Margarate N Munakampe1,2, Charles Michelo3,4, Joseph M Zulu5. 1. Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia. margaratemuna@yahoo.com. 2. Strategic Centre for Health Systems Metrics & Evaluations (SCHEME), Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia. margaratemuna@yahoo.com. 3. Department of Epidemiology & Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia. 4. Strategic Centre for Health Systems Metrics & Evaluations (SCHEME), Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia. 5. Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia.
Abstract
BACKGROUND: Despite global and regional policies that promote the reduction of adolescent fertility through ending early marriages and reducing early child-bearing, adolescent fertility remains high in most sub-Saharan countries. This study aimed to explore the competing discourses that shape adolescent fertility control in Zambia. METHODS: A qualitative case study design was adopted, involving 33 individual interviews and 9 focus group discussions with adolescents and other key-informants such as parents, teachers and policymakers. Thematic and critical discourse analysis were used to analyze the data. RESULTS: Adolescents' age significantly reduced their access to Sexual and Reproductive Health, SRH services. Also, adolescent fertility discussions were influenced by marital norms and Christian beliefs, as well as health and rights values. While early marriage or child-bearing was discouraged, married adolescents and adolescents who had given birth before faced fewer challenges when accessing SRH information and services compared to their unmarried or nulliparous counterparts. Besides, the major influencers such as parents, teachers and health workers were also conflicted about how to package SRH information to young people, due to their varying roles in the community. CONCLUSION: The pluralistic view of adolescent fertility is fueled by "multiple consciousnesses". This is evidenced by the divergent discourses that shape adolescent fertility control in Zambia, compounded by the disempowered position of adolescents in their communities. We assert that the competing moral worlds, correct in their own right, viewed within the historical and social context unearth significant barriers to the success of interventions targeted towards adolescents' fertility control in Zambia, thereby propagating the growing problem of high adolescent fertility. This suggests proactive consideration of these discourses when designing and implementing adolescent fertility interventions.
BACKGROUND: Despite global and regional policies that promote the reduction of adolescent fertility through ending early marriages and reducing early child-bearing, adolescent fertility remains high in most sub-Saharan countries. This study aimed to explore the competing discourses that shape adolescent fertility control in Zambia. METHODS: A qualitative case study design was adopted, involving 33 individual interviews and 9 focus group discussions with adolescents and other key-informants such as parents, teachers and policymakers. Thematic and critical discourse analysis were used to analyze the data. RESULTS: Adolescents' age significantly reduced their access to Sexual and Reproductive Health, SRH services. Also, adolescent fertility discussions were influenced by marital norms and Christian beliefs, as well as health and rights values. While early marriage or child-bearing was discouraged, married adolescents and adolescents who had given birth before faced fewer challenges when accessing SRH information and services compared to their unmarried or nulliparous counterparts. Besides, the major influencers such as parents, teachers and health workers were also conflicted about how to package SRH information to young people, due to their varying roles in the community. CONCLUSION: The pluralistic view of adolescent fertility is fueled by "multiple consciousnesses". This is evidenced by the divergent discourses that shape adolescent fertility control in Zambia, compounded by the disempowered position of adolescents in their communities. We assert that the competing moral worlds, correct in their own right, viewed within the historical and social context unearth significant barriers to the success of interventions targeted towards adolescents' fertility control in Zambia, thereby propagating the growing problem of high adolescent fertility. This suggests proactive consideration of these discourses when designing and implementing adolescent fertility interventions.
Entities:
Keywords:
Adolescent fertility; Double consciousness; Postcolonial criticism; Sexual and reproductive health
Authors: Tetine Sentell; Saionara Maria Aires da Câmara; Alban Ylli; Maria P Velez; Marlos R Domingues; Diego G Bassani; Mary Guo; Catherine M Pirkle Journal: South East Eur J Public Health Date: 2019-04-30
Authors: Elissa C Kennedy; Siula Bulu; Jennifer Harris; David Humphreys; Jayline Malverus; Natalie J Gray Journal: BMC Health Serv Res Date: 2013-10-31 Impact factor: 2.655