Table 1: Sociodemographic characteristics of study participants, by sex (N=58)
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Youth Males n (%)
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Youth Females n (%)
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Age range in years
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All (18-24)
30 (100%)
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All (18-24)
28 (100%)
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Highest school level
|
Primary incomplete
|
1 (3.3)
|
2 (7.1)
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Primary complete
|
1 (3.3)
|
7 (25.0)
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Secondary incomplete
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5 (16.7)
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3 (10.7)
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Secondary complete
|
17(56.7)
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8 (28.6)
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Tertiary/college
|
6 (20.0)
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8 (28.6)
|
|
Relationship status
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Single
|
20 (66.7)
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13 (46.4)
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Dating/Friends with benefits
|
8 (26.7)
|
13 (46.4)
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Married/Engaged
|
2 (6.6)
|
2 (7.2)
|
|
Religion
|
Muslim
|
30 (100)
|
23 (82.1)
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Christian
|
|
5 (17.9)
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Among youth participants (Table 1), 56.7% of male respondents reported to have completed their secondary education compared to 28.6% of females. When disaggregated by age and sex groupings, the proportion of females in dating relationships was relatively high compared to their male counterparts (46.4% and 26.7%, respectively). In this study, those dating or reported as friends with benefits referred to a participant who had a regular sexual partner with whom they enjoyed spending time, without any formal agreement to marry. Married or engaged, on the other hand was reported by those with sexual partners and in unions with formal marital arrangements. There were more Muslim female participants (82.1%) than Christians (17.9); by contrast, all male participants were Muslims. This study was done in Kwale County where the Digo community who are predominantly Muslims are the majority. This explains the higher proportion of Muslim participants in the study.
Results are presented under four key themes: (i) awareness of contraception; (ii) myths and misconceptions around contraception; (iii) males’ contraceptive narratives and young people’s preferred sources of contraceptives
Awareness of contraception
When asked to explain what they understood by contraceptives, both males and females reported awareness of contraceptives, with some providing a combination of descriptions and/or listing of the methods. Injections and the intrauterine device (IUD or the ‘coil’, as it was called by respondents in the study) were the most frequently identified contraceptives. Other methods mentioned included condoms, withdrawal and rhythm method of birth control. It was clear that young people knew or had heard about contraceptive methods, but had minimal knowledge on how they actually worked.
There are injections that you can use, I don’t know how to explain it to you. There are injections when one uses, it will just help you to family plan (Respondent 4, young women FGD 001)
There is something I have heard but I’m not familiar … with a coil, when you get to a hospital, you get the coil … they put coilto women (Respondent 9, young men, FGD 003)
Compared to young men, young women were more aware of contraceptives in that, not only did they list the contraceptives but also went ahead to explain the perceived duration of effectiveness of some methods like the injection and implant.
To add more on the injection, there is an injection that someone can have for three months and there is the implant … which is put here (shows her arm) for five years (Respondent 6, young women, FGD 001)
Myths and misconceptions around contraception
Male and female participants shared several myths and misconceptions around contraception. Some respondents mentioned that the use of contraceptives jeopardized future fertility and could lead to serious health complications such as prolonged menstrual bleeding, problems conceiving, and birth defects. The most common misconception among both male and female participants was the perceived infertilities mistakenly associated with contraceptives. Hearsays from peers about perceived side effects and misinformation came out strongly in both male and female FGDs. This finding might explain albeit tacitly young people’s source of contraceptives’ myths and misconceptions.
People say that when you get the injection and if it does not work well for you, you bleed. You will bleed until you cannot get pregnant again and give birth. You will just be bleeding and bleeding, there are people who bleed for many months because of those injections. (Respondent 1, young women, FGD 001)
If for example you want to use the-after-three-months injection they say that if you use it often, then time comes and you want to stop using it and you want to get pregnant, you may wait for ten good years or forever and you will not get a baby at all. Because … I don’t know it makes the egg to get lost and it becomes weak that is what it means by destroying the womb. (Respondent 6, young women, FGD 001)
When they have used contraceptive to prevent them from getting pregnant, if a man and a woman, maybe in some years to come they will have stopped using them and they now want to have children, some of them (children) will be born with abnormalities, not as usual children but deformed and underweight. (Respondent 9, young men, FGD 001)
Participants also reported fears that IUDs could be pushed inward during sexual intercourse and damage the women’s reproductive organs. This came from the belief that the perceived ‘discomfort’ during sexual intercourse inaccurately believed to be experienced by users of IUDs is as a result of the IUD moving out of its normal position thereby making it ‘exposed’ during sexual intercourse.
I heard about the coil, that coil is inserted here in the womb, the time you are having sex with that person and he pushes it inside already he would have messed up everything, it will force you to remove it. (Respondent 4, young women, FGD 001)
Men’s contraceptives narratives
Men in the study had their own strong concerns about adverse socio-cultural effects of contraceptives. Several of these related to sexual relations between couples and sexual desire. Some reported that contraceptives contribute to decreased sexual desires among women, ‘forcing’ men into infidelity.
Other negative effect is that, it breaks marriages because those drugs lower women’s sexual feelings, so if you (as a man) were used to like four sex rounds a week, this will reduce to two times, it will be a must for you to go outside you will not agree. (Respondent 4, young men, FGD 002)
Somewhat counterintuitively, contraceptives were also perceived to contribute to infidelity on the part of women. As a result, male respondents worried about the effect of contraception on the trust in a relationship. This was seemingly because, with reduced risks of getting pregnant, young men thought that their women will increase their sexual frequency and with more partners. This goes further to explain the contraception confusion displayed by young men; while others opined that contraceptives would decline their sexual rights due to their women’s reduced sexual desires, their counterparts in the same age group had contrasting beliefs relating to the sexual effects of contraceptives.
We have trusted one another, and the wife takes those contraceptives and prevented herself from pregnancy, there will be no trust between us because one (wife) knows that she can have sex with anyone from outside and not getting pregnant, so I will not trust her (Respondent 2, young men, FGD 001)
In short it means untrustworthiness because you cannot get pregnant, … so maybe you will be having sex with someone or feel free to have sex anyhow and thereby infecting your partner with sexual diseases (Respondent 2, young men, FGD 002)
Interestingly, male participants also perceived that contraceptive methods deny couples their sexual freedom and regarded them as an unnecessary burden. Respondents were concerned about the implied prerequisite of always attaching contraception to sex, perceiving their sexual lives to be ‘enslaved’ to contraception thereby taking away the pleasure of having sex.
I see it as slavery using them, because it will be you and your wife at home and the time you do the marriage act (sex) you will be wearing trust (condom) and then using drugs every time you cannot skip, if you skip it will be a problem, when you say that you are leaving them (family planning pills) also it is a problem. Again, every time you will be going to the hospital or going to the chemist and take drugs, as in a burden, something like that. (Respondent 4, young men, FGD 001)
Among additional socio-cultural concerns, young men in the study also expressed beliefs that it was against ‘African’ traditions to NOT want children.
First of all, in Africa, Many Africans perceive contraceptives as un-African … In the African communities, children are important …if someone avoids getting a child …, the first year no child, second year no child … husband will now start to worry … And due to that the woman will be divorced (Respondent 6, young men FGD 003)
Finally, young men confused abortion and pregnancy prevention methods, with some participants mentioning that contraceptives could also be used to terminate pregnancies. Some young men in the study reported that by preventing “natural pregnancy progression” after unprotected sex, emergency contraceptive pills served to end an ‘existing pregnancy’. It was also established that some participants in the men FGDs couldn’t tell the difference between emergency contraceptive pills that prevent pregnancy after unprotected sex and abortion pills that terminate an already existing pregnancy.
Contraceptives are things which prevent one from getting pregnant or if one wants to abort when she has been impregnated by a man (Respondent 2, young men FGD 001)
This confusion resulted in some participants feeling contraceptives were a ‘curse’.
You can say it is a curse because it is like doing murder, you will have killed, you can get a curse from God because you are not allowed to kill another for any mistake (Respondent 3, young men, FGD 003)
Young people’s preferred sources of contraceptives
Although pharmacies and public health facilities were the reported common sources of contraceptives among the respondents, there was no consensus as to where young people would prefer to go for contraceptives. Both male and female respondents expressed varied preferences and dissatisfactions with the two contraceptive sources. These variations ranged from lack of privacy at the public hospitals, attitude of the healthcare providers to the cost associated with getting their preferred methods. Some respondents preferred pharmacies (locally referred to as “chemists”) to public facilities because of their privacy nature.
The goodness of the chemist is that there is privacy, because everyone who sells at the chemist is not known to you, but you can go to the hospital and you happen to find relatives who might see you, now when you go to the chemist, one is not asked what they are going to buy (Respondent 3, young women, FGD 001)
Being served by people their age was a reported factor that made pharmacies appeal to young people. Moreover, respondents reported that pharmacies are the preferred sources of contraception because the pharmacies’ personnel were considered polite and welcoming as opposed to the reported attitudes displayed by healthcare providers at the public health centres.
Then another reason is that most of those attendants at the chemist are age mates. So when you get there you can express yourself in details and he/she will understand you, unlike at a hospital where you will find an old person is the one serving people. (Respondent 10, Young women, FGD 003)
As my colleague had said, you can get a harsh person at the hospital but when getting to the chemist most of them talk politely and welcoming the customers, they have good language (Respondent 7, young women, FGD 002)
Conversely, and unlike in the previous themes where participants acknowledged and almost approved their colleagues’ assertions about contraceptives, the preferred sources presented dissenting opinions. Public hospitals were instead considered ideal by a section of the respondents who opined that unlike pharmacies, public hospitals provided better and professional services and at an affordable cost.
Also at the hospital the services are cheap as compared to places like chemists. You see the hospital might be a government hospital so what he/she needs might be cheap compared to other centers (Respondent 1, young men, FGD 002)
There is better treatment at the hospital compared to these chemists, for example if the service provider is a form four leaver (basic O-level graduate) he will not understand anything, but at the hospital they are good and educated nurses and doctors (Respondent 7, young men, FGD 003)