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Blood Blockages and Scolding Nurses: Barriers to Adolescent Contraceptive Use in South Africa
Open accessAbstract
A third of adolescent girls in South Africa become pregnant before the age of 20, despite contraception being free and mostly accessible. This qualitative study was undertaken in Limpopo Province in 1997 on the barriers to adolescent girls accessing clinic services for contraception. Thirty-five in-depth interviews and five group discussions were conducted with girls aged 14—20, and interviews with nursing staff at 14 clinics. Many of the girls described pressure from male partners and family members to have a baby or prove their fertility. Other barriers to sustained contraceptive use included medically inaccurate notions about how conception occurs and fears about the effects of contraception on fertility and menstruation, which were not taken seriously by nurses. Nurses' attempts to stigmatise teenage sexuality, their scolding and harsh treatment of adolescent girls, and their unwillingness to acknowledge adolescents' experiences as contraceptive users, undermined the effective use of contraception by girls. Youth need better information on reproductive physiology and sexual health, and detailed information on contraception. Tools to enhance the accuracy and availability of knowledge in the clinic setting have a role, but need to be introduced along with initiatives to ensure that services are adolescent-friendly and do not stigmatise adolescent sexual activity.RésuméEn Afrique du Sud, un tiers des adolescentes sont enceintes avant l'âge de 20 ans, malgré la gratuité et l'accessibilité de la contraception. Cette étude qualitative, réalisée dans la province de Limpopo en 1997, a analysé les obstacles empêchant les adolescentes d'accéder aux services de contraception. Elle a mené 35 entretiens et 5 discussions de groupe avec des jeunes filles de 14 à 20 ans, et des entretiens avec des infirmières dans 14 dispensaires. Beaucoup d'adolescentes ont décrit les pressions de leurs partenaires et des membres de la famille qui les incitent à avoir un bébé ou à prouver leur fécondité. L'utilisation suivie de contraceptifs était aussi entravée par des notions erronées sur la conception et des craintes quant aux conséquences de la contraception sur la fécondité et les menstruations, que les infirmières ne prenaient pas au sérieux. Les tentatives des infirmières de stigmatiser la sexualité des jeunes, leurs réprimandes, leur brusquerie et leur refus de tenir compte des expériences des adolescentes comme utilisatrices de contraceptifs contrariait l'utilisation efficace de la contraception chez les adolescentes. Les jeunes doivent être mieux informés de la physiologie reproductive, de la santé génésique et de la contraception. Des outils pour améliorer la fiabilité et la disponibilité de connaissances dans les dispensaires jouent un rôle, mais doivent être introduits parallèlement à des initiatives pour que les services soient adaptés aux adolescents et ne stigmatisent pas l'activité sexuelle des adolescents.ResumenUna tercera parte de las adolescentes en Sudáfrica quedan embarazadas antes de cumplir los 20 años, pese a que los anticonceptivos son gratis y accesibles. Este estudio cualitativo sobre las barreras que enfrentan las adolescentes al intentar acceder a los servicios clínicos de anticoncepción, se llevó a cabo en la Provincia Limpopo, en 1997. Se realizaron 35 entrevistas a profundidad y cinco discusiones en grupo con mujeres jóvenes entre 14 y 20 años, así como entrevistas con el personal de enfermería de 14 consultorios. Muchas de las jóvenes informaron presión de sus parejas y familiares para tener un bebé. Otras barreras al uso sostenido de anticonceptivos fueron: creencias erróneas sobre cómo ocurre la anticoncepción y temores sobre los efectos de anticonceptivos en la fertilidad y la menstruación, las cuales las enfermeras no tomaron en serio. Los efectos de los intentos de las enfermeras de estigmatizar la sexualidad de las jóvenes, sus regaños y trato duro de las mismas, y su renuencia a reconocer las experiencias de éstas como usuarias de anticonceptivos, debilitaron el uso eficaz de la anticoncepción por parte de las jóvenes. La juventud necesita mejor información sobre la fisiología reproductiva y la salud sexual, y datos detallados sobre los anticonceptivos. Las herramientas para mejorar la exactitud y disponibilidad del conocimiento en el ámbito clínico desempeñan un papel, pero se deben introducir junto con iniciativas para garantizar que los servicios sean amigables a las adolescentes y no estigmaticen su actividad sexual.
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In the citing paper
“Also, unequal gender power relations [19, 27, 28, 30, 31, 35, 38, 39]”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
In the citing paper
“Lack of knowledge, misconceptions, and non-use of contraceptives [19, 23, 29, 30, 35, 38, 40, 44, 45]”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
In the citing paper
“Lack of knowledge, misconceptions, and non-use of contraceptives [19, 23, 29, 30, 35, 38, 40, 44, 45]”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
In the citing paper
“low self-esteem and inability to resist sexual temptation [23, 28, 30, 31, 35, 38, 39]”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
In the citing paper
“misconceptions about contraceptives [15, 19, 23, 27, 29, 30, 34, 35, 38, 40, 45, 46].”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
In the citing paper
“low self-esteem and inability to resist sexual temptation [23, 28, 30, 31, 35, 38, 39]”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
In the citing paper
“In other reports, adolescents intentionally became pregnant as proof of love and commitment to their sexual partners [30].”
From Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review (2018) · cites this paper as [30]
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Metadata
- Authors
- Wood, K., & Jewkes, R.
- Affiliations
- University of London (GB)
- South African Medical Research Council (ZA)
- Venue
- Reproductive Health Matters
- Publisher
- Informa UK Limited
- Published
- 2006-01
- Volume
- 14
- Issue
- 27
- Pages
- 109-118
- ISSN
- 0968-8080 (ISSN-L)
- 1460-9576
- OpenAlex
- W1990007370
- Cited by
- 330
- References
- 31
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 12 · 2023: 18 · 2022: 17 · 2021: 26 · 2020: 22 · 2019: 16 · 2018: 22 · 2017: 25 · 2016: 20 · 2015: 20 · 2014: 32 · 2013: 21 · 2012: 17
- FWCI
- 17.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Reproductive Health Matters (publishedVersion)
- PubMed (publishedVersion)
- SSRN Electronic Journal (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Adolescent Sexual and Reproductive Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Arts and Humanities › History › Historical Studies on Reproduction, Gender, Health, and Societal Changes
- Keywords
- adolescent contraceptive use, barriers to contraceptive access, adolescent girls, adolescent pregnancy, nurse attitudes, youth-friendly health services, reproductive health education, Limpopo Province, South Africa
- MeSH terms
- Adolescent, Adolescent Behavior, Adult, Attitude of Health Personnel, Contraceptive Agents, Female, Drug Utilization, Female, Health Education, Health Services Accessibility, Humans, Menstruation, Menstruation Disturbances, Middle Aged, Nursing Staff, Pregnancy, Pregnancy in Adolescence, Sexual Behavior, South Africa, Qualitative Research
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