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Title: Exploration of power relations in the sexual and contraceptive choices of adolescents in south west Nigeria
Author: Odewusi, Temitayo Adeola
ISNI:       0000 0004 9349 2840
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2020
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Background: Nigeria has one of the highest populations of young people worldwide including the widest health and economic inequalities. There are high levels of maternal deaths from pregnancy-related causes and sexually transmitted infections compared to other low-and-middle-income countries. The majority of research in this field is quantitative, highlighting a lack of education in sexual health. Nonetheless, there is a notable lack of research into the sexual experiences of the young people themselves. Aims: This study aimed to explore: 1) the views and experiences of Nigerian adolescents about their sexual initiation and contraceptive use; and, 2) the influence of gender and socio-economic status in the Nigerian adolescents’ accounts of their sexual initiation and contraceptive use. Design and method: Using a qualitative interpretative research approach, the data collection comprised of 8 focus group discussions and 24 individual interviews with adolescents in South West Nigeria. Interviews were conducted (July - November 2017) in English and Yoruba languages with seventy-two adolescents (16 -19 years), which included both in-school and out-of-school males and females. Data management was facilitated using Nvivo 11 and framework analysis was used to code and categorise the data until themes emerged. Findings: Three major themes were identified: 1) Diffused forms of dominance and control; 2) Changing influential relationships; and 3) Influencing contraceptive knowledge. The young people in South West Nigeria make their sexual and contraceptive choices (SCC) in the context of powerful structural and relational factors, such as the prevailing cultural norms that prevent and stigmatise adolescent pregnancy, religious beliefs that prohibit sex before marriage and a patriarchal system that leads to unequal gender power relations. Nigerian culture fosters traditional gender roles for young people, which is rooted in patriarchy, and parents are reluctant to talk to their adolescent children about sex and contraceptive use due to a culture of fear and denial. In addition, work-demands on the parents make them physically and/ or emotionally absent in meeting their adolescent children’s sexual and contraceptive health (SCH) needs. In response to this, young people rarely discuss their sexual and contraceptive concerns with their parents and seek advice in other ways. The result of these interconnecting factors suggests that there is an important gap between the adolescents and their parents, where the young people lack parental guidance and support. Adolescents feel let down by their parents and seek solutions to their unmet SCH needs by circumnavigating their parents for advice and support. Nonetheless, the young people do not openly challenge power structures, as respect for elders in the Nigerian society is a very strong cultural norm. Rather, the adolescents exercise power in more subtle ways by turning to their friends/ peers for support in similar and different ways. Power is exercised amongst peers - in particular amongst the male young people - where coercion and sexual violence towards young women often goes unchallenged. Young females do exert power in some instances, but this is in a much more nuanced way. While there are gender differences in the use of power in sexual relationships, there are also differences in the ways that the in-school and out-of-school young people negotiate their SCH needs. While both groups of young people evade their parents and seek for support from social media, there are clear differences between socio-economic groups. The in-school males consult a book called ‘The Bro Code’ as a guide in making their choices about relationships, sex and contraceptive use; in contrast, the out-of-school young people side-step their parents by choosing for themselves self-appointed parents surrogates that they referred to as “area mums/ dads or brothers”. Drawing on Foucault’ concept of Governmentality and power where he argues that power relations are everywhere and comes from everywhere (Foucault, 1991; 1998), and infiltrates all human interactions, this study demonstrates the ways that power is in constant negotiation, especially between the individual, the society and institutions in the lives of these young people (Foucault, 1980). Not only were more traditional power relations seen between parents and adolescents, enacted through patriarchy and respect for elders; but diffuse power was exerted between and among the young people. From Foucault’s view, power is not always oppressive but is also productive, whereby it brings out new behaviours in those whom the power is exerted upon (Foucault, 1978). The SCC made by the young people revealed how they developed new ways to obtain information through their self-appointed street mums/ dads/ brothers, the internet and Bro Code. Implications: What is new in this study is that it illuminates the new ways that governmentality and power work by creating the environment where the young people look for creative ways to meet their SCH needs. However, these new ways have both positive and negative impacts on the young people. The positive aspect is the creativity it brings out in the young people to solve their SCH needs, while the negative effect is their exposure to pornography that promotes unsafe sex practices, exploitation and abuse. Implications: Within this context, this study highlighted the ways that the health services in Nigeria do not meet the SCH needs of young people. It also raises the issues facing the young people and the need for a multidimensional approach to solving the problems, with the voices of young people included in any sexual health strategy and education. This study also suggests ways that nurse education and practice could be pivotal in meeting the SCH of young people in Nigeria, focusing on better access to services, improved nurse education and more effective advocacy work. Finally, this study suggests that specially trained sexual health nurses should be employed to work in schools in order to meet the SCH needs of adolescents.
Supervisor: Cuthill, Fiona ; Harden, Jeni Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: adolescence ; adolescent sexual and reproductive health ; sexual initiation