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

Author(s):  
Kelli Stidham Hall ◽  
Abubakar Manu ◽  
Emmanuel Morhe ◽  
Vanessa K. Dalton ◽  
Sneha Challa ◽  
...  

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.

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lesley Rose Ninsiima ◽  
Isabel Kazanga Chiumia ◽  
Rawlance Ndejjo

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Déom ◽  
L Ben Abdelhafidh ◽  
N Annez ◽  
C Glorie ◽  
M Roland

Abstract Early pregnancies are often linked to precarious situations. Even if Belgium has seen a decrease in teenage pregnancies, in the former mining region of the Hainaut there are still twice as many births to young women under 20 compared to the national rate. Colfontaine is one of the poorest cities in Belgium. Last year, one of the local high schools counted 10 pregnant teenagers out of 450 students. Médecins du Monde was already present in the city at the time with a mobile health clinic called the Médibus. In response, we carried out a mapping of the local sexual and reproductive health actors. The lack of accessibility to social and health structures capable of welcoming teenagers anonymously and free of charge quickly emerged as a problem, the nearest family planning center being located 30 minutes away by bus. In September 2019, in partnership with 5 local health actors, we decided to reshape the Médibus into the Adobus in order to offer family planning consultations, health promotion and harm reduction activities at the high school once a week. In addition to offering health information services, we also aim to detect teenagers experiencing vulnerable situations such as addiction, violence, gender issues and refer them to appropriate services. Halfway through the project, we met 430 teenagers in 14 afternoons. The most common reasons for consultation (N = 310) were questions related to contraception for 29% and to sexually transmitted infections for 24,5%. 70,9% of teenagers received condoms and 13 girls were tested for pregnancy. One girl received a morning-after pill. 3 teenagers with addiction problems and 17 victims of violence were detected. The teams referred 18 teenagers to other services. The success of this outreach project confirms the need for information regarding sexual and reproductive health for teenagers living in precarious situations as well as the need to develop reachable and affordable sexual and reproductive health services in semi-rural areas. Key messages Outreach is an efficient approach to respond to teenagers’ needs in poor semi-rural areas. Outreach facilitated the detection of early pregnancies, addiction and violence issues among teenagers.


2010 ◽  
pp. 143-170
Author(s):  
Riikka Shemeikka

Finland is one of the donor countries that is most supportive in family planning (FP), Sexual and Reproductive Health and Rights (SRHR) and gender issues. This study examines Finnish ODA for FP and SRHR: its decision-making structure, other stakeholders and funding levels. Data consists of documents from the Ministry for Foreign Affairs (MFA) and interviews conducted at the MFA and with other experts. While Parliament decides on the overall level of ODA funding, the Minister for Foreign Trade and Development has considerable autonomy. Other stakeholders such as the All-Party Parliamentary Group on Population and Development and the Family Federation of Finland (Vestliitto) engage in advocacy work and have influenced development policy. Although the Development Policy 2007 mentions the importance of health and SRHR issues and HIV/AIDS is a cross-cutting issue, interviewees stated that the importance of health and SRHR in ODA has declined and that the implementation of cross-cutting issues is challenging. Multilateral funding for UNFPA, UNAIDS and GFATM, and thus the proportion of SRHR funding within the health sector, is however currently rising. Funding for population-related activities has increased and represented 4.8% of Finlands total ODA in 2009. Almost all of this funding is directed towards basic reproductive health and HIV/AIDS issues and the majority is directed through multilateral channels (78% in 2009), mainly UNFPA and UNAIDS. IPPF, Ipas and Marie Stopes International also receive support.


Author(s):  
Nyanshanu Mattew ◽  
Chireshe Rumbidzai ◽  
Jidong Dung ◽  
Nyashanu Wendy ◽  
Ekpenyong Mandu Stephen

Background: Sub-Saharan Africa faces by far the highest rate of HIV and other Sexually Transmitted Infections (STIs). Illegal mineworkers are considered at risk for HIV and sexually transmitted infections (STIs). Men are generally not receptive to health promotion messages.Methods: This study explored the enablers of sexually transmitted infections. The study utilized a qualitative approach. A total of 40 participants were recruited. Semi structured interviews were used to collect data. A thematic approach was used to analyze the data. Zimbabwe, like any other country in the sub-Saharan region of Africa, has been affected by the epidemic of HIV/AIDS and other STIs, because of poor sexual health education.Results: The study found that the enablers of STIs included poor sexual health knowledge, substance misuse, prolonged stay from family, stigma, lack of entertainment, cultural status, and poor sexual health services.Conclusions: STIs among illegal gold miners is a public health concern that needs urgent attention in many developing countries.


2013 ◽  
Vol 11 (2) ◽  
pp. 32-42 ◽  
Author(s):  
Fatch W. Kalembo ◽  
Maggie Zgambo ◽  
Du Yukai

Background: The objective of this review was to explore and identify feasible, socially acceptable and effective adolescent sexual and reproductive health education (ASRHE) programs in sub-Saharan Africa. Methods: Four databases were searched to identify studies conducted within the past 15 years which evaluate the effectiveness of ASRHE programs in sub-Saharan Africa. The databases searched were Embase, Medline, CINAHL, PyscINFO. A further search for relevant articles was made in the Google scholar website. The title and abstract of each article were analyzed for relevance by applying inclusion and exclusion criteria. Further scrutiny and extraction of the studies was completed by selecting only those studies which met the criteria for inclusion. Results: Fifteen studies were identified. School, peer, mass media, health facility and community based ASRHE programs showed positive impact in one or more of the following outcomes in adolescents in sub-Saharan Africa: ( i) knowledge of HIV transmission; (ii) perceived personal risk of contracting HIV/ AIDS; (iii) self-efficacy to negotiate condom use; (iv) discussion with others about HIV/AIDS or condom use; (v) abstinence from sexual relations; (vi) reduction in high-risk sexual behavior; (vii) condom use (vii) testing for sexually transmitted infection (STI) and (viii) treatment seeking behavior. Conclusion: ASRHE programs of diverse forms can produce positive change in adolescent sexual and reproductive health (ASRH). There is need for rigorous research to assess long term behavioral effects of culturally tailored comprehensive ASRHE programs in sub-Saharan Africa.


Author(s):  
Yana van der Meulen Rodgers

This chapter discusses the evolution of the global gag rule and the existing evidence on its effects. When it was announced in Mexico City, the policy created global uproar with its abrupt change in position on population control and abortion. Pressure from domestic antiabortion groups weighed heavily in the administration’s new policy stance on family-planning assistance. Subsequent rescissions and reinstatements of the global gag rule have caused large fluctuations in US funding for family planning, as demonstrated in the chapter’s analysis of aggregate data. Evidence from qualitative studies indicates that the restrictions on US family-planning assistance under George Bush beginning in 2001 caused major disruptions in service delivery, especially in sub-Saharan Africa. This evidence is crucial for understanding the channels through which women’s reproductive health outcomes are related to restrictions on US foreign aid.


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