previous studies in the region [18]. We however, found there was a difference between participants’ contraceptive knowledge and sexual behaviour, where 70.4% of the participants engaged in sexual activity while only 41.5% reported currently using contraception. Similar trend was reported in another study in Nigeria [15]. Condom was the most commonly known contraceptive and more frequently used while other methods like intra uterine device, lactation amenorrhea and Norplant were rarely mentioned. This could be explained by education campaigns and extensive social marketing of condoms in response to HIV epidemic which has also been reported elsewhere [20, 21]. This underscores the need of adopting similar approach in promoting other contraceptive methods in order to increase its use.

The success of any family planning programme activities is determined by the level of current use of contraceptives [9]. In this study, the contraceptive ever use rate was 58.5% while 41.5% of the respondents were currently using contraceptive methods of any type with condom being the commonest method used. The observed contraceptive use rate in our study was high compared with 14.5% that was reported by Byamugisha et al. among university students in Uganda [11]. The difference between contraceptive usage and sexual risk behaviour exposes high proportion of women at risk of unintended pregnancy and other sexual transmitted infections as majority of the participants in the present study were not using contraception. Condom, withdrawal and periodic abstinence methods were the most popular methods ever used or currently being used by respondents. A very similar pattern on the choice of contraceptive method was reported among Nigerian undergraduate students [15]. In the present study, the main reason for using contraception was to avoid pregnancy before graduation (49.2%) while only 17.2% used contraceptive because they feared contracting HIV/AIDS. Similar finding was reported by a previous study in Madagascar [10]. However, the reasons for not using other contraceptive methods remain unclear which requires further studies.

The present study found that about 38.6% of the students had been using contraceptive between 1–2 years. This figure is slightly higher compared with 21.6% reported by a Nigerian investigators [18]. This difference could be attributed to age distribution or sample size differences between the studied populations. In addition, the difference in the exposure duration, and access to contraceptive information between two countries could attribute to the observed difference in contraceptive use.

Our study has showed that the mean age at sexual debut is 20 (2.3) years. This finding corresponds to the study done among Madagascar university students which reported the mean age of 19 years [10]. In this study, we found that about 70.4% of the study participants reported to have ever had sexual intercourse. This proportion is slightly lower as compared to 79% that was reported among Ethiopian students [22]. Given the relatively high degree of sexual activity and limited use of effective contraceptive methods by adolescents, these students are at great risk of acquiring sexual transmitted diseases including HIV etc., unwanted pregnancy and illegal abortions. This was the case in our study where we found that 11(26.8%) women had unwanted and 6 (54.6%) them terminate their pregnancies. In contrast, a study among female Nigerian undergraduate students reported the abortion rate of 34% [19]. The likely explanation for this difference could be due to difference in sample size and social cultural differences between two studies.

Apart from the methods requiring direct contact with the health workers; pharmacy and shops were commonest source of modern contraceptive methods. Our results is in agreement with previous study among Nigerian undergraduates [15], where authors reported pharmacy was among the commonest sources of contraceptive services. Despite the fact that the majority of the students in the current study reported to obtain contraceptive services from the pharmacies and shops, (75.2%) would prefer to get contraceptive services from the university health centre and (14.3%) from the halls of the residence. Probably this could be due to an easy access to these facilities. The findings also underscores the need to provide contraceptive information’s in shops and pharmacies possibly via advertisement, posters and brochures in addition to providing contraceptive services in the university’s health clinics.

This study showed that the knowledge about contraception among the female students was high. Majority of the students were sexually active and started sexual activity at earlier age. However, the rate of contraception use is still low. The low contraceptive usage suggests the need for sexual and reproductive health education program to promote use of contraceptive services in the study settings. The reproductive health education programs should include the importance of using dual contraceptive methods as a means to prevent HIV transmission as well as prevent pregnancy. Additional research studies are needed to understand the barriers for contraceptive use in particular type of contraceptives used and reasons for not utilizing services provided in health facilities within university campuses. Future studies also need to use rigorous recruitment approaches to enhance high participation rate.