Beliefs and perceptions of sexual and reproductive health and rights among tribal adolescent girls in Kerala, India: A qualitative study

Smitha JS, Sabitha Nayak, Lija R Nath, Lakshmi Manjeera, PrasannaKumar Shetty k, Nalini M, Manju L

Abstract

Tribal adolescents experience considerable sexual and reproductive  health challenges due to socio-cultural taboos, limited access to health services, and inadequate guidance. These factors increase vulnerability to early marriage, early pregnancy, and poor health-seeking practices. This study examined sexual and reproductive health beliefs and experiences among tribal adolescents in Kerala, India. A qualitative study employing thematic analysis was conducted. Fifty participants (18 adolescent girls, 20 mothers, and 12 health volunteers) were recruited through purposive sampling. Data were collected through eight focus group discussions using validated FGD guides.  Five major themes and sixteen subthemes emerged, including menstrual health and hygiene; behavioral and socio-cultural influences; misconceptions regarding sexually transmitted diseases; limited awareness and access to contraceptives; and barriers to reproductive health services such as distance, transport constraints, and lack of adolescent-friendly care. The study concludes that sexual and reproductive health beliefs of tribal adolescents are influenced by socio-cultural norms, knowledge gaps, limited parent–adolescent communication, and restricted healthcare access. Addressing these challenges requires culturally appropriate education, parental involvement, and strengthened adolescent-friendly health services.

Full Text:

PDF

References

World Health Organization. Adolescent health. Geneva: World Health Organization; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-health

International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019–21: India. Mumbai: IIPS; 2021. Available from: https://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf

United Nations Population Fund. State of World Population 2023: Unfinished Business—The Promise of 2030. New York: United Nations Population Fund; 2023. Available from: https://www.unfpa.org/swop

World Health Organization. Adolescent pregnancy. Geneva: World Health Organization; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent- pregnancy

United Nations. The Sustainable Development Goals Report 2023. New York: United Nations; 2023. Available from: https://unstats.un.org/sdgs/report/2023/

World Health Organization. Global guidance on adolescent sexual and reproductive health services. Geneva: World Health Organization; 2021. Available from: https://www.who.int/publications/i/item/9789240025257

Jejeebhoy SJ, Santhya KG. Reproductive and sexual health of young people in India: a review of evidence. Int Perspect Sex Reprod Health. 2019;45:1-17. doi:10.1363/45e7019.

Shri N, Singh M, Dhamnetiya D, Bhattacharyya K, Jha RP, Patel P. Prevalence and correlates of adolescent pregnancy, motherhood and adverse pregnancy outcomes in Uttar Pradesh and Bihar. BMC Pregnancy Childbirth. 2023;23:66. doi:10.1186/s12884-023-05354-6.

Coast E, Lattof SR, Strong J. Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: a scoping review. Int J Public Health. 2019;64(2):293-304. doi:10.1007/s00038-019-01209-0

Kerala Scheduled Tribes Development Department. Tribal Development Report Kerala. Thiruvananthapuram: Government of Kerala; 2021. Available from: https://www.stdd.kerala.gov.in/

Registrar General & Census Commissioner, India. Census of India 2011: Provisional Population Totals. New Delhi: Government of India; 2011. Available from: https://censusindia.gov.in

Xavier T, John A. Menstrual awareness and psychological responses among tribal adolescent girls in Kanyakumari district, India. J Clin Diagn Res. 2017;11(9):LC09-LC12. doi:10.7860/JCDR/2017/28558.10660.

Population Education Cell, Government of Kerala. Tribal adolescent challenges in Kerala. Thiruvananthapuram: Government of Kerala; 2020. Available from: https://www.kerala.gov.in

Rajan SI. Cultural practices and menstrual taboos in Kerala tribes. J Soc Sci. 2021;67(4):89-98.

Renjini MU, Balan S. Socioeconomic and health intervention outcomes among Scheduled Tribe women. Int J Rural Stud. 2019;26(1):45-58.

Rosenstock IM. Historical origins of the Health Belief Model. Health Educ Monogr. 1974;2:354-386.

Becker MH, Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975;13(1):10-24. doi:10.1097/00005650- 197501000-00002.

Champion VL, Skinner CS. The Health Belief Model. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior: Theory, Research, and Practice. 5th ed. San Francisco: Jossey-Bass; 2015.

Arabkari Z, Alipour F, Fallahi-Khoshknab M, Momtaz YA, Khoie EE, Samiei M. Sexual health of adolescent girls in Tehran: definition and dimensions. J Educ Health Promot. 2020;9:257. doi:10.4103/jehp.jehp_384_20.

Singh A, Gupta V. Reproductive health perceptions among rural Indian adolescents. Indian Pediatr. 2018;55(8):659-664. doi:10.1007/s13312-018-1346-y.

Tiwari A, Sadhu G. Teenage pregnancy among tribal populations: a review of socio-cultural, health, and policy perspectives. J Epidemiol Found India. 2026;4(1):33-39. oi:10.56450/JEFI.2026.v4i01.004.

Ministry of Health and Family Welfare, Government of India. Rashtriya Kishor Swasthya Karyakram (RKSK): Operational Framework. New Delhi: Ministry of Health and Family Welfare; 2014. Available from: https://nhm.gov.in

World Health Organization. WHO recommendations on adolescent sexual and reproductive health services. Geneva: World Health Organization; 2018. Available from: https://www.who.int/publications/i/item/9789241550471

Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. 4th ed. Thousand Oaks (CA): SAGE Publications; 2018.

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer; 2021.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa.

Gundi M, Subramanyam MA. Menstrual health communication among Indian adolescents: a mixed-methods study. PLoS One. 2019;14(10):e0223923.doi:10.1371/journal.pone.0223923.

Hennegan J, Shannon AK, Rubli J, Schwab KJ, Melendez-Torres GJ. Women’s and girls’ experiences of menstruation in low- and middle-income countries: a systematic review and qualitative metasynthesis. PLoS Med. 2019;16(5):e1002803. doi:10.1371/journal.pmed.1002803.

Shibu A, Amaresha AC. Socio-cultural practices and experiences of menstruation among adolescents and women of Kurichiya tribe of Wayanad: an ethnographic study. Int J Community Med Public Health. 2023;10(12):4669-4676. doi:10.18203/2394-6040.ijcmph20233761.

Torondel B, Sinha S, Mohanty JR, et al. Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections. PLoS One. 2018;13:e0202332.doi:10.1371/journal.pone.0202332.

Pillai RS. School drop-out among tribal children in Kerala: a case study of Wayanad. Afro Asian J Soc Sci. 2020;11(1.1).

Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health. 2018;15:15. doi:10.1186/s12978-018-0460-4

Raj A, Saggurti N, Balaiah D, Silverman JG. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India. Lancet.2009;373(9678):1883-1889. doi:10.1016/S0140-6736(09)60246-4.

Kawale SK, Sharma V, Thaware PP, Mohankar AD. Awareness about HIV/AIDS among rural population of central India. Int J Community Med Public Health. 2018;5(1):373-376. doi:10.18203/2394-6040.ijcmph20175816.

Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma and delays in seeking care among HIV-infected people in India. J Int Assoc Provid AIDS Care. 2013;12(2):103-109. doi:10.1177/1545109711432315.

Stangl AL, Earnshaw VA, Logie CH, van Brakel W, Simbayi LC, Barré I, et al. The Health Stigma and

Discrimination Framework: a global, crosscutting framework to inform research,intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1):31. doi:10.1186/s12916-019-1271-3.

Nigar A. Contraceptive awareness, and practices among rural women in Lucknow. Indian J Obstet Gynecol Res. 2018;5(4):454-457. doi:10.18231/2394-2754.2018.0104.

Suchithra ET, Sujina CM. Family planning practices among married women in rural Kerala. Indian J Forensic Community Med. 2016;3(1):13-19. doi:10.5958/2394- 6776.2016.00002.3.

Sedgh G, Ashford LS, Hussain R. Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. New York: Guttmacher Institute;2016.

Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan. 2012;27(4):288-300. doi:10.1093/heapol/czr038.

Refbacks

  • There are currently no refbacks.