The high death of mothers and their Children as a result of pregnancy has become one of the priorities of action internationally and nationally in recent years. The problem is noted that it is higher among these who become pregnant at early adolescent. Such observations are based on different studies which draws the attention of policy makers and implementers.

Study conducted by save the children in 2012 in some European, Asian and Africa countries indicated that, 16 million adolescent girls aged 15-19 years and two million girls under age 15 give birth every year. Similarly, in the poorest regions of the world, one in three girls are bearing child by the age of 18. There is a growing evidence that adolescent girls are at the highest risk of maternal mortality caused by pregnancy: such risk of pregnancy-related death is estimated as twice as high for girls aged 15-19 and five times higher for those girls aged 10-14 compared to women in their twenties [1]. Further, pregnant adolescents are more likely than adults to resort to unsafe abortions which contribute to the problems as estimated 3 million unsafe abortions occur every year among girls aged15-19 [2].

Unintended pregnancy poses a major challenge to the reproductive health of young adults in developing countries. With decreasing age of menarche and onset of sexual debut in the last few decade, young people are exposed to early unplanned and unprotected sexual intercourse leading to unwanted pregnancies, exposure to sexual transmitted diseases and associated problems such as un safe abortions and even serious socio economics problems. The magnitude of the problem is noted in many poor countries such as Sub-Saharan African countries where persistent high rates of unmet need for family planning and low rates of contraceptive use and high maternal death reported [3].

There is accumulated evidence that proper use of Family planning method can reduce the number of deaths among women by reducing the number of women who are at risk by averting unintended pregnancy, which account for about 30% of all birth in Sub-Saharan Africa [4].

It is evident that a young people enter the reproductive years the demand for family planning services will increase and programs need to be equipped to satisfy this demand, and to assist in overcoming barriers that young people are having to accessing reproductive health services. As family planning services and utilization of methods can play a vital role in combating sexually transmitted infections and HIV or unplanned and unwanted pregnancy [5].

The seriousness of the problem become more evident in situation where the coverage of such service is comparatively low as in Ethiopia DHS2011 [6].

Currently contraceptive use is lower among young women in Ethiopia. For example, 5% of all women age 15-19 and 12% of age 15-24 report current use of any contraceptive method [6]. Similarly according to the annual report of 2012 Assela town Health Office the number of induced abortion for the age group15-49 was 4278 which account 26%, and the coverage of contraceptive was 31% [7].

There is no exact documentation on utilization of contraceptive and other reproductive health service in the area concerning youth. Therefore, this study tends to assess the awareness, utilization and barriers of family planning service in the study area, which helps to facilitate the establishment of youth friendly service and other reproductive health services in the study area. This investigation will also realize the magnitude of the problem and draw some recommendation for planners and program managers in this area.

Study design and set up

A community based cross- sectional study supplemented with in-depth interview was conducted in Assella town entire preparatory school, south east Ethiopia from January 2014-June 2014. Assella town is found in south part of Arsi zone of the Oromia regional state, 175 km south east of Addis Ababa. According to the 2013 population profile, Assella town had a total population of 89,964. Regards to education profile of Assella town in 2014, a total of 2,309 regular students were enrolled in Grades 11 and 12 out of which the number of female youth students were 894 for academic year of 2014. The participants of this study were 296 female youth 15-24 years old who had attended preparatory study in the academics year of 2014.

Inclusion criteria: Those female students aged 15-24 years, who were attending grade 11-12 at day time during the data collection period, and willing to participate in the study were included.

Exclusion criteria: Critically ill during data collection

Sample size determination and sampling procedures

The sample size (n) required for this study was calculated using formula for a single population proportion (p) by taking the proportion of contraceptive use of female youth students in Addis Ababa which was 51% (8), 95% level of significance and 5% margin of error (precision). The sample size was 269 by considering 10% non response rate the final sample size was 296 female youth students.

After the list of all female students obtained from the preparatory school for grade 11 and 12, they were selected into the study by using stratified random sampling method with proportional allocation among Natural science and Social sciences stream of the school. First, the number of the female students to be in the sample was calculated proportional to their class. Then, the sampled students were selected for the self-administered questionnaire proportional to their class size by using systematic random sampling method. The questionnaire was self-administered structured anonymous questionnaire. First drafted in English developed after reviewing of relevant literatures and adapted from previous similar studies then translated into local language then back to English by another person to ensure its consistency. A number of questions were employed that address the objective of the study and able to measure female youth awareness, utilization and barriers that hinders effective use of the family planning services. A small scale qualitative study was conducted to collect qualitative data using indepth interview. Accordingly two in-depth interviews were conducted; three female youth students who were participating in different club found in the school. Other with key informants like school directors, unite leaders who were concerned in this issue were participated.

Data quality control

Data collection instrument was pre-tested on 5% of total sample size of youth female students on other preparatory school and adjustments made based on the assessment of its appropriateness. Throughout the data collection supervision was done by supervisors and the principal investigator to keep the quality of data. Completeness of data using simple to understand and pre-tested questionnaire was another quality of the study.

Data entry and analysis

Analysis of quantitative data: After data collection the data responses were checked for its completeness and edited accordingly. Then a collected data was entered into computer for analysis by using Statistical packages: Epi info version 3.5.4. After the entrance and completeness of all data, finally the data was exported to SPSS version 21 for further analysis. Dummy tables that consider the main research questions were made to lead in the analysis. Analysis of frequencies of different variables, bivariate logistic regration and multivariate logistic regration test for some selected variables were done. Those variables with p-value ≤ 0.3 were entered into multivariate analysis.

Analysis of qualitative data: In a society like our where sexuality is a taboo subject and pre-marital adolescent sexual activity face strong disapproval, it is difficult to elicit a real picture of sensitive issues like contraceptive use using purely quantitative data. Taking this into consideration a small scale qualitative study was conducted to collect qualitative data using in-depth interview. Accordingly two in-depth interviews was conducted; three female youth students who were participating in different club found in the school other with key informants like school directors, unite leaders who were concerned in this issue. This two target population of the qualitative study was used to augment the quantitative part of the study. To analyze the qualitative data obtained from in-depth interview data were immediately transcribed and written in narrative forms and was supplemented with notes taken during the interview. Finally, results were extracted and written into summery findings.

Ethical consideration

Ethical clearance was obtained from Research and ethics Committee of School of public health, Addis Ababa University. Written letter of support was obtained from Zonal Education Department and town Education office. Written consent was obtained from each study participants. Study participants’ name was not written. Privacy and confidentiality was assured. The participants were informing that it was their right to refuse or withdraw from the study at any point during the course of study.

Socio-demographic characteristics of the respondants

Response was obtained from all 296 female youth students. Two hundred sixty one (88.2%) of the respondents were in the age group of 15-19 with the mean age 18.06 ± 1.207SD. Majority 283 (95.6%) were never married. Majority 204 (68.9%) were Orthodox by religion, 199 (63.9%) were reside urban .Two hundred eight live with their parents, 48 (16.2%) were living in rental house with their peers. One hundred thirty nine (47.1%) received pocket money from their parents. Educational level of their parents 76 (25.7%) of fathers have no formal education and 100 (33.8%) of mothers have no formal education (Table 1).

Table 1: Socio-demographic characteristics of female youth students of Assella preparatory school, May, 2014.

Awareness of contraceptive and family planning

The female youth students who ever heard of contraceptive and family planning in this study were 288 (97.3%). All the respondents have awareness of at least one form of modern contraceptive method. The most commonly known methods were Injectable 182 (63.3%) and oral pills 178 (60.8%). Majority of respondents (61.5%) knew about family planning while they were in secondary school level and 111 (38.5%) were aware of it in their primary school level. The first common source of information about family planning was mass-media (62.5%) and the least source was internet 24 (8.3%).

Regarding the benefit of family planning, majority (75.6%) of the respondents reported for the prevention of unplanned pregnancy and the rest, 152 (51.8%) for birth spacing, 65 (22.6%) for prevention STI/ HIV. On the disadvantage of family planning use, more than half of the respondents (54.5%) thought it has no significant negative effect but some of the respondents 36 (12.2%) thought as it causing cancer, 58 (19.6%) increase marital unfaithfulness, 24 (8.1) promote promiscuity and 21 (7.1) decrease sexual pleasure.

Concerning the level of awareness of contraceptive 157 (54.5%) were have high level of awareness while those 131 (45.5%) low level of awareness (Table 2).

Table 2: Awareness of contraceptive and family planning among Assella preparatory female youth students, May, 2014.

Attitude associated with the overall benefit of the use of contraceptive

Over half of the respondents (56.2%) of had positive attitude and 126 (43.8%) had negative attitude towards contraceptive benefit (Table 3).

Table 3: Attitude associated with the overall opinion of the benefit of contraceptive using a likert scale among Assella preparatory school female youth students, May, 2014.

Sexual activity and contraceptive utilization

Sixty seven (22.7%) of the respondents reported having had sexual intercourse. The minimum age at sexual debut was 15 years, the maximum age 20 years; the mean age was 17.3 years with SD ± 1.155 years.

The experience of participants with contraceptive use, out of sexually active respondents 41 (61%) with (95%CI 55.5-66.5) currently using a contraceptive methods. Condom was the most commonly used method which was used by 10 (24.4%). The study finding also showed that 229 (89.8%) of respondents not currently using any form of contraceptive for the reason that they were not sexually active. More than three fourth of the (77%) the study participants intended to use in the future (Table 4).

Table 4: Sexual activity and contraceptive utilization among female youth students of Assella preparatory students May, 2014.

Perceived access to family planning services

About 222 (75%) of respondents can easily access family planning services. the services were always available for 154 (52%) them but 111 (37.5%) they didn’t know whether the service always available or not. Concerning service satisfaction from those who were attended the service 22 (33%) very satisfied with the given service, 21 (31.2) partially satisfied and 24 (35.8%) not satisfied with the service given (Table 5).

Table 5: Perceived access to family planning service among female youth students of Assella preparatory school, May, 2014.

Barriers to use family planning service

For about two fifth (39%) of the respondents service time was convenient, whereas for, 25 (61%) respondents the service rendering time was not convenient.

Added to the service hour impact on the utilization of family planning, 128 (43.3%) respondents addressed as their religion had a negative effect or barrier to use contraceptive or family planning services .This also supported by qualitative findings as follow.

A grade 11 female youth student, 18 years old, contended, “According to our religion’s rule and regulation, it is forbidden not only to use any contraceptive methods but also forbidden to play and to shake the hand of male. With respect to our religion, generally, neither youths nor women are allowed to use contraceptive” (Table 6).

Table 6: Barriers to access and use of family planning service among female youth students of Assella preparatory May, 2014.

A19 years old grade 12 girl asserted, “If I am unfortunately found, having bought contraceptive and seen on my hand or in my bag, it counts as if I am disobedient and breaks the religious norm and conduct promiscuity without being married. Even if I am in puberty stage and desire to have sex, due to religious constraint, “I have to hide my interest to buy and use contraceptive”.

There was also a great gap in discussing about the usage and helpfulness of family planning. About 279 (94.3%) of female youth students responded that they didn’t discuss issue of family planning with their family. This was also supported by the respondents in indepth- interview as follows.

A 20 years old lady argued, “ Family do not allow us to discuss about contraceptive and sexuality because they assume it as it is a health hazard and a way that promote sexuality, in this case, using contraceptive remains a secret to the girl herself”.

A 35 years old female teacher, who was working as the school administration mentioned, ‘Most of students’ parents do not discuss with their daughter about the matter of sexuality because they are not aware of the fact that their daughter is sexually active. As a result, we encounter problems in our school related to this issue, for example; there was a girl who lived alone in rental house and conceived due to unprotected sex. Lacking such transparency, she hided herself, but lastly she was forced to terminate her education and gave birth.

It is reported that, currently, there is no provision of school reproductive health service.

A 38 year’s old teacher, who is acting as HIV/AIDS club organizer, witnessed the following. “In our school there is no service that can provide family planning issues and HIV/AIDS prevention, except small session lecture given in the class room which is inadequate. Even if the problem on family planning and other health issue existed, due to manpower and budget constraints, we do not provide the service”. If Ministry of Education collaborates with Ministry of Health, the aforementioned problems can be solved easily and students can access the reproductive health service.

Determinants of utilization of family planning methods

There were statically significant associations of utilization of family planning with place of residence and service satisfaction. The odds of utilization of family planning were 4.6 times higher among female youth students reside in urban than those who were reside in rural .The odds of family planning use were 9.75 times higher among female youth students (Table 7).

Table 7: Determinants of utilization of family planning method among Assella preparatory female youth students in May, 2014.

This study has attempted to assess the awareness, attitude, utilization and barriers of family planning service among Assela Preparatory female youth students. It has been understood that 97.3% of the respondents are aware of or heard about the importance and usage of contraceptive and family planning. This is related with the study in Lesotho 97.5% and a little higher than the study Bahir Dar senior secondary school which was 88.5% [9,10].

The study has also indicated that mass media, class room teaching, families, friends and internet were frequently reported sources of information. The majority of respondents reported mass-media was the most frequent source of information which accounted 62.5%. This is related with EDHS, 2011 report which stated that the most source of information was mass- media [6].

Awareness of family planning is a prerequisite to obtain access and using a sustainable contraceptive method. Based on this finding, 97.3% of the respondents were able to mention at least one form of contraceptive method. This finding is found to be similar with the result of the study conducted in Addis Ababa, which reported that the contraceptive awareness of female youth students was 97.8% [8].

This study also revealed that overall 22.6% respondents were sexually active. The mean age at sexual debut was 17.3 ± 1.155 SD years. This is similar with the study in Bahirdar secondary school the mean age at sexual debut was 17 years [9].

Engagement in sexual activity in this study group was lower than previous report from Addis Ababa which reveled 26.5% of adolescents were sexually active and comparable with north part of Ethiopia which was 22% [8-10]. It is also lower than that of other African countries adolescent sexual activity such as in Nigeria 41% and in Kenya 30% [11,12]. Different factors may have forced school female youth to engage in a premarital sexual practice. Due to an inherent risk in being youth and the need to experiment different age related activities by this age groups. Most of female youth are sensitive to peer’s opinion; perception of peers often had a great influence on sexual and other risk taking behavior than the opinion of parents and older adults.

In this study among the reason reported by the female youth students for the initiation of sexual practice for the first time, 52.2% were to prove boyfriend. Others, 34.3% were pressurized by their peers and 13.5% were forced by relative.

In our study, 61% of sexually active female youth students currently used contraceptive. This is greater than study made in Addis Ababa which was 51% [8], and study conducted by Ethiopian Demographic and Health survey which was 12% for the age group 15-24 years of female youth sexually active. Also it is greater than study conducted in Bahirdar senior secondary school female youth which was 8.5% of sexually active high school students reported use of contraceptive [2,9]. This variation could be due the difference in study time and sociodemographic condition of the study population.

In this study, among sexually active participants, 24.4% use condom, 22% use injectable and 17% use implants contraceptive. However, the result in this study was lower than the study conducted in Gondar town. It was indicated that those who chose condom as first preference contraceptive accounted 46.5% and injectable contraceptive method 42.7% [13].

Of all health institutions, 59.2% of governmental health institutions are indicted as the nearest health institution that serves for the use of contraceptive. This result is greater than the study conducted in Gondar which showed that 52% of governmental health institutions are the nearest health institution to provide family planning service [13]. The justification could be due to the geographical coordination difference between the study areas.

Those, whose intention were to use family planning service for the future in this study accounted 77%. This may indicate that youth with secondary education and above were more likely to utilize family planning service. This can be explained by the fact that educated female youth have an increase awareness about availability of the service, benefit of utilization of family planning service, and have a higher acceptance towards new health related information and better communication.

Use of family planning service is an important indicator of the level of protection from the consequence of unprotected sex. Thus, what determine the barriers that hinder utilization of family planning service among female youth students could be important issues for planners and policy makers to identify areas of interventions to protect sexually active female youth students from consequence of unprotected sex.

The finding of this study indicated that discussion of family planning related issues with parents showed most of the study participants 94.3% didn’t discuss the issues of family planning with their parents. A qualitative finding also supports this idea. A study conducted in Kenya also indicated only 7.5% female youths were able to discuss issues of family planning with parents [14]. This might show negative association with family planning use could be opposite to the logical thinking that discussing sex related issue with parents would help to protect female youth from consequences of unprotected sex. This could indicated negative attitude of parent towards contraceptive, of course it is just not intentional but unknowingly, it could also imply the fear of parents that contraceptive encourage promiscuity.

Invariably, religion continues to pose a challenge to the successful implementation of family planning methods and services. In this study about 43.3% of participants reported religion as objection to utilize family planning methods. This is agreed with our qualitative study finding which suggested that religion was found to be a serious barrier to utilize contraceptive and agreed with study conducted in Zimbabwe and Kenya [14]. Most religions are believed to teach, the right behavior comes out of the right belief systems, hence; many people have equated sexuality with some form of religion or gospel depended that has emanated as a response to female youth sexual problems. Some of the positive impact of religion on sexuality have been said to include, postponement of age of first sexual experience, diminished pre and post marital sexual permissiveness, responsible relationship in marriage and parenthood.

One of the limitations of this study was limited similar studies so far made on preparatory students in Ethiopia specific to this age group 15-24 on the utilization of family planning to compare the results. The other limitation the study the nature of the study design, which doesn’t reflect casual relationships.

• From this study awareness of study participants were high but , there is a great gap between the parents and female youth that is lack of transparency of discussing about sexual health or there is limited such free discussion about reproductive health and family planning this resulting low utilization of family planning method. Family life education program in school and elsewhere should provide female youth with essential information how to guide them and refrain from unnecessary sexual practice, STI and HIV/AIDS, so the school should facilitate some programs that address the reproductive health problems of school youth.