Running head: INFORMATION SOURCES, TEEN-AGE PREGNANCY
Information Sources, Teen-age Pregnancy, and Contraceptive Use
in Kenya: Implications for HIV and AIDS Control and Prevention
Isaac Obeng-Quaidoo
United Nations Fund for Population Assistance
Nairobi, Kenya
Cornelius B. Pratt
Michigan State University
East Lansing, MI 48824-1212
Charles Okigbo
African Council for Communication Education
Nairobi, Kenya
Waithera Gikonyo
United Nations Fund for Population Assistance
Nairobi, Kenya
Abstract
(Word Count: 75)
This study explores information sources and knowledge of
contraceptives among Kenyan teen-agers. Respondents rely more on
health clinics than on any other source for information on
sexually transmitted diseases (STDs), their most commonly cited
health problems; however, those with high knowledge about
contraceptives are significantly more likely than those with low
knowledge to report that the mass media are information sources.
The implications of these results for preventing and controlling
STDs in sub-Saharan Africa are presented.
Information Sources, Contraceptive Use, and Teen-age Pregnancy
in Kenya: Implications for AIDS Control and Prevention
The purposes of this study are twofold. First, it explores
sources from which teen-agers in Kenya get information on health
or health-related problems and on contraceptives that they could
use to prevent sexually transmitted diseases (STDs) and
pregnancy.
Second, it discusses the implications of those sources for
AIDS control and prevention among sub-Saharan Africans. Both
purposes are predicated on three overarching realities: (a) the
endemic nature of STDs, particularly heterosexually transmitted
HIV and AIDS in Africa; (b) the finding that the high rate of HIV
and AIDS on the continent is, for the most part, a consequence of
the high rate of STDs (Green, 1994; "Improved STD Treatment,"
1995; Rushing, 1995); and (c) the argument that the control of
STDs is important in the fight against AIDS in developing
countries (Grosskurth, Plummer, & Mabey, 1993; Rushing, 1995;
Williams, 1992).
Since Schramm (1964) wrote his classic on the mass media and
national development, developing nations have formulated
systematic policies to maximize the use of the media for economic
and social development. The Schramm tome was an impetus for the
subsequent application of public-communication campaigns to
health issues worldwide (e.g., Rice & Atkin, 1989; Rogers &
Storey, 1987; Steckler et al., 1995). Africa's health challenges
are exceedingly taxing, as no region has been as consistently
ravaged by diseases as has been that continent. And the pandemic
is yet to reach an epidemiologic equilibrium (Piot, Goeman, &
Laga, 1994). Today, about 70% of all known cases of HIV and AIDS
occur in that region. Its cumulative incidence of HIV infections
is more than 11 million, in contrast to Asia's more than three
million (Bayley, 1996). It is the leading cause of
hospitalizations in Africa's major cities. Even though
health-promotion and disease-prevention agencies implement
campaigns to stem the tide of the devastating effects of the
pandemic, HIV and AIDS pose widespread problems, not only to
health practitioners on the continent, but to those worldwide.
A number of studies have investigated the reasons for
Africa's pandemic (e.g., Mann, Tarantola, & Netter, 1992;
Rushing, 1995). Macdonald (1996), in studying its incidence and
prevalence in Botswana, identifies three explanatory factors: (a)
that it is culturally acceptable for men to have more than one
sexual partner and for married men to have concubines; (b) that
young women feel they are powerless in making decisions regarding
condom use; and (c) that, culturally, young women should prove
their fertility before marriage by becoming pregnant.
Another study raises questions about, and calls for more
studies on, the validity of social theories that purport to
explain the epidemiological patterns of the AIDS pandemic in
Africa (Hunt, 1996). Still others have argued that the control
of STDs is important in the fight against AIDS in developing
countries (e.g., Grosskurth, Plummer, & Mabey, 1993). The spread
of STDs is a sequela of the constellation of factors, namely, low
level of awareness about them and Africans' dominant social and
sexual practices.
Thus, even though a growing threat to controlling the
pandemic is teen-age sexual practices, the latter have not been
systematically investigated by Africa's public-health services.
This exploratory study attempts to fill that void, by first
ascertaining youths' health problemsyyas reported by them; it
then explores their sources of information on those problems, and
presents tentative implications of the results for controlling
and preventing STDs.
RESEARCH QUESTIONS
This study is guided by four research questions:
1. What major health or health-related problems do Kenyan
youths report?
2. What social factors explain some of those problems?
3. How important are the mass media as sources of
information for controlling and preventing those
problems?
4. What are the implications of the results of this study
for controlling and preventing some of those health or
health-related problems?
WHY KENYA?
We focus on Kenyayyfor three reasons. First, it is the
world's youngest country: 52% of its 30 million people are
younger than 15. People between the ages of 10 and 19 comprise
about 25% of its population and are the fastest-growing segment
in the country (Center for the Study, 1995). Those patterns
justify the focus of this study on teen-agers.
Second, the country's adolescent fertility rates are among
the world's highest. Njau and Radeny (1995) note that Kenya's
"high teen-age sexual activity is reflected in the incidence of
pregnancy, abortion, and STDs" (p. 2). One in five women aged 15
to 19 years has begun childbearing, either given birth or being
pregnant with her first child. Seventeen percent had one child,
and another 8.6% were pregnant, according to the Kenya
Demographic and Health Surveys of 1989 and 1990. Illigumugabo,
Njau, & Rog (1994) reported in their study of four rural
districts in Kenya that 81% of girls aged 15 to 19 years had at
least one pregnancy, 14% two pregnancies, and 3.2% three. Ten
percent became mothers before they reached age 16, more than 30%
had at least one sister who had given birth out of wedlock, and
9% had more than two sisters with children born out of wedlock.
The girls were not asked to indicate the ages when their unwed
sisters had their first children. Other studies have shown that
by age 20, about 21% of Kenyan adolescents have had at least one
child (e.g., Gyepi-Garbrah, 1985).
Third, Kenya is strategically positioned as the port of call
en route to the trans-Africa highway. This makes it a reservoir
of, and a conduit for, the spread of HIV and AIDS, particularly
by long-distance truckers who cross the region from Mombasa
(Kenya) on the East Coast through Lusaka (Zambia) in the central
region to Beira (Mozambique), and to Zaire in the West Central
region. This "truck town hypothesis" asserts that the geographic
distribution of HIV and AIDS follows the major routes of truckers
who patronize prostitutes, spreading the HIV virus
(Smallman-Raynor & Cliff, 1991). (The HIV and AIDS prevalence
rates for prostitutes in Kenya are as high as 88%.)
AFRICAN SOCIETIES' VULNERABILITY
Traditional societies vary greatly in Africa and indicate
cultural differences in attitudes or reactions toward teen-age
pregnancies. In the traditional societies of the Akan of Ghana,
the Ganda of Uganda, and those of the Ibos of Nigeria, teen-age
pregnancies are infrequent because sexual activities among
unmarried teen-agers are discouraged. However, among the Tswana
of Botswana, the Zulus of South Africa and Swaziland, and the
Swazis of Swaziland, the phenomenon is more common and usually
results in early marriage and the subjugation of women to men,
since single-parenthood is abhorred.
The ever-increasing urbanization and exposure to
international media and to Western education threaten the primacy
of some of the traditional attitudes toward teen-age pregnancy in
Africa. Among West Africans, for example, changes resulting from
European influences have caused sexual networking to occur on a
more extensive basis (Caldwell, Orubuloye, & Caldwell, 1991).
For the African, urbanization threatens traditional norms and
institutions that regulate sex (Mann, Tarantola, & Netter, 1992).
In many of Africa's urban centers, evolving uniform points of
view and attitudes supplant traditional and ethnic-based value
orientations. The situation in Kenya illustrates the strong
influence of those emerging factors on attitudes toward teen-age
pregnancy, which is becoming increasingly prevalent.
Such prevalence results partly from the generally youthful
age of the entire population. According to the Population
Reference Bureau (1990) about 45% of the total population is
younger than 15 yearsyyby far the most youthful region in the
world. In a large number of African countries, fertility rates
are high (more than 6.5 births per woman) and the use of modern
contraceptives is low (lower than zero percent). Recent
demographic and health surveys in three sub-Saharan
countriesyyBotswana, Kenya, and Zimbabweyyshow that increases in
the use of modern contraceptives is associated with decreases in
fertility (Population Reference Bureau, 1990).
In Kenya, about 4% of teen-agers initiate coitus at the age
of 10, although a mean age of 13.5 years for sexual initiation
has been reported in some districts. In general, about 26% of
single women aged 15 to 19 years report having had sexual
intercourse (Kenya Demographic, 1993; Kiruhi & Simalane, 1993;
Njau, 1993).
Even though there are variations among ethnic groups,
sometimes as many as 83% of Kenyan teen-agers report having had
coitus before their 19th birthday (Illinigumugabo, Njau, & Rog,
1994; Ojwang & Maggwa, 1991; Okumu & Chege, 1994).
Not only is the incidence of teen-age pregnancy high and
that 11-year-old girls are mothers, but teen-agers account for
between 20% and 30% of the total pregnancies occurring among
women aged between 15 and 49 years. Adolescents comprise as many
as 35% of total obstetric cases in various parts of Kenya (Kenya
Demographic, 1993; Leman, Makokha, Sanghui, & Wanjala, 1987).
Although not all teen-age pregnancies are pre-marital
pregnancies, many pregnant teen-agers are unmarried. Pre-marital
pregnancies among Kenyan teen-agers are explained by "an
interplay of individual and social factors within the context of
the communities in which the teen-agers live" (Njau & Radeny,
1995, p. 4).
Early sexual activity in the absence of appropriate
knowledge and the use of contraceptive devices are major
contributors to teen-age pregnancy. Even when contraceptive
awareness is shown to be as high as 76%, contraceptive use is
reported to be as low as 4% (Kenya Demographic, 1989).
Only about 18% of sexually experienced adolescent girls use
contraceptives (Okumu & Chege, 1994), while in the capital city
of Nairobi, the proportion of users is as low as 5% (Njau &
Radeny, 1995). That low use reflects a combination of factors
that include disapproval, unavailability, lack of information,
and the inconsistent nature of teen-agers' sexual behavior, among
others (Njau, 1993; Njau & Radney, 1995).
Public-information campaigns that include the mass media are
major sources of information for a variety of health problems and
awareness about strategies for combating them (Allen et al.,
1992; Wallack, 1990). Such mass media are complemented by
interpersonal media (Njau, 1993; Njau & Radney, 1995; Obunga,
1989).
HIV AND AIDS: A BRIEF ON THEIR BEGINNINGS, THEIR CONTROL,
THEIR PREVENTION
The oldest known case that was strongly suggestive of AIDS
occurred in 1952, when a 28-year-old male was diagnosed with
"viral pneumonia" and admitted to a Memphis, Tennessee, hospital
(Grmek, 1989/1990). In 1968, a 15-year-old African-American male
was admitted to St. Louis City (Mo.) Hospital, where Chlamydia
trachomatis was isolated from his lymph, serum, and prostatic
secretion (Grmek). He died May 15, 1969. An autopsy showed
lesions typical of Kaposi's sarcoma.
The beginnings of the disease in Africa may be traced to a
Paris-based Portuguese cab driver who had served in the Angolan
civil war, after which he worked as a truck driver between 1976
and 1979, plying the route between Angola and Mozambique, driving
through Zaire (Grmek). He died in Portugal in 1979; his frozen
serum later tested positive for HIV-2.
AIDS was first documented in Africa in 1983. David
Serwadda, a Ugandan pulmonary specialist, observed patients who
had symptoms of what were then called "the new American disease."
In Zambia, Anne Bayley, a surgeon, noted that her young patients
who suffered from a voracious and untreatable lesion died because
this new version of Kaposi's sarcoma did not respond to
medication. In October 1983, Peter Piot found that 38 samples of
sera from hospital patients in Kinshasa, Zaire, were infected
with HIV.
In early 1984, Nathan Clumeck and his colleagues found AIDS
in 21 Zairian patients. Since those early sporadic cases, HIV
infections and AIDS have spread across Africa (Hilts, 1994),
infecting people in the most productive years of their lives. In
contrast to other continents, Africa, particularly its Western
part, has a second pandemic: HIV-2.
In Kenya, STDs, including HIV and AIDS, are prevalent among
teen-agers, many of whom engage in unprotected sex and are
largely misinformed or uninformed about the consequences of their
sexual behaviors. The Kenya National AIDS Control Program (1992)
reported that teen-agers aged between 15 and 19 constitute 35% of
all reported AIDS cases in Kenya. It estimates that by the year
2000, about 41,000 young people will be infected with the AIDS
virusyya significant increase from the 1985 figure of 2,365.
Njau and Radeny (1995) reported that "the rising level of STDs
[and] HIV/AIDS among adolescents (in Kenya) is related to
misinformation concerning sexual behavior and AIDS" (p. 6).
AIDS in Kenya presents challenges for public-information
management. From an initial denial of the pandemic by public
officers who feared its adverse consequences on the tourist
industry, there is now a campaign to direct both local and
international attention to the unsubstantiated claims for a
medical cure. Arthur Obel, a scientist whose work is supported
by the Kenyan Government, has made confusing claims about
inventing a cure for AIDS. While those claims have generated a
great deal of controversy, they have not provided the much-needed
education on the need of teen-agers to take precautions against
HIV, AIDS and other STDs.
METHOD
This study employs a two-phase method: interviewer-assisted
questionnaires (Phase 1), and focus groups (Phase 2).
Phase 1
Sample. In May 1994, a systematic sample of Kenyans aged 15
to 19 years (N = 351) was selected from residents in three
residential areas in Kenya's second-largest city, Mombasa. The
areas are Mombasa Municipal Estate, National Housing Corporation,
and Kizinge Estate. They were selected partly because of their
high proportion of (residential) teen-agers and partly because of
their economic, social, and ethnic diversities. Because of our
interest in interviewing teen-agers, every effort was made to
select respondents in the 15- to 19-year-old category.
Procedures. The questionnaire was administered by 25
participants of a course in Information-Education-Communication
Audience Research and Segmentation for Population, which was
organized by the Regional Training Program of the United Nations
Fund for Population Activities (UNFPA), Nairobi, Kenya. The
design and administration of the questionnaire were requirements
of the training program.
Interviewer-assisted questionnaires. A 43-item
questionnaire was developed by participants in the UNFPA course,
pretested among Kenyan teen-agers, and modified. It contained
questions on respondents' knowledge and practices regarding the
use of contraceptives, their perceptions of the causes of
pregnancy, their beliefs about adolescent reproductive health,
their sources of information on health-related issues, and their
demographic profiles.
Phase 2
Focus groups. In addition to the survey instrument (Phase
1), six focus groups (FGs) were organized on six major themes:
adolescent reproductive health, contraceptive use, family life
education, family communication patterns, peer pressure, and
access to health facilities and to health-related information.
They were held in the three residential areas from which
respondents were selected for Phase 1 of this study. Focus
groups, a qualitative method, typically have an advantage over
quantitative methods in that they enable the researcher to
capture participants' diverse perspectives of their world without
the presuppositions of predetermined categories (Hammersley,
1989). They are particularly useful in exploring questions on
HIV and AIDS because they enable the researcher to understand how
participants' understanding of AIDS was constructedyythat is, the
cultural construction of experienceyyand to explore a diversity
of opinions rather than representative opinions (Kitzinger,
1994). Their use in this study will provide a qualitative
picture of youths' perceptions of adolescent sexual behaviors and
their use of information sources about those behaviors.
The selection of the eight participants in each FG was
purposive; the demographic profile of participants was comparable
to that of respondents (Table 1). Respondents to the interview
schedules did not participate in the FGs. Each discussion, which
lasted one hour, was moderated by a participant in the UNFPA
training program and recorded (manually) by another.
RESULTS
Phase 1: Interview responses
Demographic profiles. Overall, there were 351 teen-agers,
of which 38% (n = 133) were male and 62% (n = 218) were female.
Their highest educational levels ranged from "none" to "completed
secondary." More primary-school graduates than secondary-school
graduates participated in both the survey and the focus-group
sessions.
_____________________
Table 1 about here
_____________________
Research Question 1: What are major teen-age health-related
problems? Respondents most frequently cited HIV, AIDS, STDs,
malaria, dysentery, and insanitation as the major health problems
of Kenya's youths. The others were pregnancy or abortion,
menstrual irregularities, drug abuse, and others, which included
allergy, fevers and ear-nose-throat disorders.
___________________
Table 2 about here
___________________
Teen-age pregnancy. About 79% (n = 277) of the respondents
had heard of teen-age pregnancy and 84% (n = 295) knew of girls
aged 15 to 19 years who had gotten pregnant. On being asked what
pregnant teen-agers did on discovering they were pregnant, 61% (n
= 215) said they had an abortion, while 52% (n = 181) said they
gave birth. These results show that teen-age pregnancies, STDs,
and HIV and AIDS were perceived as common health issues by the
Kenyan youths interviewed in this study.
Research Question 2: What reported social factors explain
teen-age pregnancy? A majority (70%) of respondents saw
teen-age pregnancy as a national problem; the rest disagreed.
The top four factors, in order of mention, that explained the
reported prevalence of teen-age pregnancy were religion, lack of
parental guidance, mass media exposure, and lack of
contraceptives. The other factors were low-level education and
peer pressure.
____________________
Table 3 about here
_____________________
Research Question 3: To what extent are the mass media
sources of information on contraceptives? Institutional sources
such as hospitals, clinics, and the Ministry of Health were cited
most frequently. The media were the second most important source
of information on contraceptives. The importance of the media as
sources of contraceptive information is more clearly evidenced in
the relationship between knowledge levels and sources. When
respondents' levels of knowledgeyyhigh or lowyyare
cross-tabulated with media use, results indicate that those with
high levels of knowledge about contraceptives tend to cite the
media significantly more often than their counterparts with low
levels of knowledge (y2 [1, N = 82] = 28.0, p <.001). High
knowledge levels are also significantly associated with the
school (y2 [1, N = 73] = 4.94, p < .05) and the home (y2 [1, N =
47] = 9.38, p < .01) as information sources. High knowledge
levels are not associated with counseling, friends, and neighbors
as information sources. Therefore, it appears the mass media
have two contradictory effects on respondents: as contributing to
the incidence of teen-age pregnancy (Table 3), and as
distributing contraceptive information to them.
_________________________
Tables 4 and 5 about here
_________________________
Respondents indicated awareness of various kinds of
contraceptives. Birth-control pills and condoms were the most
commonly mentioned methods, followed by the loop and IUCD. The
least-known methods were foam, jelly, natural mechanisms, and
tubal ligation. The diaphragm and "injectables" were also fairly
well-known by respondents.
____________________
Table 6 about here
____________________
Research Question 4: What are the implications of results
for controlling and preventing AIDS? The reported incidence of
pregnancy among the teen-agers, their familiarity with the
problem, and acquaintanceship with teen-agers who had become
pregnant suggest that a considerable number of youths tend to
engage in sexual activities. Therefore, they tend to expose
themselves to risks associated with contracting STDs, HIV and
AIDS, all of which were perceived as a problem by about 40% of
the male respondents, and 34% of their female counterparts.
Asked to suggest what could be done about the problem,
counseling was most frequently cited (40% of the time), followed
by the use of contraceptives (17%). Other methods were
abstinence (13%), education (12%), and parental guidance (11%).
____________________
Table 7 about here
____________________
About 70% of the respondents said that contraceptive use
encouraged them to engage in sexual activities. Even though
there were no specific questions on the incidence of HIV and AIDS
among the respondents, the responses suggest strongly that
unprotected sex was common.
Phase 2: Focus-group responses
Complementing the survey research results were those of six
focus-group (FG) sessions, consisting of two male groups, two
female groups, and two mixed groups. Audiotapes of the
discussions were transcribed and analyzed according to the key
words or phrases in the six themes that set the directions for
the sessions. Even though we expected some gender differences in
their responses to discussion items, we found hardly any
difference in their responses. Therefore, the presentation of
the qualitative responses to our questions will be presented
without much distinction by gender.
Health-related problems. The discussions started by asking
participants to identify some of the major health or
health-related problems of Kenya's youths. They mentioned
teen-age pregnancy, drug abuse, alcoholism and unprotected sex.
"I can say some of them [youths] do not protect themselves," one
participant said matter-of-factly. "You find that they go with
one man this day and another man another day. This is why I feel
that the youths are responsible for spreading the STDs."
On the prevalence of teen-age pregnancyyyas a health
problemyyparticipants agreed that there were many instances of
such pregnancies in their community. One female said: "We have
young girls who give birth in school which I think is not nice
. . . to have children while in school. They are not expected to
have babies at that time."
On the use of contraceptives to prevent pregnancy, another
female remarked: "The dilemma is on whether to use or not use
. . . Some girls are not sure whether to use contraceptives or
not . . . they are not sure on how to use them."
Controlling and preventing health problems. When
participants were asked to discuss the prevention of HIV, AIDS,
and STDs, they indicated that youths should be taught about the
dangers of all three. One female said: "They should be taught by
parents, teachers, and elders."
Condoms were cited as another solution toward preventing the
spread of STDs among youths. This suggestion was opposed by some
participants, one of whom argued: "Some young people do not have
enough knowledge about condom use. They may try to use them and
end up contracting the infection."
Another commented: "Condoms are unreliable. They break if
used wrongly."
One participant stressed the fact that one needs to have
money to purchase condoms and the youths may not be given such
money by their parents.
Another, however, claimed that early maturity is a factor
that contributes to premature sex, with its consequent
pregnancies and diseases. He said: "Nowadays, we young people,
we mature early, especially girls are growing very fast, all
their sexual organs are working fast."
On the use of contraceptives, a female participants said,
"Girls should seek advice from older people." Another suggested:
"Girls should seek counseling and avoid 'such things.'"
One male discussant questioned the meaning of 'such things'
and the female explained that it meant sex, diseases, and
pregnancy. She further explained: " . . . so the only
alternative . . . before you know how to use contraceptives, you
should avoid sex . . . because sex encourages the use of
contraceptives."
Another female argued: " . . . instead of using these
contraceptives of which we do not know the correct way of using
them, it is better for us to avoid sex . . . sex brings us
problems . . . pregnancy and STDs."
One male, however, disagreed with the females. He argued:
"It is hard to restrain people from using contraceptives because
some people are really fond of indulging in sex."
In response to the preceding remark, one male participant
asked him how the problem of AIDS could be solved if youths were
fond of sex. He replied: "By providing more information, people
would be taught more about AIDS."
Implications of FG results for controlling and preventing
health-related problems. The participants mentioned condom most
frequently as the method for preventing the spread of STDs,
adding that boys use them with more frequency. One male
participant commented: "You see, boys do not think about
pregnancy. It does not come to their minds. They just think
about themselves."
Three male discussants did not seem to understand the
function of contraceptives. One said, "Pills are used to prevent
diseases."
He was promptly corrected by a female who said, "The use of
the pill cannot prevent diseases, but can prevent pregnancy."
She quickly added, "It is condom that can prevent pregnancy, as
well as diseases."
When participants were asked about their preferred
contraceptive, most mentioned condoms. One said, "First, to us,
it is the easiest method . . . condoms are good to prevent an
unwanted pregnancy."
Some of the participants who disliked contraceptives argued:
"These pills, they pile up in your stomach when you get used
to them and you may end up being sick."
"These condoms may cause infection."
"If one is introduced early to [contraceptives] the methods
can affect their reproductive organs. They may be unable to
reproduce."
"When you try to figure out the way this sex was brought
about, it was brought about to the parents and to the people who
are already married. For teen-agers, the repercussions of sexual
activities are high."
Sources of information on contraceptives. Participants
generally agreed that one main source of information on
contraceptives is the health center. They saw the media as part
of youths' health problems. A summary of three participants'
opinions:
"You watch a movie, and just because you have seen it [sex]
being done, you decide to do it."
"They do contribute [to sex]. Normally, if you visit
schools, especially primary schools, you find the children are
just discussing what they heard and saw on TV the previous
evening. One such worst program is 'The Wild Rose' being shown
on KBC [Kenya Broadcasting Corporation] because it encourages the
youth in kissing and cuddling."
"To me, I feel the very sexy magazines are not good. They
make you want to have sex feelings."
SOME TENTATIVE IMPLICATIONSyyAND WHAT SHOULD BE DONE
This study provides preliminary data that suggest several
implications for preventing and controlling STDs in Kenya in
particular, and in the sub-Saharan region in general. First, the
dependence on formal institutions such as health clinics and the
Ministry of Health for contraceptive information limits the
exposure of teen-agers to vital health-related information. It
is important that the media be used to increase familiarity with
the risks of unprotected sexual intercourse. Such media must
include the traditional media, more commonly labelled "oramedia."
They include instruments such as drums, horns and gongs and
settings such as plays, theaters, and the marketplace; they
encompass the nature of African societies; and they reflect the
dominant mores of African communication systems, the essence of
interpersonal and inter-group exchanges, and the normative
principles that guide those communications.
Further, secondary-school curricula should offer more
material on reproductive health, and do so in settings that
encourage no-holds-barred discussions of the dangers associated
with contracting STDs.
Second, because religion and sociocultural practices
exercise major influences on the seriousness with which Kenya's
youths perceive the major health problems they confront and on
how to address them, prevention programs must be culturally
relevant. As Kiefer and Hulley (1990) note, "Every epidemic must
be seen in the particular social context in which it took hold,
in order to understand both its propagation and society's
response to it" (p. 9). Thus, it is advisable that programs
targeting youths co-opt such dominant social practices into their
themes; for example, using promotional messages to restrict
intercourse to a single partner and to empower women on their
role in decision-making vis- -vis protection during intercourse.
Third, HIV and AIDS are a part of a larger set of the health
problems of young Africans. Because exposure to minor forms of
STDs could make teen-agers vulnerable to more complicated
diseases, intervention programs must integrate the complementary
strengths of various media. In its integrated mode, such
programs merge advertising, direct marketing, public relations,
publicity, promotion, and personal selling into one managerial
activity. Teen-agers in this study tend to think that being at
risk for minor forms of STDs does not necessarily place them at
risk for the more fatal forms.
Fourth, programs must address the pervasive sex-oriented
stereotypes teen-agers hold; for example, that condoms themselves
can cause AIDS, that the device is unreliable in preventing STDs,
and that the pill could also prevent STDs. Even though health
clinics distribute free condoms, their frequent, let alone their
consistent, use is in question. Kenya's National AIDS Control
Program must strongly advocate a national policy on condom use.
A study of the acceptance of innovative female condom shows that
84% of all females reported that they liked it as much or better
than the male condom and that 55% of them would use it if it were
available (Ruminjo, Steiner, Joanis, Mwathe, & Thagana, 1996).
Few options exist in light of the cost associated with the
long-term effects of infections from STDs.
Finally, as Ainsworth and Over (1994) wrote, "AIDS is
fundamentally a development problem, not just a health problem"
(p. 584). Health practitioners on the continent must, therefore,
strengthen the links between HIV and AIDS prevention and control
and the continent's national-development interest. Such links
are particularly important in a nation where 52% of its
population is younger than 15, and where 27% is between 15 years
and 29 years. Because the effects of STDs are apparent beyond
the health sector, the health and resourcefulness of African
teen-agers could be at risk if health promotion and
STD-prevention programs do not get the necessary policy-level
support.
In conclusion, this exploratory study suggests that the
reported sexual practices of teen-agers portend tragic
consequences for millions of Africans. Therefore, strategic
responses to STDs, HIV and AIDS among Kenyan youths must include
all-encompassing media campaigns targeting not only the young,
but also adults whose lifestyles and social practices may be
viewed as model behaviors by youths. The results of this study
suggest that exposure to such media-based campaigns could be high
if the youths' knowledge of contraceptives is high.
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Table 1
Demographics of 15- to 19-year-old Respondents and Focus-Group
Participants
_____________________________________________________________
Respondents Participants
(N = 351) (N = 48)
______________________________________________________________
Variable n (%) n (%)
______________________________________________________________
Gender
Female 218 (62.1) 26 (54.2)
Male 133 (37.9) 22 (45.8)
Religion
Protestant 221 (63.0) 18 (37.5)
Catholic 60 (17.1) 15 (31.3)
Moslem 36 (10.2) 9 (18.7)
None 1 ( 0.3) 2 ( 4.2)
Others 33 ( 9.4) 4 ( 8.3)
Highest Educational Level
None 10 ( 2.8) 1 ( 2.1)
Some primary 7 ( 2.0) 7 (14.6)
Completed Primary 171 (48.7) 23 (47.9)
Some secondary 97 (27.6) 10 (20.8)
Completed secondary 19 ( 5.4) 5 (10.4)
Other 10 ( 2.8) 2 ( 4.2)
No response 37 (10.5) yy yy
Table 2
Respondents' (N = 351) Most Frequently Cited Health or
Health-Related Problems
________________________________________________________________
Health Problem Frequency Percent of Sample
________________________________________________________________
HIV, AIDS, STDs 126 35.9
Malaria 117 33.3
Dysentery 76 21.7
Hygiene 53 15.1
Pregnancy, abortion 32 9.1
Drug use 25 7.1
Menstrual 9 2.6
Others 140 39.9
_________________________________________________________________
Table 3
Respondents' (N = 351) Most Frequently Cited Causes of Pregnancy
_________________________________________________________________
Cause Frequency Percent of Sample
_________________________________________________________________
Religion 140 39.9
Lack of parental guidance 126 35.9
Mass media exposure 117 33.3
Lack of contraceptives 76 21.7
Low level of education 53 15.1
Peer pressure 32 9.1
Broken homes 25 7.1
Early marriage 9 2.6
_________________________________________________________________
Table 4
Respondents' (N = 351) Most Frequently Cited Sources of
Information on Health or Health-Related Problems
_________________________________________________________________
Percent of
Cause Frequency Sample
_________________________________________________________________
Hospitals, clinics, Ministry of
Health 122 34.8
Mass media 82 23.4
Teacher, school 73 20.8
Parents, home 47 13.4
Guidance, counseling 38 10.8
Friends 28 8.0
Neighbors 21 6.0
Others 21 6.0
_________________________________________________________________
Table 5
Respondents' Most Frequently Cited Sources of Information on
Health or Health-Related Problems, by Level of Knowledge About
Contraceptives
________________________________________________________________
Level of Knowledge
_________________________
High Low
_________________________
Source of Information n (%) n (%) y2 p <
_________________________________________________________________
Hospitals, clinics,
Ministry of Health 54 (44.3) 68 (55.7) 1.6 ns
Mass media 65 (79.3) 17 (20.7) 28.0 .001
Teacher, school 46 (63.0) 27 (37.0) 4.94 .05
Parents, home 34 (72.3) 13 (27.7) 9.38 .01
Guidance, counseling 2 ( 5.3) 36 (94.7) 30.4 .001
Friends 19 (67.9) 9 (32.1) 3.56 ns
Neighbors 13 (61.9) 8 (38.1) 1.18 ns
Others 19 (90.5) 2 ( 9.5) 13.8 .001
_________________________________________________________________
Table 6
Respondents' (N = 351) Most Frequently Cited Contraceptives
________________________________________________________________
Contraceptive Frequency Percent of Sample
________________________________________________________________
The pill 203 57.3
Condom 201 51.8
Loop, IUD 103 29.3
Diaphragm 96 27.4
"Injectables" 95 27.1
Vasectomy 81 23.1
Foam, jelly 79 22.5
Rhythm method 53 15.1
Tubal ligation 39 11.1
Others 75 21.4
_________________________________________________________________
Table 7
Respondents' (N = 351) Most Frequently Cited Strategies Against
Teen-age Pregnancy
________________________________________________________________
Percent of
Strategy Frequency Sample
________________________________________________________________
Offer counseling 141 40.2
Use contraceptive 59 16.8
Practice abstinence 45 12.8
Offer education 43 12.3
Provide parental guidance 39 11.1
Use legal measures 4 1.1
Others 111 31.6
________________________________________________________________
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