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A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study.

ABSTRACT: This study assessed the effectiveness of a school-based stigma-reduction intervention focusing on stigmatising attitudes towards girls associated with abortion and contraceptive use. In February 2017, two gender-mixed secondary schools (n = 1368) in peri-urban areas of Kisumu County, Kenya, were assigned to receive either an 8-hour stigma-reduction intervention over four sessions (intervention school: IS) or standard comprehensive sexuality education (control school: CS). A classroom survey entailing two five-point Likert scales - the 18-item Adolescents Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale, which measures abortion stigma, and the seven-item Contraceptive Use Stigma (CUS) scale - was conducted to collect data at baseline, 1-month and 12-months after the intervention. The intervention was to be considered effective if a mean score reduction of 25% was achieved for both the ASABA (primary outcome) and the CUS (secondary outcome) at the IS between baseline and 12-month follow-up. 1207 (IS = 574; CS = 633) students were included in analyses at 1-month follow-up, and 693 (IS = 323; CS = 370) at 12-months (the final-year students had left school). A decrease in mean score on both scales was observed at 1-month at both schools. At 12-months, the score decrease was 30.1% at the IS and 9.0% at the CS for ASABA, and 27.3% at the IS and 7.9% at the CS for CUS. At the IS, the score decrease for ASABA between baseline and 12-months was 23.3% among girls and 31.2% among boys; for CUS, the decrease was 27.3% and 24.3%, respectively. ASABA and CUS were positively correlated (r = 0.543; p < 0.001), implying a broader perspective on reproductive stigma. A four-session, school-based stigma-reduction intervention could lead to transformed values and attitudes towards gender norms among adolescents regarding abortion and contraceptive use. Stigma associated with abortion and contraception should become a priority for high-quality CSE programmes.

SUBMITTER: Makenzius M

PROVIDER: S-EPMC9980036 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study.

Makenzius Marlene M Rehnström Loi Ulrika U Otieno Beatrice B Oguttu Monica M

Sexual and reproductive health matters 20231201 1

This study assessed the effectiveness of a school-based stigma-reduction intervention focusing on stigmatising attitudes towards girls associated with abortion and contraceptive use. In February 2017, two gender-mixed secondary schools (<i>n</i> = 1368) in peri-urban areas of Kisumu County, Kenya, were assigned to receive either an 8-hour stigma-reduction intervention over four sessions (intervention school: IS) or standard comprehensive sexuality education (control school: CS). A classroom surv ...[more]

PMID: 36846933

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Project description:AimThe aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy.MethodsThis study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013-May 2016. The women were randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed up at 7-10 days and three months. Associated factors for contraceptive uptake were analysed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level were examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0.ResultsOut of the 810 PAC-seeking women, 76% (n = 609) accepted the use of contraception. Age groups of 21-25 (OR: 2.35; p < 0.029) and 26-30 (OR: 2.22; p < 0.038), and previous experience of 1-2 gravidities (OR 1.939; p = 0.018) were independent factors associated with the up-take. Methods used: injections 39% (n = 236); pills 27% (n = 166); condoms 25% (n = 151); implant 7% (n = 45) and intrauterine device (IUD) 1% (n = 8). At 3-month follow-up of the women (470/609; 77%), 354 (75%) women still used contraception, and most (n = 332; 94%) were satisfied with the method. Reasons for discontinuation were side-effects (n = 44; 39%), partner refusal (n = 27; 24%), planned pregnancy (n = 27; 24%) and lack of resupplies (n = 15; 13%).ConclusionsPAC-seeking women seem highly motivated to use contraceptives, yet a quarter decline the use, and at 3-month follow-up a further quarter among the users had discontinued. Implant, IUD and permanent method are rarely used. Strategies to improve contraceptive counselling, particularly to adolescent girls, and to increase access to a wide range of methods, as well as provider training and supervision may help to improve contraceptive acceptance and compliance among PAC-seeking women in Kisumu, Kenya.

Project description:IntroductionAdolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya.MethodsA mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research.ResultsCronbach's α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women's autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling.ConclusionStigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women.

Project description:BackgroundStigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion.MethodsA study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson's correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach's alpha.ResultsFor the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points (p = 0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy. Cronbach's alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach's alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale.ConclusionsThe CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.

Project description:BackgroundHIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it).MethodsDemographic, psychosocial, and behavioral eligibility screening of women 18-34 years was undertaken. Testing for pregnancy, HIV, and other sexually transmitted infections (STIs) was also conducted. We compared enrollment status across groups of categorical predictors using prevalence ratios (PR) and 95% confidence interval (CI) estimates obtained from a log-binomial regression model.ResultsOut of 692 women pre-screened April to November 2014, 463 completed screening, and 302 women were enrolled. Approximately 97% of pre-screened women were willing to switch from their current contraceptive method to use the intravaginal ring exclusively for the 6-month intervention period. Pregnancy, HIV, and STI prevalence were 1.7%, 14.5%, and 70.4% respectively for the 463 women screened. Women 18-24 (PR=1.47, CI 1.15-1.88) were more likely to be enrolled than those 30-34 years of age, as were married/cohabitating women (PR=1.62, CI 1.22-2.16) compared to those separated, divorced, or widowed. In adjusted analyses, sexual debut at less than 17 years of age, one lifetime sexual partner, abnormal vaginal bleeding in the past 12 months, condomless vaginal or anal sex in the past 3 months, and not having a sexual partner of unknown HIV status in the past 3 months were predictive of enrollment.ConclusionHigh notional acceptability suggests feasibility for contraceptive intravaginal ring use. Factors associated with ring use initiation and 6-month use will need to be assessed.

Project description:BackgroundWomen seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention-the Community Score Card (CSC)-in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision.MethodsWe implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics.ResultsThe involvement of community health volunteers and supportive community members - as well as the willingness of some providers to consider changes to their own behaviors-were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services.ConclusionSuccessful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC - or other social accountability efforts - can result in improved contraceptive access.

Project description:ObjectivesInnovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low-income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub-county and HCF level.MethodsAt baseline (pre-intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in-charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference-in-difference analysis compared changes from baseline to endline in patient-reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patient-reported acceptability following use of SaTo pan versus non-SaTo pan latrines within intervention HCFs.ResultsPatient-reported acceptability of latrines was higher following the intervention (baseline: 87%, endline: 96%, p = 0.05). However, patient-reported acceptability was also high in the control arm (79%, 86%, p = 0.34), and the between-arm difference-in-difference was not significant. Enumerator-observed odour declined in intervention latrines (32%-14%) compared with controls (36%-51%, difference-in-difference ratio: 0.32, 95% confidence interval: 0.12-0.84), but changes in flies, puddling of urine and visible faeces did not differ between arms. In the secondary assessment, fewer intervention than control latrines had patient-reported flies (0% vs. 26%) and odour (18% vs. 50%), and reported satisfaction was greater. Most cleaners reported dropholes and floors were easier to clean in intervention versus controls; limited challenges with water for flushing were reported.ConclusionsOur results suggest SaTo pans may be acceptable by cleaners and users and reduce odour in HCF sanitation facilities, though challenges exist and further evaluation with larger sample sizes is needed.

Dataset Information

A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study.

Publications

A stigma-reduction intervention targeting abortion and contraceptive use among adolescents in Kisumu County, Kenya: a quasi-experimental study.

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