Zulu Joseph Mumba, Crankshaw Tamaryn L, Ouedraogo Ramatou, Juma Kenneth, Aantjes Carolien J
Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Arch Public Health. 2024 Aug 26;82(1):137. doi: 10.1186/s13690-024-01377-3.
Access to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia.
This paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis.
Adolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter's sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl's exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents' reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers.
The embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school.
获得安全堕胎护理的机会极不平等，根本原因在于社会经济不平等，而限制性社会规范和法律制度加剧了这种不平等。我们分析了赞比亚少女在生殖健康连续体上的这些不平等情况。
本文借鉴了2021年在赞比亚五个城市、城郊和农村地区与社区成员（青年/成年人）进行的20次焦点小组讨论。采用主题分析法对数据进行分析。
据报告，社区中的青少年怀孕情况在各个社区都很普遍，贫困家庭的女孩受到的影响尤为严重。据报告，父母在促成女儿的性经济交易方面难辞其咎，而这已成为怀孕的关键驱动因素。年轻和未婚意味着少女可能面临三重耻辱：在获取避孕措施以预防怀孕方面的耻辱、意外怀孕时的耻辱以及终止意外怀孕时的耻辱。在少女面临社区和医疗服务提供者对其怀孕的指责和/或接受程度，以及她们隐瞒堕胎的能力方面，存在明显的社会经济差异。有支付医疗费用的能力使一些青少年能够更早地寻求终止妊娠并获得私立医疗机构的服务，而贫困少女由于融入社区而更容易受到社区指责。由于她们在选择安全堕胎方法时受到限制而出现并发症，这使得该群体的堕胎行为更易被发现。社区成员的羞辱态度也损害了青少年的生殖自主权和心理健康。对于选择保留意外怀孕的青少年来说，尽管有国家政策，但重新融入学校极具挑战性，婚姻被视为贫困少女母亲唯一的未来选择。
青少年怀孕嵌入经济不安全以及性别和年龄相关权力关系的社区结构中，凸显了引入社区层面方法来解决意外怀孕和不安全堕胎问题的重要性。将青少年怀孕视为社区问题为社区为年轻女孩提供支持创造了机会，尤其是当她们重返学校时。
