Knowledge of, attitudes towards, and practices of contraception in high school pupils in Tswaing subdistrict, North West province

In South Africa, contraceptive use is low in adolescents in the sense that sexual maturation and initiation of sexual activities is taking place at a younger age. This is evident from the high levels of teenage pregnancy that constitute a major health and social problem in South Africa. The risk-taking behaviour of high school pupils who engage in unsafe sexual practices also predisposes them to sexually transmitted infections (STIs), human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and unplanned pregnancies. A cross-sectional survey was carried out in 2009 among Grade 10-12 high school pupils in 15 schools in the rural Tswaing subdistrict of North West province to determine their contraceptive knowledge, attitudes and practices. Data were collected from 231 pupils using a questionnaire. The mean age for sexual maturation was 14.6 years (a range of 14-15 years). Almost equal numbers of males (88, 50.3%) and females (87,49.7%) indicated that they had engaged in sexual intercourse. The average age of respondents was 14.9 years (males) and 15.4 years (females) when they engaged in sexual intercourse for the first time. One hundred and thirty pupils were reported to have had a previous pregnancy. Of the pupils who used contraception, the most common form used by the females was injectable contraceptives (34/81, 43%), and by the males, condoms (42/54, 77%). A high proportion of respondents knew about, and had awareness of, contraception and STIs, i.e. 83/101 of the males (83%) and 113/130 of the females (86.9%). A high number of pupils (128, 73.1%) indicated that they had used contraceptives when they had sexual intercourse for the first time. Of all of the males, only 32 (36.4%), and of all of the females, only 32 (36.8%) always used contraceptives. Eighty-eight pupils (38.1%) lived with both parents. Pupils in this rural area were familiar with contraception, started sexual intercourse at an early age and were generally inconsistent with their use of contraceptives. The study highlights that knowledge and awareness do not always lead to good practice with regard to contraception. A high level of sexual activity, early sexual initiation and low contraceptive use place these adolescents at risk of pregnancy and STIs, including HIV/AIDS.