Would you offer contraception to a 14-year-old girl? Perspectives of health students and professionals in Dar es Salaam, Tanzania

Abstract

Background Rates of unplanned adolescent pregnancy and unsafe induced abortions are very high in Sub-Saharan African countries including Tanzania. Despite their availability and accessibility, modern family planning methods are reported to be critically underutilized by adolescents. This study is part of a broader study that aims to develop a curriculum that will be used in training health professionals by investigating the sexual health training needs of health providers and students in Tanzania. Aim This study describes the perceptions of health professionals and students on the provision of contraceptives to adolescents. Methods Qualitative formative assessment type of research was conducted using 18 focus groups stratified among health professionals and students (midwives, nurses, and medical doctors). Study participants were presented with the theoretical scenario of a 14-year-old girl who sought contraceptive services at a family planning clinic. This theoretical scenario was used to determine how health professionals and students would handle the case. Thematic analysis guided the examination and determination of data results. Results Three main themes emerged from the data, including (1) knowledge about the provision of contraceptives to adolescents, (2) perception of the adolescents’ right to contraceptive use, and (3) barriers to the provision of contraceptives to adolescents. Participants stated that having a baseline knowledge of contraceptive services for adolescents and their rights to contraceptives would trigger their decision on offering the contraceptive. On the other hand, being unaware of the reproductive health rights for adolescents, judgmental behavior of providers, as well as religious and cultural dynamics were all found to be major barriers for providers to offer contraceptive services to the 14-year-old adolescent girl in the theoretical scenario. Conclusion These findings support the need for comprehensive sexual health education in Tanzanian health professional training programs.

Intervenções do enfermeiro na indicação do planejamento familiar natural

“…30 Na literatura, um estudo qualitativo realizado com estudantes e profissionais de saúde da Tanzânia, África Oriental, evidenciou o entendimento e a conduta de educação em saúde em planejamento familiar, destacando ações de orientação acerca da gravidez precoce, como complicações no parto e pós-parto, aumento do risco de câncer e infecções devido a exposição a patógenos que podem ser adquiridos via relação sexual desprotegida, reforçando, assim, a importância do uso da dupla proteção. 31 No Brasil, condutas semelhantes são realizadas, com a abordagem acerca das características dos métodos, incluindo o mecanismo de ação, a forma e facilidade de uso, a eficácia e segurança, aceitabilidade aos efeitos colaterais, a disponibilidade e acessibilidade financeira ao método, a reversibilidade e a proteção contra as Infecções Sexualmente Transmissíveis. 32,33 A categoria de educação em saúde é abordada também em estudos de formato remoto, ou seja, que permitem a prática educativa do enfermeiro de forma online.…”

“…38 A anamnese se apresenta como fundamental para a compreensão por parte dos profissionais acerca do conhecimento e motivação dos seus clientes, uma vez que esse histórico inicial fornecerá informações precedentes que farão diferença na conduta clínica, isto é, darão as pistas de como lidar com a situação e quais os métodos contraceptivos oferecer. 31,39 Desse modo, a anamnese é capaz de oferecer a direção da forma do cuidado, já que permitirá o atendimento às necessidades e anseios individuais, considerando as vivências, cultura, religião e outras características pessoais, favorecendo a criação do vínculo entre profissional e cliente. 39 Estas informações, fornecidas pelo próprio usuário, estão intimamente ligadas com sua autopercepção, 39 incentivando a prática do autoconhecimento, tão importante quando se considera um planejamento familiar natural.…”

Community myths and misconceptions about sexual health in Tanzania: Stakeholders’ views from a qualitative study in Dar es Salaam Tanzania

“…Improving sexual health in Tanzania is challenging. Myths and misconceptions related to sexual health are not limited to the general population but also are common in health care providers [15][16][17]. For example, pregnant girls and women may refuse to use modern family planning methods, believing that doing so will lead to "watery" vaginas, infertility, and other bad side effects [15].…”

“…For example, pregnant girls and women may refuse to use modern family planning methods, believing that doing so will lead to "watery" vaginas, infertility, and other bad side effects [15]. Similarly, healthcare providers have mixed perceptions on whether to provide family planning to a 14 years girl or not, in case they are perceived to be encouraging sexual behavior [17].…”

“…In response to the policy that authors must have a minimal data set available on request by an agency outside of the PI's control. to patients and promote problematic care [16,17]. Political, religious and cultural factors about sexual health play such a significant role in many African countries that these factors also perpetuate myths and misconceptions in various communities and become resistant to change [23][24][25].…”