Exploring the Feasibility and Acceptability of a Participatory Workshop Program to Reduce Stigma Associated with Sexual and Reproductive Health and Contraception Among Adolescent Girls and Young Women in Kilimanjaro, Tanzania: A Mixed-Methods Pilot Study

Abstract

Background: Nearly all contraceptive services in Tanzania are free of charge, however, many adolescent girls and young women (AGYW) do not seek contraception through community clinics for various reasons. This includes a complex web of social pressures, with stigma and perceived promiscuity casting a shadow over AGYW who access contraception. In turn, adolescent sexual and contraceptive stigma contributes to reduced reproductive autonomy and a lack of female sexual empowerment. Interventions targeting contraceptive stigma are understudied, thus a participatory workshop series was adapted for contraceptive stigma reduction among AGYW. Methods: This is an adolescent friendly, culturally competent research program which has adapted and piloted a participatory stigma-reduction workshop series. The stigma-reduction training guide published by the London School of Hygiene and Tropical Medicine, originally designed to address HIV-related stigma among healthcare workers, was adapted to target sexual and reproductive health (SRH) and contraceptive stigma among AGYW. This study implemented stigma-reduction workshops and evaluated their potential efficacy in reducing stigma, as well as obtaining qualitative feedback on workshop quality and impact among AGYW aged 15-20 in Kilimanjaro Region, Tanzania (n=40). Qualitative data was collected from focus group discussions using codebook-approach thematic analysis to reflect participant narratives. Quantitative data was collected pre- and post-intervention using the contraceptive use stigma (CUS) scale, adolescent SRH (ASRH) stigma scale, and sexual double standards (SDS) scale to assess changes in attitudes and beliefs over time. Changes in stigmatizing attitudes and beliefs were assessed by comparing the pre-post survey scores using paired and independent sample t-tests, while differences in medical history and self-reported knowledge were assessed by Chi-square tests between urban and rural participants. Data collection and evaluation was completed over a 3-month period in urban and rural Kilimanjaro, Tanzania. Discussion: The findings of this study provide insights into the potential efficacy and acceptability of the intervention program and will inform necessary revisions and adaptations as well as future mixed-methods research. The results will guide the development of a larger-scale trial to examine the efficacy of the intervention and delivery strategies with a view to reach scale-up, costs, and sustainability in other districts and regions in Tanzania.