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

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.