“Those are things for married people” exploring parents’/adults’ and adolescents’ perspectives on contraceptives in Narok and Homa Bay Counties, Kenya

  • Reproductive Health, Volume 18, No. 1, Year 2021

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Study Justification:
– Contraceptive use among adolescent girls is low in many sub-Saharan African countries, including Kenya.
– Attitudes and perspectives about contraception among community members, including adolescent girls themselves, may limit contraceptive use.
– This study aimed to explore and compare adults’ and adolescent girls’ perspectives on contraception in Narok and Homa Bay counties, Kenya.
Highlights:
– Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of misconceptions about contraception.
– Some participants emphasized the need for open contraceptive talk between parents and their adolescent girls.
– Four main themes emerged: perceptions about adolescents’ sexuality and risk prevention, conceptions about contraception among nulligravida adolescents, post-pregnancy contraceptive considerations, and divergent views regarding contraceptives and parent/adolescent discussion.
– The study suggests the need for increased attention towards adolescents and their caregivers in demystifying contraceptive misconceptions.
– Programmatic responses should include comprehensive sexuality education and increased access to and utilization of sexual and reproductive health (SRH) information, products, and services.
Recommendations:
– Implement programmatic efforts, such as SRH community education, to enhance parents’ capacity to discuss sexuality with their adolescents.
– Provide comprehensive sexuality education to address misconceptions about contraception.
– Increase access to and utilization of SRH information, products, and services through a well-informed approach.
Key Role Players:
– Adolescent girls
– Parents/adult caregivers
– Community health volunteers (CHVs)
– Program implementers
– Health educators
– Policy makers
– Local administrators (Chiefs, Assistant Chiefs, Village Elders)
Cost Items for Planning Recommendations:
– Training and capacity building for health educators and CHVs
– Development and dissemination of comprehensive sexuality education materials
– Community outreach and education programs
– Access to and provision of SRH information, products, and services
– Monitoring and evaluation of program effectiveness
– Coordination and collaboration with local administrators and policy makers

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on qualitative data from interviews and focus group discussions. While this provides valuable insights into the attitudes and perspectives of adults and adolescents regarding contraception, qualitative data alone may not be generalizable to the larger population. To improve the strength of the evidence, the study could consider incorporating quantitative data to provide a more comprehensive understanding of contraceptive use among adolescent girls in the study communities. Additionally, the sample size of the study could be increased to enhance the representativeness of the findings. Finally, the study could consider conducting follow-up research to assess the impact of programmatic responses and models on contraceptive use and communication between parents and adolescents.

Background: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. Methods: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15–19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents. Results: Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents’ sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. Conclusions: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.

This study was part of a larger evaluation which aimed at providing baseline information on the key aspects of a digital adolescent SRH intervention, ‘In Their Hands’ (ITH). ITH in Kenya was a digital health program that aimed to increase adolescents’ use of high-quality SRH services through targeted interventions. The ITH programme provided SRH information while promoting adolescents’ use of contraception, pregnancy tests and testing for sexually transmitted infections (STIs) including HIV. The project was implemented in eighteen counties in Kenya, prioritized based on their burden of teenage pregnancies, unmet need for contraception among adolescent girls and incidence of STI and HIV infections. For the evaluation component, two counties were selected from the counties where the intervention had not begun at the time of the baseline study, one from Nyanza region (Homa Bay) and another from Rift Valley (Narok). This was a qualitative study involving adolescent girls, parents/adult caregivers and community health volunteers (CHVs). In Kenya, CHVs are lay members of the community sharing ethnicity, language and life experiences of the communities they serve. One needs to have a minimum of primary level education to qualify to be a CHV. They are given basic health training to support their community to improve their general health status including maternal health, nutrition, basic hygiene and other behavioral health interventions. The full training curriculum takes approximately three months. We conducted 45 in-depth-interviews (IDIs), 20 in Homa Bay County and 25 in Narok County with purposively selected adolescent girls aged 15–19 who were usual residents (lived in the study communities at least six months preceding the study). Additionally; eight focus group discussions (FGDs), four per county with parents/adult caregivers (all mothers); and another four (two in each county) were held with CHVs affiliated to health facilities that were selected for the ITH programme. Eligibility criteria for other adult FGD participants included having an adolescent girl aged 15–19 years. Participants’ characteristics varied by age, level of education, occupation, marital status and parity. Discussions were conducted in the local language and audio recorded following consent of the study participants. Interviewers were trained to facilitate the discussions and were provided with semi-structured interview and discussion guides for the IDIs and FGDs respectively. Face to face interviews were held with adolescent girls, and in groups for mothers and CHVs. IDIs were used to explore adolescent girls’ SRH concerns and services seeking behaviors including their views on contraception. The FGDs with the community (caregivers and parents) and CHVs were used to explore the community’s attitudes towards adolescent sexuality and their concerns on SRH services for adolescents including contraception for adolescent girls. To minimize discomfort and any unforeseen embarrassment surrounding the study topic, female moderators were engaged throughout the study. Additionally, female moderators freely and easily unlocked the real issues associated with adolescent girls’ SRH concerns thereby facilitating free and open feedback from the targeted respondents. Audio recordings from the IDIs were anonymized, labelled with unique identifiers and deleted from digital recorders once transcription was completed. The discussions were transcribed verbatim, translated into English, coded and analyzed thematically using NVivo version 12. A “thematic analysis” approach was used to organize and analyze the data, and to assist in the development of a codebook and coding scheme. A preliminary code book was developed using the interview guide and a set of IDIs and FGDs transcripts, and discussed among the research team. Data was analyzed by first reading the full transcripts of FGDs and IDIs, familiarizing with the data and noting the emergent themes and concepts. A thematic framework was developed from the identified themes and sub-themes, and then used to create codes for the raw data. Our qualitative analysis followed a pattern of association on the key identified themes, particularly focusing on narratives related to adolescent girls’ contraceptive use. “Misconceptions about contraception” in this study are defined as “widespread views about the effects and purpose of contraceptives that are not supported by any scientific evidence” [23], “sexual libertinism” on the other hand refers to the practice of adolescent girls pursuing their own personal sexual desires while disregarding societal expectations and norms. Our analysis and findings are presented in accordance with the Standards for Reporting Qualitative Research guidelines (SRQR) [24]. The protocol for this study was reviewed by African Population and Health Research Centre’s scientific and ethics committee and adjudged to be scientifically sound. The institutional review board (IRB) approval for the study was given by the AMREF Health Ethics and Scientific Review Committee (AMREF-ESRC P499/2018). Research permit for the study was granted by Kenya’s National Commission for Science, Technology and Innovation (NACOSTI). Additional approval was obtained from county and sub-county commissioners, Ministries of Health and Education in the respective counties; and other local administrators including, Chiefs, Assistant Chiefs and Village Elders. All participants gave written informed consent to participate in the study. For adolescents aged below 18 years and not emancipated, both parental/guardian consent and adolescent assent were obtained before starting the interviews.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Digital Health Programs: Implementing digital health programs, similar to the “In Their Hands” (ITH) program in Kenya, can provide adolescents with access to high-quality sexual and reproductive health (SRH) services. These programs can offer information on contraception, pregnancy tests, and testing for sexually transmitted infections (STIs) including HIV.

2. Comprehensive Sexuality Education: Increasing access to comprehensive sexuality education can help dispel misconceptions about contraception and promote informed decision-making among adolescents. This education should cover topics such as contraceptive methods, their effectiveness, and potential side effects.

3. Parent-Adolescent Communication: Encouraging open and supportive communication between parents and their adolescent children about sexuality and contraception is crucial. Providing resources and support for parents to have these conversations can help address barriers and increase knowledge and understanding.

4. Training Community Health Volunteers (CHVs): Strengthening the capacity of CHVs to provide accurate information and support on maternal health, including contraception, can improve access to services at the community level. CHVs can play a vital role in promoting awareness, providing counseling, and linking adolescents to appropriate SRH services.

5. Addressing Cultural and Social Norms: Addressing cultural and social norms that may hinder contraceptive use among adolescent girls is important. This can involve community engagement activities, awareness campaigns, and working with community leaders to challenge harmful beliefs and promote positive attitudes towards contraception.

6. Increasing Access to SRH Services: Improving access to SRH services, including contraceptive methods, in underserved areas can help ensure that adolescent girls have the resources they need to make informed choices about their reproductive health. This can involve expanding the availability of services in clinics, schools, and community centers.

It’s important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the communities in Narok and Homa Bay Counties, Kenya.
AI Innovations Description
Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Comprehensive Sexuality Education (CSE): Develop and implement a comprehensive sexuality education program that targets both adolescents and their caregivers. This program should aim to provide accurate information about contraception, dispel misconceptions, and promote open discussions about sexual and reproductive health (SRH) between parents and their adolescent girls. The program should be culturally sensitive and delivered in the local language to ensure maximum impact.

2. Digital Health Interventions: Build upon the success of the “In Their Hands” (ITH) digital health program in Kenya to further increase adolescents’ access to high-quality SRH services. Expand the program to more counties, prioritizing those with high rates of teenage pregnancies, unmet need for contraception, and STI/HIV infections. The digital interventions should provide SRH information, promote the use of contraception, and offer services such as pregnancy tests and STI testing. Ensure that the program is accessible to adolescents in rural areas who may have limited access to healthcare facilities.

3. Strengthen Community Health Volunteers (CHVs): Provide additional training and support to CHVs who play a crucial role in improving maternal health in their communities. Enhance their knowledge and skills in SRH, including contraception, maternal health, nutrition, and basic hygiene. Empower CHVs to engage in community education and outreach activities, particularly targeting parents and caregivers to enhance their capacity to discuss sexuality with their adolescents.

4. Addressing Misconceptions: Develop targeted interventions to address misconceptions about contraception among adolescents and their communities. These interventions should provide accurate information about the side effects and benefits of contraception, dispel fears of infertility and malformation, and challenge societal norms that discourage contraceptive use. Utilize various communication channels, including community meetings, radio programs, and social media, to reach a wide audience and promote behavior change.

5. Increased Access to SRH Information and Services: Improve access to and utilization of SRH information, products, and services through a well-informed approach. This can be achieved by strengthening existing healthcare facilities, ensuring the availability of a wide range of contraceptive methods, and reducing barriers to access, such as cost and stigma. Additionally, explore innovative approaches such as mobile clinics or community-based distribution of contraceptives to reach underserved populations.

By implementing these recommendations, it is expected that access to maternal health will be improved, leading to better reproductive health outcomes for adolescent girls and their communities.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Comprehensive Sexuality Education (CSE): Implementing comprehensive sexuality education programs that provide accurate and age-appropriate information about reproductive health, including contraception, can help dispel misconceptions and empower adolescents to make informed decisions about their sexual and reproductive health.

2. Community Engagement: Engage community members, including parents, caregivers, and community health volunteers, in discussions and awareness campaigns about the importance of maternal health and contraception. This can help address cultural and social barriers that may limit contraceptive use among adolescent girls.

3. Access to Contraceptive Services: Improve access to a wide range of contraceptive methods, including long-acting reversible contraceptives (LARCs), through increased availability and affordability. This can be achieved by strengthening the supply chain, training healthcare providers, and ensuring that contraceptives are included in essential healthcare packages.

4. Strengthening Parent-Adolescent Communication: Promote open and supportive communication between parents and their adolescent children about sexual and reproductive health, including contraception. This can be done through educational programs and interventions that provide guidance on how to initiate and maintain these conversations.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline Data Collection: Collect data on the current status of maternal health and contraceptive use among adolescent girls in the target communities. This can be done through surveys, interviews, and focus group discussions.

2. Intervention Implementation: Implement the recommended interventions, such as comprehensive sexuality education programs, community engagement activities, and improved access to contraceptive services. Ensure that these interventions are tailored to the specific needs and cultural context of the target communities.

3. Monitoring and Evaluation: Continuously monitor and evaluate the implementation of the interventions, including tracking the reach and effectiveness of each component. This can involve collecting data on indicators such as contraceptive use rates, knowledge about contraception, and parent-adolescent communication.

4. Impact Assessment: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. Compare the baseline data with the post-intervention data to identify any changes or improvements in contraceptive use, knowledge, and attitudes towards maternal health.

5. Feedback and Adaptation: Use the findings from the impact assessment to provide feedback and make necessary adaptations to the interventions. This can involve refining program strategies, addressing any identified gaps or challenges, and scaling up successful interventions to reach a larger population.

6. Continuous Improvement: Continuously monitor and evaluate the interventions, making adjustments as needed to ensure sustained improvements in access to maternal health. This can involve ongoing data collection, analysis, and feedback loops to inform programmatic decisions and improvements.

By following this methodology, it is possible to simulate the impact of the recommended interventions on improving access to maternal health and identify effective strategies for addressing the barriers and challenges faced by adolescent girls in accessing contraception and maternal health services.


Statistics:
Citations: 2
Identifiers:
DOI: 10.1186/s12978-021-01107-w
Research Areas:
Community Interventions, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations
Study Countries:
Kenya
Study Design:
Cohort Study, Cross Sectional Study, randomised-control-trial
Study Approach:
Qualitative
Participants Gender:
Female
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