Health workers’ perceptions and ethical issues faced in the delivery of contraceptives to adolescents at selected Public health facilities in Kampala

Abstract

Introduction: Adolescent pregnancy and subsequent childbirth among women less than 18 years old continues to be a major global public health concern, affecting more than 16 million girls and young women worldwide. Uganda reports the highest proportion of women giving birth before the age of 20 (63%), and has the highest total fertility rate (6.2) in East Africa. More adolescent girls die due to pregnancy-related conditions like obstructed labor, post-partum hemorrhage and unsafe abortions with a 60% death rate in Africa. Despite the importance in using contraceptives for preventing unwanted pregnancies, unsafe abortions and abortion related complications that expose adolescents to health-related risks, consumption is still very low in Uganda (7.6%). The low consumption rates have been addressed in several studies through sensitization, and providing free contraception services to the adolescents and young adults but the rate remains unchanged. This has been related to the reluctance of Health Care Providers (HCP) to provide contraceptives to young people below 18 years of age. Therefore, this study aimed at identifying HCPs perceptions and ethical issues associated with promoting the use of contraceptives by adolescents. Objective: The objective of this study was to explore HCPs’ perceptions and ethical issues associated with the delivery of contraceptives to adolescents at selected public health facilities in Kampala District Method: A cross sectional study employing qualitative data collection methods, including in- depth interviews (IDIs) was conducted. The study involved 15 participants, including nurses, midwives and counselors. All interviews were conducted in the English language; audio recorded, transcribed verbatim and analyzed thematically using Microsoft Excel. Results: Most participants were Midwives and had an experience of more than 10 years of working as health care providers. Twelve out of fifteen participants were willing to provide contraceptives to adolescents. However, many of them had very little knowledge on ethics and its elements. Several HCPs thought of ethics as mere rules and regulations that govern them professionally. HCPs were not aware of any laws concerning adolescent use of contraceptives in Uganda and as a result, they were very prone to medical litigation incase parents sued them for giving their children contraceptives without parental consent. This was an enormous ethical dilemma that they faced. HCPs also considered parents and community members as a boundless

hindrance to adolescents’ use of contraceptives. HCPs requested the government to improve the awareness of the parents and public at large through sensitizations and other possible means Conclusion: This study discovered that HCPs have positive attitude when it comes to providing contraceptives to adolescents. They are aware of the several benefits of contraceptives to adolescents and feel these adolescents should also be entitled to this kind of health care services without any hindrances. However, Parents and community members are still a barrier to adolescents’ use of contraceptives given now that the country has no laws promoting it directly. This also makes the consenting process difficult because these adolescents are below the legal age of making decisions on their own yet the HCPs have to maintain the adolescents’ confidentiality.