Abstract of Master’s Dissertation
No.1

International HealthDevelopment

CourseName

Etsuko Yamaguchi

Thesis

Cross-sectional study of stigma related to girls’ contraceptive use perceived

Title

among unmarried in-school adolescents in rural areas of central Zambia

Abstract of Master’s Dissertation
Background:
Stigma perceived by adolescents (aged 10–19) related to their sexual and reproductive
health (SRH) should be a critical barrier to their access to contraceptives, which is
however focused by few studies. A non-governmental organization (NGO) called
JOICFP initiated a five-year program in rural communities of central Zambia in 2018 toimprove access to modern contraceptives among sexually active adolescents towards
reduction of adolescent pregnancies. The program trained Peer Educators (PEs) andadult volunteers to conduct SRH promotion, distribution of free contraceptives, andreferrals of adolescents to health facilities, whose healthcare workers were also trainedby the program in adolescent friendly SRH service delivery. Routine data,
nevertheless, showed an increase in adolescent pregnancies.
Objectives:
The study aimed to estimate the level of stigma on adolescent girls’ contraceptive use
perceived among unmarried adolescents in the program sites. The hypothesis wasthat their stigma precluded them from using contraceptives resulting in the increase inadolescent pregnancies.
Methods:
A school-based cross-sectional quantitative study with self-administered questionnaires
was conducted in the program sites in Kapiri Mposhi and Mpongwe districts. The
validated scale of Contraceptive Use Stigma among adolescents (CUS) was used tomeasure adolescents’ stigma levels, which consists of seven stigma statements scored ona five-point Likert scale for the extent of respondent’s agreement/ disagreement witheach statement, thereby the total score ranges from the lowest stigma level of seven tothe highest of 35. Data was collected in January and February 2022 from male andfemale PEs and unmarried students aged 10–19. All the 51 eligible PEs were invited.
Two hundred students were selected using the probability proportionate cluster
sampling method. Descriptive statistics, non-parametric tests, and logistic regression
models were used to estimate the association between CUS scores and sex, age,contraceptive use, and program exposures.
＊ The abstract, containing background, objectives, methods, results and conclusion should notexceed 300-500words and printed double sided on A4 paper)

Abstract of Master’s Dissertation
No.2
CourseInternational HealthDevelopment

Name

Etsuko Yamaguchi

Results:
Totally 246 responses (51 PEs and 195 students) were analyzed. The scaledemonstrated acceptable internal consistency (α=0.7029). PEs’ mean CUS score was
16.92 (standard deviation (SD)=6.21) against 25.16 (SD=5.16) among the students.
The most significant determinant of lower scores was PEs (odds ratio (OR)=0.09, 95%confidence interval (CI) 0.08－0.095). Among the students, those of Mpongwe showed
the highest association with higher scores (OR=4.39, 95% CI 1.85－10.37) while SRH
service use was associated with lower scores (OR=0.19, 95% CI 0.10－0.40). As few as
24 respondents (9.8%) reported contraceptive use, composed of 31.4% of the PEs and4.1% of the students. Higher contraceptive use was strongly associated with PEs(P<0.001) and with male students (P=0.03).
Conclusion:
No direct association was established between adolescents’ stigma levels and theircontraceptive use, which could not however be entirely rejected considering the strong
associations of PEs with both lower stigma levels and higher contraceptive use andbetween students’ SRH service use and lower stigma levels. To tackle SRH-related
stigma among students, the program should intensify its interventions with more
careful attention to the quality through nurturing their self-esteem and addressing
gender- and age-related norms. More research is required to identify effective stigma
reduction interventions.

(Word count: 500 words)