Key Social Norms Take-aways In Kisumu, Kenya, adolescent girls face intense social stigma around sexuality and pregnancy, with pregnancy seen as the most feared and shame-inducing consequence of sexual activity. Unlike HIV—which is viewed as treatable—pregnancy visibly signals sexual behavior and attracts harsh judgment from families, communities, and healthcare providers. These stigmas suppress open dialogue, restrict access to contraception, and push some girls toward unsafe abortions or suicidal ideation. Social norms emphasize chastity and family honor, leaving girls isolated and unsupported when navigating their reproductive health.
Objectives To explore how social norms and stigma around adolescent sexuality, contraception, pregnancy, and abortion shape adolescents’ decision-making and sexual and reproductive health behaviors in the informal settlements of Kisumu.
Methods The study used qualitative methods, conducting 14 focus group discussions with 120 adolescents aged 15–19, sampled from four informal settlements. Groups were stratified by age, gender, school status, and motherhood. Semi-structured interview guides and vignettes were used to elicit attitudes and community norms. Data were analyzed using the Framework Approach, guided by the Social Ecological Model, with inductive and deductive coding conducted collaboratively by U.S. and Kenyan researchers.
Results Pregnancy was described as more feared than HIV due to its visibility and stigma. Girls feared being expelled from home or school, while boys feared social shaming and punishment. Despite this fear, contraception use was low due to stigma, embarrassment when accessing methods, and misinformation—particularly for girls. Accessing contraception was often avoided to prevent being labeled as sexually active. This stigma led some girls to pursue unsafe abortions, sometimes with fatal outcomes, or to consider suicide. Even when girls carried pregnancies to term, they often experienced social isolation and mistreatment from healthcare providers during childbirth, compounding the trauma.
Conclusions Adolescents in Kisumu navigate a complex web of stigma where fear of social exposure outweighs health concerns. Programs aiming to reduce unintended pregnancy must address these entrenched norms and the associated silence around adolescent sexuality. Expanding access to adolescent-friendly services is necessary but insufficient; community-level interventions that normalize conversations around sexual and reproductive health and reduce judgment are critical. Learning from the success of HIV stigma reduction, similar investments and systemic approaches are needed to transform how adolescent pregnancy and sexuality are perceived and addressed.