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Parmar D, Berhe S, Bradley S, Fenny A, Aziato L, Ceesay H. Access to adolescent sexual and reproductive health services in Accra, Ghana: An exploratory qualitative study. Glob Public Health 2024; 19:2341420. [PMID: 38634489 DOI: 10.1080/17441692.2024.2341420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents' access to, and experiences of, SRH services in Accra, Ghana. We conducted 12 focus group discussions (FGDs) with adolescents and 13 key informant interviews (KIs) in Ghana. The FGDs were conducted with school-going and out-of-school adolescents. KIIs were conducted with various stakeholders working with adolescents or in SRH services. All interviews were conducted in English, audio recorded and transcribed verbatim. We applied the Dahlgren-Whitehead Rainbow model of health determinants and used a thematic analysis. Eight themes were identified, across micro, meso and macro levels, that influence adolescents' SRH access and experience in Accra. These included: family, social networks, the role of schools, health providers and services, the policy landscape, gender norms, cultural norms, and poverty. The findings highlight several factors that influence adolescents' access to appropriate SRH services in this context and demonstrate the need for a multisectoral effort to address structural factors such as harmful gender norms and persistent poverty.
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Affiliation(s)
- Divya Parmar
- Department of Population Health Sciences, King's College London, London, UK
| | - Semira Berhe
- Department of Population Health Sciences, King's College London, London, UK
| | - Susan Bradley
- School of Health Sciences, City, University of London, London, UK
| | - Ama Fenny
- Institute of Statistical Social and Economic Research (ISSER), University of Ghana, Legon, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Thongmixay S, Essink D, Kahrs T, Vongxay V, Wright P, Sychareun V, Broerse JEW. Isolation: The experience of adolescent motherhood in Laos. Front Glob Womens Health 2023; 4:986145. [PMID: 36970119 PMCID: PMC10031130 DOI: 10.3389/fgwh.2023.986145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
BackgroundTeenage pregnancy is a persistent public health problem with pervasive socio-economic consequences, particularly in in low- and middle-income countries, often related to low social participation and low economic security. The experiences of adolescent pregnancy and motherhood have seldom been described from a personal point of view. This study aimed to gain insights into how adolescent mothers in Laos experience their motherhood, how they perceive their situation and try to cope with it.MethodsThis qualitative study was undertaken with 20 pregnant adolescents and young mothers living in peri-urban areas in two of the 18 provinces in Laos. Data were collected during 20 semi-structured interviews and two focus group discussions (n = 10). Digital recordings were transcribed verbatim, summarised and thematically analysed using an inductive analysis and exploratory approach.ResultsThe most common theme was that the young mothers experienced exclusion individually, socially and in relation to official systems. In only two cases was the pregnancy intended. All were determined to be good mothers, but were overwhelmed and unsure how to overcome structural barriers to educational, social and economic participation.ConclusionParticipants revealed that their adolescent pregnancy was tied to losses of past and future aspirations, and believed that working to prevent unintended adolescent pregnancy is worthwhile, but also advised that community support structures would help young women in their position.
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Affiliation(s)
- Souksamone Thongmixay
- Faculty of Public Health, University of Health Sciences, Vientiane, Laos
- Athena Institute, Faculty of Science, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
- Correspondence: Souksamone Thongmixay
| | - Dirk Essink
- Athena Institute, Faculty of Science, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Taewee Kahrs
- Athena Institute, Faculty of Science, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Viengnakhone Vongxay
- Faculty of Public Health, University of Health Sciences, Vientiane, Laos
- Athena Institute, Faculty of Science, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Pamela Wright
- Guelph International Health Consulting, Amsterdam, Netherlands
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Boateng AA, Botchwey COA, Adatorvor BA, Baidoo MA, Boakye DS, Boateng R. A phenomenological study on recurrent teenage pregnancies in effutu municipality- Ghana.the experiences of teenage mothers. BMC Public Health 2023; 23:218. [PMID: 36726092 PMCID: PMC9890793 DOI: 10.1186/s12889-023-15074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Generally, recurrent teenage pregnancies are public health menaces that impede the quality of life of teenage mothers, their offspring, and society as a whole. However, there is paucity of information regarding factors influencing this social issue especially, in developing countries where Ghana is no exception. Moreover, this menace has been least investigated from the perspective of the teenager with multiple pregnancies. Hence, this study aimed at identifying the factors influencing recurrent teenage pregnancies and the challenges confronted by these teenage mothers. METHOD This study is a phenomenological qualitative study that was conducted in the Effutu Municipality in the Central Region of Ghana. Employing convenience and snowball sampling, 40 participants who were residents of the study area, had a child each, and were pregnant at the time of the study were included. Other participants included teenage mothers who had at least two (2) children. A face-to-face in-depth interview with the help of an interview guide was conducted. Proceedings were recorded, transcribed, and analysed using thematic analysis. Quotations were used in the result presentation. RESULTS The results of the study revealed that factors influencing recurrent teenage pregnancies are multifactorial. It includes peer pressure, parental neglect, poverty, living with a partner, and inadequate knowledge of family planning. The teenager with recurrent pregnancy is confronted with financial difficulties and is faced with stigmatisation in the society where she finds herself. CONCLUSION To this effect, it is important to intensify education on family planning and good parental practices among parents with teenage mothers while providing a similar form of sensitization for members of the society about the harmful effects of stigmatisation on the teenage mother and her children. Again, a social support network for teenagers with recurrent pregnancies could be formed to help curb this public health menace.
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Affiliation(s)
- Agartha Afful Boateng
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region, Winneba, Ghana.
| | - Charles Owusu-Aduomi Botchwey
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | | | - Michael Afari Baidoo
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | - Dorothy Serwaa Boakye
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | - Richard Boateng
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
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Del Mastro N I. Adapting to poverty and dealing with gender: a comparative perspective on teenage pregnancy in the Peruvian Amazon. Cult Health Sex 2023; 25:33-47. [PMID: 34951335 DOI: 10.1080/13691058.2021.2018499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
Teenage pregnancy rates in the Peruvian Amazon are double the national average and among the highest in Latin America. Peruvian women living in rural, underserved and Amazon areas are more likely to become teenage mothers but the factors contributing to this socio-demographic trend are unclear. Thirty-one interviews and ethnographic observations of teenage and adult mothers living in the Peruvian Amazon were conducted to examine how social class and gender impacted their motherhood experiences. Despite preconceptions concerning the undesirability of teenage pregnancy, results show that teenage and adult mothers have similar experiences of motherhood. Both groups of women lack career and educational opportunities and are therefore economically dependent on men. This, combined with the cultural valorisation of motherhood, pushes them toward pregnancy and motherhood. In other words, pregnancy is a response to a lack of career and educational opportunities and not vice versa. The one difference found between teenage and adult mothers is that the former have less agency over reproductive decision making. In conclusion, motherhood among teenage and adult mothers in the Peruvian Amazon is an adaptive mechanism that gives women protection and fulfilment but is also the result of gender and class constraints that limit their life choices.
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Moisan C, Bélanger R, Calvin J, Shipaluk L, Fraser S, Morin V, Muckle G. Exploring ambivalence toward pregnancy among young Inuit women. Cult Health Sex 2023; 25:94-109. [PMID: 35015967 DOI: 10.1080/13691058.2021.2022211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Ambivalence toward pregnancy is an important predictor of early pregnancy as documented in diverse Western societies. Inuit women from Nunavik, a northern region of Quebec, Canada, experience a high rate of early pregnancy, yet no study has explored their attitudes toward pregnancy. Grounded in a participatory approach, this study aimed to explore ambivalence toward pregnancy, among other pregnancy-related attitudes, and identify themes underlying ambivalence among young Inuit women from Nunavik. We conducted semi-structured interviews with 15 women aged 16 to 20 years, who became pregnant during the year preceding the interview. We used an inductive approach to analyse the data. Eleven participants were identified as ambivalent toward pregnancy while three were characterised as having a favourable attitude, and one as unfavourable. Four themes related to ambivalence were identified: the value of childbearing/motherhood; the use of contraceptives; the likelihood of becoming pregnant; and the ideal age to become pregnant. A better understanding of young women's attitudes toward pregnancy could contribute to the development of culturally relevant programmes to more effectively support adolescents, pregnant adolescents and young mothers, and to lead to better care.
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Affiliation(s)
- Caroline Moisan
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Center - Université Laval, Quebec City, Canada
- School of Psychology, Université Laval, Quebec City, Canada
| | - Richard Bélanger
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Center - Université Laval, Quebec City, Canada
- Department of Paediatrics, Centre mère-enfant Soleil, CHU de Québec - Université Laval, Quebec City, Canada
| | | | | | - Sarah Fraser
- School of Psychology, Université de Montréal, Montréal, Canada
| | - Véronique Morin
- Nunavik Regional Board of Health and Social Services, Nunavik, Canada
| | - Gina Muckle
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Center - Université Laval, Quebec City, Canada
- School of Psychology, Université Laval, Quebec City, Canada
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Senkyire EK, Boateng D, Boakye FO, Logo DD, Ohaja M. Socio-economic factors associated with adolescent pregnancy and motherhood: Analysis of the 2017 Ghana maternal health survey. PLoS One 2022; 17:e0272131. [PMID: 36584169 PMCID: PMC9803283 DOI: 10.1371/journal.pone.0272131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Adolescent pregnancy and motherhood have been linked to several factors stemming from social, cultural and to a large extent economic issues. This study examined the socio-economic factors associated with adolescent pregnancy and motherhood in Ghana. DESIGN This was a secondary analysis of the 2017 Ghana Maternal Health Survey, which was a nationally representative cross-sectional survey. Data from 4785 adolescents aged between 15-19 years were included in the analysis. Adolescent pregnancy was defined as adolescents who have ever been pregnant, whiles adolescent motherhood was defined as adolescents who have ever given birth. Weighted logistic regression was used to assess the association between the socio-economic variables and adolescent pregnancy and motherhood. RESULTS Of the 25062 women aged between 15 and 49 years included in the 2017 maternal health survey, 4785 (19.1%) were adolescents between 15-19 years. Adolescent pregnancy was reported in 14.6% (CI:13.2% -16.1%) of the respondents, whereas 11.8% (CI: 10.5% -13.1%) of the respondents had ever given birth. In the multivariate regression analysis, zone (p<0.001), wealth index (p<0.001), age (p<0.001), marital status (p<0.001) and level of education (p<0.001) were all significantly associated with adolescent pregnancy and motherhood. The odds of pregnancy and motherhood were significantly higher in the Middle and Coastal zones (p<0.001), and among older adolescents (p<0.001). However, the odds of pregnancy and motherhood was significantly lower among adolescents from households with the highest wealth index (p<0.001), among those who were never married (p<0.001) and among adolescents who had secondary/higher education (p<0.001). CONCLUSION Several socio-economic variables including education, household wealth, marital status and zone of residence were significantly associated with adolescent pregnancy and adolescent motherhood. Sexual and reproductive health education should be intensified among these populations. Adolescent friendly corners should be made available and accessible to all adolescents in Ghana irrespective of where they live or their age.
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Lambonmung A, Acheampong CA, Langkulsen U. The Effects of Pregnancy: A Systematic Review of Adolescent Pregnancy in Ghana, Liberia, and Nigeria. Int J Environ Res Public Health 2022; 20:ijerph20010605. [PMID: 36612928 PMCID: PMC9819978 DOI: 10.3390/ijerph20010605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 05/13/2023]
Abstract
There is a high incidence of adolescent pregnancy in West Africa. The objective of this study is to highlight the health impacts of adolescent pregnancy through a systematic review. A search was conducted in the electronic databases of Google, Google Scholar, SCOPUS, EBSCO, CINAHL, Web of Science, African Journals Online (AJOL), and the Demographic Health Surveys (DHS) Program. The study found anemia, complications of pregnancy, obstetric and gynecological risks, unsafe abortions, and psychological effects to adversely impact the health of adolescent girls in Ghana, Liberia, and Nigeria. Pregnancy could be deleterious to the health and well-being of adolescent girls in various forms. In addition, adolescent pregnancy could expose adolescent girls to gender-based violence, exclusions, and inequities, be detrimental to upholding women's sexual and reproductive health rights, and could also have implications for Sustainable Development Goal 3. Targeted interventions to prevent pregnancy in young women and mitigate these effects by stakeholders are encouraged.
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Affiliation(s)
- Augustine Lambonmung
- Faculty of Public Health, Thammasat University, Pathum Thani 12120, Thailand
- Tamale Teaching Hospital, Ministry of Health, Tamale P.O. Box TL 16, Ghana
| | | | - Uma Langkulsen
- Faculty of Public Health, Thammasat University, Pathum Thani 12120, Thailand
- Correspondence: ; Tel.: +66-8-7078-5123
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Ocran B, Talboys S, Shoaf K. Conflicting HIV/AIDS Sex Education Policies and Mixed Messaging among Educators and Students in the Lower Manya Krobo Municipality, Ghana. Int J Environ Res Public Health 2022; 19:15487. [PMID: 36497562 PMCID: PMC9738677 DOI: 10.3390/ijerph192315487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
While school-based comprehensive sex education (CSE) is effective in HIV prevention among young people ages 10-24 years, Ghana's national sexual and reproductive health education policy promotes abstinence. Meanwhile, the Ministry of Health's HIV prevention programs provide more comprehensive school-based education. This qualitative study evaluated the HIV/AIDS education program in the Lower Manya Krobo Municipality to assess the perspectives of students and educators in 10 schools on school-based sexual and reproductive health programs, including HIV/AIDS education and conflicting HIV/AIDS sex education policies. HIV prevalence in the Lower Manya Krobo Municipality of Ghana was more than twice the national average at 5.64% in 2018, and prevalence among youth in the municipality aged 15-24 was the highest in the nation at 0.8%. Educators have mixed feelings regarding abstinence-based and CSE approaches. However, students generally endorse abstinence and describe the limitations of condom use. Ambiguity in overarching policies is identified as a factor that could influence the orientation of school-based health educators, create disharmony in sex education interventions, introduce confusing sex education messages to young people, and create a potentially narrow curriculum that limits the gamut of HIV/AIDS sex education to exclude young people's risky sexual behaviours and diverse teaching and implementation strategies. Policies and the scope of sex education should be realigned to ensure the transparent implementation of HIV/AIDS sex education programs in Ghana.
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Affiliation(s)
- Benedict Ocran
- Department of Social Work, Care and Community, School of Social Sciences, Nottingham Trent University, 50 Shakespeare St., Nottingham NG1 4FQ, UK
| | - Sharon Talboys
- Division of Public Health, School of Medicine, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84108, USA
| | - Kimberley Shoaf
- Division of Public Health, School of Medicine, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84108, USA
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Amoadu M, Ansah EW, Assopiah P, Acquah P, Ansah JE, Berchie E, Hagan D, Amoah E. Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review. BMC Pregnancy Childbirth 2022; 22:834. [DOI: 10.1186/s12884-022-05172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adolescent pregnancy is a public health challenge that has well-defined causes, associated health risks, and social and economic consequences for adolescent, their families, communities, and society. The purpose of this scoping review is to summarize studies published on socio-cultural determinants of adolescent pregnancy in Ghana.
Methods
Search for records was done in four major databases, including PubMed CENTRAL, Science Direct and JSTOR. Records from Google and Google Scholar were also added, and results and findings from published and unpublished studies were included. All the 22 studies that met the eligibility criteria, were critically appraised. The guidelines for conducting scoping reviews by Arksey and O’Malley were followed.
Results
The result revealed that poverty, peer influence, low level of education, dysfunctional family, lack of communication between parents and their daughters, lack of sexual and reproductive health education, child marriage, coerced sex, misconception and non-usage of contraceptives, and decline in cultural values such as puberty rites and virginity inspection are some of the determinants of adolescent pregnancy in Ghana. The study also showed that there is a lack of high-quality observational studies that adjust for confounding variables.
Conclusion
Interventions and policies should be designed to take into consideration the needs, context, and background of adolescents. Programmes to enhance adolescent reproductive health need to consider multilevel factors such as person, family, community, institutions, national, and global issues that affect such programmes.
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Agbenyo JS, Nzengya DM, Mwangi SK. Perceptions of the use of mobile phones to access reproductive health care services in Tamale, Ghana. Front Public Health 2022; 10:1026393. [PMID: 36339214 PMCID: PMC9633860 DOI: 10.3389/fpubh.2022.1026393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Africa has one of the world's highest populations of young people. In addition, Africa has one of the highest proportions of young people facing the worst health challenges. Although previous scholars have reported that young people were using mobile phones to fill in the gaps in accessing reproductive health services, among other health services, there was little comprehensive research on the perception of young people in Tamale, Ghana, on the use of mobile phones to access reproductive health services. This study analyzed the perceptions on mobile phone use to access reproductive health services among young people in Tamale, Ghana. Methods The research used a quantitative method design from a target population of 72,706 young people from selected peri-urban, low-income, middle income and high-income residential areas in Tamale Metropolis, Ghana. The sample size used was 397 young people. Participants were selected using a stratified multistage sampling strategy. Descriptive statistics were used to analyse the data. Results A total of 86% of the respondents agree that the use of mobile phones helps to overcome cultural challenges that young people in Tamale encounter in accessing reproductive health care. Also, 84.6% of the respondents agree that the use of mobile phones helps them to overcome inadequate access to reproductive health information and services. The use of mobile phones helps to overcome the negative attitude of health providers toward young people in need of reproductive health services was agreed by most of the respondents [strongly agree (35.4%) and agree (49.4%)]. Conclusion This study informed highly positive perceptions and attitudes toward the use of mobile phones to access Reproductive Health Services in Tamale, Ghana. There is, therefore the need for the health sector to reform its mode of prescriptions of medication, consultation, and service delivery to leverage on the advantages that mHealth presents.
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Nketsia W, Mprah WK, Opoku MP, Juventus D, Amponteng M. Achieving universal reproductive health coverage for deaf women in Ghana: an explanatory study of knowledge of contraceptive methods, pregnancy and safe abortion practices. BMC Health Serv Res 2022; 22:954. [PMID: 35897008 PMCID: PMC9327200 DOI: 10.1186/s12913-022-08323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The first world conference on sexual and reproductive health (SRH) in 1994 helped create the awareness that reproductive health is a human right. Over the years, attempts have been made to extend services to all persons; however, lapses persist in service provision for all in need. Recently, countries have been encouraged to target minority groups in their reproductive health service provision. However, studies have rarely attempted to develop deeper insights into the experiences of deaf men and women regarding their knowledge of SRH. The purpose of this study was to develop an in-depth understanding of the knowledge of deaf persons regarding services such as knowledge of contraceptive methods, pregnancy and safe abortion practices. Methods A sequential explanatory mixed-methods approach was adopted for this study. In the first quantitative phase, 288 deaf persons recruited from three out of the 16 regions in Ghana participated in this study. They completed a 31-item questionnaire on the main issues (knowledge of contraceptive methods, pregnancy and safe abortion practices) addressed in this study. In the second phase, a semi-structured interview guide was used to collect data from 60 participants who took part in the first phase. The key trend emerging in the first phase underpinned the interview guide used for the data collection. While the quantitative data were subjected to the computation of means, t-tests, analyses of variance, correlations and linear regressions to understand the predictors, the in-depth interviews were analysed using the thematic method of analysis. Results The results showed a convergence between the quantitative and qualitative data. For instance, the interview material supported the initial findings that deaf women had little knowledge of contraceptive methods. The participants offered reasons explaining their inability to access services and the role of religion in their understanding of SRH. Conclusion The study concludes by calling on policymakers to consider the needs of deaf persons in future SRH policies. The study limitations and other implications for future policymaking are discussed.
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Affiliation(s)
- William Nketsia
- School of Education, Western Sydney University, Sydney, Australia
| | - Wisdom Kwadwo Mprah
- Centre for Disability and Rehabilitation Studies, Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, P. O. Box 15551, Al-Ain, United Arab Emirates.
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Anima PA, Kumi-Kyereme A, Mariwah S, Tampah-Naah AM. Reflections on lived experiences of teenage mothers in a Ghanaian setting: a phenomenological study. International Journal of Adolescence and Youth 2022. [DOI: 10.1080/02673843.2022.2085052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Prisca Ama Anima
- Department of Geographic Science, University of Energy and Natural Resources, Sunyani, Ghana
| | - Akwasi Kumi-Kyereme
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
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Kotoh AM, Sena Amekudzie B, Opoku-Mensah K, Baku EA, Glozah FN. Pregnant adolescents' lived experiences and coping strategies in peri-urban district in Southern Ghana. BMC Public Health 2022; 22:901. [PMID: 35513816 DOI: 10.1186/s12889-022-13318-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Adolescence, a transition period from childhood to adulthood forms the foundation of health in later life. The adolescence period which should have been characterised by good health is often marred with life-threatening and irreparable consequences of public health concern. Teen pregnancy is problematic because it could jeopardise adolescents’ safe transition to adulthood which does not only affect adolescents, but also their families, babies and society. There is ample evidence about the determinants and effects of teen pregnancy, but it is fragmented and incomplete, especially in Sub-Sahara Africa. This study presents pregnant adolescents’ voices to explain significant gaps in understanding their lived experiences and coping strategies. Methods This narrative inquiry, involved in-depth interviews with 16 pregnant adolescents, who were recruited from a peri-urban district in Southern Ghana using purposive and snowball techniques in health facilities and communities respectively. The audio recorded interviews were transcribed verbatim and analysed manually using content analysis. Results Many pregnant adolescents are silent victims of a hash socio-economic environment, in which they experience significant financial deprivation, parental neglect and sexual abuse. Also, negative experiences of some adolescent girls such as scolding, flogging by parents, stigmatisation and rejection by peers and neighbors result in grieve, stress and contemplation of abortion and or suicide. However, adolescents did not consider abortion as the best option with regard to their pregnancy. Rather, family members provided adolescents with critical support as they devise strategies such as avoiding people, depending on God and praying to cope with their pregnancy. Conclusion Adolescent pregnancy occurred through consensual sex, transactional sex and sexual abuse. While parents provide support, pregnant adolescents self-isolate, depend on God and pray to cope with pregnancy and drop out of school. We recommend that the Ministries of Education and Health, and law enforcement agencies should engage community leaders and members, religious groups, non-governmental organisations and other key stakeholders to develop interventions aimed at supporting girls to complete at least Senior High School. While doing this, it is also important to provide support to victims of sexual abuse and punish perpetrators accordingly.
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Zegeye B, Anyiam FE, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Yaya S. Women's decision-making capacity and its association with comprehensive knowledge of HIV/AIDS in 23 sub-Saharan African countries. Arch Public Health 2022; 80:111. [PMID: 35387689 PMCID: PMC8985301 DOI: 10.1186/s13690-022-00849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) remains a public health problem with a higher burden in sub-Saharan African countries. Though the coverage is low in sub-Saharan Africa (SSA), comprehensive knowledge about HIV is vital for preventing and controlling the transmission of the virus. Women's decision-making power is significantly linked with the knowledge and use of healthcare services. However, there is no available evidence on women's decision-making capacity and comprehensive knowledge of HIV. Therefore, this study investigated the association between women's decision-making capacity within households and comprehensive knowledge of HIV/AIDS in SSA. METHODS We derived data from the 2010 to 2020 Demographic and Health Surveys of 23 sub-Saharan African countries for the analysis. Using Stata version 14, both bivariate logistic regression and multivariate multilevel logistic regression analyses were used to examine the association between women's decision-making capacity and comprehensive knowledge of HIV/AIDS at p ≤ 0.05. Results were reported using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). RESULTS The pooled results show that comprehensive HIV/AIDS knowledge among married women in the studied countries was 35.5%, from 18.3% in Chad to 77.1% in Rwanda. Regarding sub-regional distribution, comprehensive knowledge of HIV/AIDS in Southern Africa was 73.2%, followed by East Africa (52.4%), West Africa (43.6%), and Central Africa (35.5%). The study showed higher odds of comprehensive knowledge of HIV/AIDS among married women who had decision making power (yes-aOR = 1.20, 95% CI; 1.16-1.25) compared to those who had no decision-making power. Age, women and partner's level of education, place of residence, exposure to media, HIV testing status, community socio-economic status, parity, religion, and distance to health facilities also had significant association with comprehensive HIV/AIDS knowledge. CONCLUSIONS Comprehensive knowledge of HIV/AIDS in SSA is low but varies per country. Married women with decision-making capacity were more likely to have comprehensive knowledge of HIV compared to those with no decision-making capacity. Therefore, comprehensive knowledge of HIV/AIDS can be increased through enhancing women's decision-making capacities, strengthening employment opportunities, socioeconomic capacities and creating awareness through media. Moreover, improving access to health care facilities working closely with religious leaders, can be considered to increase coverage of comprehensive knowledge of HIV among married women in SSA.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, , Shewarobit Field Office, Shewarobit, Ethiopia
| | - Felix Emeka Anyiam
- Centre for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.,Centre for Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, QLD4811, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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15
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Aluga D, Okolie EA. Socioeconomic determinants of teenage pregnancy and early motherhood in the United Kingdom: A perspective. Health Promot Perspect 2022; 11:426-429. [PMID: 35079585 PMCID: PMC8767081 DOI: 10.34172/hpp.2021.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/05/2021] [Indexed: 11/09/2022] Open
Abstract
The United Kingdom has one of the highest teenage birth rates among countries in western Europe. Government initiatives such as the Teenage Pregnancy Strategy introduced by the labor government in 1999 to reduce the teenage pregnancy rate by half in ten years could be responsible for the steady decline in teenage conception and childbirth for the past two decades. However, to sustain this decrease it is crucial to consider the broader socioeconomic and environmental determinants of teenage pregnancy at the population level. A selected literature search was conducted in this respect to highlight the factors that could be neglected by recent interventions on teenage pregnancy and childbirth in the United Kingdom.
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Affiliation(s)
- David Aluga
- School of Health and Life Sciences, Teesside University Middlesbrough, United Kingdom
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16
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Shikukutu F, Ramrathan L. ‘You are not a real man until you have scored’ masculine discourses and teenage pregnancy. International Journal of Adolescence and Youth 2022. [DOI: 10.1080/02673843.2021.2021960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Labby Ramrathan
- College of Humanities, School of Education, University of KwaZulu – Natal
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17
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Decker MR, Wood SN, Byrne ME, Yao-N’dry N, Thiongo M, Gichangi P, M. OlaOlorun F, Koffi AK, Radloff S, Ahmed S, O. Tsui A. Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings. PLoS One 2021; 16:e0257009. [PMID: 34843466 PMCID: PMC8629179 DOI: 10.1371/journal.pone.0257009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence). METHODS Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use. FINDINGS Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing. INTERPRETATION AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.
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Affiliation(s)
- Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nathalie Yao-N’dry
- Association Ivoirienne pour le Bien-Etre Familial (AIBEF), Abidjan, Côte d’Ivoire
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | | | - Alain K. Koffi
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy O. Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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18
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Decker MR, Wood SN, Thiongo M, Byrne ME, Devoto B, Morgan R, Bevilacqua K, Williams A, Stuart HC, Wamue- Ngare G, Heise L, Glass N, Anglewicz P, Gummerson E, Gichangi P. Gendered health, economic, social and safety impact of COVID-19 on adolescents and young adults in Nairobi, Kenya. PLoS One 2021; 16:e0259583. [PMID: 34752473 PMCID: PMC8577767 DOI: 10.1371/journal.pone.0259583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. METHODS An existing cohort of youth ages 16-26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), supplemented by virtual focus group discussions and interviews with youth and stakeholders, to examine economic, health, social, and safety experiences during COVID-19, and gender disparities therein. RESULTS COVID-19 risk perception was high with a gender differential favoring young women (95.5% vs. 84.2%; p<0.001); youth described mixed concern and challenges to prevention. During COVID-19, gender symmetry was observed in constrained access to contraception among contraceptive users (40.4% men; 34.6% women) and depressive symptoms (21.8% men; 24.3% women). Gender disparities rendered young women disproportionately unable to meet basic economic needs (adjusted odds ratio [aOR] = 1.21; p<0.05) and in need of healthcare during the pandemic (aOR = 1.59; p<0.001). At a bivariate level, women had lower full decisional control to leave the house (40.0% vs. 53.2%) and less consistent access to safe, private internet (26.1% vs. 40.2%), while men disproportionately experienced police interactions (60.1%, 55.2% of which included extortion). Gender-specific concerns for women included menstrual hygiene access challenges (52.0%), increased reliance on transactional partnerships, and gender-based violence, with 17.3% reporting past-year partner violence and 3.0% non-partner sexual violence. Qualitative results contextualize the mental health impact of economic disruption and isolation, and, among young women, privacy constraints. IMPLICATIONS Youth and young adults face gendered impacts of COVID-19, reflecting both underlying disparities and the pandemic's economic and social shock. Economic, health and technology-based supports must ensure equitable access for young women. Gender-responsive recovery efforts are necessary and must address the unique needs of youth.
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Affiliation(s)
- Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Meagan E. Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kristin Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Anaise Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - H. Colleen Stuart
- Johns Hopkins Carey Business School, Baltimore, MD, United States of America
| | - Grace Wamue- Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
- Women’s Economic Empowerment Hub, Kenyatta University, Nairobi, Kenya
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, MD, United States of America
- Center for Global Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Elizabeth Gummerson
- Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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19
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Boamah-Kaali EA, Mevissen FEF, Owusu-Agyei S, Enuameh Y, Asante KP, Ruiter RAC. A Qualitative Exploration of Factors Explaining Non-Uptake of Hormonal Contraceptives Among Adolescent Girls in Rural Ghana: The Adolescent Girls' Perspective. Open Access J Contracept 2021; 12:173-185. [PMID: 34764703 PMCID: PMC8577562 DOI: 10.2147/oajc.s320038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adolescent pregnancy remains a public health concern globally. The use of hormonal contraceptive methods are proven ways of preventing pregnancies and in turn unsafe abortions. However, research shows that use of hormonal contraceptive methods is rather low among African adolescent girls, of which Ghana is no exception. OBJECTIVE This manuscript uses the socio-ecological model to guide our understanding of the factors associated with non-use of hormonal contraceptives among adolescent girls in Ghana. METHODS An explorative study was done using qualitative data collection methods. Two focus group discussions and sixteen in-depth interviews were conducted among adolescent girls aged 15-19 years (N = 38) in the Kintampo area of Ghana to determine factors affecting uptake of hormonal contraceptives. RESULTS Adolescents showed a lack of in-depth knowledge related to the different hormonal contraceptive types. Negative attitudes towards adolescent hormonal contraceptive use, fear of real and perceived side effects of hormonal contraceptives, lack of self-efficacy to use contraceptives, fear of disclosure of use and fear of societal stigma related to sexual intercourse and its related issues among adolescents may explain why adolescent girls in this context do not use hormonal contraceptive methods. CONCLUSION To promote hormonal contraceptives among adolescent girls, a combination of multifaceted social-psychological, personal and community level interventions are needed.
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Affiliation(s)
- Ellen Abrafi Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Fraukje E F Mevissen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Municipal Public Health Service Rotterdam-Rijnmond, Department of Public Health, Rotterdam, the Netherlands
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
- Department of Epidemiology & Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana
| | - Robbert A C Ruiter
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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20
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Odusina EK, Ahinkorah BO, Ameyaw EK, Seidu AA, Budu E, Zegeye B, Yaya S. Noncompliance with the WHO's Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis. Biomed Res Int 2021; 2021:6696829. [PMID: 34589549 PMCID: PMC8476249 DOI: 10.1155/2021/6696829] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA). METHODS We used data from the Demographic and Health Surveys of eight countries in SSA. A pooled sample of 63,266 pregnant women aged 15-49 years who had given birth to children within 5 years prior to the surveys was included in this study. To examine the factors associated with noncompliance with ANC 8+ visits, multilevel binary logistic regression analysis was conducted, and the results were reported using odds radios at 95% confidence interval (CI). RESULTS The pooled prevalence of noncompliance with ANC 8+ visits was 92.3% (95% CI: 91.1%-93.3%) with the highest and lowest prevalence in Zambia (98.7%, 95% CI: 98.3%-99.1%) and Libya (73.4%, 95% CI: 70.4%-76.2%), respectively. With the individual level factors, women's age (44-49 years-aOR = 0.33, 9% CI: 0.14-0.78), health insurance registration, (yes-aOR = 0.53, 95% CI: 0.29-0.98), and economic status (richest-aOR = 0.16, 95% CI: 0.05-0.49) were negatively associated with noncompliance with 8+ ANC visits, while parity (five or more children-aOR = 1.68, 95% CI: 1.12-2.52) was positively associated with noncompliance with 8+ ANC visit. With the community level factors, community level literacy was negatively associated with noncompliance with 8+ ANC visit (high-aOR = 0.56, 95% CI: 0.32-0.99). CONCLUSION About eight out of ten pregnant women did not comply with the WHO's recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Empowering the economic status of women , enhancing health insurance and education coverage, and giving more attention to young pregnant women and those with more children are crucial for improving the coverage of ANC 8+ visits in the region.
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Affiliation(s)
- Emmanuel Kolawole Odusina
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University, Oye Ekiti, Nigeria
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology, Sydney, Australia
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Sanni Yaya
- University of Parakou, Faculty of Medicine, Parakou, Benin
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21
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Polis CB, Otupiri E, Hindin M, Chiu DW, Keogh SC, Aidoo C, Larsen-Reindorf R, Bell SO. Prevalence and Correlates of Perceived Infertility in Ghana. Stud Fam Plann 2021; 51:207-224. [PMID: 32964426 PMCID: PMC7539950 DOI: 10.1111/sifp.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Perceived infertility is an understudied phenomenon in low‐ and middle‐income countries, where biomedical infertility can have severe consequences, particularly for women. We conducted a nationally representative survey of Ghanaian women, estimated the prevalence of and reasons for perceived infertility, and assessed factors associated with higher levels of perceived infertility using a partial proportional odds model. Among 4,070 women, 13 percent believed they were “very likely” to have difficulty getting pregnant when they wanted to, 21 percent believed this was “somewhat likely,” and 66 percent believed this was “not at all likely.” Reasons for perceived infertility varied by whether the respondent was currently seeking pregnancy. In multivariable analysis, several factors were associated with higher levels of perceived infertility, while unexpectedly, women who reported ever using contraception were less likely to report perceived infertility. Acknowledging the need to address infertility globally and understanding the role of perceived infertility are important components in supporting people's ability to decide whether and when to have children.
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Affiliation(s)
- Chelsea B Polis
- Chelsea B. Polis, Guttmacher Institute, New York, NY.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Easmon Otupiri
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | - Michelle Hindin
- Suzanne O. Bell, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Easmon Otupiri, Cara Aidoo, Roderick Larsen-Reindorf, School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana. Michelle Hindin, Population Council, New York, NY
| | - Doris W Chiu
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Sarah C Keogh
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Cara Aidoo
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | | | - Suzanne O Bell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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22
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Keogh SC, Otupiri E, Castillo PW, Li NW, Apenkwa J, Polis CB. Contraceptive and abortion practices of young Ghanaian women aged 15-24: evidence from a nationally representative survey. Reprod Health 2021; 18:150. [PMID: 34275462 PMCID: PMC8286596 DOI: 10.1186/s12978-021-01189-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background Young Ghanaian women experience high rates of unmet need for contraception and unintended pregnancy, and face unique barriers to accessing sexual and reproductive health services. This study provides a comprehensive national analysis of young women’s contraceptive and abortion practices and needs. Methods In 2018, we conducted a nationally representative survey of women aged 15–49, including 1039 women aged 15–24. We used descriptive statistics, multivariable logistic and multinomial regression to compare young versus older (25–49 year-old) women’s preferred contraceptive attributes, reasons for discontinuing contraception, quality of counseling, use of Primolut N-tablet, method choice correlates, and friends’ and partners’ influence. We also examined youth’s self-reported abortion incidence, abortion methods, post-abortion care, and barriers to safe abortion. Results Among Ghanaian 15–24 year-olds who had ever had sex, one-third (32%) were using contraception. Compared to older women, they had higher desires to avoid pregnancy, lower ever use of contraception, more intermittent sexual activity, and were more likely to report pregnancies as unintended and to have recently ended a pregnancy. Young contraceptors most commonly used condoms (22%), injectables (21%), withdrawal (20%) or implants (20%); and were more likely than older women to use condoms, withdrawal, emergency contraception, and N-tablet. They valued methods for effectiveness (70%), no risk of harming health (31%) nor future fertility (26%), ease of use (20%), and no effect on menstruation (19%). Infrequent sex accounted for over half of youth contraceptive discontinuation. Relative to older women, young women’s social networks were more influential on contraceptive use. The annual self-reported abortion rate among young women was 30 per thousand. Over half of young women used abortion methods obtained from non-formal providers. Among the third of young women who experienced abortion complications, 40% did not access treatment. Conclusions Young people’s intermittent sexual activity, desire for methods that do not harm their health, access barriers and provider bias, likely contribute to their greater use of coital-dependent methods. Providers should be equipped to provide confidential, non-discriminatory counseling addressing concerns about infertility, side effects and alternative methods. Use of social networks can be leveraged to educate around issues like safe abortion and correct use of N-tablet. Young Ghanaian women can experience difficulties accessing sexual and reproductive health services, and many are not using contraception despite wanting to avoid pregnancy. To better understand their needs, we describe their preferences and behaviors around contraception and abortion. We surveyed a nationally representative sample of women aged 15–49, and compared young (15–24) versus older (25–49) women’s contraceptive preferences, reasons for stopping contraception, quality of counseling, friends’ and partners’ influence on contraceptive use, and use of abortion. One-third of 15–24 year-olds who ever had sex were using contraception. Compared to older women, young women’s pregnancies were more likely to be unintended and to end in abortion. Young women most commonly used condoms, injectables, withdrawal or implants; and were more likely than older women to use condoms, withdrawal, emergency contraception, and Primolut N-tablet. They preferred methods that were effective, did not harm their health or future fertility, were easy to use, and did not disrupt their menstrual cycle. Over half of young women who stopped contraception did so because they were not having sex regularly. Friends had more influence on contraceptive use among young women than older women. Each year on average, there were 30 abortions per 1000 young women. Over half of young women who had abortions used methods from non-formal providers, and 40% of those who had complications did not get treated. Providers should be equipped to provide confidential, non-discriminatory counseling about contraceptive side effects and options. Social networks can be used to educate women about safe abortion.
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Affiliation(s)
- Sarah C Keogh
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA.
| | - Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Naomi W Li
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
| | - Joana Apenkwa
- St. Michael's Nursing and Midwifery Training College, Pramso, Ghana
| | - Chelsea B Polis
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA
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Yaya S, Zegeye B, Ahinkorah BO, Seidu AA, Ameyaw EK, Adjei NK, Shibre G. Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey. Reprod Health 2021; 18:70. [PMID: 33766075 PMCID: PMC7993505 DOI: 10.1186/s12978-021-01124-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In Cameroon, maternal deaths remain high. The high maternal deaths in the country have been attributed to the low utilization of maternal healthcare services, including skilled birth attendance. This study examined the predictors of skilled birth services utilization among married women in Cameroon. METHODS Data from the 2018 Cameroon Demographic and Health Survey was analyzed on 7881 married women of reproductive age (15-49 years). Both bivariate and multivariable logistic regression analyses were carried out to determine the predictors of skilled childbirth services. The results were presented with crude odds ratio (cOR) and adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS The coverage of skilled birth attendance among married women of reproductive age in Cameroon was 66.2%. After adjusting for potential confounders, media exposure (aOR = 1.46, 95% CI: 1.11-1.91), higher decision making (aOR = 1.88, 95% CI: 1.36-2.59), maternal education (aOR = 2.38, 95% CI; 1.65-3.42), place of residence (aOR = 0.50, 95% CI; 0.33-0.74), religion (aOR = 0.55, 95% CI; 0.35-0.87), economic status (aOR = 5.16, 95% CI; 2.58-10.30), wife beating attitude (aOR = 1.32, 95% CI; 1.05-1.65), parity (aOR = 0.62, 95% CI; 0.41-0.93) and skilled antenatal care (aOR = 14.46, 95% CI; 10.01-20.89) were found to be significant predictors of skilled birth attendance. CONCLUSIONS This study demonstrates that social, economic, regional, and cultural factors can act as barriers to skilled childbirth services utilization in Cameroon. Interventions that target women empowerment, antenatal care awareness and strengthening are needed, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women. Such policies and interventions should also aim at reducing geographical barriers to access to maternal healthcare services, including skilled birth attendance. Due to the presence of inequities in the use of skilled birth attendance services, programs aimed at social protection and empowerment of economically disadvantaged women are necessary for the achievement of the post-2015 targets and the Sustainable Development Goals. Globally, Cameroon is one of the countries with high maternal deaths. Low utilization of maternal healthcare services, including skilled birth attendance have been found to account for the high maternal deaths in the country. This study sought to examine the factors associated with skilled childbirth services utilization among married women in Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey, we found that the coverage of skilled birth attendance among married women of reproductive age in Cameroon is high. Factors such as higher decision-making power, higher maternal education, place of residence, religion, higher economic status, wife beating attitude, parity and skilled antenatal care were found to be the significant predictors of skilled birth attendance. This study has shown that socio-economic, regional and cultural factors account for the utilization of skilled childbirth services utilization in Cameroon. Interventions aimed at enhancing the utilization of skilled childbirth services in Cameroon should target women empowerment, antenatal care awareness creation and sensitization, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Heiligenhafen, Germany
| | - Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Chavula MP, Svanemyr J, Zulu JM, Sandøy IF. Experiences of teachers and community health workers implementing sexuality and life skills education in youth clubs in Zambia. Glob Public Health 2021; 17:926-940. [PMID: 33661081 DOI: 10.1080/17441692.2021.1893371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zambia, like other low- and middle-income countries, faces numerous adolescent sexual and reproductive health challenges such as teenage pregnancies. This study aimed at understanding teachers' and community health workers' (CHWs) implementation of comprehensive sexuality education (CSE) as part of a comprehensive support package for adolescent girls to prevent early childbearing. Data collected using in-depth interviews [n = 28] with teachers [n = 15] and community health workers [n = 13] were analysed using thematic analysis. The teachers and CHWs reported that the use of participatory approaches and collaboration between them in implementing CSE enabled them to increase girls' and boys' participation youth clubs. However, some teachers and CHWs experienced practical challenges with the manuals because some concepts were difficult to understand and translate into local language. The participants perceived that the youth club increased knowledge on CSE, assertiveness and self-esteem among the learners. Training and providing a detailed teaching manual with participatory approaches for delivering CSE, and collaborative teaching enabled teachers and CHWs to easily communicate sensitive SRH topics to the learners. However, for the adoption of CSE to be even more successful, piloting of the curriculum with local facilitators and translating the manuals into the local languages before they are implemented, is recommended.
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Affiliation(s)
- Malizgani Paul Chavula
- Department of Health Policy and Health Promotion and Education, School of Public Health, University of ZambiaLusaka, Zambia
| | - Joar Svanemyr
- Department of Global Public Health and Primary Care, Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway.,Chr. Michelsen Institute, Bergen, Norway
| | - Joseph Mumba Zulu
- Department of Health Policy and Health Promotion and Education, School of Public Health, University of ZambiaLusaka, Zambia
| | - Ingvild Fossgard Sandøy
- Department of Global Public Health and Primary Care, Center for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
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Adomako EB, Frimpong-Manso K, Munemo P, Duah HO, Agbadi P. The relationship between accurate knowledge on HIV/AIDS transmission and adolescent pregnancy in Ghana: A further analyses of the 2017 multiple cluster indicator survey. Heliyon 2021; 7:e06265. [PMID: 33644480 PMCID: PMC7893434 DOI: 10.1016/j.heliyon.2021.e06265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/19/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The literature posits that HIV knowledge is associated with precautious sexual behaviour and practice. We hypothesised and investigated the association between knowledge of HIV transmission and adolescent pregnancy in Ghana, given that the relationship between HIV knowledge and adolescent pregnancy has not been extensively studied. METHODS We did analyses on 5836 cases (weighted as 5121) of 15-24 years old reproductive age women in the female dataset of the 2017 Multiple Cluster Indicator Survey. Adolescent pregnancy was operationalized as reproductive age women between 15-24 years who became pregnant before the age of 18 years. Accurate HIV knowledge was measured by computing the scores of correct responses on six questions exploring women's knowledge about HIV transmission. We accounted for sample design and weight before performing a Chi-square test of independence and Poisson regression. RESULTS The results indicate that having lower scores on the HIV transmission knowledge scale was correlated with a higher probability of girls becoming pregnant before their 18th birthday. After controlling for the moderating effect of socio-demographic characteristics of the participants, we found that accurate HIV transmission knowledge loses its statistical significance in determining adolescent pregnancy. The factors that remain significant in the adjusted model were formal education status, household wealth, and region of residence. HIV transmission knowledge was statistically significantly related to adolescent pregnancy in the model after the education level variable was omitted. This observation was due to the significant effect of school education on other variables in the model. This result demonstrates that HIV knowledge has a major impact on adolescent pregnancy, but this effect is predicated by formal education attainment of the adolescent girl. CONCLUSIONS Given the results, adolescent pregnancy issues can be resolved by the government and other development partners by adequately educating adolescents about HIV transmissions. Also, because they have the potential to reduce pregnancy among adolescents in Ghana, we recommend that programs and initiatives should address existing disparities in formal educational attainment and household wealth.
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Affiliation(s)
| | | | - Petronella Munemo
- Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Ghana
| | | | - Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, Kumasi, Ghana
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Gbogbo S. Early motherhood: voices from female adolescents in the Hohoe Municipality, Ghana-a qualitative study utilizing Schlossberg's Transition Theory. Int J Qual Stud Health Well-being 2020; 15:1716620. [PMID: 31975645 PMCID: PMC7034467 DOI: 10.1080/17482631.2020.1716620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose: Using Schlossberg's Transition Theory, this study explored the lived experiences of pregnant adolescents and adolescent mothers coping strategies during their transition to motherhood.Methods: Based on a phenomenological perspective, this qualitative study used in-depth interviews (IDIs) and focus group discussions (FGDs) to answer the research aim. The process of data gathering included 8 FGDs and 12 IDIs held with adolescent mothers and pregnant adolescents. Audio recordings were transcribed and imported into MAXQDA 2018 for analysis.Results: Applying the interpretative phenomenologial analysis (IPA), four key themes emerged. This included: news of pregnancy; adolescent motherhood; social support and coping strategies. The findings display female adolescents' expressions of some of the negative aspects of motherhood they have been confronted with that have affected their lives. The dominant societal challenges posited by the adolescents included coping with economic and financial constraints, opting for unsafe abortion to reduce stigma associated with unplanned pregnancy, and managing the extra responsibility of taking care of the baby and the challenge of going back to school after delivery.Conclusion: There is the need to build social capital among community members regarding their support to improve the psychosocial well-being of adolescents during early motherhood.
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Affiliation(s)
- Sitsofe Gbogbo
- School of Public Health, University of Health and Allied Sciences, Ho, Ghana
- Institute of Education, Johannes Gutenberg University Mainz, Germany
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Abstract
Background Fear of infertility (FOI) is often reported in studies about reproductive health but this literature not yet mapped. The aim of this rapid scoping review of qualitative studies was to describe the nature of FOI in Africa. Methods Eligibility criteria were qualitative data from Africa reporting views of women and men of any age. MEDLINE and CINAHL databases were searched for English language citations to February 2019 using keywords related to fear, infertility and Africa. Two independent reviewers screened texts for inclusion. Results Of 248 citations identified, 38 qualitative and six review papers were included. FOI was reported in diverse groups (e.g., men, women, fertile, infertile, married, unmarried, teachers, religious leaders). Two types of fears were identified: (1) fear of triggering infertility due to specific reproductive choices and (2) fear of the dire future consequences of infertility. Choices were perceived to affect fertility via internal accumulation and blockage (e.g., of menstrual blood), structural damage (e.g., burnt eggs), internal movement of contraceptive material, deliberate toxicity preventing population growth and behavioral effects impeding sexual activity. Diverse feared consequences of infertility were reported (e.g., polygamy, economic hardships). Fears were reported to affect reproductive behaviour (e.g., stopping contraception), help-seeking and social behaviour. Conclusion FOI is a phenomenon that should be studied in its own right. Fears could originate from genuine threats, incorrect knowledge, distortions of truths, or dissemination of false information. Rigorous studies are needed to better understand FOI and integrate it in health education, client counselling and family planning service provision.
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Affiliation(s)
- Jacky Boivin
- School of Psychology. College of Biomedical and Life Sciences, Cardiff University, 70 Park Place, CF10 3AT, Cardiff, Wales, UK.
| | - Judith Carrier
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Deborah Edwards
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
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Bain LE, Muftugil-Yalcin S, Amoakoh-Coleman M, Zweekhorst MBM, Becquet R, de Cock Buning T. Decision-making preferences and risk factors regarding early adolescent pregnancy in Ghana: stakeholders' and adolescents' perspectives from a vignette-based qualitative study. Reprod Health 2020; 17:141. [PMID: 32917278 PMCID: PMC7488420 DOI: 10.1186/s12978-020-00992-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Worldwide, over half of the adolescent pregnancies recorded are unintended. The decision to continue the pregnancy to term or to opt for an abortion is a constant dilemma that is directly or indirectly influenced by stakeholders and also by the wider social environment. This study aimed at understanding the perceived decision-making preferences and determinants of early adolescent pregnancy in the Jamestown area of Accra in Ghana. METHODS A vignette-based qualitative study design was used. Eight focus group discussions were carried among various purposively selected groups of participants: parents, teachers, adolescent students who had not been pregnant before, and adolescents who had had at least one pregnancy in the past. The vignette was a hypothetical case of a 15-year-old high school student who had not experienced her menses for the past 6 weeks. The data were analyzed using a thematic analysis approach. RESULTS Lack of parent-daughter communication, the taboo on discussing sex-related issues in households and weak financial autonomy were considered to be the main contributing factors to the high early adolescent pregnancy rates in the community. Partner readiness to assume responsibility for the girl and the baby was a key consideration in either continuing the pregnancy to term or opting for an abortion. The father was overwhelmingly considered to be the one to take the final decision regarding the pregnancy outcome. Irrespective of the fact that the respondents were very religious, opting for an abortion was considered acceptable under special circumstances, especially if the pregnant adolescent was doing well in school. CONCLUSION Inadequate and inappropriate communication practices around sexuality issues, as well as weak financial autonomy are the major predictors of early adolescent pregnancy in this community. The father is perceived to be the main decision maker regarding a young adolescent's pregnancy outcome. Policy-makers should carefully evaluate the implications of this overwhelming perceived desire for the father to be the final decision-maker regarding adolescent pregnancy outcomes in this community.
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Affiliation(s)
- Luchuo Engelbert Bain
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Infectious Diseases in Lower Income Countries (IDLIC) Team, Inserm, Bordeaux Population Health Research Centre, University of Bordeaux, Bordeaux, France.
- Lincoln International Institute for Rural Health (LIIRH), College of Social Science, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire, UK.
| | - Seda Muftugil-Yalcin
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Marjolein B M Zweekhorst
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Renaud Becquet
- Infectious Diseases in Lower Income Countries (IDLIC) Team, Inserm, Bordeaux Population Health Research Centre, University of Bordeaux, Bordeaux, France
| | - Tjard de Cock Buning
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
Early pregnancy occurs frequently in Zambia and is considered a public health issue. The aim of this study was to improve understanding of how gendered sexual norms make young unmarried girls vulnerable to unintended pregnancies in a specific context. It combined individual interviews and focus group discussions with girls and boys aged 13-18 years and the parents of other young people of this same age, with peer interviews with girls aged 13-20 years at four sites in the southern province of Zambia. For girls, sexual relationships and early pregnancies were at odds with dominant norms and were consistently met with disapproval because they led to economic difficulties for young women and their parents, school dropouts and health problems for the young woman and her baby. Lack of resources and insufficient knowledge about sexuality and reproduction, together with gender norms governing sexual behaviour and contraceptive use, combine to place adolescent girls in a vulnerable position with respect to unintended pregnancy.
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Affiliation(s)
- Joar Svanemyr
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Chr. Michelsen Institute, Bergen, Norway
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Pillay N, Manderson L, Mkhwanazi N. Conflict and care in sexual and reproductive health services for young mothers in urban South Africa. Cult Health Sex 2020; 22:459-473. [PMID: 31035891 DOI: 10.1080/13691058.2019.1606282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
In South Africa, sexual and reproductive health services aim to facilitate access to and utilisation of care to young people. We draw on narrative interviews with 45 young mothers and six health care providers delivering sexual and reproductive health services at an urban health centre, to understand how young mothers experienced services in relation to ante- and post-natal care, including termination services. Although health care providers emphasised what they considered young women's 'ignorance' and 'irresponsibility' as central to early and unintended pregnancy; they also expressed their sympathy and concern. In a resource-limited health care setting, with health system inefficiencies and lack of specialised training, there was little opportunity to deliver high-quality care to young women. We draw attention to the need to prioritise the training of health care providers to expand early pregnancy testing and termination services and to deliver patient-centred family planning services to young women.
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Affiliation(s)
- Nirvana Pillay
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nolwazi Mkhwanazi
- Wits Institute for Social and Economic Research, University of the Witwatersrand, Johannesburg, South Africa
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Engelbert Bain L, Zweekhorst MBM, Amoakoh-Coleman M, Muftugil-Yalcin S, Omolade AIO, Becquet R, de Cock Buning T. To keep or not to keep? Decision making in adolescent pregnancies in Jamestown, Ghana. PLoS One 2019; 14:e0221789. [PMID: 31483813 PMCID: PMC6726415 DOI: 10.1371/journal.pone.0221789] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 01/31/2023] Open
Abstract
Background Jamestown, an urban coastal slum in Accra, Ghana, has one of the highest adolescent pregnancy rates in the country. We sought to understand the decision (to keep or terminate) factors and experiences surrounding adolescent pregnancies. Methods Thirty semi-structured indepth interviews were carried out among adolescents (aged 13–19 years) who had been pregnant at least once. Half of these were adolescent mothers and the other half had at least one past experience of induced abortion. A pretested and validated questionnaire to assess the awareness and use of contraception in adolescent participants was also administered. To aid social contextualization, semi-structured in depth interviews were carried out among 23 purposively selected stakeholders. Results The main role players in decision making included family, friends, school teachers and the partner, with pregnant adolescents playing the most prominent role. Adolescents showed a high degree of certainty in deciding to either abort or carry pregnancies to term. Interestingly, religious considerations were rarely taken into account. Although almost all adolescents (96.1%) were aware of contraception, none was using any prior to getting pregnant. Of the 15 adolescents who had had abortion experiences, 13 (87.0%) were carried out under unsafe circumstances. The main barriers to accessing safe abortion services included poor awareness of the fairly liberal nature of the Ghanaian abortion law, stigma, high cost and non-harmonization of safe abortion service fees, negative abortion experiences (death and bleeding), and distrust in the health care providers. Adolescents who chose to continue their pregnancies to term were motivated by personal and sociocultural factors. Conclusion Decision-making in adolescent pregnancies is influenced by multiple external factors, many of which are modifiable. Despite legal access to services, options for the safe termination of pregnancy or its prevention are not predominantly taken, resulting in a high number of negative experiences and outcomes. Including safe abortion care within the sexual and reproductive health package, could diminish barriers to safe abortion services. Given the vulnerability of the Jamestown setting, a comprehensive sexual education package that addresses the main decision factors is recommended. Interventions aiming to reduce adolescent pregnancy rates should also recognize that adolescent pregnancies are culturally acceptable in some settings, and under certain circumstances, are desired by the adolescents themselves.
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Affiliation(s)
- Luchuo Engelbert Bain
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France
- * E-mail:
| | - Marjolein B. M. Zweekhorst
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mary Amoakoh-Coleman
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Seda Muftugil-Yalcin
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Renaud Becquet
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IDLIC, Bordeaux, France
| | - Tjard de Cock Buning
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Asare BYA, Baafi D, Dwumfour-Asare B, Adam AR. Factors associated with adolescent pregnancy in the Sunyani Municipality of Ghana. International Journal of Africa Nursing Sciences 2019. [DOI: 10.1016/j.ijans.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Anifah F, Dasuki D, K HF, Triratnawati A. Role of family structure and parenting style in adolescent pregnancy in Surabaya, Indonesia. MOG 2018. [DOI: 10.20473/mog.v26i22018.91-97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives: To explore the relationship of family structure and parenting style with adolescent pregnancy in SurabayaMaterials and Methods: This research uses mix methods approach with case-control design and case study. Data were collected by questionnaire and in-dept interview guidelines. This study involved 46 adolescent (23 cases and 23 control) by purpossive sampling and 6 adolescents as main participants. Quantitative data were analyzed on univariable, bivariable with chi square and multivariable with multiple logistic regression with p=0,05 and CI 95%. Qualitative data were analyzed by in-depth interviewResults: Family stucture were not statistically significant (OR 10.53; CI 0.657-168.93), but socially meaningful. There is not statistically significant between parenting style with adolescent pregnancy (OR 1.191; CI 0.373-3.806). Other factors that have a significant relationship with adolescent pregnancy is education of responden (OR 559.76; CI 3.608-23026.4). There is no statis-tically significant in education father, education mother, employment status and where they living. Parenting style can be influenced by communication between parents and adolescent.Conclusions: Risk of adolescent pregnancy on people who have low education. Adolescents from extended family and single parent have a role to the incidence of teenage pregnancy.
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Krugu JK, Mevissen FEF, Van Breukelen G, Ruiter RAC. SPEEK: effect evaluation of a Ghanaian school-based and peer-led sexual education programme. Health Educ Res 2018; 33:292-314. [PMID: 30016477 DOI: 10.1093/her/cyy017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
In sub-Saharan Africa, theory and evidenced-based interventions that are systematically designed and using sound evaluation methods to report on effectiveness are limited. A sex education programme called SPEEK was developed, implemented and evaluated in Ghana using the Intervention Mapping approach. SPEEK aimed at delaying sexual initiation, reducing sexually transmitted infections (STIs) and preventing pregnancy, targeting junior high school students in a West African rural setting. The final programme included 11 (interactive) lessons using a diverse range of theory-based methods. In this article, we report on the effect evaluation of the programme. Participating schools were randomized to the intervention (N = 10 schools) and a waiting-list control group (N = 11 schools). The students completed survey questionnaires at baseline (N = 1822), at direct post-test (N = 1805) and at six months follow-up (N = 1959), measuring cognitive and affective psychosocial determinants of sexual delay, condom use and STI testing. Mixed regression models showed that at direct post-test, students having received the SPEEK programme scored significantly more positively on knowledge on condom use, pregnancy and STIs testing; attitude toward exercising sexual rights, condom availability and condom use; perceived behavioural control toward sexual delay, condom use and sexual intercourse; and perceived risk toward STIs (P's < 0.002). The results suggest that the programme may improve adolescent sexual health in Ghana or in similar cultures, but would need further study that include behavioural measures and a longer follow-up to make this assertion with more confidence.
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Affiliation(s)
- John K Krugu
- Department of Work and Social Psychology, Maastricht University
- Adolescent Health Unit, Youth Harvest Foundation, Ghana
| | | | - Gerard Van Breukelen
- Department of Methodology & Statistics, Faculty of Psychology and Neuroscience, and CAPHRI Research School for Care and Public Health, Maastricht University
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Krugu JK, Mevissen FEF, Flore KA, Ruiter RAC. Girls cannot be trusted: young men's perspectives on contraceptive decision making and sexual relationships in Bolgatanga, Ghana. EUR J CONTRACEP REPR 2018; 23:139-146. [PMID: 29671351 DOI: 10.1080/13625187.2018.1458225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is extensive research on African girls sexual experiences, but much less is known about boys thoughts and actions. There is a need to understand the male perspective in order to develop sexuality education programmes that address the high rates of teenage pregnancy and sexually transmitted infections in sub-Saharan Africa. METHODS For this qualitative, phenomenological study we spoke to 20 boys from Bolgatanga, Ghana and explored their sexual decision making, using semi-structured interviews designed to highlight psychosocial and environmental factors. Content analysis was used to construct categories and later the themes. RESULTS Boys often had negative perceptions about sexual relationships. They believed that girls could not be trusted and mostly embarked on sexual relationships for material gain. The boys reported engaging in multiple sexual partnerships to secure their masculine status; however, they expected girls to be 'faithful'. We found that accurate knowledge of safe sex was lacking, boys were under peer pressure to conform to beliefs about masculinity and communication about sex mainly took place within peer groups. CONCLUSIONS There is a need to emphasise condom use in established relationships. There should also be more discussion of issues surrounding fidelity and gender equality, as part of sexuality programmes aimed at boys in Ghana and in similar cultures.
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Affiliation(s)
- John K Krugu
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands.,b Youth Harvest Foundation , Bolgatanga , Ghana
| | - Fraujke E F Mevissen
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - Kirsten A Flore
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - Robert A C Ruiter
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
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Teye-Kwadjo E, Kagee A, Swart H. Determinants of condom use among heterosexual young men and women in southeastern Ghana: a mediation analysis. Psychology & Sexuality 2017. [DOI: 10.1080/19419899.2017.1391870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Matieland, South Africa
| | - Hermann Swart
- Department of Psychology, Stellenbosch University, Matieland, South Africa
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Abstract
Gender has a profound effect on the sexual risk preventive intentions and behaviour of young people. However, little is known about the role of gender on condom use negotiation among adolescents in Ghana. This study explored gender differences in condom use negotiation among school-going adolescents in Ghana. Participants ( n = 684) completed self-report measures based on attitudes towards condom use, subjective norms regarding condom use, perceived behavioural control over condom use, intentions to use condoms, and on actual condom use behaviour. Results revealed statistically significant differences in condom use by gender. Specifically, attitudes towards condom use were more favourable among male students than they were among female students. Male students perceived slightly greater control over condom use than did female students. Moreover, male students reported slightly more condom-protected sexual behaviour than did female students. These results highlight the usefulness of designing gender-specific sexual risk reduction programmes among high school adolescents in Ghana.
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Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
| | - Hermann Swart
- Department of Psychology, Stellenbosch University, South Africa
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