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

• Type of Material: Article
• Authors: Kelli Stidham Hall, Emory University; Abubakar Manu, University of Ghana; Emmanuel Morhe, University of Allied Health and Sciences; Vanessa K. Dalton, University of Michigan; Sneha Challa, University of Michigan; Dana Loll, University of Michigan; Jessica L. Dozier, University of Michigan; Melissa K. Zochowski, University of Michigan; Andrew Boakye, Kwame Nkrumah University of Science and Technology; Lisa H. Harris, University of Michigan
• Language: English
• Date: 2018-05-30
• Publisher: PAGEPress
• Publication Version: Final Published Version
• Copyright Statement: K. Stidham Hall et al., 2018
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4081/qrmh.2018.7062
• Title of Journal or Parent Work: Qualitative Research in Medicine and Healthcare
• Volume: 2
• Issue: 1
• Start Page: 55
• End Page: 64
• Grant/Funding Information: Funding: this work was supported by the Society of Family Planning Research Fund Award #SFPRF8-1, the National Institute of Child Health and Human Development (NICHD) #1K01HD080722-01A1 (KSH), NICHD #K12HD001438 (for KSH while she was at the University of Michigan, PI Johnson), and awards from the University of Michigan’s African Social Research Initiative and Office of the Vice President of Research.; Funding sources had no involvement in study design, in the collection, analysis, and interpretation of data, in the writing of the report or in the decision to submit the paper for publication.
• Keywords: Stigma; Sub-Saharan Africa; Sexual and reproductive health; Contraceptive use; Conceptual model; Family planning service use; Adolescents
• Research Categories: Health Sciences, Public Health; Sociology, Individual and Family Studies; Psychology, Behavioral

Abstract

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.