Influencing Factors towards Thai Adolescents

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Jul 18, 2017 - methods, unprotected sex has the potential to place adolescents at risk of ... (2012) found 60% of young Thai female respondents aged 12–19 ...

Influencing Factors towards Thai Adolescents’ Decision Making on Contraceptive Use: Preliminary Results Sansanee Chanthasukh PhD candidate, Auckland University of Technology, Auckland, New Zealand Pharmacist, Sirindhorn College of Public Health, Khon Kaen, Thailand [email protected] Sari Andajani Auckland University of Technology, Auckland, New Zealand Tagaloatele Peggy Fairbairn-Dunlop Auckland University of Technology, Auckland, New Zealand


Abstract Adolescent pregnancy has been a critical public health problem in Thailand since 2008. Contraceptive methods become a medical strategy to prevent unplanned pregnancies. Studies illustrate that contraceptive use rate among sexually active Thai adolescents, compared to adults, is relatively low. Studies also show that decisions on contraceptive use could be influenced by several factors. However, little is known what influence Thai adolescents’ decision about contraceptive use. This qualitative study aims to explore influencing factors. The researchers purposively recruited 38 adolescents aged 15–19 years from two schools in an urban area of Khon Kaen. Of 38 participants, 29 participated in five single-gender discussion groups. Discussion group participants were subsequently invited to in-depth interviews, and 11 of them responded. Other 9 participants were in in-depth interviews but did not join group discussions. Data collection was partially facilitated by a local youth advisory group. Thematic analysis was used to interpret the data. Preliminary findings illustrate that fear associated with pregnancy steered young people to choose to use some kind of contraceptive method. Their fears originated from fear of negative consequences of pregnancy on parents; fear of physical and socio-economic difficulties to self; and fear of being unable to fulfil cultural expectations as the first female child in the family. Fears of HIV/AIDs and side effects of contraceptive pills led some sexually active participants to favour condoms. Female negotiation skills and seniority of the female in a relationship were likely to affect the decision to adopt condoms. Interestingly for one female participant, complicating factors consisted of cohabitation, male preference for contraceptive methods, and an allergy to hormone pills. Based on preliminary results, numerous factors could influence Thai adolescents to choose certain kinds of contraceptive methods. To tackle sexual and reproductive health problems including adolescent pregnancy, these complex influencing factors should be considered thoroughly.



Introduction Pregnancy and complications in childbearing are the second leading cause of death worldwide for adolescent girls aged 15–19 years (World Health Organization, 2015). Pregnancy during adolescence can place girls at increased risk of serious on-going health issues and death. Pregnant girls have a higher risk of mental health problems such as depression, compared to pregnant women of other age groups (Siegel & Brandon, 2014). They drop out of school, rarely return to school and are likely to end up in low-paid work (World Health Organization, 2012a). Studies have shown that they and their children struggle with social and financial problems and need additional provisions such as social support, healthcare subsidies and child welfare aid, which cost their families, communities and states must meet (Hoffman, 2006; World Health Organization, 2012a). Adolescent pregnancy has become a global health dilemma. Globally, a total of 16 million adolescents aged 15–19 years give birth each year (United Nations Children's Fund, 2012; World Health Organization, 2012a). The global adolescent birth rate is currently at 49 per 1,000 female adolescents (World Health Organization, 2012a). Thailand, a country located in the Indochinese Peninsula, has also been confronted with adolescent pregnancy problems. In Thailand, the adolescent birth rate was 48 in 2015, just below the world average (Ministry of Public Health, 2012; United Nations Children's Fund, 2015b). Moreover, 70% of adolescent pregnancies in Thailand are unwanted (Hemachandra, Rungruxsirivorn, Taneepanichskul, & Pruksananonda, 2012). Unfortunately, the severity of the problem in Thailand could remain underreported, because the number of miscarriages and illegal abortions has never been recorded. Tangmunkongvorakul, Banwell, Carmichael, Utomo, and Sleigh (2011) have reported that adolescent participants in their study may have sought to terminate unwanted pregnancies by taking abortifacient agents bought from the black market. In addition, approximately 90% of participants (aged 15–21 years) in another study sought illegal abortions (Manopaiboon et al., 2003). Contraceptive use is a significant determinant of adolescent pregnancy worldwide (World Health Organization, 2012b). Contraceptive methods are techniques or devices mostly used in family planning programmes for individuals or couples to control the number, birth interval and dates of birth of children (World Health Organization, 2014). In the absence of effective contraceptive methods, unprotected sex has the potential to place adolescents at risk of unwanted pregnancy, unsafe abortion or other sexual and reproductive health problems (World Health Organization, 2012a). Globally, adolescents aged 15–19 years have low rates of contraceptive use and high failure rates. Global contraceptive use among adolescents aged 15–19 years sits at 21%, compared to 38%, 52% and >60% among those aged 20–24, 25–29, and 30–44 years, respectively (United Nations Population Fund, 2013). Approximately 25% of adolescents (aged 15–19 years), mostly unmarried, do not want unplanned children, but they still do not use contraceptive methods (Blanc, Tsui, Croft, & Trevitt, 2009; Chandra-Mouli, McCarraher, Phillips, Williamson, & Hainsworth, 2014; United Nations Population Fund, 2013). In Thailand, contraceptive use among the larger group of females at reproductive age (15–49 years) is approximately 80%, whereas this rate is

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