Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana

Challa, Sneha; Manu, Adom; Morhe, Emmanuel; Dalton, Vanessa K.; Loll, Dana; Dozier, Jessica L.; Zochowski, Melissa K.; Boakye, Andrew; Adanu, Richard; Hall, Kelli Stidham

doi:10.1080/03630242.2017.1306607

Cited by 78 publications

(96 citation statements)

References 35 publications

(39 reference statements)

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“…However, for mothers who experienced challenges and side effects discouraged other mothers from using IUD. This is in agreement with a study done in Ghana which found out that the willingness and ability of young women to use FP methods and services were affected often negatively, by factors operating within and across each level and some of those factors included peer in uence, non-spousal support and support and lack of support from relative (11). It also indicates a need to increase on socializing ability of the women using the method with those not yet using the method to proof their good experiences so as to increase on the IUD usage.…”

Section: Experiences Faced By Wra Using Iud Contraceptivesupporting

confidence: 91%

IUD Contraceptive Use Among Women of Reproductive Age: Experiences, Motivators and barriers in a General Hospital, Uganda

Teddy

Olwit

Osingada

et al. 2020

Preprint

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BackgroundDespite availing contraceptives, IUD uptake remains low in family planning service provision. Yet there is evidence that access to family planning reduces Maternal mortality especially in developing countries like Uganda. The study explored the reasons for low uptake of IUD among women of reproductive age.MethodologyFocus-groups and in-depth interviews with women in reproductive was employed to explore experiences, barriers and for low use of IUD. A thematic analysis was used to analyse the data.ResultsThis study explored women’s experiences, their motivations and barriers to IUD use. The positive experiences reported included; IUD is a long-term method of family planning; un affected libido, body image, reassurance from the health providers. The negative experiences included; pain on insertion; discomfort and bleeding and fear of strings. The motivators were; availability of IUD services at the facility, unaffected body image, information from the health workers and the barriers included; mistrust of health providers, financial constraints, myth and misconceptions and lack of social support.ConclusionThe experiences were both positive and negative, the motivators were their drivers to use the method and barriers were reported to influence the IUD use. There is need for mothers who have used IUD and are satisfied with the method to talk to other mothers so that we can increase IUD use as a method of family planning and health care providers have role to play to demystify the myth and misconceptions the mother have.

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Section: Experiences Faced By Wra Using Iud Contraceptivesupporting

confidence: 91%

IUD Contraceptive Use Among Women of Reproductive Age: Experiences, Motivators and barriers in a General Hospital, Uganda

Teddy

Olwit

Osingada

et al. 2020

Preprint

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“…Nor have studies formally investigated a more comprehensive set of dimensions comprising stigma, beyond enacted and internalized stigma, that may relate to young peoples’ SRH perceptions and experiences, especially in sociocultural contexts like Ghana. In our own prior qualitative analysis of data from this same cohort of young Ghanaian women, 33 participants alluded to lived experiences which we believe support a need for a more nuanced understanding of stigma as a potentially unique phenomenon. Taking a broad and initial perspective using a grounded theory approach, we previously found that influences operating at the community and macro levels of young women’s environments, including unaccepting social, cultural and religious norms around premarital sexual activity, pregnancy, and abortion, shaped FP decision- making and behaviors.…”

Section: Introductionmentioning

confidence: 86%

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Hall

Manu

Morhe

et al. 2018

Qual Res Med Healthc

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Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women’s family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents’ use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide.

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“…Frequently depicted as a series of concentric circles, the SEM includes: (1) individual characteristics, knowledge, attitudes, and skills (Individual level) at the centre; (2) relationships with family, friends, and those within their close social networks (Interpersonal level); (3) the structural, cultural, and services environment within their “local” community (Community level); and (4) the greater social, cultural, economic, and policy structures (Societal level) within which an individual exists (McLeroy et al, 1988; Smedley and Syme, 2000). Though widely applied in health behavior research (Challa et al, 2018; Clark et al, 2017; Larios et al, 2009), we only found one study that explicitly applied the SEM to frame factors influencing maternal care-seeking behaviors (Shahabuddin et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

How a woman's interpersonal relationships can delay care-seeking and access during the maternity period in rural Zambia: An intersection of the Social Ecological Model with the Three Delays Framework

Kaiser

Fong

Hamer

et al. 2019

Social Science & Medicine

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To reduce maternal mortality, countries must continue to seek ways to increase access to skilled care during pregnancy and delivery. In Zambia, while antenatal attendance is high, many barriers exist that prevent women from delivering with a skilled health provider. This study explores how the individuals closest to a pregnant woman in rural Zambia can influence a woman's decision to seek and her ability to access timely maternity care. At four rural health centers, a free listing (n = 167) exercise was conducted with mothers, fathers, and community elders. Focus group discussions (FGD) (n = 135) were conducted with mothers, fathers, mothers-in-law, and community health workers (CHWs) to triangulate findings. We analyzed the FGD data against a framework that overlaid the Three Delays Framework and the Social Ecological Model. Respondents cited husbands, female relatives, and CHWs as the most important influencers during a woman's maternity period. Husbands have responsibilities to procure resources, especially baby clothes, and provide the ultimate permission for a woman to attend ANC or deliver at a facility. Female relatives escort the woman to the facility, assist during her wait, provide emotional support, assist the nurse during delivery, and care for the woman after delivery. CHWs educate the woman during pregnancy about the importance of facility delivery. No specific individual has the role of assisting with the woman's household responsibilities or identifying transport to the health facility. When husbands, female relatives, or CHWs do not fulfill their roles, this presents a barrier to a woman deciding to deliver at the health facility (Delay 1) or reaching a health facility (Delay 2). An intervention to help women better plan for acquiring the needed resources and identifying the individuals to escort her and those to perform her household responsibilities could help to reduce these barriers to accessing timely maternal care.

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Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana

Cited by 78 publications

References 35 publications

IUD Contraceptive Use Among Women of Reproductive Age: Experiences, Motivators and barriers in a General Hospital, Uganda

IUD Contraceptive Use Among Women of Reproductive Age: Experiences, Motivators and barriers in a General Hospital, Uganda

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

How a woman's interpersonal relationships can delay care-seeking and access during the maternity period in rural Zambia: An intersection of the Social Ecological Model with the Three Delays Framework

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