Reproductive Health Needs and the Reproductive Health Behaviour of the Youth in Mangaung in the Free State Province: a Feasibility Study

Curationis 28(3): 20-30 From the community profiles conducted by nursing students in Mangaung, the following observation was prevalent: an increase in the prevalence of teenage pregnancy together with a high prevalence of HIV infection was demonstrated. The relationship between young people's reproductive behaviour and the prevalence of HIV is well documented. To address this problem, a com m unity-based education program m e is required. Developing a successful community-based educational program m e that addresses the needs o f youth requires that such a programme be based on the needs o f such a group. The research question is applicable: How do youth in M angaung in the Free State province in South Africa perceive their reproductive health needs and their reproductive health behaviour? The aim o f this article is to explore and describe the reproductive health needs and the reproductive health behaviour o f the youth in M angaung. A quantitative research design that is descriptive and explorative in nature was conducted. The reproductive health needs and the reproductive health behaviour of the youth were collected by means o f a structured questionnaire with open-ended and closed questions. A purposive non-probability sampling method was utilized and (n=250) drawn from the youth. The justification of the sample was further enhanced by collecting data from youth aged 13-25 at three high schools in M angaung and at the health centre of MUCPP. Qualitative data obtained from open-ended questionnaires was coded and analyzed by using T ech's (1990) content analysis approach. A descriptive statistical analysis was performed on the quantitative data from closed questions. A descriptive analysis o f the p articip an t's ages and their perceived reproductive health needs and reproductive health behaviour was done. The mean age of the participants was 18.6, which could be because all the respondents were of school-going age. The results indicated that the youth received insufficient reproductive health information to be able to prevent pregnancy and HIV/AIDS. The special needs of youth were indicated by 92% who requested that the clinic should accommodate both boys and girls and 96% o f the respondents requested sessions for discussions facilitated by a professional person. A total o f 95% o f the youth requested that a Correspondence address: special program m e of activities be conducted during school holidays. The risk Ms Eunice Seekoe behaviours practised by the youth were: having sex with a stranger, …


Abstrak
Uit die gem eenskapsprofiele wat deur verpleegstudente in M angaung opgestel is, is die volgende w aam em ing gemaak: D ie ontwikkeling van 'n suksesvolle gemeen skapsgebaseerde onderrigprogram wat die behoeftes van die jeu g aanspreek, vereis dat so d an ig e p ro g ram op die beh o eftes van so 'n g ro ep g eb aseer w o rd .D ie n a v o rs in g s v ra a g van to e p a ssin g is: H oe sien d ie je u g in M angaung in die Vrystaat-provinsie hul behoeftes en gedrag in reproduktiew e gesondheid?Die doelstelling van hierdie artikel is om die behoeftes en gedrag in reproduktiewe gesondheid van die jeug in M angaung te ondersoek en te beskryf.
'n Kwantitatiewe navorsingsontwerp wat beskrywend en ondersoekend van aard is, is gebruik.Die behoeftes en gedrag in reproduktiewe gesondheid van die jeug is deur m iddel van 'n gestruktureerde vraelys met oopeinde-en geslote vrae, ingesamel.'n Gerieflike en doelgerigte steekproef (n = 250) is uit die jeug getrek.Die regverdiging van die steekproef is verder verhoog deur data in te samel van jeugdiges tussen die ouderdom van 13 tot 25 by drie hoërskole in M angaung.Kwalitatiew e data wat deur oopeindevrae op vraelyste verkry is, is gekodeer en geanaliseer deur van Tech (1990) se inhou d an alise-b en ad erin g geb ru ik te maak.'n Deskriptiewe statistiese analise is op die kwantitatiewe data, wat uit die geslote vrae verkry is, uitgevoer.'n Deskriptiewe analise van die deelnemers se ouerd eo m m e en hul w aarg en o m e behoeftes en gedrag in reproduktiew e gesondheid, is gedoen.Die gemiddelde ouderdom van die deelnem ers was 18.6, w at m o o n tlik is a a n g e s ie n al die respondente van skoolgaande ouderdom is.Die resultate het aangetoon dat die jeug nie genoeg inligting oor reproduktiewe gesondheid ontvang om hulle in staat te stel om sw angerskap en M IV /V igs te voorkom nie.Die spesiale behoeftes van die je u g is d eu r 92% a a n g e d u i w at versoek het dat die k lin iek seuns en meisies akkommodeer, en 96% van die respondente het besprekings wat deur 'n professionele persoon gefasiliteer word, versoek.'n Totaal van 95% van die je u g het versoek dat 'n sp esiale p ro g ra m m et a k tiw ite ite ty d e n s die sk oolvakansies aangebied w ord.Die risikogedrag wat deur die jeug getoon is, is: seksuele omgang met 'n vreemdeling, verskeie seksuele maats, die drink van alkohol en die gebruik van dagga en dwelmmiddels.Die navorser beveel aan dat sodanige program deur verskillende universiteitsdepartem ente ondersteun word en in verskillende distrikte in die Vrystaat-provinsie aangebied word.

Introduction and background to the study
T he p rin cip le know n as re sp ect for persons presumes that all human beings have dignity and are worthy o f respect.Showing respect for the youth as people m eans recognizing their autonom y and treating them as capable decision-makers and full participants in their own health (SEATS 11,2004:1).A second principle is equity, which requires a fair distribution o f health care.
S in c e the im p le m e n ta tio n o f the R e c o n s tru c tio n and D e v e lo p m e n t Programme Policy in South Africa, much has been done for all interest groups, particularly in the provision o f health services and special program m es , but little has been allotted to youth health as an entity in the Free State province.Programmes have been developed for the health of women, whereas young women live in risky situations as indicated by increasing levels of teenage pregnancy and related com plications as w ell as sexually transmitted infections, including H IV /A ID S, which som etim es lead to school drop-outs (SEATS 11,2004:1).
In 1994 the R e c o n s tru c tio n and D e v e lo p m e n t P ro g ra m m e P o lic y reco m m ended the d ev elo p m en t o f a National Youth Programme which was to help young people to realize their full potential, to participate fully in society a n d to d e v e lo p a se n se o f se rv ic e towards the nation (The Reconstruction and Development Programme, 1994:73).Health was one o f the areas at which the youth service program m e was aimed.However, most of the efforts o f the health p r o fe s s io n a ls have b een on the implementation of primary health care and the provision o f free services, w hich excluded youth reproductive health as an entity.A s a co n se q u e n c e o f the h isto ric a l developm ent o f Bloem fontein and the policy of apartheid in South Africa, most o f the black populations of Bloemfontein currently live in previously termed black to w n sh ip a re a s o f M a n g a u n g .T he residents of these areas previously had • High rates of sexually transmitted diseases among young people, lack of information on HIV/AIDS and lack of knowledge on contraceptive use and drug abuse.

MUCPP Health Centre
The youth in Mangaung expressed the need for a youth health service.There was a concern that the health care staff in the M UCPP did not cater for the needs of the youth as a group.Young people p resen ted th em selv es at the H ealth Centre for contraceptives and advice.The reproductive service provided at this centre did not pay special attention to the youth.Therefore, the leaders o f the youth group at the Health Centre took it upon themselves to provide counselling services to young people.The abovementioned leaders had no experience of counselling.The dem ands o f younger people for accessible health care could be driving forces behind a series of initiatives to develop more appropriate services.The official strategic planning document of the National Department of H e a lth on (H IV /A ID S 2 0 0 0 -2 0 0 5 )

Literature review
A literature review was conducted in order to ensure the validity of the content o f the questionnaires and to direct the study.
The literature review was based on the re p ro d u c tiv e h e a lth n ee d s and the reproductive health behaviour o f the youth.

The relationship of youth to parents
The relationship of youth to their parents has impact on their reproductive health needs and their reproductive behavior.
When there is no relationship between parents and youth, the communication

Reproductive health needs of youth and contraceptives
The Health services and facilities Erken and Desidario (2004:4) anticipated that there will be a rapid dramatic increase in the incidence o f HIV infection and AIDS in the coming years, hence relative lack of information and youth friendly services as w ell as the reluctan ce o f service providers to address issues such as youth sexuality must be addressed to avert the growing num ber o f youth to HIV/AIDS.

Reproductive health information needed by youth
A c c o rd in g to the c e n te r fo r h e a lth sy ste m s re se a rc h an d d e v e lo p m e n t (1999:7) parents often believe that sex education leads to earlier or increased sexual activity among youth, hence the reluctance to discuss it with youth.

Reproductive health behaviour of youth
Reproductive health behavior o f youth is influenced by communication between youth and parents, moral development, their dating behavior, sexual activity, risk taking and sexual risk taking.

Communication between youth and parents
Youth are m ore at risk o f unw anted p re g n a n c ie s if th e re is p o o r com m unication with their parents.The c e n te r fo r h e a lth sy ste m s re se a rc h (1999:8) cited the study in the Northern Province which indicated that elders did not provide useful information on sexual issues to youth at all, this was mainly due to lim itations in com m unication between parent and child stemming from the notion that children should always respect their elders and yet parents may also believe that their children do not want to discuss sexual matters with them.

School performance
W hen human sexuality is taught, girls leave school at a disadvantaged age, especially in previously disadvantaged communities.In real life situations girls are th o u g h t to lea v e in itia tiv e and decisio n m aking to boys.M ales are a llo w e d to d o m in a te an d th e re is tolerance of male predatory and violent sexual behavior.Male infidelity is allowed while women are blamed and thrown out.W omen often rely on "sugar daddies" and sporadic or permanent prostitution (Center for health systems research and development 1999:6).

Moral development
Obstructive, judgm ental and moralizing am ongst health w orkers influence the health-seeking behavior o f youth.Some h e a lth w o rk e rs re fu s e y o u th contraceptives fearing that this could encourage premarital relationships while teenagers continue to voice discontent ion w ith the ju dgm ental attitu d es o f health workers regarding their sexuality.N u rse s fail to p ro v id e y o u th w ith condoms without asking questions about their sexual relations and lecturing them on being too young to have sex (Centre for health systems and research 1999:8)

Dating behavior
Dating and going out are activities which many youth engage starting from age 11, 12 an d 13 (P o p u la tio n A c tio n International 2004:1) .Youth go through datin g (single or group) and related ev en ts (for exam ple having crushes, admiring opposite sex or having admirers, h av in g boy frien d s or g irlfrie n d s) at younger ages as compared to a decade ago.T hese behavior changes can be attributed to: improved communication and transport system w hich facilitate in te ra c tio n o u tsid e h o m e , liv in g arrangements that keep a youth away from h o m e (fro m p a re n ts an d re la tiv e s supervision).This is therefore greater d a tin g ten d en cy am ong c h ild re n o f parents who are economically better off, n o t s tric t and u n sta b le m a rria g e s (Bluemethial and Mcintosh 2004:1).

Sexual activity
According to a study conducted by the R eproductive Health Unit (RHRU ) in South Africa 67% of youth engage in sexual activity at the age o f 15-24.Peers seem to be the most influential source of sex information among youth, therefore peer pressure in youth can be changed to make a positive effect in order to p ro te c t y o u th fro m h a rm in g them selves and their bodies.Peer led education has shown to be effective in re la tio n to su b sta n ce ab u se , giv in g information on HIV/AIDS related talks, and been successful in changes in HIVrelated knowledge and attitudes.

Risk taking behavior
Erken and Desidero (2004:2 ) indicated that youth are like a community, they are a group of people who know each other and stick together because they know that they are stronger that way, at the same time they stay far from each other but are able to work together like Trade unions.As a high risk group they do not alw ays know each other and can not always work together.Youth does not rely on other people to take charge of their lives; they want to take charge of e d u c a tin g th e m se lv e s th a n b e in g educated by an adult who is seen as an outsider in a group.

Terminology Youth
A c c o rd in g to th e N a tio n a l Y outh Commission (2000:6), youth refers to a young male or female from the age of 14 to 35 who is at a time in life when most young people are going through dramatic changes in their life circum stances as they move from childhood to adulthood.In this study, youth will be targeted from the age of 13 to 25.

Reproductive health needs
Reproductive health will be defined as follows: The word reproductive is derived from reproduction, which refers to the structure of ovaries (females) and testis (m ale), how they produce sex cells, hormonal controls, menstrual cycle, major events of pregnancy and delivery.Health is a state o f well-being resulting from harmonious interaction o f body, mind, spirit and the environment (Hitchcock et al 2003:3).

Reproductive health behaviour
R eproductive health behaviour is the achievement o f a complete state of health or ill health o f youth due to good or bad c o n d u c t, w h ic h c o u ld a ffe c t the reproductive organs of a male or female youth (Ostler and Swannel 1986: 310).

The aim of the study
The aim o f the study was to explore and describe the reproductive health needs and the reproductive health behaviour of youth in M angaung in the Free State province.

The objectives of the study
The objectives of the study were to: Explore the reproductive health needs and the reproductive health behaviour o f youth in M angaung in the Free State province.Describe the reproductive health needs and the reproductive health behaviour o f y o u th in M an g au n g F re e S tate province.

Research design and methodology
A com bined qualitative and quantitative research design that is explorative and d escriptive in nature was conducted.This design was chosen because through its use, the perceptions o f the youth about their reproductive health needs and their reproductive health behaviour could be explored and discussed.

Population and sampling
The population o f the study included youth between the ages of 13 -25 at three high schools in M angaung.There are several high schools in Mangaung, but the researcher utilized high schools that were closer to the MUCPP.The area of the M UCPP was selected because the M U C PP w as estab lish ed in o rd er to support and provide for the health needs o f the poorest o f the poor community am ong the previously disadvantaged communities of Mangaung.A purposive non -probability sampling method was utilized (Burns and Grove 2001:235).A sample (n=250) was drawn from the youth in three schools in M angaung.Fifty pupils who agreed to be part of the study per school were selected.The selection o f participants follow ed the inclusion criteria as indicated below:

•
Youth living in M angaung who attended clinic on the day of data collection and agreed to take part in the study.
• Youth attending school in the three high schools in M angaung around the MUCPP.
• Both male and female youth aged from 13-25 were requested to take part in the study.

•
The participants were mainly Sotho (English, Xhosa and Tswana) speaking.

Data collection
A T he layout o f the q u estionnaire was explained to each group of researcher and q u estio n s w ere answ ered to provide clarity to the participants.Questionnaires were adm inistered by the researcher to youth who attended the clinic.

Data analysis
Q ualitative data from the open-ended questions was coded and analysed by using Tech's (1990) content analysis.A d e s c rip tiv e s ta tis tic a l a n a ly s is w as p erfo rm ed on the q u a n tita tiv e d ata (Burns and Grove, 2001:527).Rigour in data analysis was ensured by applying the p r in c ip le s o f c o n te n t a n a ly s is described by Tesch (1990).A literature control on the reproductive health needs and the reproductive health behaviour of the youth was conducted.The questionnaire was pilot tested by being given to a group o f youth at a school around the M UCPP in Mangaung, which was not included in the study.Ten p e rc e n t o f th e q u e s tio n n a ir e w as calculated from the youth aged 13-25 at a school in M angaung.The results of a p ilo t stu d y s h o w e d th a t th e questionnaire was understood by the youth and there were no corrections and concepts that were not understood by the youth.

Ethical considerations
T he e th ic a l s ta n d a rd s o f n u rs in g research , as d escrib ed by D E N O SA (1998), were adhered to in relation to informed consent, anonymity and quality o f the research .T h e n am es o f the participating clients were not required on the questionnaires to ensure privacy.Permission for conducting the study was obtained from different health authorities, the departm ents o f the U niversity and the M UCPP Health Centre.Clients were re q u e ste d to tak e p a rt in th e study through a written consent form and the purpose o f the research was explained.An option for withdrawal from the study was explained.The participants were assured o f c o n fid e n tia lity o f all the information obtained during the study.

Presentation of results
The results are presented in relation to the sample realization o f the explorative and d e s c rip tiv e a n a ly s is o f th e re p ro d u c tiv e h e a lth n e e d s an d th e rep ro d u ctiv e h ealth b e h a v io r o f the youth in M angaung.The results will be discussed according to the form at of a questionnaire.The q u estionnaire was designed in different form ats as to some questions one respondent was allowed to respond more than once or twice to the q u e s tio n .
T h e d a ta on the demographics, the structure and family relationships between parents and youth will be described first and followed by the reproductive health needs under the following headings:

Sample realization
Youth involvement in the study showed a distribution of the areas o f Mangaung which is indicated by Phahameng (2%), R o cklands (3% ), P h elin d ab a (25% ), Freedomsquare (20% ), Ipopeng (25%) and Chris Hani (25%).A total o f 250 youth in Mangaung gave their consent as they were requested to participate in the study, and 237 responded to the questionnaire.
This reflects a sample realization of 94.8%.The average age of participation was 18 years, which was due to the fact that school-going age was mostly targeted.Clients from areas around the M UCPP seemed to utilize the community health centre more than clients who came from further away.

Descriptive and explorative analysis
Information was identified according to three sections: the dem ographic data, family structure and the relationships of the youth with parents, the reproductive h e a lth n ee d s o f th e y o u th and the re p ro d u c tiv e health b e h a v io r o f the youth.

Demographic data, family structure and relationships between parents and the youth
The demographic data, family structure and the relationship o f the youth with their parents will be discussed below.

Demographic data
A total o f 250 youth in M anaung were requested to participate in the study.Only 237 responded to the questionnaire.E Among the participants who responded to the questionnaire 45% were males, while 55% were females.

Family structure and the relationship between the youth and their parents
At the age o f 14 99.2% o f the youth indicated that they lived with their mother and stepfather while 91.4% lived with their father and stepmother.Only 50.6% lived with both biological parents, 82.7% lived with their mother and other adults, 98% lived with their father and other 25 Curationis August 2005 a d u lts w h ile 86.9% liv e d w ith grandparents only.A m ong the youth 58.9% indicated that their parents were married to each other while 20.6% were not married and 13.6% had separated or d iv o rc e d p a re n ts.M ost o f the p a rtic ip a n ts (5 4 % ) w ere ra is e d by b io lo g ic a l p a re n ts.T h o se w h o se biological parents did not raise indicated that their parents were divorced ( 'Mother married another man', 'they left me when I was a year old', 'never married', 'mother or both parents died', 'parents lived too far from school', 'they don't understand school', 'they live in another country', and 'mother did not have money to raise the three of us').The relationships between parents and their children, including the responsi bilities that were given to the youth after sch o o l, in d icated that 70.9% o f the participants w ent shopping with their parents while 80.2% did not.Only 28.5% went to the movies with parents while 36.4% went to sports events or museums with their parents.Some o f the youth 59.1 % had done things like cooking with their parents.Some youth 59.9% were given the responsibility of cleaning their rooms while 68.4% were responsible for keeping the rest of the house clean.Other youth 55.7% indicated that they washed the dishes while 55.7% did cooking at hom e. Som e p a rtic ip a n ts (4 1 .4% ) indicated that they received rules about watching television, 58.6% were expected to keep their parents informed o f where they went, 61.6% had rules about doing their homework and only 29.5% had rules about dating.Parents (60.7%) were clear and consistent about rules.Most (34.6%) of the youth indicated that they were involved in making these rules.However 71.4% o f the parents trusted their youth to behave when they were not around.Some wished that their parents would spend more time and m ake decisions together with them.Most o f the youth 76.7% were satisfied with the affection they received from their parents, while 75% indicated that they received all the love they w anted from their parents.Most (96.7% ) of the participants were m o tiv ate d to do th e ir best by th e ir p aren ts.O ther (98.4% ) p a rtic ip a n ts indicated that their parents loved and were interested in their wellbeing.

Reproductive health needs of the youth
The reproductive health needs o f the youth will be discussed next.Girls were th e o n ly re s p o n d e n ts w ho w ere requested to respond to this section of the questionnaire.

Reproductive health and contraceptives
Some (29%) of the girls who participated in the study indicated that they had had their first menstruation at the age of 15, while 22.7% indicated that they had had their first menstrual cycle at 14, 19.3% at 17, 17% at 13, and only a few ( 1. 1%) girls had it at 10 and (3.4%) at 11. M ost of the girls seem to get their first m enstrual period between age 13 and 15, few of them had it at age 10 and 11.

Reproductive health training workshops attended by the youth
Among the (n= 214) participants who took part in the study, 52.8% attended a course relating to sex education.The course on sex education consisted of the fo llo w in g to p ic s : fe m a le m o n th ly menstrual cycle (55.8%),contraceptive m e th o d s (3 5 .4% ), w h ere to o b ta in contraceptives (27.4% ), beneficial and harmful effects of contraceptives (24.8%) and diseases that could result from sexual intercourse (57.5%).Some of the youth seem to have received some education on sexuality as indicated in table 2.

Abortion
Youth gave the following reasons for a woman to have an abortion: if a woman is raped (62.9% ), if she is unm arried (15.4% ), if she is 16 years and under (36.5% ), if she had already had one abortion (14.4% ) and if she could not ra is e a c h ild (2 9 .8% ).T h e m ale respondents indicated that making a girl pregnant made them feel like real men.

Health services and facilities
Among the n = 84 young people who utilize the health services and facilities in the M U CPP, 52.4% needed or used c o n tr a c e p tiv e s , 6 8 .2% o b ta in e d co n tracep tiv es from fam ily planning clinics, while 31.8%obtained them from p riv ate m edical practitio n ers.W hen rating the availability of family planning services in the M UCPP, 75.4% w ere positive about availability, 58.5% rated the service to be youth friendly, 50% indicated that the service was accessible, 52% found the distance from home to the center to be reasonable w hile 74.1% found the service able to give them time to ask questions.

The source of the reproductive health information received by the youth
The youth received information about pregnancy, m enstrual cycle, sexually transm itted diseases and prevention of pregnancy.Only the girls were requested to re s p o n d to th is se c tio n o f the questionnaire.The mean age of the girls w ho re c e iv e d in fo rm a tio n on the prevention o f pregnancy is 15.163.O f the g irls w ho re sp o n d e d to th is q u e s tio n n a ire 100% had re c e iv e d information from school, home and the family planning clinic.Some (66.4%) girls rec eiv e d in fo rm a tio n on the fem ale monthly cycle.M ost (100%) o f the girls received this in fo rm atio n from their schools, hom e and at fam ily planning clinic.M ost o f the girls (73% ) received information on how pregnancy occurs.Most o f the participants (100%) received information from school, home and the family planning clinic.Most o f the girls (75.4%) received information on sexually transm itted disease.The mean age of g irls w ho re c e iv e d in fo rm a tio n on sexually transmitted diseases was 15.378.T he g irls sh o w e d th e ir so u rc e o f information as school, home and family p la n n in g c lin ic .O th e r p a rtic ip a n ts (83.6% ) received inform ation on the prevention o f the pregnancy and 69.3% of these girls received information on the menstrual cycle.Most of the girls (73.6%) were positive about receiving information on how pregnancy occurs and (82.4%) o f the girls indicated that they received in fo rm atio n on sex u ally tran sm itted infections.H ow ever, their sources of inform ation w ere: friends and fam ily m em bers, health care w orkers, health lectures, m inister o f religion and mostly media.M ost o f the girls (86.1%) even received information on the prevention of pregnancy.

The reproductive health behaviour of the youth
C o m m u n ica tio n betw een youth and p a re n ts, sch o o l p erfo rm an ce, m oral developm ent, dating behaviour, sexual activity, risk-taking behaviour, and sexual risk taking behaviour will be described below.

School performance
The school perform ance o f the youth is indicated by varied problem s, 27.9%

Moral development
Table 3 indicates that the youth seemed to differ about how they made decisions.Some o f them acted w ithout thinking, 51.4% indicated that they w ere strict about w hat was right and w rong, and 56.5% indicated that they did not put themselves in the shoes o f other people when they did things.The boys showed that they did not experience problem s with putting a condom on in front o f their girlfriend and did not find it embarrassing if they lost their erection while doing so.
The boys indicated that their parents would be very upset if they made girls pregnant while they them selves would be upset.

Dating behaviour
A m ong the (n=149) respondents 71% indicated that they dated one person only while 21 % dated a number o f people.
The youth agreed to being exposed to the following risk-taking behaviours: Stopped by police and questioned for doing som ething wrong, on probation several times used alcohol, used dagga drugs.Some of the young people had b e e n c o n v ic te d fo r th e fo llo w in g behaviours: assault, robbery, and theft by deception, destruction o f property, trespassing and breaking in, and major traffic violations.The youth seemed to be involved in risk-taking behaviours in different ways.

Sexual risk-taking behaviours
Some of young people are exposed to th e fo llo w in g sex u al ris k -ta k in g behaviors: having sex with a stranger, indicated by 18.3% , having had sex w ith a p ro s titu te , (4.7%), having sex with many o th e r p e o p le (1 8 .9% ) and having sex with someone who took d ru g s u sin g a n eed le (5.9%).

Demographic data
The youth who attended the c lin ic in th e M U C P P community health centre, live in the different black township and their parents Most of the young people seem to have been brought up by one of their biological parents.M ost o f the parents seem to involve youth in doing some household chores and doing things jointly, except during shopping.The youth seem to have been kept occupied with household ch o res a fte r th e ir school a c tiv itie s.Parents had not been to entertainm ent areas with their youth.This could be due to the lack o f entertainm ent areas in Mangaung.Blumethial and M cintosh (2004: 2) cited that in situations where parents did not look after their youth, the only way o f involving parents in youth issues w as to co nvince them o f the consequences o f not com m unicating with the youth.Parents are how ever traditional informants about sex.They may feel embarrassed and may even lack know ledge and skills, w hich can be p a sse d on to the y o u th .T he reproductive health needs and problems o f the y o u th in S o u th A fric a are embedded in the socio-cultural, economic and political settings in which they grow up.R ecognition o f the needs o f the youth as a unique group could minimize the problems and meet their total needs.Problems relating to reproductive health impact negatively on youth development and w e lfa re .T h ese p ro b le m s are d a u n tin g c h a lle n g e s fo r se rv ic e providers such as nurses, com m unity

Reproductive health needs of the youth
The reproductive health needs o f the youth will be discussed next.Girls were the o n ly re s p o n d e n ts w ho w ere requested to respond to this section of the questionnaire.

Reproductive health and contraceptives
Erken

Health services and facilities
Youth from the M angaung community seem to appreciate the services o f the M U C P P c o m m u n ity h ea lth c e n tre .
According to the research conducted by the Center for health systems research (1999:18) the reproductive health needs of adults and youth cannot be met under the sam e roof.U nique rep ro d u ctiv e health facilities catering exclusively for the youth remain a necessity.The youth p re fe r n u rse s and p riv a te m e d ica l practitioners for health advice and not school teachers and counselors while they experience frustrations with these services when accessing contraceptive methods.
The source of the reproductive health information received by the youth SEATS 11 (2004:1) asserted that youth have a rig h t to re p ro d u c tiv e health inform ation and services, while adults ex p erien ce d isco m fo rt in discu ssin g sexual issues with the youth.A report by the K aiser daily reproductive health (2 0 0 4 :1 ) in d ic a te s th a t th e re are m is c o n c e p tio n s th a t se x u a l and r e p ro d u c tiv e h e a lth and se x u a l behaviour inform ation leads to high rates of abortion, pregnancy and sexually transm itted infections among the youth, w hich has how ever been opposed by P resident Am y in Population A ction International (2004:26) that the Dutch experience has proved that talking openly about sexu ality and m aking services available to the youth have the does the opposite result as their reproductive health benefits.

The reproductive health behaviour of the youth
C o m m u n ic atio n betw een yo u th and p a re n ts, sch o o l p erfo rm an ce, m oral developm ent, dating behaviour, sexual activity, risk-taking behaviour, and sexual risk taking behaviour will be described below.

Communication between youth and parents
The Youth seem to be able to talk to their parents on an individual basis and not when both parents are together about

Moral development
The youth seemed to be involved in risktaking behaviour, which is indicated by d o in g th in g s f irs t and th in k in g afterwards.The boys seemed to be aware of the effect of making girls pregnant in their relationship with their parents, but these still showed signs o f immaturity when handling sex matters.

Dating behaviour
It is important to educate the youth about sexual risk-taking behaviour as it starts with dating more than one partner.In o ther d ev elo p ed co u n tries, d ating is characterized by abuse, bullying and date rape.It is therefore im portant that the youth be educated about dating and its consequences.It is however indicated that some of the modern parents do not have control over the dating o f youth w h ich c u lm in a te in p ro b le m s o f prostitution, rape and pregnancy (Van Dyk 2003:16).

Sexual activity
The youth seem not to think before they did things.It is important that they be educated about health risk behaviours because the future o f many nations is impaired by unplanned pregnancies, HIV/ AIDS, and other sexually transm itted youth in fectio n s (P o p u latio n A ction International 2002:1) (see table 6).

Sexual risk-taking behaviours
The W HO (World Health Organization) called for attention to the social problems o f youth as they lead to an increase in tobacco mortality and m orbidity o f any country (Erken and Disederio 2004:4).Many sexually active youth are not using contraceptives.Even among the married youth contraceptive use is very low.The youth c o n tra c t se x u a lly tra n sm itte d infections that lead to in fertility and death.
The high levels of youth pregnancy are an indication that the youth are sexually active and that they do not use condoms the youth who have unprotected sex with their partners or with single partners who have other partners are not just exposed to pregnancy, but to infection with STI's, including the one that can kill them: HIV (Center for health systems research and development 1999:4).

Recommendations
The follow ing reco m m en d atio n s are made, based on the findings o f the study:

•
A youth health centre that can em pow er the youth on life and reproductive health skills should be established.

•
The youth health center should have programmes with structured activities, which could be implemented during school holidays where the youth can learn different skills.
• Awareness on the use of condoms, information on HIV/ AIDS and STIs should be created aggressively to empower the youth.
• The youth should be receiving education on how to say no to sex and risk-taking behaviours.
• Accessibility o f reproductive health services to the youth should be promoted through the establishment of youthfriendly reproductive health care systems.

•
The other departments of the Free State University should support the programme and it should be rolled out to other districts in the province.

Limitations
Students from the Free State University and youth were trained as data collectors, but during the study there was a need for on-site supervision due to the lack of ex p erience.The results o f the study could not be generalized in the greater Bloemfontein as the focus was only on the previously disadvantaged popula tion, where there was evidence o f youth problems.

Conclusion
The study shows evidence o f the need fo r y o u th h ea lth s e rv ic e s w h ere structured training could be given to the youth according to th eir needs.The youth seem to see abortion as a quick-fix solution and yet its consequences are not considered.Most of the girls (73.6%) were positive about receiving information on how pregnancy occurs.M ost of the youth seem to have been brought up by one o f their biological parents.
Most o f the parents seem to involve the youth in doing household chores and doing things jointly with them except during shopping.The household chores served as after school activities.
'n to e n a m e in d ie v o o rk o m s van tienersw angerskap is saam met 'n hoë voorkoms van M IV-infeksie getoon.Die v e rh o u d in g tu s s e n m e n se se reproduktiewe gedrag en die voorkoms van MIV is goed gedokum enteer.Ten einde hierdie probleem aan te spreek, w o rd 'n g e m e e n s k a p s g e b a s e e rd e o n d e rrig p ro g ra m b e n o d ig .
significantly lower standards o f living th an the re st o f the re s id e n ts o f B lo e m fo n te in .T he in tro d u c tio n o f p rim a ry h ealth care c h a lle n g e d the institutions of higher learning to ensure that their curricula were relevant to the needs o f the communities.In response to this challenge, the School o f Nursing at the U n iv e rsity o f the F ree S tate im p le m e n te d a p r o b le m -b a s e d , community-based education programme for nursing students.The students of the School o f Nursing at the University of the F ree S ta te w ere p la c e d in the M a n g a u n g c o m m u n ity and at the M a n g a u n g U n iv e rsity C o m m u n ity Partnership Program (M U CPP) in the C om m u n ity H ealth C en tre.In th eir learning process, students identified the follow ing problem s related to youth health: • Lack of youth health services at MUCPP Health Centre.
level b e c o m es low and y o u th sta rt searching for information from peers and o th e r p e o p le w ith in the co m m u n ity (Bluemethial and Mcintosh 2004:2).
During the past decades South Africa has seen factors such as rapid urbanization, the explosion o f telecom m unication, migration patterns which literally ran riot w ith se x u a l d is p o s itio n o f y o u th s through the provision of role models and op p o rtu n ities for sexual en co unters.Youth reproductive health especially the p re v a le n c e o f u n p ro te c te d sexual re la tio n s befo re m arriag e has been influenced by a great m any variables including urbanization, increased travel, tourism, migration along with shrinking fam ily and e arlie r m enarche.Youth p re g n a n c y sh o w e d an e n o rm o u s in c re a s e , th e c o n tra c tio n o f S T I's skyrocketed among youth w hile HIV/ AIDS introduce itself since the early 1980's.Youth do not always perceive themselves to be at risk.Even if they know the risk o f unprotected sex, they feel AIDS could not possibly happen to them.The health seeking behavior of youth in relation to S T I's differ from adults as youth tend to delay health seeking for ST I's for longer than adults do.This can be due to lack o f youth ap p ro p riate services w hich is not in the y o u th 's c o n tro l (C e n te r fo r h e a lth sy ste m s research 1999:9).
structured questionnaire with closed and open-ended questions was used to collect data (Bums and Grove 2001:368).The questionnaire was divided into three sections.The first section consisted of q u e s tio n s th a t a d d re sse d the d e m o g ra p h ic d a ta , s tru c tu re and 24 Curationis August 2005 re la tio n sh ip o f the yo u th w ith th eir parents, the second section consisted of q u e s tio n s th a t a d d re s s e d the reproductive health needs o f the youth, w hile the th ird sectio n c o n siste d o f q u e s tio n s th a t a d d re s s e d the reproductive health behaviour o f the youth.The participants were requested to reveal their age, their areas o f location in Mangaung and their relationships with their parents.A visit to each school was scheduled on specific dates per school.D ata w as c o lle c te d th ro u g h the d istrib u tio n o f q u estio n n aires to the youth in a classroom , provided by each school on the specified date per school.
C o n te n t v a lid ity w as e n s u re d by s u b m ittin g th e p ro p o s a l and the questionnaire to the bio-statistician of the F ree S ta te U n iv e rs ity b e fo re the questionnaire was adm inistered and to the research com m ittee o f the MUCPP for evaluation (D evos 2001:83).The content and the question o f the study w ere d e v e lo p e d fro m lite ra tu re .Questionnaires were even translated to a c o m m o n ly sp o k e n la n g u a g e in M angaung, which is Sesotho.Statistical re lia b ility an d v a lid ity w ere not determined.ReliabilityA p ilo t stu d y w as co n d u c te d .T he purpose o f the pilot study was to test the understand ability and ensure the reliability o f the questionnaire.A pilot study pre-tests a measuring instrument by trying it out on a small num ber of people having characteristics similar to those of the target group o f respondents.
reproductive health and c o n tra c e p tiv e in fo rm a tio n , reproductive health training workshops attended, abortion, health services and fa c ilitie s , and r e p ro d u c tiv e h e a lth information needed by the youth.T he re p ro d u c tiv e h e a lth b e h a v io u r re su lts w ill be d e sc rib e d u n d e r the fo llo w in g head in g s: co m m u n icatio n b etw een y o u th an d p a re n ts, school performance, moral development, dating, sexual activity, risk -taking and sexual risk taking behaviour.

28
Curationis August 2005reproductive health issues.This lack of com m unication betw een parents and youth may result in problems of abuse, violence and rape(Erken and Disederio  2004: 1).A breakdown in traditional and formal culture has taken place in South Africa.According the center for health sy ste m s re se a rc h and d e v e lo p m e n t (1999:7), because o f a breakdow n in family life styles, the youth are nowadays very rarely educated in reproductive matters in their family context.Parents h ave to w o rk in o rd e r to k eep the h o u s e h o ld g o in g , an d as a re s u lt com m unication and relations between parents and youth lose the intensity and cohesion that exist in traditional settings.Talking about sexuality between parents and children is taboo.One of the biggest needs the youth have identified around the world understands on the part o f their parents, teachers and community leaders; they need people they can turn to and trust, and adults who will listen as they explain what they are experiencing and coping with.School performance T h e y o u th in th is a re a e x p e rie n c e behaviour o f problem s, which may lead to a drop-out, which may be due to the low level o f education o f parents around th e a re a. D e s p ite h ig h le v e ls o f educational participation, South Africans s till lag b e h in d in e d u c a tio n a l a c h ie v e m en t.T h e re is still 23% o f Africans aged 15-19 years who have not passed grade 6.A m ong the people aged 16 years and over, tw o thirds o f the members o f the poorest households have only prim ary school education or no education at all.Young people grow up in households where two thirds o f adults aged 45 years and over have no formal e d u c a tio n at all.A m ong the S outh Africans who drop out o f school, even th o u g h th e y w ish to c o n tin u e th e ir education, they experience problems of the lack o f finances w hile pregnancy becomes the reason for dropping out for women (Center for health systems and research 1999:10).
Parents have not been to entertainment areas with their youth, which may be due to a lack o f entertainment areas in Mangaung.The y o u th d id not h av e k n o w le d g e o f alternative contraceptive methods.The m ost com m only used m ethod w as a condom , which was often not used by most girls and boys.The youth seem to be involved in risk-taking behaviours in different ways.

References
BLUEM ETHIAL & M CINTOSH, 2004: O v e rv ie w : K ey e le m e n ts o f y o u th friendly reproductive health programmes.A pocket guide for fam ily planning service providers.International center for research on women : Engender health.BU RN S, N & G R O V E , SK 2001: The practice o f nursing research conduct, critique and utilization.Toronto: W.B. Saunders company.C E N T R E FO R H EA LTH SY STEM S R E S E A R C H AND D E V E L O P M E N T 1999: South Africa: Free State University.DENOSA 1998: Ethical standards for nursing research Pretoria : Denosa.DE VOS, AS (editor) 2001: Research at g rassro o ts: A prim er for the carin g professions.Pretoria: Van schaik ER K EN , A & DESIDERO, and R 2004: M eeting the reproductive health needs o f young people: UNFPA initiatives in E u ro p e : In te rn a tio n a l p la n n e d parenthood Federation.H IT C H C O C K , J ; SC H U B ER T , P E & T H O M A S, SA 2003: Community health nursing care in action.KAISER FAMILY FOUNDATION 20(M: Hiv and sexual behaviour among young S o u th a fric a n s: A n atio n a l su rv ey .Washington , dc : Advocates for youth.NA TIO N A L Y O U TH C O M M ISSIO N 2000: Y O U T H P O L IC Y : S O U T H AFRICA. Population action interna-tional 2004.Why good reproductive health is good for youth.Pathfinder international.R E P R O D U C T IV E H E A L T H U N IT (R H R U )2004: South Africa: University o f the Witwatersrand.O S T L E R S & SW ANNEL J 1986: The little oxford dictionary of current English Oxford: Claredon press.S E A T S 11 2 0 0 4 : M e e tin g the rep ro d u ctiv e health needs o f young people, usaid: Youth initiative.SO U T H A FR IC A , 2000-2005: Usaid strategic planning document of National department of health and development in South Africa.Pretoria: government publishers.29 Curationis August 2005

High rates of sexually transmitted diseases among young people, lack of information on HIV/AIDS and lack of knowledge on contraceptive use and drug abuse
available on this data), while group five of 1997 were in Ward 26, which also addressed the needs through a Health Expo.Three schools in M angaung also requested the H ealth Expo.N ursing s tu d e n ts o rg a n iz e d , p la n n e d and cond u cted the three sessio n s during their free time, but they could not cope with providing this service as the demand increased.However, what became evident was the fact that there was a need for

Table 3 : Moral development Sexual activity
In table 4 among the participants, 62.5% indicated that they were sexually active and 45% indicated that at the time of the first sexual intercourse, the thought of pregnancy made them feel like avoiding it, while 35.9% did not think about it.Only 9.2% wanted to be pregnant and 9.9% did not even care.