Ampliación

Outcome concerns pertain to the consequences or end product of experiencing or engaging in certain sexual and reproductive practices. Adolescent participants were concerned

about a range of outcomes related to menstruation, sexual activity, pregnancy, contraceptives, and STI/HIV.

Regarding menstruation, the main outcome that female participants were concerned about pertained to discomfort of wearing sanitary napkins, cramping and headaches which resulted in missed school days and social activities. As a result of this, most female participants reporting that they disliked ‘having periods’. The following two excerpts illustrate female participants’ views:

Mary: Well first of all I hate seeing my period (Uhuh) because every month I don’t like to feel pad, I hate to use it.

(PAM, UI14)

Jenna: One thing I’m most concerned about is my period because it always changes dates and it gives me headache and cramps….The good thing…is I don’t do any work at all, just lie down and sleep for the whole day and drink Supligen and Welsh’s wine [energy drinks].

(Female Adolescent, RI1) Jenna, unlike other female participants talks about being pampered during her menstrual period due to the discomfort she experienced. Moreover, adolescents’ dislike toward their menstrual cycle may be a result of the timing and manner in which they learn about menstruation. According to female adolescent participants, they learned about menstruation during menarche from a female family member, or in primary and/or secondary school which sometimes occurred after menarche. In the following focus group excerpt, participants Kara and Andrea discuss their experience learning about menstruation:

Kara: But when I never used to see my period... [my] mother never used to (pause) talk about period and stuff.

Andrea: Yeah and now like when we going out she’s like, “don’t/ go out and have sex because you could get pregnant.”...

Kara: She used to tell me that./ Or…she doesn’t like come out plain and tell me, she does just tell me, “be careful”....

(Female Adolescents, UCFG10)

In the above excerpt, 17-year old Kara discusses that her mother never told her about menstruation before she experienced it, and both Kara and 15-year old Andrea note that

unlike prior to menarche, now they are cautioned to practice sexual abstinence because of the risk of pregnancy. Therefore, it is possible that some parents view menstruation in their adolescent daughters as an unwelcomed developmental marker because it signals the potential for pregnancy. Parents’ view of menstruation may also explain female participants’

high levels of vulnerability to pregnancy discussed in section 5.2.1. The above excerpt also suggests that parents may experience discomfort talking about menstruation and sexual activity, as Kara states that her mother ‘doesn’t like come out plain and tell me’, which is consistent to other female participants’ response (section 6.2).

Additionally, there were outcome concerns about menstruation that were related to pregnancy. This pertained to irregular menstruation (i.e. ‘missed period’ and ‘spotting’) as an indication that conception had occurred. However, not all participants viewed irregular menstruation as a cause for concern. In the excerpt below, 18-year old Brian discussed two reasons why irregular menstruation might occur.

Brian: ...if the girl don’t see she period for the last month, well to me like she breed....I hear when girl like- she accustom having sex [and] you go and have sex with somebody else, the period does change.

(NEWLO, UFG1) Although some adolescent mothers discussed that their experiences of spotting or light flow was indeed a sign of conception, Brian also point out that irregular menstruation could indicate the body balancing itself because of change as is done via homeostasis, or conceptualized via astrology. Seventeen-year old Sara from the rural community more clearly discusses an astrological perspective which would not cause concerns about pregnancy:

Sara: Well, no I don’t find she should worry about that, because (pause) according to what me mother said, according to how the moon cut your period does miss sometimes.

(Female Adolescent, RCFG5)

Nonetheless, pregnancy as an outcome of sexual activity was a concern shared across subgroups of adolescent participants, as is clearly illustrated in the card sort activity. One reason for this is because pregnancy was viewed as a big responsibility for the adolescent parent(s) and/or his or her family. For example, during the word game, when adolescent participants were asked “what comes to mind when you think, hear or see the words teenage pregnancy, adolescent mother, adolescent father” most times responsibility was the first and

most recurring adjective used. Responsibility was discussed as being able to provide the basic needs for the baby and mother during and after pregnancy, and participants discussed that this was no easy feat. In the following excerpt, male focus group adolescent boys discuss their feeling about becoming teenage fathers based on the scripted story:

Shaka: Yes, scared of the whole issue of becoming a father.

Jay: Like if I, me and my girlfriend get pregnant I go kinda fall down, yeah I go get scared because I still in school, I have to go and work and mind me child and mind she too. I go feel kinda frustrated.

(NEWLO, UFG9)

As illustrated in the above excerpt, participants see teenage fatherhood as scary and resulting in taking on adult responsibility. However, most male participants agreed that most boys their age wanted to be fathers, which may be one of the reasons why girls are concerned about their vulnerability to early pregnancy (section 5.2.1). Furthermore, with early pregnancy, most participants were concerned that the burden of responsibility lies with the adolescent mother.

According to participants, whether or not some men/boys admit to causing the pregnancy they may not accept/undertake their responsibility as fathers, and policies such as the Education Policy on Pregnant Students (section 4.2.2) do not appear to emphasize the responsibility of the young father. Additionally, some male participants discussed that pregnancy was used as a survival strategy for some adolescent girls, as is illustrated in the following male focus group excerpt:

Justin: Or according to what family you come out in too, they go do anything to get child from you because they know (sucks teeth) the family go stand up.

James: Yeah you rich.

Justin: So they go like, “the money man, make a child for him.”

(Adolescent Males, RCFG8)

In the above excerpt, the male participants suggest that a girl may choose a boy to conceive with based on his family’s socioeconomic status as a means of securing her livelihood during difficult economic situations. This has implications for whether girls decide to proceed with a pregnancy, and help-seeking.

Another outcome concern pertains to adolescents being hindered from achieving their educational and career aspirations as a result of unwanted outcomes, such as pregnancy and HIV. The majority of participants discussed that especially for early pregnancy, they risked being ‘thrown out of school’. This happens in spite of legislation and policy mandating education for all between ages 5 and 16 (section 4.2.2). Adolescent participants discussed that girls are more likely to be ‘thrown out of school’ or leave of their own volition (section 6.4).

Thus adolescents were concerned about early pregnancy occurring as a means of interrupting their education and future careers. However, adolescent mothers in the study discussed that pregnant girls can attend PAM successfully and go on to have their dream careers, as is also documented in PAM’s Handbook (PAM, 2008).

Related to pregnancy and STI/HIV are outcome concerns pertaining to the side effects of some contraceptive methods. However, this was only discussed among female participants. For example, some female adolescents were concerned about the carcinogenic outcome of some contraceptives. This is illustrated in the following focus group excerpt:

Coco: The pill and the condoms can also give you cancer (pause) anyway.

These two can also give you cancer so it doesn’t make no sense using those things, you just have to wait (pause) and wait. (giggle)

Sherma: The spermicide and pills good for when people married already and thing

Coco: And abstinence until you ready (Okay) well not when you ready, but (pause) when you settle./

(Female Adolescents, RCFG2) The above excerpt also suggests that contraceptive may be for married adults and that abstinence is the preferred method for adolescents until they are older and have finished college and/or married, as this group of adolescents defined as the right time for adolescents to have sexual intercourse. Additionally, one participant, 16-year old Carmen indicates a balancing act between two outcome concerns – concerns about the carcinogenic outcomes of the pill similar to the females in rural focus group above, but also the about the outcome of being expelled from PAM even if she does not want to use the pill:

Carmen: And then most people who on the contraceptives die from cancer.

Interviewer 1: Okay. So you think it's safer not to be on contraceptives?

Carmen: Yeah. But because of the school ah go have to get it though, huh (laughs) I want the card, just the card I want to show that I join in the thing.

(PAM, RI15)

Some adolescents are concerned about experiencing certain SRH outcomes, because of the consequences attached to them, however other adolescents discussed that SRH outcomes may be desirable, especially for boys. The findings suggest that outcome concerns are caused by behaviours of the adolescents or paraphernalia, such as issues contraceptives, designed to prevent these concerns. Notwithstanding, some adolescent participants discussed first-hand experience, mainly via semi-structured interviews, with some of the above concerns and how they coped with them. Adolescents’ help-seeking behaviour as a form of coping with their SRH concerns is discussed in section 5.3 below.