Sexual and reproductive health information in Mulanje District, Malawi: Exploring perceptions of adolescent girls, their mothers and initiators

Abstract

Purpose: Adolescent pregnancy contributes to mortality, morbidity and social consequences due to factors including poorer maternal outcomes among adolescents, unsafe abortion, and school dropout. This study aims to explore what girls in Mulanje District learn about sexual and reproductive health (SRH), the venues and sources currently providing this information, as well as preferred channels of such information. This formative research was undertaken in preparation for an information, education, and communication (IEC) intervention to reduce unintended pregnancy among girls less than 18 years old. Methods: The data were gathered through semi-structured interviews with three participant groups: adolescent girls, mothers/female guardians of adolescent girls, and women who counsel adolescent girls in initiation rites. Interviews were conducted in 15 different Mulanje village sites. Data were analyzed and coded using Dedoose 7.5. Results: Most participants confirmed that transactional sex among young girls is common and that some initiation rites still encourage girls to practice sex at puberty. Yet, contraceptives, and even condoms in many cases, are discouraged for girls under age 18. And there are misconceptions about the side effects of contraceptives, as well as barriers to access. Many parents report delaying discussing SRH until after their girls have experienced sexual debut due to concerns that such discussion will actually encourage them to engage in sex. Conclusions: Taken together, the results of this study indicate conditions that perpetuate high rates of unintended pregnancy. As a result, correct and comprehensive SRH IEC is urgently needed. While each of the study findings must be addressed to improve the problem, IEC on contraception for girls, targeted to girls, parents and leaders of initiation rites, as well as improved access to contraception, represents an effective and practical intervention. Messaging can emphasize the “cost” of not providing contraceptives and condoms in terms of the real costs of birthing and supporting a child. Equally important is training initiation leaders and village chiefs in correct and comprehensive SRH information and incenting them to update their practices accordingly. As gatekeepers, involving parents, especially mothers, is critical to IEC efforts addressing both contraception and timing of SRH education.