“We Don't Fear HIV. We Just Fear Walking around Pregnant.”: A Qualitative Analysis of Adolescent Sexuality and Pregnancy Stigma in Informal Settlements in Kisumu, Kenya

Abstract

In Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision‐making among adolescents in the informal settlements of Kisumu. We used purposive sampling to recruit 120 adolescent boys and girls aged 15–19 for focus group discussions. A semistructured interview guide was used to elicit social norms and community attitudes about sexual and reproductive health. We analyzed the data using the Framework Approach. The social stigma of adolescent sexuality and the related fear of pregnancy as an unambiguous marker of sexual activity emerged as main themes. This stigma led adolescents to fear social retribution but did not lead to more frequent contraception use due to additional stigma. The intensity of this fear was most acutely expressed by girls, leading some to seek unsafe, sometimes fatal, abortions, and to contemplate suicide. Fear of pregnancy outweighed fear of contracting HIV that was viewed as both treatable and less stigmatized. Our findings illustrate how fear of pregnancy among these adolescents is driven primarily by fears that their community will discover that they are sexually active. Interventions are urgently needed to address adolescent sexual stigma and to prevent negative outcomes.

Brief Report: HIV Pre-Exposure Prophylaxis Awareness and Use Among Adolescents in Kenya

“…In focus group discussions that were conducted as a component of our study, older adolescents were better informed about PrEP than the younger adolescents and viewed PrEP as an alternative HIV prevention tool because of their dislike of using condoms. 34 More than half of adolescents with no prior use expressed willingness to take PrEP, an encouraging finding. Previous studies have noted that adolescent sexuality stigma, which is pervasive in African culture, is as a key barrier because of fear that people who use PrEP would be perceived as promiscuous.…”

“…In focus group discussions that were conducted as a component of our study, older adolescents were better informed about PrEP than the younger adolescents and viewed PrEP as an alternative HIV prevention tool because of their dislike of using condoms. 34…”

“…24,25 Eighteen initial participants or "seeds" were selected from among adolescents who participated in the qualitative study component. 26,27 The seeds were distributed across the following demographic categories: 15-to 17-year-old girls, 15-to 17-year-old boys, 18-to 19-year-old girls, and 18-to 19-year-old boys. Upon completing the survey, participants were provided with up to 5 referral coupons to distribute to adolescent peers in their community.…”

Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi

“…Sometimes, their partners deny paternity and refuse to support them, which make them vulnerable to poor mental health [28,29]. Previous studies have also shown that community or neighborhood-level factors are relevant in understanding poor mental health among pregnant and parenting adolescents [30][31][32].…”

Safeguarding in practice: anticipating, minimising and mitigating risk in teenage pregnancy research in urban informal settlements in Nairobi, Kenya

“…School girls in Western Kenya experiencing lockdown had twice the risk of falling pregnant compared with the pre-COVID-19 period 14. Teenage pregnancy in Kenya is considered shameful and can result in stigma against the girl and/or family, exclusion or expulsion from school and violence from partners or parents 15–18. Many teenage pregnancies in Kenya stem from consensual boyfriend–girlfriend relationships19 but patriarchal norms mean teenage fathers may not experience the same increase in vulnerability.…”