title: Blood blockages and scolding nurses: barriers to adolescent contraceptive use in South Africa.
abstract: 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.
authors.affiliation: Research Associate, Thomas Coram Research Unit, Institute of Education, University of London, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Wood
authors.forename: Rachel
authors.initials: R
authors.lastname: Jewkes
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000328:Adult; D001291:Attitude of Health Personnel; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004363:Drug Utilization; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008598:Menstruation; D008599:Menstruation Disturbances / Q000139:chemically induced*; D008875:Middle Aged; D009740:Nursing Staff / Q000523:psychology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D036301:Qualitative Research; D012725:Sexual Behavior / Q000523:psychology; D013019:South Africa
chemical_list: D003271:Contraceptive Agents, Female