UPTAKE OF MODERN CONTRACEPTIVES AMONG YOUTHS (15-24) BUDONDO COUNTY JINJA DISTRICT
A RESEARCH REPORT SUBMITTED TO CLARKE INTERNATIONAL UNIVERSITY IN
PARTIAL FULFILLMENT FOR THE AWARD OF BACHELORS` DEGREE IN PUBLIC HEALTH
iDECLARATION AND APPROVAL
I, Namwanje Sarah, do declare that the work here in this report is solely of my effort, except where reference has been appended and that to the best of my knowledge it has never been submitted to any institution for an academic award.
This proposal has been submitted for examination with the approval of the following supervisor.
Signed: …………………………………. Date: …………………………..
I dedicate this research report to my Family, mentors and friends for the unconditional support they have given me throughout my studies.
I need to recognize everybody who partook for their assistance and support, without which this exploration would not have been done.
I additionally stretch out my genuine appreciation to the God who has empowered me achieve this piece of my exploration work. The achievement of this exploration and report is totally to the Omnipotent.
I am appreciative to my directors for the profitable direction, master counsel, consolation offered and not abandoning me. They furnished me with all the learning, background and bolster that I expected to achieve this exploration proposition. The assistance and support are extremely valued.
Finally, yet not slightest, a unique cheer for every one of my partners for their excitement, love and consolation.
DEFINITION OF KEY TERMS
Contraception: The practice of utilizing methods intended to prevent or space future pregnancy.
Contraceptive uptake: For this study will be reported picking or buying of contraceptives in the last one year.
Contraceptive use: For this study will be reported actual utilization or intake of contraception in the last one year.
Modern contraceptive methods: A product or medical procedure that interferes with reproduction from acts of sexual intercourse
Sexually active: For this study, will be reported sexual relationship in the last one year.
Sexual relationship: An intimacy relationship involving sexual intercourse.
Traditional contraceptive methods: These consist of periodic abstinence and withdrawal. ix
The Study considered the uptake of contraceptives among Youth aged 15-24 years inside the undertaking territory of Jinja locale. The examination likewise investigated the components impacting uptake of contraceptives among youth and their shrewd of the current Contraceptive administrations: An Study of Budondo Region Jinja District.
The study considered the uptake of contraceptives among youths aged 15-24 years within the project area of Jinja district. The study also scrutinized the factors influencing uptake of contraceptives among youth and their insightful of the existing contraceptive services: A study of Budondo County Jinja District.
The Study utilized the clear research outline. The examination utilized two speculations of conduct change correspondence. These were: the hypothesis of arranged conduct (TPB) and the procedure of conduct change (PBC). Subjective information was gathered utilizing the meeting strategy. Key witness meetings and center gathering dialog techniques were utilized to gather information. The instruments utilized were talk with calendars and meeting guides separately. The information was translated utilizing pinpointing, analyzing, and recording designs inside information. The Study discovered that the adolescent had an essential information and comprehension of contraceptives and distinctive battles. The battle helped them to know about different strategies they can use to ensure pregnancies and where to get to them. They learnt about the crusade from media, distinctive centers and their companions.
The Study reasoned that the crusade ought to likewise be communicated through different stages which are all the more engaging the young like street demonstrates everywhere throughout the nation, real visits to schools particularly amid social days, sports days or when there is an action at school and center gathering talks. The examination suggests that Service of wellbeing and its accomplices like Uganda Considerations, Regenerative Wellbeing Uganda, Straight Talk Establishment and UHMG ought to guarantee that they give enough data about the kinds of contraceptives they offer and even give out booklets to enable the adolescent to settle on levelheaded choices on their Contraceptive decision and where to purchase from.
Background of the Study
Worldwide there over 1.8 billion Youth and nearly 90 percent of whom live in developing countries. The age-range 15 to 24 is a period when most people begin to actively explore their sexuality. Globally, most people become sexually active before their 20th birthday and in sub-Saharan Africa, 75 percent of young women report having had sex by age 20 (Blum, 2007). Research indicates that youths who begin early sexual activity are at high risk of having high-risk sex (having multiple partners, engaging in unprotected sexual activity, and experimenting sex with alcohol and other drugs), thereby increasing their risk for unintended pregnancy and sexually transmitted infections including HIV/AIDS. (UNFPA: Adolescent reproductive health.)
Among youths, rates of early and unplanned pregnancies, unsafe abortions, maternal deaths and injuries, and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) are very high. One in every 10 births and one in 10 abortions worldwide and one in six births in developing countries is to women aged between 15-19 years. Each day half a million of Youthare infected with a sexually transmitted disease (Barbara S, Monica J, Grant A, Blanc K,2007). Nearly 12 million Youthare living with HIV/AIDS; and more than 7,000 Youthbecome infected with HIV every day (UNICEF, 2002). While about 16 million adolescent girls aged 15-19 give birth each year, accounting for more than 10 per cent of all births worldwide.
Young people’s reproductive choices have an enormous impact on their health, schooling and employment prospects, as well as their overall transition to adulthood (Lloyd, 2015). Particularly, early childbearing has been linked to higher rates of maternal and child morbidity and mortality, truncated educational opportunities, and lower future family income, larger family sizes, which in turn may lead to greater population growth (Ashcraft A, Lang K,2006). Research shows that use of contraceptive services is beneficial for women’s health and important at meeting HIV prevention goals: it has been shown to be more cost effective to prevent the birth of HIV positive children through providing family planning to women in the general population than increasing
the provision of Nevirapine for HIV-positive mothers within antenatal care women in the general population than increasing the provision of Nevirapine for HIV-positive mothers within antenatal care. (Reynolds H, Janowitz B, Homan R, Johnson L 2004)
1.1 General Overview of Contraceptive uptake in Uganda
Uganda has the most youthful age structure on the planet; with 77 percent of its populace younger than 30 and around 20 percent matured 15-24 years (Populace Reference Department, 2009). In Uganda, youngsters regularly turn out to be sexually dynamic, wed, and bear kids right off the bat throughout everyday life. By 15 years old, 11 percent of teenagers have started sex and by 18 years 64 percent of youngsters have had their first sexual experience. Young ladies in Uganda are especially defenseless against outcomes of early pregnancy, dangerous fetus removal and hazardous sex.
Uganda’s regenerative wellbeing pointers keep on being poor, with a maternal mortality proportion of 336 passings for each 100,000 live births. With one of the most noteworthy aggregate richness rates in sub-Saharan Africa, at 6.7 kids for every lady, adolescent pregnancies comprise 25 percent of all pregnancies in (Uganda Statistic and Wellbeing Study 2017). Birth interims stay short, and Ugandan ladies have in excess of three kids by their late 20s (Populace Reference Agency, 2009). About portion of the 1.4 million yearly pregnancies happening in Uganda are undesirable (Khan S, Bradley S, Fishel J, Mishra). Unintended pregnancies have been connected to risky premature births that comprise almost 33% of maternal passings among youngsters in Uganda (Nalwadda G, Nabukere S, Salihu HM,2005).
Uganda has a liberal family arranging approach that enables access to Contraceptives administrations to each sexually dynamic individual and couples independent of age (Service of Wellbeing (MOH); 2006) and also, contraceptives are free out in the open offices and private offices charge low expenses as a business showcasing system. In any case, notwithstanding all the above great factors a substantial extent of sexually dynamic Ugandan Youthhave never utilized contraceptives. Just 10-20 percent of youngsters report consistently utilizing Moderncontraceptives separated from condoms (Biddlecom AE, Munthali A, Singh S, Woog V 2007) in spite of familiarity with something like one Contraceptive technique being high at 98 percent (Joined Countries; 2006). The interest for contraceptives among Ugandan youngsters is 45 percent and 57 percent for age bunches 15– 19 and 20– 24 individually (Khan S, Bradley S, Fishel J, Mishra V) Studies have uncovered that Youthare neither generally welcomed nor agreeable in standard family arranging centers, which are for the most part government-possessed maternal and kid wellbeing/family arranging MCH/FP) offices and along these lines the requirement for new methodologies with demonstrated systems to keep contraceptives accessible in regularly difficult circumstances (.Erulkar AS, Onoka CJ and Phiri A,2006) Additionally still, in excess of 80 percent of the Ugandan populace lives in provincial territories where access to clinical family arranging administrations is insufficient. Hence, people group wellbeing programs remain an essential component for appropriating contraceptives. In the Network Based Dispersion (CBD) approach, CBDs as a rule town ladies or men are prepared to instruct their neighbors about family arranging and to convey certain contraceptives.
In Uganda, people group based family arranging programs are numerous and fluctuated, and have made a critical commitment to the achievement of national family arranging endeavors. Each program centers around bringing fitting family arranging directing and supplies out of the facility and into the network. As indicated by FHI, CBD of family arranging has been polished throughout the previous 26 years in Uganda and CBD exercises have been actualized in 66 (82.5 percent) of the 80 locale in Uganda sooner or later in time (Family Wellbeing Global, 2007)
A few Studys on network based family arranging arrangement have archived abnormal amounts of customer worthiness from both customer and supplier points of view and furthermore customer fulfillment (Fernandez V, Montufar E, Ottolenghi E, Enge K:1997). Much as proof demonstrates that CBD can advance access among populaces in which geological separations or disgrace around Contraceptives utilize could discourage get to, no examinations on network based access to contraception have yet centered around adolescents and in this way confirm CBD is “fruitful “at expanding Contraceptive uptake among youngsters is constrained. This examination depended on a Network Based FP program that has been working in Busia Area, Uganda utilizing volunteers at town level since 2008. The CBD program is controlled by the region wellbeing group with help from the USAID through FHI360. The point of the examination was toassess the uptake of contraceptives among Youthmatured 15-24 years inside the venture territory of CBDFP in Busia locale, Uganda. The examination likewise inspected the elements affecting uptake of contraceptives among this age gathering and their discerning of the current Contraceptive administrations.
1.2 Problem Statement
Studies have revealed that youths are neither well-received nor comfortable in mainstream family planning clinics, which are mostly government-owned maternal and child health/ family planning MCH/FP) facilities and thus the need for new approaches with proven strategies to keep contraceptives available in often challenging situations (.Erulkar AS, Onoka CJ and Phiri A,2006) Further still, more than 80 percent of the Ugandan population lives in rural areas where access to clinical family planning services is inadequate. For these reasons, community health programs remain an important mechanism for distributing contraceptives. In the Community Based Distribution (CBD) approach, CBDs usually village women or men are trained to educate their neighbors about family planning and to distribute certain contraceptives.
In Uganda, community-based family planning programs are many and varied, and have made a significant contribution to the success of national family planning efforts. Each program focuses on bringing appropriate family planning counseling and supplies out of the clinic and into the community. According to FHI, CBD of family planning has been practiced for the last 26 years in Uganda and CBD activities have been implemented in 66 (82.5 percent) of the 80 districts in Uganda at some point in time (Family Health International, 2007)
Several studies on community based family planning provision have documented high levels of client acceptability from both client and provider perspectives and also client satisfaction (Fernandez V, Montufar E, Ottolenghi E, Enge K:1997). Much as evidence shows that CBD can promote access among populations in which geographical distances or stigma around contraceptive use could deter access, no studies on community-based access to contraception have yet focused on youths and therefore evidence that CBD is “successful “at increasing contraceptive uptake among Youthis limited. This study was based on a Community Based FP programme that has been operating in Busia District, Uganda using volunteers at village level since 2008. The CBD programme is run by the district health team with support from the USAID through FHI360. The aim of the study was toassess the uptake of contraceptives among youths aged 15-24 years within the project area of CBDFP in Busia district, Uganda. The study also examined the factors influencing uptake of contraceptives among this age group and their perceptive of the existing contraceptive services.
1.3 Purpose of the study
The study identified challenges and opportunities in the current Family Planning service delivery approaches in addressing the Family Planning needs of youths and therefore this information is expected to inform family planning programming to improve contraceptive service provision for Youth in order to reduce unintended pregnancies.
The results of this study could also be used to strengthen future development of health service delivery to youths
The study findings also provide insights on youths’ sexuality and therefore informative to the design of dual protection programs for HIV prevention among youths.
1.4 Specific Objective
1. To establish the knowledge levels of contraceptive use among youths in Budondo County Jinja district.
2. To find out the type of modern contraceptive methods used contraceptives among youths in Budondo County Jinja district.
3. To find out the challenges faced by youth towards accessing modern contraceptives and information.
4. To establish the role of communication in influencing contraception uptake as an intervention on increasing contraceptive prevalence and social behavior change.
1.5 Research questions
I. What are the knowledge levels of contraceptive use among youths in Budondo County Jinja district?
II. Which types of contraceptive methods are being used contraceptives among youths in Budondo County Jinja district?
III. What are the challenges faced by women towards accessing modern contraceptives and information?
IV. Does the effective communication Campaign contribute to increase in contraceptive prevalence and social behavior change?
1.6 Conceptual Framework
Uptake of Modern contraceptives among Youth in Budondo town Jinja region is asserted to be impacted by a mind boggling association of numerous variables at individual, social and conceptive wellbeing administration conveyance levels. Separately, age, consistency, instruction and learning about contraception do impact uptake of current contraceptives. Socially; social standards, conjugal status, accomplice/family bolster, assigned sexual orientation jobs and the interest for greater families impact the person’s origination decisions. Furthermore, peer weight; religious lessons and strategy impact flexibility of decision of a Contraceptives technique. Likewise, regenerative wellbeing administration conveyance factors, for example, mentalities and abilities of the suppliers, technique particular reactions, accessibility of strategies, convenience and access of Contraceptives strategy do act straightforwardly or by implication to impact uptake of contraceptives.
2362200130810Peer / Partner support
3322320151765Receipt of Contraceptives
00Receipt of Contraceptives
-228600169545 Reproductive health factors
Choice of care i.e. Public health facility, Private for profit (drug shops and clinics), CBD and outreach
Method Choice and Availability
Design of services i.e. cost of services, waiting time etc.
Provides’ attitude and actions
Assemblage of services
00 Reproductive health factors
Choice of care i.e. Public health facility, Private for profit (drug shops and clinics), CBD and outreach
Method Choice and Availability
Design of services i.e. cost of services, waiting time etc.
Provides’ attitude and actions
Assemblage of services
Use among youths
Use among youths
34061405080Furtherance of contraception
00Furtherance of contraception
266700020002500-228600285750 Individual Factors
Demographic factors i.e. age, gender, education, marital status etc.
Socio-cultural factors i.e. decision making powers, desire for children etc.
Socio-economic factors like cost of services, transport
00 Individual Factors
Demographic factors i.e. age, gender, education, marital status etc.
Socio-cultural factors i.e. decision making powers, desire for children etc.
Socio-economic factors like cost of services, transport
1.6 Justification of the Study
Several research findings have indicated that the low contraceptive prevalence rates are evidence of the failure of preventive interventions. A few research discoveries have shown that the low Contraceptives commonness rates are confirmation of the disappointment of preventive mediations. Among the adolescent, it seems obvious that giving Contraceptives data isn’t sufficient to change their conduct and dangerous practices. Other unexplored psychosocial factors appear to add to the viability
of Contraceptive learning and data. This Study tried to set up how to connect the hole between information on contraceptives and increment popular and use.
The discoveries of this exploration are helpful to wellbeing accomplices, contributors and the Service of Wellbeing to recognize the young’s musings, observations, difficulties and learning on Contraceptive utilize and their suggestions on what should be possible so as to expand the interest for and usage of RH/FP administrations.
The findings helped the legislature of Uganda to know the key zones to deliver as to social standards, legends and misinterpretations, enhancing learning and practices of Ugandans with respect to regenerative wellbeing and family arranging this is keeping in mind the end goal to gain ground towards accomplishing Millennium Development Goals (MDGs).
The research findings likewise helped in deciding the correspondence needs of the adolescent and in this manner give manners by which Contraceptive correspondence mediations can be successfully packaged with the knowledge, consultation and participation of young people.
The findings presented in this Study helped in the distinguishing proof of regions for further explore in the field of wellbeing correspondence. It is important that this Study was restricted to youth from Budondo County located in Jinja district. There is space to examine other youth’s in provincial regions in the nation.
This section This segment fundamentally singled out, clarifications of speculations, observational Studys, approaches and other past examinations identified with the examination which evaluated the uptake of Modern contraceptives and the components which impact uptake among Youth (15-24 years) in Budondo Jinja area. The writing secured both essential and optional writing. Different distributions in the books, diaries and Web sources were utilized to accumulate important data about the Study. The segment will likewise take a gander at the hypothetical edge works. The hypothetical system will give the speculations whereupon the study was based.
2.1 Role of Communication towards Contraceptive Uptake and Social Behavior
According to Griffin (2009), communication refers to a process of transmission of information in order to create awareness and change people’s thinking, feeling and behavior towards a certain direction. In this study communication ‘s important goal is to inform people about contraceptives, increase their demand for and utilization of contraceptives, to change their behavior and persuade them to use them. Communication plays a key role in ensuring people know about the modern contraceptive methods available, where they can access them and be advised on which methods best suites them depending on their situation and persuaded to make a decision. Strategic communication is increasingly being recognized as an essential element of any successful health, social or development programme. When properly implemented, communication results in sustained change in policy, social norms and behaviors. Communication is also essential in overcoming barriers to access to services or generating demand for such services. Within the context of reproductive health, communication has been seen as an important input into tackling sexual and reproductive health issues including deteriorating indicators, unmet need for reproductive health, poor utilization of available services as well as weak dissemination of existing policies and guidelines on reproductive health to the lower levels. However, in this study of the Campaigns, communication can be more effective if the characteristics of the youth being targeted can be well understood in terms of their belief systems, religion, level of education, background, principles and socialization.
This will help the health and communication practitioners design messages that best suit their needs and easy for conceptualization in order to achieve the intended results. Research revealed that communications leads to the improvement of interpersonal and group interactions in clinical situations (for example, provider-patient, provider -provider, and among members of a health care team) through the training of health professionals and patients in effective communication skills. Collaborative relationships are enhanced when all parties are capable of good communication.
Communication is recognized as an important input in various programs, which use different terms to describe the approaches in use – information, education, and communication (IEC), behavior change communication (BCC) and others. Therefore, effective communication can achieve the desired social behavior change which is the increase in demand, uptake and utilization of modern contraceptive methods.
The Ministry of Health recognizes communication as a vital tool for effective implementation of the Country’s RH policies. In a setting beset with numerous challenges ranging from social and cultural factors to system and implementation challenges, effective communication is critical to facilitate shifts in attitudes, beliefs, perceptions and behavior which ultimately bring about social change. Also communication initiatives have a chance of succeeding only when situated within the cultural context of the target audience (UNAIDS, 1999). Kunda and Tomaselli 2009 reiterate that “Effective health communication interventions depend on understanding the knowledge, attitudes and practices of people from given cultural vistas”. Therefore, any intervention focusing on behavior change has to design communication messages that can easily be understood and that are not biased. It is important to understand the target audience’s characteristics.
According to the Ministry of Health, Social and behavior change communication is an interactive, researched, and planned process aimed at changing social conditions and individual behaviors. This process includes five steps which include understanding the situation, focusing & designing your strategy, creating interventions and materials, implementing and monitoring and evaluating and replanning. Social and behavior change communication (SBCC), which includes advocacy, social mobilization, and individual behavior change, is vital to Uganda’s achievement of the MDGs, SBCC is a crucial component in changing social norms; addressing myths and misconceptions; and improving knowledge, attitudes, and practices of Ugandans with regard to
RH/FP and MNH. Without normative changes, increased uptake of available RH services cannot be achieved.
This argument has contributed to healthy practitioners carrying out a situation analysis and background study before rolling out any contraceptive campaign based on behavior change. Change can only take place when the targeted population can understand the messages being conveyed and able to offer feedback.
The Ministry of Health further observes that developing appropriate SBCC programming and more targeted communication messages requires an understanding of the underlying determinants for positive RH/FP behaviors for each audience, as well as the perceived benefits of changed behaviors. Knowing this information contributes to more targeted communication messages and programs. It is also essential to collect information on barriers to uptake of RH services and to conduct further qualitative formative research, using key informant interviews and focus group discussions with carefully segmented audiences. Barriers should be addressed in the corresponding communication objectives. Behavior change communication (BCC) involves the development of tailored messages
and approaches to develop promote and sustain individual, community and societal behavior change. Cognizance is given to cultural diversity and audience reception and a multi-channel approach is employed. BCC can improve and promote dialogue at community and national level on a range of health issues.
2.2 The Role of Campaigns towards increasing contraceptive uptake
This is one of the mediations to expand mindfulness and Up Take on Modern Contraceptive utilize received by Uganda Youth and Youth Wellbeing Discussion. This battle is being financed by Uganda Youth and Youth Wellbeing Discussion in organization with General Wellbeing Diplomats Uganda, the Adolescent Correspondence Center Uganda and Naguru High school and Data Center under the subject; “Contraception; It’s Your Life, It’s Your Obligation “There have been different crusades supporting for forbearance for instance the battle like Conceptive Wellbeing Uganda that focused the young.
The C-Word (C for Contraceptives) BCC (Conduct Change Correspondence) crusade in Kenya was produced as a team with the Service of Wellbeing – Division of Regenerative Wellbeing, and propelled in October 2010, keeping in mind the end goal to address the low mindfulness and Up Take of contraception among sexually dynamic ladies matured 15-24 years. This was after they conveyed a circumstance examination and finding uncovered that the 15-24-age section had low rates in Up Take of contraceptives. The crusade’s goals are to demystify the subject of contraceptives among youth matured 15-24 years and additionally instruct youth on the cutting edge Contraceptives decisions accessible to them. Proof demonstrated that among all sexually dynamic youth of conceptive age, the neglected need and non-utilization of family arranging (FP) is most noteworthy among youth matured 15-24 years, and the aggregate interest for FP administrations is at 71.1% among hitched youth contrasted with just 16.4% among unmarried youth. Besides, over the most recent 20 years, dynamic and steady national correspondences to make mindfulness and interest for family arranging, (FP) has been lacking; in this way, there is a huge accomplice of youth who have never been presented to FP informing. Albright (2007) propose that scientists must contemplate the attributes of their objective populaces including socioeconomics and also the particular social and social setting, with a specific end goal to propel their comprehension. Further, she includes that conditions of the specific arrangement of people or target groups of onlookers must be plainly comprehended keeping in mind the end goal to outline an data procedure. Contraceptives messages should be focused to littler gatherings or people on account of the scope of individual data needs and procedures through which people comprehend their universes and their substances. A broad communications approach intended to change conduct is lacking to give motivating force to all individuals from the general public.
Uganda has encountered emotional statistic development since freedom. The key highlights of this development have been quick increment in ripeness and considerable decreases in mortality; especially youth mortality which have quickened populace development rate. The high populace development rate has added to differing, social, monetary, political and natural issues which required Government’s forceful projects especially family wanting to capture it. A portion of the projects incorporate executing the RH correspondence technique rules and correspondence battles towards expanding the Up Take of Modern contraceptives. To achieve a harmony among assets and populace, Ugandan populace strategy advances family arranging as a qualification that depends on educated and willful decision. Along these lines, it is the duty of Associations like regenerative Wellbeing Uganda to guarantee its conceptive wellbeing administrations are effectively open to the adolescent to enable them to settle on which technique to utilize.
The Service of Wellbeing already had outlined crusades to address Contraceptives utilize. Correspondence programming stresses double insurance, including utilization of double Contraceptive strategies.
A portion of the topics and key messages of these battle included: Dispersing your youngsters somewhere around two years separated is key for a sound and prosperous family, Modern family arranging techniques are protected and dependable, utilize a cutting edge family arranging strategy to postpone pregnancy or space births, converse with your accomplice about an advanced family arranging technique for your decision and visit a wellbeing office for more data and family arranging administrations. The other battle was focusing on the Youth and was designated “Don’t take risks, take control”. The crusade focused on the Youth matured 18-24. A portion of the subjects and key messages included: It is alright to find out about different Modern techniques for contraception to take control of your life and avoid undesirable pregnancies, a few current strategies for contraception exist and every ha its own advantages and constraints, it is imperative to visit a wellbeing supplier for directing on fitting strategies, no one but condoms can shield you from sexually transmitted illnesses, it is critical to postpone youngster bearing and it is vital to defer sexual introduction.
2.3 Types of Modern Contraceptive Methods
Contraception (conception prevention) counteracts pregnancy by meddling with the typical procedure of ovulation, treatment and implantation. Family arranging enables individuals to achieve their coveted number of kids and decide the dividing of pregnancies. It is accomplished through utilization of Contraceptives strategies and the treatment of fruitlessness (WHO, 2013). There are various types of conception prevention that demonstration at various focuses all the while (Whitney, 2003). Not every single Contraceptives strategy is proper for all circumstances and the most fitting technique for anti-conception medication relies upon a lady’s general wellbeing, age, recurrence of sexual action, number of sexual accomplices, want to have kids later on and family history of specific maladies. People ought to counsel their social insurance suppliers to figure out which technique for conception prevention is best for them. A few kinds convey genuine dangers, despite the fact that those dangers are raised with pregnancy and might be higher than the dangers related with the different techniques.
As indicated by World Wellbeing Association (WHO), current contraception alludes to birth control by counteractive action of origination or impregnation by utilization of pills, condoms (female and
male), Intrauterine Gadgets (IUD), Tubal ligation, vasectomy, Tops, Lactational amenorrhea technique (LAM) and injectable. This is the definition that was utilized in this Study. There are two changeless strategies for contraception: female cleansing/tubal ligation and vasectomy (male sanitization). This is the reason this Study looks to discover they kind of Modern contraceptives focused by Conceptive Wellbeing Uganda together with its accomplices in the Battle.
2.3.1 Benefits of Modern Contraceptive Methods
Promotion of family planning and ensuring access to preferred contraceptive methods for
the youth is essential to securing the well-being and autonomy of women, while supporting the health and development of the country. At the point when the young are engaged with satisfactory data on sorts of Modern contraceptives accessible they can settle on educated decisions on what technique to use on the off chance that they are sexually dynamic. This will enable them to postpone pregnancies and different dangers of medical issues and passing from early childbearing. By lessening rates of unintended pregnancies, family arranging additionally diminishes the requirement for perilous premature birth (WHO, 2013).
The utilization of contraception among sexually dynamic youth can forestall undesirable pregnancies,
which add to the world’s most noteworthy baby death rates. Research has demonstrated that
babies of moms who kick the bucket because of conceiving an offspring additionally have a more serious danger of death and weakness.
Current contraception lessens the danger of unintended pregnancies among ladies living with HIV, bringing about less tainted children and vagrants. Also, male and female condoms give double security against unintended pregnancies and against STIs including HIV. Pregnant Youth will probably have preterm or low birth-weight babies. Children destined to Youth have higher rates of neonatal mortality. Numerous youthful young ladies who end up pregnant need to leave school. This has long haul suggestions for them as people, their families and networks. In any case, if the young are engaged on the advantages of current contraceptives then they can conquer these dangers. Modern contraceptives offer the way to abating unsustainable populace development and the subsequent negative effects on the economy, condition, and national and local improvement endeavors (WHO, 2013).
2.4 Modern Contraceptive Uptake in Uganda
According Rob et al. (2007), in their study on contextual influences on modern contraceptive use among women irrespective of their HIV status, in six countries in Sub-Saharan Africa that included Kenya, Malawi, Tanzania, Ivory Coast, Burkina Faso, and Ghana, showed that younger age especially age group (20-29) years was more likely to be associated with use of modern contraceptives.
According Todd et al. (2008) in their Study on factors related with Contraceptive use among hospitalized obstetric patients revealed that Contraceptives utilize was freely connected with having a more noteworthy number of living kid’s Singular factors that decide a man’s utilization of administrations, for example, FP are intervened by the attributes of the network in which the individual lives. It is imperative to look past individual variables while inspecting FP utilize or nonuse. Social standards and desires are fluctuated and incorporate among others; submission to the inevitable ascribed to HIV illness, dread of contaminating the unborn youngster, sexual orientation jobs assigned by society, for example, the job of ladies in kid bearing and the interest for greater families (Srikanthan and Reid 2008).
Contraceptives assume a basic job in family arranging and in this way controlling populace development, which remains a key column in the quest for monetary and social improvement and additionally in the accomplishment of Thousand Years Objectives 4 and 5 (Service of Health,2010). Further, contraceptives have been instrumental in the battle against sexually transmitted ailments (STIs), not slightest HIV/Helps. Many creating economies are portrayed by fast populace development that is halfway credited to high ripeness rate, high birth rates joined by consistent decreases in death rates, low contraceptive prevalence rate and high however declining death rate (Oyedokun, 2007). In this manner, the administration has a basic task to carry out to guarantee that they are supporting a populace that is engaged with data on Contraceptives utilize and access consequently prompting a sound people who can contribute towards the nation’s improvement. Be that as it may, this can be influenced conceivable if ladies to can be convinced to change their ways of life, convictions, propensities and observations with respect to Modern Contraceptives Up Take. This will thus build request and usage of family arranging administrations. Hence, this Study will survey the commitment of the C-Word campaign towards Up Take of current contraceptives among Uganda.
According to the United Nations Population Fund (UNPF, 1998) one of the goals of family planning and reproductive health programs is to ensure that women have the freedom to decide whether they want children, when and how many. Each individual has the privilege to the most noteworthy achievable standard of wellbeing, which incorporates the privilege to social insurance administrations, including conceptive medicinal services. Despite the fact that the legislature has made some energizing headways, all the more should be done to counteract unintended pregnancies. Engaging individuals, including youth, with information about family arranging and access to administrations will enhance wellbeing and prosperity and prepare for a more prosperous Uganda.
In Uganda, not the greater part of wedded couples utilize Modern family arranging strategies – condoms, pills, infusions, inserts and intrauterine Contraceptive gadgets (IUCDs). The neglected requirement for family arranging is high; one of every four wedded ladies either don’t approach family arranging administrations or need data or inspiration to utilize administrations. This obviously demonstrates the requirement for making Contraceptives writing generally and effectively available particularly utilizing methods of correspondence that the vast majority can bear, comprehend and identify with. Since still numerous individuals fear discussing their sexuality, methods of correspondence that offer secrecy ought to be utilized. There is additionally need of conveying family arranging administrations closer to the general population for example building up preventive locales close working environments and private spots.
As indicated by (Boamah EA, 2013) 67% (211/315) of sexually dynamic Youth had ever utilized contraceptives. Contraceptive use amid the main sexual experience was 55.2% (174/315). Around 22.9% (72/315) utilized contraceptives reliably, while 44.1% (139/315) utilized contraceptives once in a while. A portion of the techniques utilized were condoms, the pill, and froth, among others 33% (104/315) of teenagers had never utilized any strategy to avoid pregnancy. Youth who reliably utilized a Contraceptive technique were essentially less inclined to get pregnant or impregnate somebody contrasted with the individuals who did not utilize contraceptives reliably.
Utilization of contraceptives was moderately low among the Youth examined, as was found in a few different examinations led among teenagers. Albeit a few teenagers had revealed regularly utilizing a Contraceptives strategy in this review, steady Contraceptive utilize was low. A few factors, for example, level of information, sex, age, cost, and Contraceptive accessibility, among others, may represent this. Despite the fact that Contraceptive utilize was low, there was an unbalanced utilization of male condoms when contrasted with other Contraceptives strategies. Conceivable purposes behind this could incorporate the way that Youth have simple access to condoms. (Biddlecom AE, 2007).
As per (Francis Obare, 2011) on a Study of Levels, patterns and determinants of Contraceptive use among juvenile young ladies in Kenya. It demonstrated that under 40% of pre-adult young ladies who have ever engaged in sexual relations have ever utilized any technique for family arranging. The extent that at any point utilized any Contraceptives technique stayed stable at 36% and 35% separately somewhere in the range of 1998 and 2003 preceding somewhat expanding to 39% out of 2008-2009. There was, be that as it may, an enduring increment in the extent that at any point utilized a cutting edge strategy for family arranging over a similar period with the best increment happening somewhere in the range of 2003 and 2008-2009.
An Study by Stanwood et al. (2007), in a partner of for the most part (68%) monogamous HIV-positive ladies in care in the Unified States demonstrated that, among ladies who were sexually dynamic yet had not had tubal ligation, 90% were utilizing some type of reversible Contraceptives technique and that PLWHA had regenerative examples like those of their HIV negative partners.
As indicated by think about by Justin Geno Obwoya, 2018 demonstrated that just 42.6% of the Study members detailed utilizing family arranging techniques in lifetime and 36% of the respondents utilized contraceptives strategies over the most recent three months (any strategy).
2.5 Challenges towards Modern Contraceptive Uptake
While contraceptive use has developed in Kenya throughout the years, both neglected requirement for family arranging and unintended pregnancies stay high proposing vital obstructions to successful contraception (APHRC Approach Brief No.26, 2011). In Africa, 53% of ladies of regenerative age have a neglected requirement for Modern contraception. Keeping in mind the end goal to control this issue Contraceptive suppliers should make contraception data open to build individuals’ information and consciousness of the accessible Modern Contraceptives strategies, which may in the long run influence their observations and conduct. It is likewise vital to spread data about wellbeing and family arranging utilizing numerous channels to achieve planned target gathering. The diverse battle focuses on the adolescent and therefore electronic, print and web based life are generally suitable. A portion of the contributing components towards the high neglected need is quickly developing populace and deficiency of family arranging administrations (WHO, 2013).
An expected 222 million ladies in creating nations might want to postpone or quit childbearing yet are not utilizing any strategy for contraception. Explanations behind this include: constrained selection of techniques; restricted access to contraception, especially among youth, poorer portions of populaces, or unmarried individuals; dread or experience of symptoms; social or religious resistance; low quality of accessible administrations; sexual orientation based hindrances (WHO, 2013).
Socio-social convictions and practices, sexual orientation elements, poor male commitment, and feeble wellbeing administration frameworks keep on blocking the interest for and use of RH/FP administrations. Another boundary to viable correspondence mediation incorporates absence of Youth inviting administrations and offices not accessible in many districts of the nation (MOH 2012). This Study expects to discover a portion of the difficulties experienced by the adolescent towards getting to Modern contraceptives and how they can be survived.
2.6 Importance of Reproductive Health Communication Strategy
The RH Correspondence Methodology was actualized as per the National Conceptive Wellbeing Arrangement and the National Regenerative Wellbeing Technique (2009– 2015). The procedure is overseen and facilitated by the Division of Conceptive Wellbeing (DRH) of the Service of Wellbeing and at the national level, and by common and locale wellbeing administration groups at their particular levels. The general motivation behind this execution manage is to guarantee coordination and collaboration of RH/FP
Social and Conduct Change Correspondence (SBCC) programming. It likewise guarantees
reliable SBCC on RH/FP by setting the phase for scale and effect. This rule moreover
characterizes a typical estimation for progress. The execution manages along these lines plots the
jobs and exercises of the GOK and accomplices at national, local, and region levels. Created through a consultative procedure with the RH Correspondence Specialized Working Gathering (TWG) and accomplices, the guide will help partners working in RH/FP to create SBCC projects and exercises that are lined up with the RH Correspondence System (MOHPS 2010-2012).
The RH correspondence technique plots the parts that any solid correspondence battle ought to have so as to guarantee its viability. A portion of the segments incorporate being results arranged, prove based, customer focused, cooperation, advantage situated, benefit connected, multi-diverted, specialized quality, promotion related, extended to scale, automatically practical and savvy.
2.7 Theoretical Framework
The section secured the particular hypotheses whereupon the Study was based; the theories
guided the actual study.
The UK government Choosing health: making healthy choices easier white paper (DOH 2004) identifies one fundamental and important problem with health messages: that it is not a lack of information in health, but that it is ‘inconsistent, uncoordinated and out of step’ (DOH 2004: 21) with the way the population live their lives. This suggests perhaps that despite efforts from health practitioners, some messages are not as effective as they could be. The Population Reference Bureau (2007) in the US suggests that human behavior is the central factor in most leading causes of mortality and morbidity. They advocate that behavior change strategies should be at the forefront of any attempts to reduce mortality and morbidity. Being able to predict behavior makes it easier to plan an intervention (Naidoo and Wills 2000).
Therefore, the first stage of any communication campaign is to analyze the behavioral aspects of the health problem (Rice &Atkin, 2001).
In addition, it is proposed that if we can understand factors that influence behavior ‘we will be in a better position to devise strategies and formulate methods that will achieve our health education goals no matter what our philosophy or what model we choose to follow’ (Tones and Green 2004). Theory enables the practitioner to predict the outcomes of interventions and the relationships between internal and external variables.
Underpinning communication in health promotion should be an understanding of how
and why people change their behaviors and at what point of intervention it is best to target a message. This allows identification of the actions needed to change that behavior and highlights the pathways of influence that hinder (or promote) that behavior.
This study selected two types of theories. The cognitive and stage step theories. Cognitive theories provide “continuum accounts of behavior”, (Rutter & Quine,2002). They propose that a certain set of perceptions or beliefs will predict a behavior.
The theory of planned behavior (TPB) will be discussed and applied to the adoption of contraceptive use and awareness among the youth. Stage step theories assume that the individual is not on a continuum but at a “step or stage”. Each stage on the model is a step ahead towards
attaining the desired behavior. The individual goes through a process of change which involves a series of stages (a cyclic or literal series of steps). This study embraced the theory of process of behavior change (PBC) and its application to the context of contraceptive use and awareness. These two theories were selected because of their suitability and clear link towards communication of health messages based on understanding people’s beliefs, attitudes, knowledge levels, religion and cultural
2.7.2 The Theory of Planned Behavior (TPB)
This theory is a revised version of Theory of Reasoned Action (TRA) by Ajzen and Fischbein (1980). What was a supplementary is the variable of “perceived behavioral control”? TRA explains that any intervention attempting to change behavior should focus on beliefs. As a result, for different campaigns to successfully influence youth to adopt the use of contraceptives it should focus on their beliefs. However, later there were advices that behaviors are not under “volitional control” leading to the revision of the model and expansion to include “perceived behavior control” (Rutter and Quinine, 2002).
TRA was revised to the Theory of Planned Behavior (TPB) (Ajzen, 1991). TPB focuses on beliefs of the individuals and behavioral control which is a determinant of behavioral intention and behavioral change. According to TPB the closest determinant of behavior is the intention to perform or not perform that behavior. The main determinant of behavior is based on the person’s intention to perform that behavior.
Objective is determined by three factors which include the attitude to the behavior. This
involves the balancing of the pros/cons of performing the behavior or the risks/rewards
they associate with that choice. The youths weighing the risks of not using contraceptives
and the rewards for using then they make a choice.
Subjective norm involves social pressure from significant others, for example peers,
media or family. Other youths who are already using contraceptives share the experience
with others, messages from the advertisements on electronic media of the C-Word
campaign. Under perceived behavioral control the perception that the person has about their ability to perform the behavior. From side to side information empowerment from the messages on
electronic media concerning the C-Word the youths feel they could use contraceptives in
order to take charge of their sexuality.
The more positive the attitude, helpful the personal norm and higher the perceived
behavioral control and the stronger the intention the more likely it is that a person will
perform that behavior. This theory has been widely applied in the context of
understanding and predicting behavior. Hence it can be used to design contraceptive
messages that promote usage, demand for and utilization of family planning services.
2.7.3 Process of Behavior Change (PBC)
The Population Communication Services/Centre described this theory for
Communication Programmed (2003, U.S.A). It explains that communication is a process
where people move between stages of the process of behavior change framework. In the PBC people move through a number of steps. In pre-knowledge the person is unaware of any risks or problems associated with their behavior. At this stage the youth is not aware of any modern contraceptive method and of any need to use contraceptive because they have not been exposed to contraceptive information. The next step is knowledgeable when a person is aware of the problem and of the risks attached to them behavior. At this step the youth is aware that by using contraceptives they may reduce chances of contracting sexually transmitted diseases and unwanted pregnancies. They now know the various methods available and their effectiveness. Then the person approves and becomes in favor of changing their behavior. This step is when the youth is in favor of using modern contraceptives.
The other step involves intention when a person is intending to take action to change them behavior. This step is when the youths want to change their behaviors and intends to start using a certain modern contraceptive method, which they are comfortable with. They then start practicing the intended behavior is being practiced. At this point the person starts using a particular contraceptive method. Lastly they start advocating. The new behavior is being implemented and the youth advocates that behavior to another. The youth has been using a certain contraceptive method over a period and is advocating the behavior to her friends. Depending on what stage the youth is at on the PBC framework different messages are designed for them for communication. A person moves upwards towards the final goal of using contraceptives.
This section exhibits the systems that were utilized in directing the Study. These incorporated the Study outline and method of reasoning, ponder setting and basis, think about populace, test estimate assurance, inspecting methodology, consideration criteria, meaning of factors, look into instruments, information accumulation techniques, information administration, information examination moral contemplations, restriction of the examination and the spread of the examination results.
3.2 Study Design and Rationale
A cross sectional expressive plan was utilized. Both quantitative and subjective Study techniques in-profundities interviews were utilized to gather point by point perspectives of research members because of the exploration questions. Subjective examination was utilized to empower the analyst produce a point by point portrayal of Up Take and utilization of Modern contraception among Youth of various social foundation. This Study configuration was utilized in light of the fact that it helped the scientist to assemble a great deal of information in a brief span and depicted components at a specific point in time.
3.3 Study Setting
The Study was carried from Budondo town in Jinja locale Youth (15-24 years). Jinja locale outskirts the area of Iganga and Kamuli in the North, Mukono in the south-west, Kayunga in the West, Mayuge in the East and Lake Victoria in the south.
3.4 Study Population
The study population was comprised of sexually active youths between ages 15-24 years. A blend of both wedded and unmarried Youth was considered in the Study regardless of their instructive and word related status. The testing outline was the rundown of all Youth between ages 15-24 years from the six arbitrarily chose Villages of Budondo sub area Jinja region. The examples were adolescents (15-24) from the six Study Villages of Budondo sub area who volunteered to participate in the study.
3.4.1 Sample Size Determination
The study utilized an example size of 323 Youth from six Villages of the two examination wards and was resolved basing on three factors: the evaluated Contraceptive commonness rate for adolescents (for this situation, 30% is a normal for the 15-19 and 20-24 sub-gatherings); the certainty level at 95%; and the safety buffer at 5%. The recipe beneath for straightforward irregular testing utilizing single extents given by: (Kish Leslie, 1965) was utilized to figure the example measure. It was picked on the grounds that every individual was picked completely by possibility and every individual from the populace had an equivalent shot of being incorporated into the example. n= t2xp(1-p)
n = required sample size t = confidence level at 95% (standard value of 1.96) p = estimated contraceptive prevalence rate for youths (15-24) at national level m = margin of error at 5% (standard value of 0.05)
3.4.2 Sampling Procedure
Multi-level sampling was used in this study. Different sampling techniques will be used as explained below;
Simple random sampling procedure was used to select study sub counties: The names of the eight sub provinces were printed out and consistently collapsed and put into a non-straightforward encompass. The envelopes were then being poured on the floor and the rule agent will haphazardly pick one paper. The envelope picked were opened and the chosen Sub Province considered for the Study.
Three areas were chosen as study wards. Straightforward arbitrary inspecting was utilized to decide these wards. The names of the three areas in Jinja were composed and printed out independently. Every printout was consistently collapsed and put into a non-straightforward wrap. The envelopes were then poured on the floor and the guideline agent haphazardly pick two papers, in a steady progression. The envelopes picked were opened and the chosen wards considered as the examination areas.
Six Villages were purposively tested into the examination, considering three Villages for each parish.These will include,Buwagi Ivunamba ,Kibibi ,Namizi ,Nawangoma.The third town per area will be picked basing on its land area inside the ward. Utilizing a ward outline with direction of area pioneers, a focal town into the Study.
3.4.7 Identification and Sampling of Study Subjects for the Survey
The study participants were included based on the inclusion or exclusion criteria. Among the 6 Villages chose, 60 family units took an interest in the examination. The nearby committee (LC list that was utilized in the circulation of mosquito nets) was utilized to choose each tenth house beginning from the primary house as recorded in the LC enlist. In every town 12 family units were picked and 3 respondents for each family talked with who were youth (15-24) years old.
Preceding the Study, a gathering was held with a neighborhood committee pioneer from every one of the six Villages. Those included; Amid this gathering, the important examiner will clarify the reason for the examination to the nearby pioneers’ and demand for their precious commitment and support towards the Study. In this gathering, dates to do the overview were set. The gathering was likewise to concede to when to do the ID exercise of the examination subjects. Town gathering makes a beeline for be encouraged and thought of a refreshed rundown of all Youth qualified to be consider subjects.
3.5.1 Inclusion Criteria
All sexually active youth who were between 15-24 years and occupants of the six Study Villages were incorporated into the examination. So also, sexually dynamic unmarried Youth who were between 18-24 years and occupants of the six examination Villages were additionally considered for this Study. Also, even sexually active youth unmarried adolescents (15 and 18 years) who were inhabitants of the six Study Villages and whose guardians or watchmen allowed their support in the of the study.
3.5.2 Exclusion Criteria
The study avoided visiting youth in the chose Villages and all adolescents underneath 15 years or over 24 years.
A rundown of all names of families inside the examination Villages (produced by the specialists amid appropriation of mosquito nets). The primary respondent who was incorporated into the examination was haphazardly chosen from the testing outline by the rule specialist and from that point, each tenth individual was orbited and considered Study subject. Subsequent to examining, the specialists were educated of the Study subjects and demand to tell the chose Youth to permit partake in the examination
3.6 Study Variables
Variables are characterized as normal for intrigue that an analyst might want to deal with, watch or control in the examination.
The independent variables: These included the socio-demographic data of respondents such as age, sex, tribe, educational level, religion, tribe, occupation, working experience
The dependent variables: This will include;
In this study, the dependent (outcome) variable was contraceptive use among youths 15-24 years’ old
3.7 Data Collection Instruments
The Study used both primary and secondary information. This information was both numerical and printed information. The examination utilized subjective information accumulation strategies, where the specialist connected meeting calendars to gather information from key sources and meeting advisers for gather information from the Study populace. The poll was planned noting the particular goals of the examination and it was pretested to decide its exactness and mistakes to Youth in Luuka area.
3.8 Data Collection Method
3.8.1 Key Informants Interview
In-depth interviews were employed in data collection using an interview schedule. Key
informant interviews were of a conversational style rather than a formal question answer
format (Campbell et al., 1999). Interview method, as stated by Strauss & Corbin (1990),
enables striking of rapport with the participants thereby enabling the researcher to easily
win their trust. This in effect becomes a necessary ingredient for the participants to freely
express themselves and also enables both verbal and nonverbal aspects of communication
from the participants to be captured (Ndeti, 2013). This in turn makes it possible for
holistic capturing of the responses from the sampled participants (King & Horrocks,
3.8.2 Focus Group Discussions
Focus group discussions were used primarily to investigate the normative aspects of
behavior. They were used in the study to explore the ways in which the youths interact
in their discussions and extent of agreement of opinions, beliefs, attitude and norms
(Campbell et al, 1999). The advantage of these group discussions is the greater breadth of
ideas, opinions and experiences that may be expressed by participants. This study
engaged four focus groups of 10 youth each in the following age brackets: 15-16, 17-
18, 19-21 and 22-24.
3.7.1 Data Management
For qualitative data, all filled questionnaires were reviewed by principal Investigator and statistician for consistence and data quality, and then entered using SPSS.
For qualitative data, every day, the hand written notes were taken during the dialogues. These were reviewed and a detailed report written for each dialogue. The raw data and community dialogue reports were harmonized and revisited time and again to ensure accuracy and quality control. The in-depth interviews (in the local language) were transcribed and then translated in English.
3.7.2 Data Analysis
For qualitative data, codes (numbers) were made for diverse themes (variables). The coding process was done after data had been entered into a computer conferring to its respective source. In the process of entering data into a computer, a template form was created and arranged
information according to the identified themes. Coding of the data and the analysis was done manually. Latent content analysis technique that involves in-depth interpretation of the underlying meanings of the text and condensing data without losing its quality was used. The analysis was discussed among the research team members and discrepancies on coding and other issues that require clarity were settled by discussion. Data was analyzed using SPSS and results will be presented in tables and figures with corresponding frequencies, percentages and explanatory remarks.
Quality Control and Assurance
To ensure the quality of the data collected, the following safeguards were carried out:
Pre-testing the tools:
The questionnaire, was pre-tried and refined by input produced from the pre-testing exercise before information gathering began. This activity was to approve the propriety of the apparatuses, regardless of whether it was too long or not, troublesome or straightforward, checked for lucidity of the questionnaire things and dispensed with vagueness, troublesome wordings or unsatisfactory inquiries. Members were given the chance to remark on the lucidity of the inquiries and they were asked for to make recommendations for development.
3.8.1 Ethical Consideration
After approvals of the proposition by the by the Supervisor and, an introductory letter was given from the University introducing the researcher. The specialist at that point clarified the nature and motivation behind the examination, guarantee them of most extreme privacy of their reactions and educated assent was looked for before gathering information from them.
3.8.2 Informed consent:
Study participants were educated of their rights and dangers of taking an interest in the Study. Composed assent was gotten from all examination members in the wake of clarifying the motivation behind the Study. For members beneath 18 years of age, assent was looked for from their folks. assent frame was produced for the two guardians or watchmen and adolescents over 18 years. Sexuality being a touchy subject, the assent shapes were also the way that members must be sexually dynamic. Rather they called attention to that members might be required to share individual encounters on contraception. In the wake of acquiring assent, members were subjected to screening inquiries to prohibit the individuals who are not sexually dynamic.