"Those are things for married people" exploring parents'/adults' and adolescents' perspectives on contraceptives in Narok and Homa Bay Counties, Kenya.

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.

Factors associated with condom breakage among female sex workers in the Western Region of Ghana.

Condoms have been extensively demonstrated as being effective in reducing Human Immunodeficiency Virus (HIV) infection rates among both men and women. With proper use and production, condom breakage is ideally minimal. However, breakage is reportedly a widespread problem among Female Sex Workers (FSWs), who are classified as a Key Population and warrant special transmission prevention efforts. Nationally, Ghana records an average rate of 5% of condom breakage. This study sought to identify the factors associated with condom breakage among FSWs in the western region of Ghana, a region with an extensive sex worker population and HIV incidence rate of 2.5%, higher than the national average. This study employed a cross-sectional survey among FSW populations in the Western region, Ghana. A sample of 416 participants were proportionately invited between brothel based and roamer communities to participate in the surveys. A total of 403 consented to participate indicating a response rate of 96.9%. Data were analysed for frequencies and prevalence of variables including condom breakage. At the bivariate level, associations with breakage were examined and statistically significant variables were analysed with simple and multiple logistic regression analysis. Of the 403 research participants who consented to participate, 17.4% had experienced breakage over the past week. Brothel-based FSWs were only half as likely to report condom breakage as non-brothel based FSWs (aOR = 0.526; 95% CI, 0.296 - 0.936). Notably, FSWs who consumed alcohol-containing drinks every day were only 65.2% as likely as those who consumed alcohol at least once a week or less than once a week or never to experience condom breakage (aOR = 0.348; 95% CI, 0.164 - 0.740). The study determined that the occurrence of condom breakage among FSWs in the western region was 17.4%. Factors significantly associated with condom breakage were being non-brothel based, frequency of alcohol consumption and parity. Condom use education programmes targeted at non-brothel based FSWs are necessary to reduce breakage and lower the risk of HIV transmission.

Promoting respectful maternity care for adolescents in Ghana: a quasi-experimental study protocol.

BACKGROUND: Intra-partum mistreatment by healthcare providers remains a global public health and human rights challenge. Adolescents, who are typically younger, poorer and less educated have been found to be disproportionately exposed to intra-partum mistreatment. In Ghana, maternal mortality remains a leading cause of death among adolescent females, despite increasing patronage of skilled birth attendance in health facilities. In response to the the World Health Organisation Human Reproduction Programme (WHO-HRP) recommendations to address mistreatment with Respectful Maternity Care (RMC), this study aims to generate evidence on promoting respectful treatment of adolescents using an intervention that trains health providers on the concept of mistreatment, their professional roles in RMC and the rights of adolescents to RMC. METHODS: This study will employ a pre-test post-test quasi-experimental design. At pre-test and post-test, quantitative surveys will be conducted among adolescents who deliver at health facilities about their labour experience with mistreatment and RMC. A total target of 392 participants will be recruited across intervention and control facilities. Qualitative interviews will also be conducted with selected adolescents and health professionals for an in-depth understanding of the phenomenon. Following the pre-test, a facility-based training module will be implemented at intervention facilities for the facility midwives. The modules will be co-facilitated by the principal investigator and key resource persons from the district health directorate Quality of Care teams. Training will cover the rights of adolescents to quality healthcare, classifications of mistreatment, RMC as a concept and the role of professionals in providing RMC. No intervention will occur in the control facilities. Descriptive statistics, logistic regressions and difference in differences analyses will be computed. Qualitative data will be transcribed and thematically analysed. DISCUSSION: This study is designed to test the success of an intervention in promoting RMC and reducing intra-partum mistreatment towards adolescents. It is expected that the findings of this study will be beneficial in adding to the body of knowledge in improving maternal healthcare and reducing maternal mortality, especially for adolescents. TRIAL REGISTRATION: Name of the registry: Pan African Clinical Trials Registry. PACTR202008781392078 .

Are respectful maternity care (RMC) interventions effective in reducing intrapartum mistreatment against adolescents? A systematic review.

Intrapartum mistreatment of women by health professionals is a widespread global public health challenge. It leads to a decreased quality of maternity care and is evinced to precipitate detrimental maternal and neonatal outcomes, especially among adolescents. Relatedly, research indicates that Respectful Maternity Care (RMC) interventions are especially effective in mitigating intrapartum mistreatment and improving birth outcomes. However, evidence on the success of RMC, specifically for adolescents, is insufficient and unaggregated. Accordingly, this review specifically aims to synthesize existing evidence on RMC care provision to adolescent parturients. This review searched for relevant literature from published and gray sources including PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, as well as Population Council, WHO and White Ribbon Alliance data sources published between January 1990 and December 2021. Based on eligibility, studies were selected and quality appraised after which thematic analysis and narrative synthesis was conducted. Twenty-nine studies were included in the systematic review. Due to paucity and heterogeneity of quantitative studies, the review was limited to a thematic analysis. Adolescent and health provider perspectives alike underscored the burden and outcomes of mistreatment. Need for RMC interventions to improve quality of maternity care was recommended by majority of studies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020183440.

Evidence on respectful maternity care for adolescents: a systematic review protocol.

BACKGROUND: Intrapartum mistreatment of women is an ubiquitous public health and human rights challenge. The issue reportedly has severe maternal and neonatal outcomes including mortality, and generally leads to a decreased satisfaction with maternity care. Intrapartum mistreatment, despite being ubiquitous, indicates higher incidence amongst adolescent parturients who are simultaneously at a higher risk of maternal morbidity and mortality. Studies have suggested that Respectful Maternity Care interventions reduce intrapartum mistreatment and improve clinical outcomes for women and neonates in general. However, evidence on the effect of RMC on adolescents is unclear. Hence, the specific aim of this study is to synthesise the available evidence relating to the provision of RMC for adolescents during childbirth. METHODS: The methodology of the proposed systematic review follows the procedural guideline depicted in the preferred reporting items for systematic review protocol. The review will include published studies and gray literature from January 1, 1990, to June 30, 2021. Electronic databases including MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar and Web of Science will be searched to retrieve available studies using the appropriate search strings. Studies included in the review will be appraised for quality using tools tailored to each study design. If appropriate, we will conduct random effects meta-analysis of data to summarise the pooled estimates of respectful maternity care prevalence and outcomes. The selection of relevant studies, data extraction and quality assessment of individual studies will be carried out by two independent authors. RESULTS: Summaries of the findings will be compiled and synthesised in a narrative summary. In addition to the narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for respectful maternity care prevalence and outcomes. DISCUSSION: Respectful Maternity Care for adolescents holds great promise for improved maternal and neonatal care. However, there is a gap in knowledge on the interventions that work and the extent of their effectiveness. Findings from this study will be beneficial in improving Adolescents Sexual and Reproductive Health and Rights and reducing maternal mortality, especially for adolescents. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020183440.

Exploring experiences of infertility amongst women and men in low-income and middle-income countries: protocol for a qualitative systematic review.

INTRODUCTION: Infertility is increasingly recognised as a global public health issue for women and men that merits further investigation to support policy and programming. While research in high-income settings has examined the consequences of infertility and access to services, there has been limited synthesis of how individuals experience infertility in low-income and middle-income countries (LMICs). This protocol describes a systematic review that will synthesise qualitative evidence on experiences of infertility among women and men in LMICs. METHODS AND ANALYSIS: The review will follow the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines for reporting on qualitative evidence syntheses. The study team will search for published literature in PubMed, CINAHL and Scopus and PsycINFO databases and review available grey literature. Using Covidence software, two independent reviewers will conduct title and abstract screening based on inclusion and exclusion criteria, followed by full-text reviews and extraction by a larger team. Quality will be appraised using an adapted version of the Critical Appraisal Skills Programme guidelines. We will conduct thematic synthesis to characterise individual experiences and related factors at the individual, interpersonal, community and health system levels. We will develop a conceptual framework to describe evidence on experiences of infertility in LMICs and to help inform interventions across settings. ETHICS AND DISSEMINATION: This protocol has been internally approved as exempt by the Institutional Review Board of the Population Council, as it does not involve contact with human subjects or personally identifying data. Results of the review will be published in a peer-reviewed journal and will be used to inform future infertility research and programming in LMICs. PROSPERO REGISTRATION NUMBER: CRD42021227742.

Pregnancy in Disability: Community Perceptions and Personal Experiences in a Rural Setting in Ghana.

BACKGROUND: Persons with disabilities (PWDs) generally face strong discrimination and exclusion, especially with regard to their sexual and reproductive health. There is a prevailing social myth in Ghana that women with disabilities are asexual and cannot experience a positive motherhood experience. Although the World Health Organization recommends that research is conducted in this regard, community attitudes towards pregnant women living with disabilities remain largely unexplored. The purpose of this study was to explore community attitudes to pregnancy among women living with disabilities. METHODOLOGY: The study design was a mixed method cross-sectional study involving quantitative face-to-face individual interviews with 400 randomly selected community members (both males and females) in three communities in the Adaklu District of Volta Region in Ghana. In addition, in-depth interviews were held with five female PWDs. Simple and multiple logistic regression analysis were used to examine the factors associated with perceptions towards pregnant PWDs. RESULTS: Majority of respondents agreed that pregnant women with disabilities should be kept in special institutions until delivery to prevent transmission of their disability to fetuses of pregnant women without disabilities. People also believed that pregnant PWDs are incapable of a safe motherhood experience. Among the strongly influencing factors for negative attitudes towards pregnancy of PWDs were educational status (p<0.001) and perceptions that the disability is caused by accidents (p<0.001) or spiritual issues (p<0.01). Regarding the relationship between perceived cause of disability and the resultant attitudes, respondents were three times more likely to have negative attitude and perceptions towards pregnant women with disabilities if their causes of disabilities were perceived to be spiritual compared to the cause being medical. CONCLUSION: Our findings indicate that there are generally negative societal attitudes towards pregnant PWDs. The evidence suggests that a degree of prejudice and misconceptions exists towards the pregnancy of women living with disabilities. Generally, there is a public perception that women living with disabilities cannot have a safe motherhood experience and are capable of transferring their disability to an unborn child of another pregnant woman.