Facilitating women's access to misoprostol through community-based advocacy in Kenya and Tanzania.

OBJECTIVE: To explore the feasibility of educating communities about gynecologic uses for misoprostol at the community level through community-based organizations in countries with restrictive abortion laws. METHODS: In 2012, the Public Health Institute and Ipas conducted an operations research study, providing small grants to 28 community-based organizations in Kenya and Tanzania to disseminate information on the correct use of misoprostol for both abortion and postpartum hemorrhage. These groups were connected to pharmacies selling misoprostol. The primary outcomes of the intervention were reports from the community-based organizations regarding the health education strategies that they had developed and implemented to educate their communities. RESULTS: The groups developed numerous creative strategies to reach diverse audiences and ensure access to misoprostol pills. Given the restrictive environment, the groups attributed their success to having addressed the use of misoprostol for both indications (abortion and postpartum hemorrhage) and to using a harm reduction approach to frame the advocacy. CONCLUSION: This initiative proves that, even where abortion is legally restricted and socially stigmatized, community-based organizations can publicly and openly share information about misoprostol and refer it to women by using innovative and effective strategies, without political backlash. Furthermore, it shows that communities are eager for this information.

Rape myth attitudes in rural Kenya: toward the development of a culturally relevant attitude scale and "blame index".

Rape myth attitudes (RMAs) can excuse men for rape, placing blame on female victims. This study identified and classified RMAs in rural western Kenya through 31 focus group discussions with youths and adults. We found that about half of the participants were likely to blame victims unconditionally. Stereotypes about rape victims and perpetrators were rife. Five of seven standardly used RMA categories emerged spontaneously in focus groups, along with a new category: "she owed him." Based on the data, we developed a "blame index" to assess the likelihood of community victim blaming in Kenya. To reduce victim blaming and bring about more prosecutions for rape, community education, teacher training, and reforms of rape laws are highly recommended.

Community norms about youth condom use in Western Kenya: is transition occurring?

Most HIV prevention strategies for African youth have been ineffective in changing key behaviors like condom use, partly because community antagonism and structural barriers have rarely been addressed. Through qualitative research in rural Western Kenya, we sought to describe the attitudes of different segments of society towards youth condom use and to identify where transitions may be occurring. We found that about half of community members strongly opposed youth condom use, with many advocating punishment such as beatings and expulsion. Our research revealed significant differences in attitudes by gender, with females generally more opposed to youth condom use. Health providers, teachers and male students seemed to be transitioning to more permissive attitudes. They also had more accurate knowledge about the condom. Building on these transitional views, we would recommend that schools eliminate sanctions for students found with condoms and that clinics discourage providers from interrogating youths about their reasons for wanting condoms. Furthermore, we believe that health campaigns should portray condoms as "disaster preparedness" devices for responsible youths, and more efforts should be made to dispel myths about condoms' efficacy.