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

Abstract

Background: In Kenya, unsafe abortion is the leading cause of maternal deaths in adolescent girls aged 15-19 years, and a majority did not use a modern contraceptive before becoming pregnant. The aim of this study was to explore attitudes related to abortion and contraceptive use among secondary school teachers and student peercounsellors in a low-resource setting in western Kenya. Methods: A mixed methods design, combining a questionnaire-survey and focus group discussions (FGDs), was utilised to explore attitudes to abortion and contraceptive use among teachers (n = 15) and student peercounsellors (n = 21) at a secondary school in Kisumu, Kenya. First, two Likert scale questionnaires were used: a modified version of the Stigmatising Attitudes, Beliefs and Actions (SABA) scale and the Contraceptive Use Stigma (CUS) scale. Secondly, four FGDs were conducted. Descriptive statistics and Abductive Thematic Network Analysis (ATNA) were used to analyse the data. Results: Overall, Social judgments on abortion and contraceptive use were found among teachers and student peercounsellors, with similar patterns between sexes. Christian and cultural values; A majority, 28/36 considered abortion a sin, and chastity and purity before marriage were highly valued feminine ideals. Discrimination and isolation; 18/36 believed that a girl who has had an abortion might be a bad influence on other girls, and 13/35 stated that an adolescent girl cannot decide for herself if to use a contraceptive method. Conflicting views on abortion and contraceptives; A third (11/34) believed that contraceptives may cause infertility, and its use was related to promiscuity. Girls associated with abortion and contraceptive use were considered immoral, lacking parental guidance, and were used to represent bad examples in school. Although conflicting views were present, sexuality was considered a taboo topic, which left adolescents ignorant on contraceptive use.Conclusions: Adolescent girls associated with abortion and contraceptive use are at risk for social judgements and discrimination, by both peers and teachers. Sexual and reproductive health training needs to be implemented in teacher education to increase knowledge on adolescent sexuality, abortion and contraceptive use to improve adolescents' sexual health and decrease the stigma.(Continued on next page) Trial registration: This was a prestudy nested in a cluster randomised intervention study, registered on February 28, 2017, at ClinicalTrials.gov (NCT03065842).

“We Don't Fear HIV. We Just Fear Walking around Pregnant.”: A Qualitative Analysis of Adolescent Sexuality and Pregnancy Stigma in Informal Settlements in Kisumu, Kenya

“…Our observations regarding unsafe abortions, combined with the frequent discussion of suicide, speaks to the desperation adolescent girls feel and the lengths they are willing to go to avoid carrying a pregnancy to term (Håkansson et al. 2020; Jayaweera et al. 2018; Levandowski et al.…”

“…This barrier can be reduced by including contraceptive counseling in routine health care for adolescents living with HIV, scheduling adolescent‐only clinic days, or building stand‐alone clinics with staff trained to provide a range of adolescent‐appropriate services (Håkansson et al. 2020; Hagey et al. 2015; Mugwanya et al.…”

“…A recent survey of teachers and peer‐counselors in Kisumu found that one‐third of respondents believed contraceptives cause infertility, encouraged promiscuity, and that adolescent girls cannot make their own decisions about use, highlighting the limited access adolescents in the region have to evidence‐informed counsel (Håkansson et al. 2020).…”

“…Social norms are what is considered acceptable behavior within a community, while social stigma is disapproval and retribution when those norms are violated (Bicchieri 2006;Goffman 1959). In general, social stigma does not lead to decreased adolescent sexual activity but rather decreased disclosure of behavior and use of contraceptives, and increased feelings of social isolation (Kinaro et al 2015;Håkansson et al 2020;Rice et al 2018;Kaljee et al 2007). Fearing social stigma, some adolescents conceal their pregnancies, make decisions without social support, seek unsafe abortions, and/or experience suicidal ideation (Smith et al 2017;Crowley, High, and Thomas 2019).…”

Perceptions of contraceptives as factors in birth outcomes and menstruation patterns in a rural community in Siaya county, Western Kenya

“…Studies confirm that most of the adolescents faced morbidity and mortality from unsafe abortion due to their low contraceptive knowledge and uptake. 13 Many of the respondents identified side effects of using contraceptives, especially related to menstruation. It was found that the most common side effects among the participants included irregular patterns of menstruation, excessive bleeding, and sometimes discontinuation of the menses.…”