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Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya
  1. Miranda Håkansson1,
  2. Monica Oguttu2,
  3. Kristina Gemzell-Danielsson3,
  4. Marlene Makenzius1
  1. 1Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
  2. 2Kisumu Medical and Education Trust (KMET), Kisumu, Kenya
  3. 3Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Miranda Håkansson; miranda.hakansson{at}


Introduction Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya.

Methods A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research.

Results Cronbach’s α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women’s autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling.

Conclusion Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women.

  • stigma
  • abortion
  • contraception
  • adolescent pregnancy
  • healthcare providers

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  • Contributors The lead author for this manuscript was MH. Study design and planning: MM and MO. Training and implementation of the study: MO and MM. Data collection: MH, MM and MO. Data analysis: MH, cross-checked by MM. Data interpretation: MH and MM, MO and KG-D. Literature search: MH and MM. Writing: MH. Editing and proof-reading: MM, MO, KG-D and Scribendi (language editing).

  • Funding This study was funded by the Swedish Research Council for Health, Working Life and Welfare (2015-01194), and the Swedish Research Council (2016-05670). In addition, the Swedish International Development Cooperation Agency (Sida) funded this study by a Minor Field Study scholarship.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval JOOTRH Ethical Review Committee (ERC.1B/VOL.I/263).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data are available by emailing