Examining how well an intervention improved adolescents’ attitudes towards contraception, unsafe abortion, and intimate partner violence in southeast Nigeria

This study assessed the effect of an intervention on adolescents’ attitudes towards condom use, contraceptive use, unsafe abortion, and intimate partner violence in urban and rural communities in Southeast Nigeria. A cross-sectional study was conducted in twelve (12) communities purposively selected from six (6) local government areas (LGAs) in Ebonyi State, southeast Nigeria, after the implementation of a suite of interventions that focused on improving adolescents’ attitudes towards contraception, unsafe abortion, and intimate partner violence. A pre-tested interviewer-administered questionnaire was used to interview 855 unmarried adolescent boys and girls aged 13–19 that were selected using simple random sampling. In addition, eight focus group discussions (FGD) were held. The FGDs were disaggregated by sex and location (in-school and in-community adolescents). Univariate and multivariate analyses were undertaken on the survey data, while a thematic framework approach was used to analyze the qualitative data. The intervention resulted in more adolescents having improved attitude towards the use of condoms (OR = 1.09; CI 1.83–1.47) and other contraceptives (OR = 2.29; CI 1.46–3.62). Also, there was a positive overall attitude toward SRH issues such as condom use, contraception, engaging in unsafe abortion, and intimate partner violence. Adolescents age (OR = 1.27 CI 1.04–1.39), location of residence (OR = 0.61; CI 0.39–0.96), and work for pay (OR = 2.25; CI 1.22–4.17) were significant predictors of improved attitude towards issues on SRH in intervention group. Adolescents who attended SRH campaign (OR = 1.61; CI 0.78–3.30) and discussed sex-related topics with someone afterward (OR = 2.37; CI 1.30–4.32) were twice as likely to show a positive attitude compared to those who did not in the same group. Likewise, the FGDs revealed that adolescents who took part in the intervention gained greater confidence in using condoms during casual sex and became more assertive in refusing sexual harassment and coercion. They noted that this shift in attitude towards condom use led to a reduction in incidents where parents in the communities would have male partners arrested for impregnating adolescent females. The intervention has led to improvements in the attitudes of adolescents toward condom use and other SRH services. Hence, there is a need to sustain, and scale-up the intervention to cover the entire state and all parts of Nigeria with similar contexts for universal promotion of positive attitudes towards contraceptive use, abortion, and sexual violence among diverse adolescents.