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

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Judgment* ; Peer Group* ; Social Stigma*; Abortion, Induced/*psychology ; Contraception Behavior/*psychology ; School Teachers/*psychology ; Students/*psychology; Adolescent ; Adult ; Aged ; Female ; Focus Groups ; Humans ; Kenya ; Male ; Middle Aged ; Poverty Areas ; Pregnancy ; Pregnancy in Adolescence ; School Teachers/statistics & numerical data ; Schools ; Students/statistics & numerical data ; Young Adult

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 peer-counsellors 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 peer-counsellors (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 peer-counsellors, 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.
Trial Registration: This was a prestudy nested in a cluster randomised intervention study, registered on February 28, 2017, at ClinicalTrials.gov (NCT03065842).

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2015-01194 Forskningsrådet om Hälsa, Arbetsliv och Välfärd; 2016-05670 Vetenskapsrådet

Keywords: Abortion; Adolescent pregnancy; Comprehensive sexuality education; Contraception; Stigma

ClinicalTrials.gov NCT03065842

Date Created: 20200417 Date Completed: 20201002 Latest Revision: 20201002

20231215

PMC7161104

10.1186/s12889-020-08578-9

32295574