Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya

Abstract

IntroductionAdolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya.MethodsA mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research.ResultsCronbach’s α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women’s autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling.ConclusionStigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women.

Social judgments on abortion and contraceptive use: a mixed methods study among secondary school teachers and student peer-counsellors in western Kenya

“…The findings in this study show that premarital sex and abortion are considered sins in this context, thus adolescent girls associated with abortion and contraceptive use face social stigma and are often discriminated against. Similar findings have been shown previously in Kenya, as well as in many other contexts all around the world [11,20,29,30]. Most respondents disagreed with the idea of discrimination against girls associated with abortion or contraceptive use, however expressed discriminating attitudes in the discussions.…”

“…In some communities, laws and policies prevent provision of contraceptives to unmarried adolescents or to those under a certain age. However, even where there are no legal restrictions, misconceptions and stigmatising views among adolescents, parents and health care providers continue to block adolescents from using effective contraceptive methods [10,11].…”

“…Abortion stigma has been researched among women with unintended pregnancies, as well as among health care providers [11,20]. However, less is known about secondary school teachers' and students' views on adolescent pregnancy, abortion and contraceptive use.…”

Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa

“…Inadequate access to comprehensive abortion care (CAC) impedes women’s sexual and reproductive health and rights (SRHR). Previous research shows that some healthcare providers report hesitancy in providing such care and have judgmental attitudes towards women-seeking abortions [3,4]. This hesitancy may be explained by a conceptual conflict between human rights and societal norms, which also causes misconceptions [4].…”

“…Previous research shows that some healthcare providers report hesitancy in providing such care and have judgmental attitudes towards women-seeking abortions [3,4]. This hesitancy may be explained by a conceptual conflict between human rights and societal norms, which also causes misconceptions [4]. Such misconceptions create fear of being stigmatised and discourage women from seeking adequate care [5].…”