Sexual and reproductive health needs among young women who inject drugs in Nigeria

Adebiyi, Adeolu (2024) Sexual and reproductive health needs among young women who inject drugs in Nigeria, Thesis (Doctoral), Liverpool School of Tropical Medicine.

Text A Adebiyi Final Thesis submitted LSTM2024.pdf - Accepted Version Restricted to Repository staff only until 18 March 2025. Download (8MB)

Abstract

The prevalence of drug use, both legal and illegal, in Nigeria is almost three times the global average and one out of every four persons who use drugs in the country is a woman. Young women are underserved in relation to sexual and reproductive health (SRH) services and SRH needs have also been found to increase with the use of psychoactive substances among women. In view of this, the research presented aims to understand SRH-related experience of young women (15-24 years') who inject drugs (YWID), their unmet needs, and issues to consider for effective integration of SRH and drug-related services into existing HIV and primary healthcare models.

Method
Mixed methods were used. A cross-sectional survey was conducted among YWIDs (N=287) using snowball sampling while focus group discussions and interviews were held with both YWIDs and national stakeholders who are policy and program managers of health respectively. Qualitative data were analysed thematically. Quantitative analysis used chi-square tests to compare dependent (frequency of condom use, lifetime pregnancy, abortion, symptoms of sexually transmitted infections (STI) and independent variables (age, education, employment, income, religion, living arrangement, knowledge of contraceptives, number of sexual partnerships, age at first sex/injection drug use, type and frequency of injection) while selected outcomes were analysed using logistic regression modelling.
Qualitative and quantitative data were triangulated for each objective and integrated in the results.

Result
Crack (69.1%) was reported as the most frequently injected drug followed by pentazocine (65.7%) and methamphetamine (60%). 57.5% of the YWID sell sex. While some of the SRH needs found in this study are similar to what are already known among young women in general population, the risks of unprotected sex (65.6%), abortion (70%) and unintended pregnancies (52.8%) are high. The likelihood of STI symptoms among the young women in this study increases with increase in frequency of injecting drug use (P < 0.01). The majority of the study participants (>70%) could name several modern contraceptives (MC), however, there is a huge gap between their knowledge and actual usage, mostly due to lots of myths and misconceptions about MC. Study participants who engaged in sex work engaged more in unprotected sex and abortion and there were some differences in their expressed SRH needs compared to non-sex workers. Unmet SRH needs among the entire study population were also linked to drug use criminalisation policy, lack of understanding of their needs by healthcare service providers which also include unfriendly attitude, service locations, operating hours, cost, stigma within and outside healthcare settings which all constitute major barriers to service utilization. Study participants expressed desire for integrated community-based SRH services, under one-roof which should also include drug-related health services such as drug information, counselling, harm reduction and referrals for voluntary treatment and rehabilitation when needed. However, national stakeholders identified critical enablers and barriers that are to be considered for effective and efficient SRH and drug-related service integration into the HIV program or primary healthcare for young women who inject drugs.

Conclusions
YWIDs are not a homogenous population and have high unmet SRH needs. These needs include low knowledge and utilization of MC; high rate of unprotected sex, unintended pregnancy and abortion; poor management of STI and low utilization of healthcare services.
Understanding these needs provides the required evidence for development and implementation of policies and programs to achieve better health outcomes for YWID. Furthermore, removal of law criminalising drug use would enable an appropriate environment for public health interventions.

Item Type:	Thesis (Doctoral)
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services WP Gynecology > WP 20 Research (General) WP Gynecology > Contraception > WP 630 Contraception
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	18 Dec 2024 09:51
Last Modified:	18 Dec 2024 09:57
URI:	https://archive.lstmed.ac.uk/id/eprint/25852

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