A Pre and Post Test Intervention Program to Prevent Abortion and Contraceptive-use Stigma Among School Youths in Kenya: A Quasi-Experimental Design

Today, abortion is one of the most common practices within gynaecological care. Despite its existence across time and its persistence across geographic location, the impact of abortion on women, families, communities and societies differs a lot across the world. Safe abortions - done by trained providers in hygienic settings and particularly early medical abortions carry fewer health risks. In countries like Sweden, Romania, Nepal and South Africa, liberalisation of abortion laws has had a direct and positive impact on maternal mortality. Yet, approximately half of the 42 million abortions that take place every year are unsafe. Nearly one in five maternal deaths can be attributed to unsafe abortion, and more than 500 women per 100,000 live births die from consequences of unsafe abortions. There is an inherent need to invest in intervention strategies to improve maternal health, especially amongst youth.

Until recently, abortion was only legally permissible in Kenya to save the life of a woman, but a new constitution adopted in 2010 makes abortion available to protect a woman's health. Article 43 in the constitution further widens access to reproductive health rights, as every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care. However, contraceptive use remains low in Kenya. Consequently unwanted pregnancy and unsafe abortions are common, many of which require medical care for complications. A Kenyan woman has a one in 55 chance of dying from pregnancy related causes over her lifetime, and about 360 women per 100,000 live births die.

Sexuality education is part of general education. Its preventive nature not only contributes to the prevention of negative consequences linked to sexuality, but can also improve quality of life, health and well-being. In this way, sexuality education contributes to health promotion in general. In some countries SRE in school is compulsory, as for example in Sweden. In Kenya, SRE is not compulsory in the teacher education. Many teachers receive additional training, although this training has a focus on teaching about HIV/AIDS. Oginga (2014) recommend that SRE need to be incorporated and compulsory in the teacher-training curriculum in Kenya.

While extensive research has investigated the public health consequences of unwanted pregnancy and unsafe abortion from a human rights perspective, there is little research on stigma related to contraceptive use and abortion among youths. Causes of abortion stigma such as negative gender stereotypes, intent to control female sexuality, compulsory motherhood - are social constructs that can be deconstructed. Women's subordinate status in most societies has negative implications for women's sexual and reproductive health and rights (SRHR).

Although there is lack of research on stigma related to contraceptive use and abortion and how it can be reduced, the occurrence of such stigma are widely acknowledged in many countries. Few conceptual and methodological tools exist to measure its effects. For many years now, the International Planned Parenthood Federation (IPPF), together with partner organizations, has implemented programmes to specifically address and combatting HIV stigma. In the past five years there has been increased global attention on abortion stigma. IPPF has thus expanded its work to address the impact that negative beliefs and attitudes about abortion has on access to, and scale-up of, safe abortion services. Abortion stigma manifests at many levels, from individuals and service providers to communities, institutions, laws and policies, and wider public discourse including the media.