Contraceptive literacy among school-going adolescents in Botswana

by Francis Barchi PhD Associate Professor, Oleosi Ntshebe PhD Senior Lecturer, Helen Apps
MSc Research Advisor, Peggie Ramaphane

INTRODUCTION
✓ In 2009, the World Health Organization (WHO) called for strengthening how health
sectors address adolescent health and development through improved prevention, treatment, and
care relating to HIV and early pregnancy (World Health Organization, 2009). Despite
improvements, roughly ✓ ✓ 1.75 million adolescents are HIV positive1 and accounted for 11%
of new adult HIV infections worldwide in 2020 (UNICEF, July 2021). ✓ ✓ Globally, 23 million
girls aged 15–19 years have an unmet need for contraception2, and ✓ ✓ 16 million girls give
birth before their 16th birthday3 (Alkema et al., 2016). ✓✓ Adolescent girls under the age of 15
often face complications during pregnancy and childbirth. Maternal mortality4? is a leading cause
of death in this age group in developing countries.5 Inadequate sexual and reproductive health
(SRH) knowledge adds additional risk to adolescent health. ✓ ✓ Eighty-five percent of all
HIV-infected adolescents globally live in sub-Saharan Africa6, where they are often limited in
their ability to access SRH information, resources, and clinical care (Woog et al., 2015; Yakubu
& Salisu, 2018).

✓ Radio/TV and peers have been identified in numerous studies as primary sources of
SRH information for adolescents in sub-Saharan Africa (Smith, 2020). Studies in South Africa
and Ethiopia have reported that parents are important resources7 (Ramathuba, Khoza, &
Netshikweta, 2012; Melakuet al., 2014), whereas other studies found that parents played only a
limited role8 (Kagashe & Honest, 2013). Studies that examined the role of nurses and other
health providers as SRH educators and information resources for adolescents are few.9

✓ ✓ Health literacy is defined as “the degree to which individuals have the capacity to
obtain, process, and understand basic health information and services needed to make
appropriate health decisions” (Ratzan & Parker, 2000, p. iv). ✓ Understanding contraceptive
literacy, operationalized? in this study as knowledge relating to contraception and the correct use
of condoms, is an important first step in equipping adolescents to make healthy decisions in
sexual relationships.10

Adolescent SRH in BOTSWANA

✓ ✓Adolescents represent one fifth of Botswana’s total population and are one of the
most at-risk groups for HIV acquisition. Despite a national mandate to improve adolescent SRH
education and services (Republic of Botswana Ministry of Youth, Sport and Culture, 2010a,
2010b),✓ implementation has been slow due to inadequate human and physical resources. ¹
✓Adolescent risk behaviors and teen pregnancy remain a major health concern in Botswana,
where ✓ ✓three in every 10 new HIV infections in 2018 occurred among young people aged
15–24 years ²and the✓ adolescent fertility rate was five per 1000 births (UNICEF Botswana,
n.d.; Malao, 2017). ✓ Recent work by these authors has contributed to a broader understanding
of the attributes and behaviors among Botswana adolescents³ that predict whether or not they
have engaged insexual intercourse and are confident in their ability to insist on condom use4
(Barchi et al., 2021). ✓Predictors of sexual experience included sources of SRH information,
attitudes about the acceptability of adolescent sex, and perception of sexual activity by one’s
peers 5. ✓✓Adolescents’ confidence in their ability to insist on condoms was significantly
associated with age,6 reported knowledge of correct use of condoms, and endorsement of
prevailing gender norms. However, ✓ information on adolescent knowledge about modern
contraceptive methods in general7 and the correct use of condoms in order to prevent pregnancy
and HIV infection remains limited. The current study addresses this gap by (1) ✓ establishing a
foundational understanding of adolescent contraceptive literacy in Botswana8 and (2) ✓
identifying the factors associated with adolescent self-confidence9 regarding correct condom use.

Reference
Apps, H., Barchi, F., Ntshebe, O., & Ramaphane, P. (2021). Contraceptive literacy among
school-going adolescents in Botswana. International Nursing Review, 69(1), 86–95.
Retrieved September 12, 2022, from https://doi.org/10.1111/inr.12713
Critical Reading Assessment
1. What issue is the writer focusing on?
- The writer is focusing on the contraceptive literacy of the adolescents in
Botswana. They focused on this topic as adolescents in Botswana are at risk for
contracting HIV infection and teenage pregnancy is rampant in the country.

2. Does the writer take a clear stand on this issue?

- Yes, they provided the background information of the issue to show the relevance
of the topic. They were able to inform the readers why contraception literacy is
important to instill to the minds of the youth residing in Botswana. They also
provided evidence to back up their position regarding the issue.

3. What is the writer’s thesis or the central point of the paper (if there is one)?
- The central point of the paper is how understanding contraceptive literacy is the
crucial first step for adolescents to make healthy sexual decisions. The youth must
not have insufficient knowledge about the sexual and reproductive health (SRH)
because this leads most adolescents to HIV and early pregnancy.

4. What is the writer’s purpose for writing?

- The author's purpose for writing is to investigate the literacy level or knowledge
of adolescents in Botswana about contraception and how confident they are about
using it. Given that teenage pregnancy is prevalent in their country, it is
concerning for the writer as teens represent a large portion of their population.
SRH education and information on how to avoid HIV and unintended pregnancies
are still inadequate as well, which contribute to the factors of experiencing these
health concerns.

5. Who is the audience for this writing?

- The writing is directed to teenagers/adolescents to make them understand the
usage and the importance of contraceptives. It is also to let them know that HIV
can be transmitted even if they’re young.

6. What is the writer’s tone? Why do you think he/she writes with this tone?
- The writer’s tone is objective because it talks about contraceptive literacy in
Botswana. It’s a sensitive topic because minors are involved, thus the writer
should present evidence rather than just their opinion. The writer provided
extensive background and evidence related to the topic.
7. Does the writer seem to assume readers will agree with his/her position?
- The author presents a detailed article, in text citation, and an example such as the
age of the target audience. By that, the author assumes that the readers will agree
with his/her position.

8. What evidence does the writer use to support the essay’s thesis/central argument? Does
the writer include enough evidence?
- Yes, the writer included enough evidence to support the essay’s central argument,
such as statistics from organizations regarding HIV infections and fertility rates
among adolescents, as well as how one’s environment, peers, and parents
influence their knowledge of SRH. This evidence proves the significance of
teaching contraceptive literacy to school-going teens.

9. Does the writer consider, address and/or refute opposing arguments?

- The opposing argument that is presented in the article was addressed by the
writer, particularly with regard to the information about the issue of teenagers
with HIV and early teenage pregnancy. The argument has been refuted by
providing evidence about the limited knowledge of adolescents about
contraceptive methods, especially in the country of Botswana.

10. Do you understand the vocabulary? If not, look the words up. Give the definitions of the
difficult words in the article.
- Maternal mortality refers to the death of a woman from pregnancy complications
or childbirth.
- Operationalized means something is explained or defined in context of the
measures used to regulate or prove it.
- Aside from “maternal mortality” and “operationalized,” the vocabulary in the
article is clear and easy to read. Despite the use of certain unfamiliar words, the
terms that comprise the overall context are comprehensible.

11. Did the writer use references/citations? Explain how effective these references and
citations are.
- Yes, the author makes use of references and citations. The writer uses proper
citations on the article to properly credit the owner of the words or ideas, as well
as citing the own article of the author to avoid being accused of plagiarism in the
writer's work .
12. Do you agree with the points the writer makes? Why/why not?
- We agree with the points the writer made because sexual activity among
adolescents has been prevalent, which results in a higher likelihood of teenage
pregnancy. Teaching adolescents the importance of contraceptives will also lower
the number of STD infections, such as HIV, in their group.

13. What connections can you make between this article and others you have read?
- This article, as well as the other articles, tackles the topic of contraceptives and
their importance in healthcare. There is also a commonality in the mention of
women, particularly those in their younger years, as they are said to contract
unintended or teenage pregnancy due to greater sexual activity or a lack of
contraception education.