Abstract
ObjectiveUsing our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana.MethodsWe drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models.ResultsIn unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55).ConclusionsFindings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.
Highlights
Stigma “deeply discredits and transforms people from whole individuals to tainted, discounted ones” [1,2]
In unadjusted bivariate analyses, compared to their counterparts, Sexual and Reproductive Health (SRH) stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant
Higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,0.09), higher educational attainment (β = -1.22, CI = -1.82,0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,0.55)
Summary
Stigma “deeply discredits and transforms people from whole individuals to tainted, discounted ones” [1,2] It is a complex, contextual, dynamic social process that “marks” an individual for an attribute that violates social expectations and is devalued culturally [1,2]. Our recent work has formally conceptualized and measured social stigma spanning a broader continuum of SRH events to explore whether adolescent SRH stigma at the environmental or community level negatively influences family planning decision-making and behaviors [22,23,24]. Based upon formative qualitative research [22,23], we developed an Adolescent SRH Stigma Scale to assess environmental stigma within the community accompanying different dimensions of SRH and family planning [24]. The 20-item instrument, which comprises Internalized Stigma, Enacted Stigma, and Stigmatizing Lay Attitudes sub-scales, was tested in a survey study of 1,080 women ages 15–24 recruited from schools, health facilities, and universities in two cities in Ghana
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