| More Details |
The researchers found that the teenagers had been provided with virtually no useful information about menstruation or sexual matters by older relatives or teachers. Some discussed contraception with their friends, but others did not, perceiving sexual matters to be secret'. First contraceptive use was commonly initiated by mothers, once daughters started to menstruate. Some adolescents decided to start contraception themselves because they perceived that sexual initiation was imminent and often because their peers used contraception. Others only began after they had their first baby, which was often conceived in response to pressure from their families, as well as boyfriends. Teenage pregnancy was largely socially sanctioned and regarded as infinitely preferable to the threat of contraceptive-induced infertility.
Nuristerate was the preferred method for most teenagers and all the nurses as Depo was perceived sometimes to cause permanent infertility. Oral contraceptives were regarded as inconvenient and easily forgettable'. Most teenagers, in response to information from nurses, said that forgetting to take one pill would probably result in pregnancy. Nurses were generally unfamiliar with emergency contraception. Condoms were rarely perceived to be a contraceptive and were often not offered to girls in clinics. Teenagers expressed fears of using them in case they were left inside', and would have to be removed either with the tongue, by a doctor, or in hospital where they had the right equipment'. Several said they had just never thought of using them.
Menstrual irregularities were the most severe and common side-effects of the injection. Amenorrhoea was often interpreted as blood having accumulated' or clotted', usually in the womb or abdomen. This state of blockage' was described as a dangerous condition, identified by dark clots' or by waist pains', and construed as an indication or cause of illness. Prolonged absence of menstruation was also seen to be problematic as teenagers did not know whether they were pregnant, feared that blocked blood might eventually come out too fast' with adverse effects, and were anxious that dirt' would accumulate in the womb and cause STDs. Several other side-effects of contraceptives were mentioned, including some experienced by the male partners of contraceptive users.
Nurses' management of side-effects was a source of dissatisfaction. Change of method was usually reserved for cases where they identified a pathological condition, and so teenagers often did not feel that they were taken seriously when they reported side-effects. This often led to them stopping contraceptive use, either for a short break or altogether. Although teenagers reported sharing a waiting area with elders to be problematic, by far the most important concerns when seeking contraception from public clinics were the attitudes of nursing staff towards them. Many teenagers reported verbal harassment' by nurses, who were commonly described as rude, short-tempered and arrogant. Teenagers said that nurses would not provide the method until they had asked funny questions' about whether they had boyfriends, why they had sex so young and whether they had told their mothers, and had lectured them that they were far too young to be sexually active and must stop going around with men'. Teenagers who refused to answer these questions were reportedly scolded. Scolding' provoked emotions of shame, unhappiness and fear in the teenagers and many reportedly stopped using contraception and had unwanted pregnancies as a result of it. Some teenagers also reported instances in which they had been refused contraception if they had previously attended a GP or did not have parental permission, as well as situations where nurses had given a method but refused to explain about it because the teenager had not gone to her nearest clinic. Some teenage informants clearly perceived that nurses at times transgressed their professional role to an unacceptable degree, and were out of touch with adolescents in their advice about sexual abstinence.
Nurses perceived that the effects of their comments were usually to make a teenager shy and look down' silently, and acknowledged that at times they would prevent further contraceptive seeking. Nonetheless, they perceived that giving moral guidance to teenagers and discouraging sexual activity formed part of their roles. Most nurses said that giving contraception to young teenagers did not make them feel very good', although they were somewhat consoled by the thought that they were helping to prevent adolescent pregnancy and early educational drop-out. Nurses described several other sources of stress in working with teenagers. Some mentioned overwork and tiredness, but mostly they related to small acts of insubordination, including not taking heed of health lessons, forging' clinic cards to mask contraceptive breaks, lying in an attempt to procure abortion and being rude in out-of-clinic settings.
Several recommendations are made for improving the services. These concern improving supervision, introducing continuing education of staff, values clarification workshops, curricular changes and providing information leaflets and pregnancy testing in clinics. |
Publications
