Attached.

GENDER DYNAMICS IN HEALTH SEEKING BEHAVIORS AMONG
ADOLESCENTS: THE CASE STUDY IN NAKURU COUNTY

BY

ANET ADHIAMBO OKOTH

C50/KER/PT/25503/2013

A RESEARCH PROPOSAL SUBMITTED IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTERS OF ARTS
(GENDER AND DEVELOPMENT STUDIES) IN THE SCHOOL OF HUMANITIES
AND SOCIAL SCIENCES AT KENYATTA UNIVERSITY.

SEPTEMBER 2016

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DEDICATION

I dedicate this work to my family and friends for assisting me.

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DECLARATION
This proposal is my original work and has not been presented for a degree award in any other
university.
Name:

ANET ADHIAMBO OKOTH

Registration Number : C50/KER/PT/25503/2013

Signature _________________________

Date __________________________

This proposal has been submitted for registration with our approval as University Supervisors.
Name: Dr. Okemwa Pacificah
Signature _______________________

Date __________________________

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ACKNOWLEDGEMENT

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Table of Contents
DEDICATION....................................................................................................................................... ii
DECLARATION ................................................................................................................................... iii
ACKNOWLEDGEMENT........................................................................................................................ iv
LIST OF FIGURES .............................................................................................................................. viii
ABBREVIATIONS AND ACRONYMS....................................................................................................... ix
ABSTRACT ......................................................................................................................................... xi
OPERATIONAL DEFINITION OF KEY TERMS ......................................................................................... xii
CHAPTER ONE ....................................................................................................................................1
1.1 Introduction..............................................................................................................................1
1.2 Background of the study ............................................................................................................1
1.3 Statement of the Problem..........................................................................................................4
1.4 Purpose of the Study .....................................................................................................................5
1.5 Objectives of the study ..................................................................................................................5
1.6 Research questions .......................................................................................................................6
1.7 Assumptions of the study ..............................................................................................................6
1.8 Justification and Significance of the study .......................................................................................6
1.8 Scope of the study.........................................................................................................................7
1.9 Limitations of the study.................................................................................................................7
1.10 Delimitation of the study .............................................................................................................8
CHAPTER 2 .........................................................................................................................................9
LITERATURE REVIEW...........................................................................................................................9
2.1 Introduction..................................................................................................................................9
2.2 Barriers facing Adolescents seeking reproductive health care services and facilities ..........................9
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2.3 Socio-Demographic Barriers...........................................................................................................9
2.3.1 Rights of Service and adolescents level of education .................................................................. 10
2.3.2 Distance to Health Facilities ...................................................................................................... 10
2.4 Socio-cultural barriers` inhibiting access to boys and girls reproductive health care ........................ 11
2.4.1 Access to youth friendly health services to cater for health care services ..................................... 12
2.5 Economic barriers inhibiting access to adolescent reproductive health care ................................... 12
2.3 Theoretical Framework................................................................................................................ 13
2.4 Conceptual Frameworks .............................................................................................................. 16
2.5 Conclusion .................................................................................................................................. 17
RESEARCH METHODOLOGY ............................................................................................................... 19
3.1 Introduction................................................................................................................................ 19
3.2 Research design .......................................................................................................................... 19
3.3 Study Site ................................................................................................................................... 19
3.4 Target Population........................................................................................................................ 21
3.5 Sample size and sampling techniques ........................................................................................... 22
3.6 Research Instruments.................................................................................................................. 22
3.6.1 Questionnaires for PHOs........................................................................................................... 22
3.6.2 Interview Scheduled for service deliverers and Adolescents........................................................ 23
3.7 Focus group Discussions .............................................................................................................. 23
3.8 Data collection procedures .......................................................................................................... 23
3.9Data Analysis and Presentation ..................................................................................................... 23
3.10 Ethical considerations................................................................................................................ 24
APPENDICES..................................................................................................................................... 24
QUESTIONNAIRE FOR THE PUBLIC HEALTH OFFICERS .......................................................................... 24
Letter of Introduction ....................................................................................................................... 24
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Instructions to Public Health Officers ................................................................................................. 25
SECTION A: Demographic information of Respondents ....................................................................... 25
SECTION B: Barriers inhibiting Adolsecents access to reproductive health care..................................... 26
APPENDIX TWO ................................................................................................................................ 36
INTERVIEW SCHEDULE FOR PATIENTS ................................................................................................ 36
APPENDIX THREE .............................................................................................................................. 40
INTERVIEWS SCHEDULE FOR SERVICES DELIVERANCE ......................................................................... 40
APPENDIX FOUR ............................................................................................................................... 46
RESEARCH BUDGET........................................................................................................................... 46
APPENDIX FIVE ................................................................................................................................. 47
STUDY TIMETABLE ............................................................................................................................ 47
REFERENCES..................................................................................................................................... 48
Appendix One................................................................................................................................... 50

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LIST OF FIGURES

Figure 2.1: Health Seeking Behavior Among Adolescents In Nakuru County……………. 15

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ABBREVIATIONS AND ACRONYMS

ARHDP: Adolescent Reproductive Health and Development Policy
AIDS: Acquired Immune Deficiency Syndrome
ANC: Antenatal Care
ARH: Adolescent Reproductive Health
DHS: Demographic and Health Survey
FGM: Female Genital Mutilation
HIV: Human Immune-Deficiency Virus
KDHS:

Kenya Demographic and Health Survey

KNBS: Kenya National Bureau of Statistics
MOH:

Ministry Of Health

MDG: Millennium Development Goals
NCSTI: National Commission for Science, Technology, and Innovation
WHO: World Health Organization

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ABSTRACT
The study set out to investigate whether boys and girls access health care and services and those who do
not access health care and services, health-seeking behaviors as well as the dynamics that influence the
behaviors among boys and girls in Nakuru County. A total of 25 boys and 25 girls in Nakuru County
were interviewed using mixed methods of research that entailed both qualitative and quantitative research
methods. The tools included questionnaires, interviews, and focus group discussions. Besides the girls
and boys, five clinical officers from the Rift Valley Provincial General Hospital and War Memorial
Hospitals were also interviewed. A sample population of 60 respondents and 2 pharmacists was selected.
The sample was collected through the snow balling sampling technique. This method allowed the
researcher to collect the required data with respect to the objectives of the study. The data analysis was
done using simple descriptive analysis technique. The study found that education, income, gender,
ethnicity and distance to health affect health-seeking behavior. The higher the level of education and
income, the more the respondents sought health services, whereas, the greater the distance to health
centers, the less health services were sought. A high percentage of boys and girls delayed visits to health
facilities citing that they cannot get appointments from health facilities and while others did not have time
to attend health facilities.
The study concludes that socio-demographic, socio-cultural and economical barriers influence healthseeking behaviors among boys and girls and therefore it will establish ways through which boys and girls
access health care and ways in which the same services can be enhanced. For instance, those boys and
girls who cannot access health care and facilities cited that they delay seeking health care, others cannot
get appointments from health facilities while others do not have time to attend health facilities and those

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who access health care and services cited reasons that they have enough income to cater for hospital bills
and also they can access routine gynecological examination.

OPERATIONAL DEFINITION OF KEY TERMS

Adolescent stage- defined as the second decade of life that is between 10-19 years of age
Youth- is a person aged 15-24 years old
Adolescent- is the period between 11 and 19 years old
Reproductive health-is a state if complete physical, mental and social well-being and not
merely the absence of disease or infirmity in all matters related to the reproductive system and to
its functions and processes
Reproductive health care-defined as the constellation of methods, techniques, and services that
contribute to reproductive health and well-being (United Nations, 1995-30)
Gender Dynamics- The way in which men and women are treated or behave differently in
society, either with their own gender or with each other

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CHAPTER ONE
1.1 Introduction
This chapter discusses the background of the study, statement of the problem, purpose of the
study, objectives, research questions, assumptions, justifications, and significance of the study,
scope, limitations, delimitations, theoretical, and conceptual framework.
1.2 Background of the study
Young people constitute a major potential for socio-economic development in every country. In
Kenya, adolescents aged 11-19 years account for 30 percent of the total population (MOH,
2012). As the future leaders of the country, it is important to ensure that young people are
educated, well informed, and provided with improved health care services and facilities. Creating
an acceptable atmosphere for adolescents to learn about transition to adulthood is one of the
central issues in health-care provision. Values, attitudes, and behaviors for promoting positive
living, including those on reproductive health are developed at the adolescent stage. Therefore,
educating adolescents and young adults on sexual and reproductive health has the benefit of
contributing to the well-being of the members of the society as well as helping them to develop
their potentials.
The development of the Adolescents Reproductive Health and Development Policy of 2003 is in
line with some of the short and long-term objectives of the government of Kenya. In 1994, the
International Conference on Population urged governments to make reproductive health services
available, accessible, acceptable, and affordable to young people. In line with this
recommendation, the Government of Kenya developed a national Adolescent Reproductive
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Health and Development Policy (ARHDP) in 2003. The Policy establishes a relationship
between the nation’s development and the health of its youth and recognizes the critical role
young people can play in promoting their own good health. It also emphasizes a multi-sector,
interdisciplinary approach to the provision of integrated and quality reproductive health services.
The policy brings into focus key adolescent reproductive health issues and a range of challenges,
from sexually transmitted infections (including HIV) to teenage pregnancy, unsafe abortions, and
school dropout, along with harmful practices such as early marriages, female genital mutilation
(FGM), and gender based violence, and drug and substance abuse.
Globally, there are an estimated 72 percent of girls and 56 percent boys reporting health
problems with an average of 1.93 percent complaints per girl and 0.5 complaints per boy
according to a survey conducted by the World Health Organization in 2014 (WHO, 2014).
However, only 43 percent girls and 35 percent boys report to a clinic voluntarily to seek help and
only one-fifth report their actual problems reflecting poor health seeking behavior.
The World Health Organization reports that an estimated 1.4 billion adolescents died in 2013
worldwide. Around 1 in 6 persons in the world is an adolescent. All these deaths take place in
low-resource settings. The risk of an adolescent in a developing country of dying from a
reproductive health-related causes during their lifetime is about 33 times as compared to
adolescents in developed countries. Complications linked to sexually transmitted diseases
contribute the second cause of death for 15-19 year old girls globally. One of the Millennium
Development Goals is to achieve universal access to reproductive health for which one of the
indicators is the state of reproductive health among the 15 to 19 age group.

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According to the Russian Federation Reproductive Health Survey of 2013, 54 percent of
adolescents have a routine gynecological examination. Twenty percent delay seeking
reproductive health care. Twenty one percent of them cannot get an appointment from health
facilities; thirteen percent of them do not have time to attend health facilities while eleven
percent says that health facilities are not open during the periods that they require reproductive
health care. According to the same report, twenty-eight percent of the adolescents can easily
satisfy their needs economically, while fifty-nine percent can hardly satisfy their needs, eleven
percent can hardly make ends meet while two percent of the adolescents are not sure.
Africa has the largest number of adolescents in the world according to the Adolescent
reproductive health and Development Policy where approximately 98 percent of the Adolescents
seek health care facilities in the region (Babahola and Fatuss, 2009). Ghana is one of the six
countries that has 25 percent of Adolescents seeking health care facilities and services, the others
being India, Syria, Gabon, Nigeria, and Democratic Republic of Congo (DRC) (Hogan, et al,
2013). The adolescent response ratio is estimated at 900 per 100,000 girls and boys according to
this Demographic and Health Survey (DHS) conducted in 2012 (Meganaw, 2013).
Safe initiation of adolescents Health Policy conducted in Havrongo region of Ghana and reported
that the barriers adolescents in developing countries face when seeking health care services
include long distance from the health services, high costs like direct fees and transportation,
disparities in education and unemployment. Young girls are less likely to have access to
available resources and are more likely to be employed in low-paying jobs. Some socio-cultural
practices include law, norms, and customs especially those related to sex (Babahola and Fatuss,
2009)..
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In Kenya, most areas have not enabled the boys and girls to access health care services and
facilities. Therefore, a significant portion of boys and girls do not have access and are therefore
not ab...