Online Program

Understanding “Bad Girl:” Qualitative findings on stigma and adolescent sexual and reproductive health in Ghana

Tuesday, November 3, 2015 : 11:00 a.m. - 11:15 a.m.

Kelli Hall, PhD, MS, University of Michigan, Ann Arbor, MI
Abubakar Manu, University of Ghana, Accra, Ghana
Melissa Zochowski, MBA, University of Michigan, Ann Arbor, MI
Andrew Boakye, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology Role: Co-Investigator, Kumasi Ghana, Kumasi, Ghana
Sneha Challa, University of Michigan, Ann Arbor, MI
Dana Loll, University of Michigan, Ann Arbor, MI
Jessica Dozier, University of Michigan, Ann Arbor, MI
Lisa Harris, MD, PhD, Obstetrics and Gynecology and Women's Studies, University of Michigan, Ann Arbor, MI
Richard Adanu, University of Ghana, Accra, Ghana
Vanessa Dalton, MD, MPH, University of Michigan, Ann Arbor, MI
Objective: We qualitatively explored stigma experienced with different dimensions of adolescent sexual and reproductive health (SRH) among young African women.


Methods: We conducted 63 in-depth, individual interviews with adolescent and young adult women ages 15-24 in Accra and Kumasi, Ghana. Women were recruited from 5 secondary schools and 5 health facilities. Purposive sampling was used to ensure diversity in reproductive, relationship, and socioeconomic backgrounds. Interviews were recorded and transcribed verbatim. Applying principles of grounded theory, we conducted a thematic analysis to identify key codes and themes using Dedoose.


Results: Stigma and discrimination emerged as a major theme. Young women described personal feelings and lay attitudes that adolescent sexual activity and its consequences (particularly non-marital sex, contraceptive use, pregnancy, and childbearing, and abortion generally) are perceived to be acts of disobedience, “disgrace,” “disrespect,” “shame,” and contribute to community “gossip” and “bad girl” labeling. Enacted stigma was described as experiences of discrimination, marginalization, and psychological and physical mistreatment of sexually active, pregnant, and parenting adolescents by family members, peers, intimate partners, teachers, religious leaders, and health care workers. Secret-keeping and non-disclosure, which were strategies used to avoid or reduce stigma, impacted sexually-active adolescents’ willingness to seek family planning (FP) services and use modern contraception.


Conclusion: Stigma associated with adolescent SRH appears to preclude effective FP and contribute to unintended pregnancy and its sequelae. Findings have informed development of a new scale to quantitatively measure adolescent SRH stigma and its impact on FP outcomes in a community-based survey of 600 Ghanaian young women.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe adolescent and young adult women's experiences with stigma and discrimination related to sexual and reproductive health

Keyword(s): Adolescents, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author because I am the PI of the study and the principle investigator of numerous studies and federally funded/foundation funded grants focused on adolescent sexual and reproductive health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.