EXPLORING MEDIA FRAMING OF ABORTION CONTENT ON KENYAN TELEVISION: A FOCUS ON ADOLESCENTS By Catherine Kafu School of Literature, Language and Media Studies Department of Media Studies A Dissertation submitted to the Department of Media Studies, Faculty of Humanities, University of the Witwatersrand, Johannesburg, in fulfilment of the requirement for the degree of Doctor of Philosophy. 2024 i DECLARATION I declare that this thesis is my original unaided work, and it has not been previously submitted for a degree or diploma at any other university. Where other people’s works have been used, this has been fully acknowledged. This thesis is submitted in fulfilment of the requirements of the award of the Degree of Doctor of Philosophy in the Faculty of Humanities at the University of the Witwatersrand, South Africa. Signature: Date: ___________________________ December 12, 2024 Catherine Kafu Student Number: 1540298 Johannesburg, 2024. ii ACKNOWLEDGEMENT This academic journey has been enriching but arduous and would not have been possible without the support and commitment of numerous individuals and organizations. Given the space limitations, I might not be able to name them all, but I will mention a few. To begin with, I am grateful to the School of Literature, Language and Media (SLLM), specifically, the department of Media Studies for offering me the opportunity and support to undertake this doctoral program. I am honored and grateful for my outstanding supervisors Professor Dina Ligaga and Dr. Juddy Wachira for their tireless support and intellectual generosity. They played a major role in supporting the development of this work from proposal to dissertation through their contribution of thoughts and ideas that helped shape this work. Over the last five years they have consistently mentored me intellectually, guided me into thinking more critically, and calmed me in the storm of my dissertation. I have benefited greatly from their invaluable advice and intellectual rigor. It’s no doubt that they have contributed significantly to my growth as a scholar and a person. Special thanks go to my family, friends and colleagues. My son Ty Wekesa Onyango, thank you buddy for being patient with me. Sabina Achieng, Job Mwaura, Beryl Maritim, Oyeyemi Oyelade, Lindiwe Farlane, Siphamandla Gumede, Ann Maina and Samuel Mwaniki you have been amazing friends, my greatest support system, my biggest cheerleaders, and always believed that I could do this. Thank you. I also acknowledge the inspiration and motivation that I received over the years from colleagues at CARTA, as well as Sebastian Brett and Soledad Falabella of ESE:O. Through conversations and/or written comments at earlier stages of this journey, they influenced my thinking around the topic and the work that I ultimately produced. I am very thankful to them for their suggestions, words of encouragement, and the help they offered me along this journey. iii I would also like to acknowledge the contribution of study participants who shared their time, experiences and opinions with us during focus group discussions; research assistants who facilitated data collection; and Job Mwaura and Mark Omollo for their invaluable assistance with data analysis. Without this team, this work would not have been possible. Funding Acknowledgement: This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No. G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Center, Norwegian Agency for Development Cooperation (Norad), and by the Wellcome Trust [reference no. 107768/Z/15/Z] and the UK Foreign, Commonwealth & Development Office, with support from the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme. The statements made and views expressed are solely the responsibility of the Fellow. iv DEDICATION This work is dedicated to girls, women and/or families affected by unsafe abortion. May you never shy from using your voices to advocate for development and implementation of policies that heighten the realization of women’s optimal sexual reproductive health and rights outcomes. v TABLE OF CONTENTS DECLARATION ............................................................................................................................. i ACKNOWLEDGEMENT .............................................................................................................. ii DEDICATION ............................................................................................................................... iv LIST OF TABLES .......................................................................................................................... x LIST OF FIGURES ....................................................................................................................... xi LIST OF ABBREVIATIONS ....................................................................................................... xii ABSTRACT ................................................................................................................................. xiv CHAPTER ONE ............................................................................................................................. 1 BACKGROUND AND LITERATURE REVIEW ........................................................................ 1 Introduction ................................................................................................................................. 1 The framing theory: media framing as a multilevel model ......................................................... 5 Framing .................................................................................................................................... 5 Frame building ......................................................................................................................... 6 Framing effects ........................................................................................................................ 7 Framing research ......................................................................................................................... 8 Framing of abortion messages in the news media....................................................................... 8 Abortion as culturally problematic ........................................................................................ 10 Abortion: An immoral Act .................................................................................................... 12 Abortion media coverage is not all inclusive ........................................................................ 14 Abortion is dangerous and thus appropriately restricted. ...................................................... 17 Abortion right discourse ........................................................................................................ 20 Abortion coverage and the audience ......................................................................................... 22 Research Gap............................................................................................................................. 24 Objectives .................................................................................................................................. 25 Significance of the study ........................................................................................................... 26 Justification of the study ........................................................................................................... 27 Scope of the study ..................................................................................................................... 28 Conclusion ................................................................................................................................. 30 CHAPTER TWO .......................................................................................................................... 32 THE KENYAN SOCIO-CULTURAL SCENE............................................................................ 32 vi Introduction ............................................................................................................................... 32 The Kenyan Socio-Cultural Scene ............................................................................................ 33 Religion and women’s sexuality in Kenya ............................................................................ 35 Colonialism, cultural subjugation and the control of women sexuality in Kenya ................. 43 Post-Independence Kenya, Patriarchy and Abortion ............................................................. 53 The value of children in the context of a family in Kenya .................................................... 65 Consequences of unsafe abortion .......................................................................................... 75 Conclusion ................................................................................................................................. 77 CHAPTER THREE ...................................................................................................................... 79 RESEARCH METHODOLOGY.................................................................................................. 79 Introduction ............................................................................................................................... 79 Research Approach ................................................................................................................... 79 Research Design ........................................................................................................................ 80 Study Site .................................................................................................................................. 81 Research Population .................................................................................................................. 81 Research Sample ....................................................................................................................... 82 Data collection tools .................................................................................................................. 83 The checklist .......................................................................................................................... 84 The Interview Guide .............................................................................................................. 84 Field Notes ............................................................................................................................. 85 Data collection procedure.......................................................................................................... 85 Retrieval of material for content analysis .............................................................................. 85 Focus Group Discussions ...................................................................................................... 87 Data analysis ............................................................................................................................. 88 The coding frame. .................................................................................................................. 88 Piloting the coding frame ...................................................................................................... 89 Main analysis phase ............................................................................................................... 91 Ethical considerations ............................................................................................................... 92 Trustworthiness ......................................................................................................................... 94 Pilot study .............................................................................................................................. 94 Triangulation ......................................................................................................................... 95 vii Member checking .................................................................................................................. 96 Dependability......................................................................................................................... 96 Confirmability ....................................................................................................................... 96 Conclusion ................................................................................................................................. 97 CHAPTER FOUR ....................................................................................................................... 100 KENYAN BROADCAST MEDIA FRAMING OF ABORTION ............................................. 100 Introduction ............................................................................................................................. 100 Sample description. ................................................................................................................. 100 Abortion as dangerous and deadly .......................................................................................... 103 Abortion as dangerous to women’s health in the short-term ............................................... 105 Abortion as dangerous to women’s health in the long-term ................................................ 108 Abortion as deadly ............................................................................................................... 111 Men in abortion trajectories .................................................................................................... 113 Men as selfish and exploitative ........................................................................................... 113 Men as empathetic and supportive ...................................................................................... 115 Rights versus Morality ............................................................................................................ 120 Bodily Autonomy and Self-Determination.......................................................................... 120 The right to the highest attainable standard of Health ......................................................... 124 The right to life .................................................................................................................... 125 Victimhood .............................................................................................................................. 128 Women victimized by the abortion legislation. ................................................................... 128 Women victimized by the socio-cultural context. ............................................................... 132 Marginalized voices in the abortion discourse ........................................................................ 134 Discussion ............................................................................................................................... 135 Conclusion ............................................................................................................................... 141 CHAPTER FIVE ........................................................................................................................ 145 ADDRESSING UNSAFE ABORTION IN KENYA: SUGGESTIONS FROM TELEVISED ABORTION COVERAGE ......................................................................................................... 145 Introduction ............................................................................................................................. 145 Sample description. ................................................................................................................. 145 Themes .................................................................................................................................... 146 viii Deal with unwanted pregnancies............................................................................................. 147 Institute the appropriate legal framework. ........................................................................... 148 Address abortion within the Public Health framework. ...................................................... 166 Address unsafe abortion within a socio-cultural framework. .............................................. 170 Partnerships with key stakeholders ......................................................................................... 180 Adopt existing strategies. ........................................................................................................ 186 Discussion ............................................................................................................................... 188 Conclusion ............................................................................................................................... 195 CHAPTER 6 ............................................................................................................................... 198 KENYAN TELEVISED NEWS MEDIA FRAMING OF ABORTION: PERSPECTIVES OF UNIVERSITY STUDENTS ....................................................................................................... 198 Introduction ............................................................................................................................. 198 Study Participants Characteristics ........................................................................................... 198 Themes .................................................................................................................................... 199 Adolescents’ experiences with and perceptions of abortion coverage in Kenyan televised new media ....................................................................................................................................... 199 Platforms and formats of publishing abortion content ........................................................ 201 Frequency and quantity of abortion content in televised news media ................................. 202 Negative framing of abortion .............................................................................................. 204 Positive framing of abortion ................................................................................................ 210 Impact of televised abortion coverage ................................................................................. 214 Adolescents’ recommendations for abortion coverage in Kenyan televised new media ........ 221 Key messages to include in abortion coverage or stories. ................................................... 221 Abortion content creation, production, and delivery format ............................................... 241 Discussion ............................................................................................................................... 248 Conclusion ............................................................................................................................... 252 CHAPTER SEVEN .................................................................................................................... 255 CONCLUDING REMARKS ...................................................................................................... 255 Introduction ............................................................................................................................. 255 Major Findings of the Study.................................................................................................... 255 Limitations and Recommendations for Future Research ........................................................ 258 ix Implication for practice ........................................................................................................... 260 References ................................................................................................................................... 262 APPENDIX I: INTERVIEW GUIDE (FGD) ............................................................................. 306 APPENDIX II: PARTICIPANT INFORMATION SHEET (FGDs) ......................................... 308 APPENDIX III: CONSENT FORM ........................................................................................... 311 APPENDIX IV: RESEARCH ASSISTANT CONFIDENTIALITY AGREEMENT ............... 312 APPENDIX V: DISTRESS PROTOCOL (PARTICIPANTS) .................................................. 314 APPENDIX VI: DISTRESS PROTOCOL (RESEARCH TEAM) ............................................ 315 APPENDIX VIII: BUDGET....................................................................................................... 318 APPENDIX X: IREC APPROVAL ........................................................................................... 320 APPENDIX XI: NACOSTI LICENSE ....................................................................................... 321 APPENDIX X: HREC APPROVAL .......................................................................................... 322 x LIST OF TABLES Table 3.1 Checklist for news items to be included in the study. .................................................. 84 Table 3. 2 FGD composition ......................................................................................................... 87 Table 3. 3 Coding Frame. ............................................................................................................. 90 Table 4. 1 Abortion news coverage across three leading TV stations in Kenya, 2016-2019….. 102 Table 5. 1 Distribution of news coverage on addressing unsafe abortion in Kenya…………… 147 xi LIST OF FIGURES Figure 3. 1 Flowchart representing inclusion and exclusion of abortion news items ................... 86 Figure 4. 1 News Source Designation......................................................................................... 104 xii LIST OF ABBREVIATIONS Abbreviation Definition ACK Anglican Church of Kenya AIC African Inland Church APHRC African Population and Health Research Centre ASRHR Adolescents Sexual and Reproductive Health and Rights CRE Christian Religion Education CSE Comprehensive Sexuality Education D&C Dilation and Curettage FIDA-Kenya Federation of Women Lawyers in Kenya FGD Focus Group Discussion FGM Female Genital Mutilation HREC-Non-Medical Human Research Ethics Committee Non-Medical ICPD International Conference on Population and Development ICPD PoA International Conference on Population and Development Program of Action ICPD25 25th International Conference on Population and Development ICU Intensive Care Unit IRB Institutional Review Board KANU Kenya African National Union KDPB Kenyan Drugs and Poisons Board KELIN Kenya Legal & Ethical Issues Network on HIV and AIDS KMA Kenya Medical Association KMPD Kenya Medical and Pharmacies Board KMPDB Kenya Medical Practitioners and Dentists Board KNH Kenyatta National Hospital KOGS Kenya Obstetrical and Gynecological Society LNC Local Native Council MoE Ministry of Education MoH Ministry of Health xiii MTRH Moi Teaching and Referral Hospital MTRH/MU-IREC Moi Teaching and Referral Hospital/Moi University-Institutional Research and Ethics Committee MYWO Maendeleo Ya Wanawake Organization NACOSTI National Commission for Science Technology and Innovation NCCK National Council of Churches of Kenya NGO Non-Governmental Organization PCEA Presbyterian Church of East Africa QCA Qualitative Content Analysis RHNK Reproductive Health Network Kenya SRH Sexual and Reproductive Health SRHR Sexual and Reproductive Health and Rights SSA Sub-Saharan Africa STI Sexually Transmitted Infections SUPKEM Supreme Council of Kenya Muslims VOs Voice-Overs VO/SOTs Voice-Overs/Sound On Tape WHO World Health Organization USA United States of America xiv ABSTRACT Media framing of abortion messages is a rapidly emerging field of research. However, studies are limited in number and scope. Previous studies are predominantly quantitative and have majorly been conducted in the USA. Notably lacking in this area of study is literature from Sub- Saharan Africa and especially studies that include adolescents. This study, therefore, sought to investigate the framing of abortion in Kenyan televised news media, and to examine adolescents’ perceptions and experiences with abortion coverage on Kenyan televised news media. This qualitative study was conducted in Nairobi and Uasin Gishu counties of Kenya. Purposive sampling was used to select 55 news items from three leading media outlets aired between January 2016 to December 2019, for content analysis. Additionally, convenience sampling was used to select 37 university-going adolescents for four Focus Group Discussions. The data was transcribed, translated (where necessary) and analyzed thematically. The analysis established that Kenyan televised news media predominately frames abortions negatively. First, it’s depicted as dangerous to women’s physical, mental, and social outcomes. Secondly, Kenyan women are portrayed as victims of an abortion law that compromises their bodily autonomy and access to abortion. Lastly, men are shown as perpetrators of reproductive coercion and abuse against women. There were various recommendations to end unsafe abortion. One, the institutionalization of an enabling legal and policy framework. Two, acknowledgement of abortion as a public health issue. Three, recognition of the socio-cultural influence on abortion. Finally, inclusion of young people in policy development and implementation. Furthermore, televised news media’s framing of abortion was perceived as having an impact on the public’s understanding, attitudes, and behaviors around abortion. In conclusion, beyond laying groundwork for future studies in media framing of abortion in Sub-Sharan Africa, the findings from this study have the potential to facilitate more critical reflection and discussions on (un)safe abortion with a probable effect on health and social policies around abortion. The findings are informative for those who wish to develop media aimed at promoting Sexual Reproductive Health and Rights, especially safe abortion among adolescents. 1 CHAPTER ONE BACKGROUND AND LITERATURE REVIEW Introduction One of the prerequisites to achieving sustainable development goals is recognizing adolescents’ health as a priority. Adolescence is the phase of life between childhood and adulthood, and its definition has long posed a conundrum (Sawyer et al., 2018). Historically, adolescence was defined as 10-19 years of age which corresponds to the time of pubertal onset to the legal definition of adulthood in many countries (Jaworska & Macqueen, 2015). However, recent works have expanded the definition and timeframe of adolescence to align with the contemporary patterns of adolescent growth (Jaworska & Macqueen, 2015; Sawyer et al., 2018). The definition of adolescence has been extended from 10–19 years to 10–24 years to better fit with the biological growth and major social role transitions in many societies in the past century (Kinghorn et al., 2018; Sawyer et al., 2018). Delayed timing of role transitions, including completion of education, finding gainful employment, marriage, and parenthood continue to shift popular perceptions of when adulthood begins (Sawyer et al., 2018). Our study adopts this expanded definition of adolescence as 10-24 years based on the realities of adolescence in resource-limited contexts. In 2024, the worldwide population of individuals aged between 10 and 24 years was approximately 1.9 billion, representing nearly a quarter (24%) of the population (UNFPA, 2024). Approximately 90% of people in this age group live in low-income and middle-income countries, with majority residing in Sub-Saharan Africa (SSA) (Gore et al., 2011; Karim, 2015; Sawyer et al., 2012). The size of this population makes their health status of interest, largely because it is a determinant of their future health as well as the social and economic development 2 (Gore et al., 2011; Sawyer et al., 2012). Investing in adolescent health ensures triple dividends in terms of health during adolescence, health during later adulthood as well as health of the future generation ((WHO), 2022). Biological and social transitions that define adolescence have important links to health (Sawyer et al., 2012). This age group establishes patterns of behavior that can either protect their health and the health of others around them, or put their health at risk in the present and in the future (WHO, 2022b). Generally, this age group has been associated with poor health outcomes (Karim, 2015). In 2020, an estimated 1.5 million adolescents aged 10–24 years died, with the mortality rates being almost twice as high in Africa as in any other Region (WHO, 2022a). This high mortality due to preventable causes (such as maternal deaths; pregnancy complications and unsafe abortions) are the leading causes of death among 15-19-year-old girls (WHO, 2022b). Some behaviors that start or are consolidated during adolescence lead to the future burden of adult mortality and morbidity including risky sexual behavior, substance abuse, unhealthy diet, etc. (Ross et al., 2021). Adolescents’ poor health outcomes are a result of their health, especially their sexual and reproductive health and rights (SRHR), remaining a challenge and being poorly addressed (Renzaho et al., 2017). Adolescents face considerable challenges in meeting their sexual and reproductive health needs ((WHO), 2018a; World Bank Group, 2014). They have limited and, in some places, no access to Adolescents Sexual and Reproductive Health and Rights (ASRHR) information and health care services, especially for contraception ((WHO), 2018a). This predisposes adolescent girls to early and unintended pregnancies (Salam, Faqqah, et al., 2016). When faced with unintended pregnancies, “adolescents in many LMICs turn to illegal abortion oblivious of the dangers” (Chandra-Mouli et al., 2013). An estimated 24.3 million (97%) of the 25.1 million 3 women who had unsafe abortions annually between 2010-2014 live in developing countries (Ganatra et al., 2017; Glasier et al., 2017). An estimated 5 million of them were adolescents living in Sub-Saharan Africa (SSA). West and East Africa were documented as the most affected in terms of high prevalence rates of induced abortions among adolescents as elaborated elsewhere in this chapter (Olufunke et al., 2014). Abortion can occur as part of the natural history of a pregnancy (also called miscarriage, in lay terms) or it can be induced for health-related reasons as a therapeutic intervention or on request by the pregnant woman. Miscarriage is a clinical entity that reproductive health practitioners struggle to remedy for women whose goal is to have the babies that they are losing due to reproductive pathology. However, induced abortion remains an important and divisive topic in the public discourse. In Kenya, when abortion is induced under circumstances explicitly stated in Chapter 26(4) of the 2010 Constitution and is in conformity with any other written law, it is considered legal. Legal or not, induced abortion that is performed by suitably qualified professionals in settings that provide the infrastructure and support for a safe procedure, it is considered a safe induced abortion. On the other hand, any abortion procedure performed by an unqualified individual or qualified person in settings that do not adequately support the procedure, it is considered unsafe abortion. Unsafe abortion often leads to adverse consequences on the health and lives of girls and women. Unsafe abortion among adolescents has far-reaching consequences on the health, social, and economic aspects. In terms of health, it is a significant cause of maternal mortality and morbidity. Annually, an estimated 62 % of all unsafe abortion-related deaths occur in Africa with a further 5 million women suffering from abortion-related medical complications (Morris & Rushwan, 2015a; Olukoya et al., 2001). Adolescents disproportionately bear this health burden 4 of unsafe abortion (Sully et al., 2018). Economically, women and their families incur the costs of providing medical care for abortion-related complications (Singh et al., 2012). Besides, post- abortion care services place a substantial financial burden on national health systems (Singh, 2010a). Socially, abortion carries the risk of stigma and being denounced to authorities(Singh et al., 2012). Adolescents’ sexual and reproductive health and rights (ASRHR) provides an opportunity for this population to remain healthy and become productive adults (World Bank Group, 2014). To grow and develop in good health, adolescents need knowledge and skills to realize their health, well-being and dignity; to realize the effect of their choices on their own well-being as well as that of others; and to understand and ensure the protection of their rights throughout their life ((WHO), 2018b). Mass media and specifically prime-time television news has a great potential of supporting adolescents realize optimal Sexual and Reproductive Health and Rights (SRHR). Television as a primary source of shared stories creates awareness and motivates discussions about ASRHR issues especially around taboo topics like abortion (Sisson, 2017; Svanemyr et al., 2015). This builds an enabling environment where adolescents have access to information and services, as well as the capacity to make decisions on their own within the context of informed and supportive communities (Salam, Faqqah, et al., 2016; Svanemyr et al., 2015). Given these potentialities, television remains a critical ground for inquiry on the subject of ASRHR issues (Sisson, 2017). Media, specifically television, has been shown to be an important source of information regarding safe abortion practices (Whaley & Brandt, 2017). Accurate information on the difference between safe and unsafe abortion and depending on the context, where safe legal 5 services can be accessed (Chandra-Mouli et al., 2013; Salam, Das, et al., 2016) is likely to mitigate the prevalence of unsafe abortions. The success of mass media interventions largely depends on the framing of the messages. Therefore to understand media’s role in the promotion or erosion of ASRHR, one needs to study how these issues are framed in the media and the implications of framing on the audiences (Jaworski, 2009). This chapter offers an understanding of media framing of abortion. It presents previous scholarly work in this field of study and the gaps therein. The chapter begins by expounding on the key tenets of framing using the framing theory. This multilevel model explains how frames are constructed, manifested in texts, and influence on the minds of the audiences. With abortion’s never-ending controversy that attracts continued media interest, the chapter reveals the multifaceted portrayal of abortion in mainstream news media worldwide and the gaps therein. Based on these gaps, we lay out the objectives of this study, the significance of this study and the rationale for conducting this study. Finally, we explain the extent to which this study was explored and the parameters which it operated. The framing theory: media framing as a multilevel model The framing theory is a multilevel model that explains how frames are constructed, how they are manifested in texts and how they influence the minds of the audiences. Framing Framing is one of the most robust areas of research in media studies that is commonly used to analyze media content and media effects (Bruggemann, 2014; Cacciatore et al., 2016). Given its popularity, different scholars have defined framing differently. It was first posited by Gregory Bateson in 1972 who defined frames as a “spatial and temporary bounding of set of interactive messages” (Bateson, 1972, p. 197). In 1974, Goffman, a social psychologist defined a 6 frame as the way information is presented and organized in the media and interpreted by the individual (Goffman, 1974). Gamson and Modigliani defined framing as the “central organizing idea or story line that provides meaning to an unfolding strip of events.” (Gamson & Modigliani, 1987, p. 143). Also, Gitlin described frames as "principles of selection, emphasis, and presentation composed of little tacit theories about what exists, what happens and what matters." (Gitlin, 2003, p. 6). These definitions, while useful, only describe the term ‘frame’ leaving the explicit operational understanding of the frame concept open. This study is inspired by Entman’s (1993) definition which states that framing is the “selection of some aspects of a perceived reality and making them more salient in a communicating text, in such a way as to promote a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described” (Entman, 1993, p. 52). For this study, framing is conceptualized as a way of imposing a particular meaning on an issue by focusing on a few select aspects of the issue to convey the desired meaning, agenda or intent of the journalist, media organization and/or the source as shown in Chapter 4 of this dissertation. This in turn could inform people about how to articulate their opinions about this issues and influence the actions that they take (Jaworski, 2009) as illustrated in Chapters 4, 5 and 6 of this dissertation. Frame building Frame building is an integral part of the framing theory that is rarely studied despite being pertinent for a comprehensive understanding of this theory (Borah, 2011; De Vreese, 2012). Frame building refers to the processes that influence the creation and adaption of frames by journalists (Bartholomé et al., 2015; Cacciatore, 2016). Frame building alludes that journalistic framing practices lie on a continuum between passively passing on interpretations 7 provided by other actors (frame sending) and providing the audience with the journalist’s individual interpretations of a situation (frame setting) (Boesman et al., 2017; Bruggemann, 2014; Cacciatore et al., 2016). Pure frame sending is unlikely to happen. Journalists do not solely report about given topics but they also define what is at issue (Bartholomé et al., 2015). Thus, what is probable to occur is a combination of frame sending and frame setting. Framing building is not an isolated incident. Various factors contribute to this dynamic process of framing. These factors can be broadly categorized as individual level, organizational and professional level, as well as societal level factors. Individual level factors include gender, personal interest in adolescent sexual reproductive health issues, education, interventionist role conceptions and professional experience (Bartholomé et al., 2015; Boesman et al., 2017; Bruggemann, 2014; Ogunyemi, 2011). Examples of organizational and professional level factors include editorial policies, news making routines, time and space limitations, editorial line/high autonomy and beat bias (Aduy, 2006; Bruggemann, 2014). Societal level factors include press freedom, consonant national elite consensus, polarized pluralist issue culture and feedback from the audience (Bruggemann, 2014; Laar, 2010). During frame building there will be overlaps and mutual influences between the different levels of influence. Frame building is an integral area of framing research; however, the focus of this study is not on journalistic framing, but on its effects on audiences as explored in the next section as well as demonstrated in the findings presented in Chapter 6 of this dissertation. Framing effects Journalistic framing of a given topic in the news media is likely to have cognitive, affective, and/or behavioral effects on the audience (Perse, 2001; Randolph & Viswanath, 2004). Audience’s interpretation of news messages is influenced by various factors that can be broadly 8 categorized as intra-personal, interpersonal and community factors. At an intra-personal level, adoption of frames is influenced by an individual’s personality, prior experiences, preexisting attitudes, age, gender, social class and gratifications sought from the media (Otieno et al., 2013; Perse, 2001). At an interpersonal level, interactions with parents and peers tends to have a great influence on audience’s interpretation of media content. At a community level, culture, religion and the law play a central role in the processes of framing as it sets limits on what is socially and legally acceptable or not. Framing research Framing research is a central focus of media studies with dozens of framing studies being produced annually (Cacciatore et al., 2016). Majority of these studies are quantitative in nature with focus on the impact of health message framing on various health issues including nutrition (Bergmann et al., 2010; De Backer & Hudders, 2016), safe sex (Wang & Singhal, 2016), smoking (Wakefield et al., 2010), Sexually Transmitted Infections (STI) screening (Dowshen et al., 2015) and physical activity (Bergmann et al., 2010). The main focus of these studies has been the prominence of these health messages in the mass media (Laar, 2010) without challenging how the media actually engages the public. Furthermore, little focus has been paid on how sensitive topics like abortion are framed in the mass media, and especially in relation to vulnerable populations like adolescents. This is particularly true for contexts outside of the USA. Framing of abortion messages in the news media Abortion is a topic that is so controversial and fraught. It not only invokes existential issues of life and death but also taps into the deepest level of cultural and social beliefs of a society. (Ferree et al., 2004; C. Macleod et al., 2018). Abortion’s never-ending controversy attracts continued media interest and is continually contested in the worldwide media (Izugbara 9 et al., 2015; Mitchell et al., 2006; Park et al., 2013; Purcell, Hilton, & McDaid, 2014; Sisson et al., 2017). Abortion garners vast media attention during critical discourse moments which influence and are influenced by critical political events such as legislative actions, court decisions and presidential elections (Ferree et al., 2004). Key examples of critical discourse moments include the 1973 landmark Roe v. Wade Supreme Court decision that legalized abortion giving the United States the most liberal abortion policy among Western democracies (Patterson & Hall, 1998; Rohlinger & Klein, 2012; Yanda et al., 2003). Similarly, the June 2022 Supreme Court overturning of the Roe v. Wade ruling attracted media attention worldwide. The ruling stated that there is no longer a federal constitutional right to abortion, giving individual states the power to set their own abortion laws (Mangan & Breuninger, 2022). Examples of critical discourse moments in Kenya include the _________________________ 1 On June 12, 2019, the High Court of Kenya, Constitutional and Human Rights Division, ruled that women and girls have a right to access lawful abortion in cases of pregnancy resulting from sexual violence as provided for by the Kenya Constitution 2010. The Court further ruled that the Ministry of Health’s 2014 withdrawal of the “Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya” (S&Gs) and the “National Training Curriculum for the Management of Unintended, Risky and Unplanned Pregnancies” (Training Curriculum) was arbitrary and unlawful. The S&Gs and training curriculum were originally published in 2012 by the MoH but withdrawn by the Director of Medical Services in 2013 and 2014 respectively. In 2015, two civil society organizations (Center for Reproductive Rights-CRR & Ipas Africa Alliance), Federation of Women Lawyers (FIDA) Kenya, and two community human rights advocates, filed a case against the Attorney General, Director of Medical Services, and the Ministry of Health. At the center of the petition was the withdrawal of S&Gs and the Training Curriculum. Full petition available on Petition 266 of 2015 - Kenya Law 2The Nairobi Summit on ICPD+25 took place in Nairobi, Kenya to mark the 25th anniversary of the International Conference on Population and Development (ICPD) held in Cairo, Egypt in 1994 that recognized sexual and reproductive rights as human rights for the first time. During the ICPD in Cairo, 179 countries adopted a landmark Programme of Action. The ICPD Programme of Action (PoA) set forth a vision to achieve gender equality, promote, respect and fulfil human rights and reproductive freedom for all. From 12-15, November 2019, governments, civil society, academia, the private sector, faith-based organizations, international financial institutions, grass roots organizations and other partners, interested in the pursuit of sexual and reproductive health and rights convened at the Nairobi Summit on ICPD+25 to discuss and agree on innovative actions aimed at accelerating the implementation of the ICPD Programme of Action. Participants made commitments as part of an international effort to ensure that the promise of the ICPD Programme of Action (PoA) and the 2030 Agenda are achieved, and women and girls have autonomy over their bodies and their lives. A summary report of the ICPD+25 Nairobi report available on Summary ICPD+25 IPPF Report.pdf http://kenyalaw.org/caselaw/cases/view/175490/ https://www.ippf.org/sites/default/files/2020-07/Summary%20ICPD%2B25%20IPPF%20Report.pdf 10 June 2019 reinstatement of safe abortion guidelines by the Kenyan high court1, and the 25th International Conference on Population and Development (ICPD+25) summit2 held in Nairobi November 2019 (Muchangi, 2019; Muigai, 2019; Muki, 2019; Ogila, 2019; Oginde, 2019). Therein after these four critical discourse moments in USA and Kenya, the abortion debate became entrenched in the incommensurable pro-life ( with specific frames around themes of morality) and pro-choice (with specific frames around themes of rights) positions (Jaworski, 2009). Content analysis of news items in mainstream media worldwide suggests that abortion coverage is often muddled with falsehoods and misconceptions as demonstrated in the subsequent section below. For most part, abortion is subject to consistent negative framing in news media (Laar, 2010; Larsson, Eliasson, Klingberg Allvin, et al., 2015; Purcell, Hilton, & McDaid, 2014). The tones used are often judgmental, prurient, and shaming, with scant regard for medical facts (Hallgarten, 2018). Abortion is predominantly framed as culturally problematic, immoral, dangerous, undesirable and selfish. Sporadically, abortion is framed as a human right. Abortion as culturally problematic Women’s experiences with unwanted pregnancy and abortion are conditioned by the socio-cultural constructions of motherhood and abortion (Hessini, 2005). In most societies, abortion remains ingrained in the cultural fabric of reproduction which is intertwined in patriarchal ideologies (Braam et al., 2018; C. I. Macleod & Hansjee, 2013). Cultures have certain repertoires of expressions of femininity that women are expected to learn to use in order to be perceived as, and to also experience themselves as ‘real’ women (Alex & Hammarström, 2004). 11 In most cultures, motherhood is often regarded as an essential component of being a woman and becoming a mother is perceived as a gender role that “completes” a woman (Chrisler et al., 2014). Women’s bodies are viewed as the personification of society reproducing itself (Braam & Hessini, 2004). Women are therefore expected to become mothers within tightly proscribed limits: namely bearing children when neither too young nor too old, whilst in a stable relationship and financially secure position (C. I. Macleod & Hansjee, 2013). Not living up to these normative expressions implies a threat to this idealized womanhood (Alex & Hammarström, 2004). Abortion is therefore portrayed as culturally problematic; as a perversion that goes against family values and therefore society as a whole (Braam et al., 2018; Gianella, 2017; C. I. Macleod & Hansjee, 2013). This portrayal of abortion as culturally problematic perpetuates reproductive norms. Women who choose to terminate a pregnancy transgress a boundary. Consequently, they are often met with hostility and negative evaluations (Huang et al., 2016; C. I. Macleod & Hansjee, 2013; Osborne & Davies, 2012). Studies conducted in Kenya in 2011 and 2013 revealed that men do not condone abortion because they perceive it as women’s strategy to conceal their deviation from culturally acceptable gender and motherhood standards. They also viewed abortion as a challenge to their stature as men because women would make decisions to have an abortions without consulting them (C. I. Macleod & Hansjee, 2013; Moore et al., 2011). In Uganda, a country strongly grounded in a pronatalist culture, abortion is widely condemned especially by men. Moore et al., in their 2011 study found that men used an almost uniform language to describe their opposition to abortion. This bespeaks the effectiveness of cultural messages that condemn abortion in Uganda (Moore et al., 2011). This language is reproduced in the news media, which is a site for the expression and reconstruction of societal discourses. 12 Against this backdrop, it is not surprising that the news media marginalizes women who procure abortion, and when covered, they are portrayed as different and distinct (Purcell, Hilton, & McDaid, 2014). The British media portrays such women as having failed to manage their sexuality within the socially constructed tight limits (Purcell, Hilton, & McDaid, 2014). In America, more often than not, they are portrayed as selfish, irresponsible, immoral, young, and childless (Hallgarten, 2018; Wayne, 2017). This depicts abortion as being incompatible with notions of the family, femininity and motherhood (Purcell, Hilton, & McDaid, 2014). This is suggestive of the broader effacement of women from the reproductive process by patriarchal institutions (Armstrong & Boyle, 2011; Purcell, Hilton, & McDaid, 2014). Discrediting women who behave in a manner that does not fit the normative femininity falsely distances them from the rest of the society. This often promotes abortion-related stigma with lived consequences for women who experience abortion. Since news media plays a role in (re)producing social norms, it becomes necessary to investigate the influence of the Kenyan socio-cultural context, as presented in Chapter 2, on abortion coverage. It is also useful to assess the impact of such coverage in the context of normative constructions of women and reproductive agency in Kenya and especially from the perspectives of adolescent boys and girls. Abortion: An immoral Act Central to the abortion debate is the “morals” frame that is framed within broader societal aims by different actors. It reflects the disputes on the understanding of society and societal values (Gianella, 2017). Thus, the media presents complex and sometimes contradictory views about the morality of abortion. Largely, the morals frame leans towards the sanctity of human life discourse (Blackburn, 2005; Boyle, 2004). This discourse posits that human life is the most important value and, as 13 such, abortion is a sin against God and man. (Rohlinger, 2002). A central assumption in this discourse is that life begins at conception and no circumstances can justify abortion (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015). Even though it is essentially a religious concept, it is used in non-religious circles to indicate the utmost respect with which human life should be treated (Baranzke, 2012). This discourse prevails in countries where religion holds a strong position in society. Uganda for instance, is a country strongly grounded in a religious culture as aforementioned. A 2015 discourse analysis of Uganda’s two main local newspapers revealed that the religious discourse of the sanctity of the life of the fetus was salient (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015). Similar findings have been reported in Latin America countries (Chile, El Salvador, Nicaragua, Honduras and República Dominicana) where the Catholic church is strong (Zúñiga-fajuri, 2013). Conversely, other scholars argue that morality of abortion has relatively little to do with the moral status of the fetus, and much to do with judgments about women's appropriate behavior and their proper role in society (Borgmann, 2014). Similar to the socio-cultural discourse, this religious discourse prescribes the limits within which women should become sexually active and consequently pregnant (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015; C. I. Macleod & Hansjee, 2013). Abortion is portrayed as a consequence of unintended pregnancies resulting from unmarried girls and women being sexually active (Chia, 2012). The problem is majorly framed as girls’ sexuality. These sparks conversations embedded in both the religious and cultural frameworks. The core tenet of these conversations is the need for girls to control their sexuality. Men who are co-conceivers of these pregnancies are barely urged to restrain from sexual activity (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015; Purcell, Hilton, & McDaid, 2014; Ziegler, 2013). This places the full responsibility of 14 unwanted pregnancies on women (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015) (Ziegler, 2013). In this context, the religious discourse is likely to be viewed as a means of controlling women’s sexual autonomy (Chia, 2012; Ziegler, 2013) as claimed by some news sources in Chapter 4 of this dissertation. Beyond the religious framework, sanctity of life is portrayed as a societal responsibility. It is viewed as society’s responsibility to protect the most vulnerable from murder (Gianella, 2017). Religious and societal stance on abortion tends to have a strong impact on public discourse ultimately influencing how abortion messages are presented in the media (Kangwa, 2017; Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015). Abortion media coverage is not all inclusive A major criticism against media coverage of abortion is the rare coverage of people who are directly affected by it. The absence of the perspectives of women who have experienced abortion leads to narrow and reductive representations of abortion, particularly the reasons for seeking abortion. Women’s reasons for seeking abortion are either over-simplified or disregarded. Studies in USA and Uganda revealed that the most cited reasons for abortion in the mass media are immaturity, avoiding career and educational goals disruptions and a desire not to ever parent (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015; Sisson & Kimport, 2016). This depicts women seeking abortion as selfish and ultimately rejecting to take personal responsibility of their actions. This portrayal has been argued to be counterfactual, as abortion decision-making does not happen in a vacuum. It takes place in the context of an individual woman’s life circumstances. Normally it is a combination of various factors that coalesce into a situation in which the woman determines that abortion is her best option (Alex & Hammarström, 2004; Frederico et al., 2018; Hessini, 2005; Jackson, 2000; Peters, 2014). Studies investigating 15 factors associated with abortion have shown that abortion decision-making is influenced by a variety of factors at various levels; individual, interpersonal, societal, and national. At an individual level it could be shaped by a woman’s health (physical and mental), marital status, childhood experiences, desired number of children, economic independence, educational level and women’s plans for their future which entail delaying childbearing in order to obtain more education, better jobs prospects and relationships (Alex & Hammarström, 2004; Mathewes-green, 2013; Nixon et al., 2017; Sedgh et al., 2016). At an interpersonal level, it could include factors such as expected support (financial, emotional, physical, medical, etc.) from partner, family and friends. At a societal level, it includes factors such social norms, religion, perceptions around pre-marital and extra-marital sex, attitudes towards motherhood at a young age, to non-nuclear families and autonomy within society. At a national level it includes the existence of sex education, the health care system structuring and current abortion laws (Agadjanian, 2002; Frederico et al., 2018; The Lancet, 2007). Interpersonal level factors, and specifically male involvement has a significant influence on women’s abortion decision making and the subsequent trajectories for both safe and unsafe abortions (E. Freeman et al., 2018; Olivari et al., 2015). The quality of the relationship and the potential support that a woman anticipates to receive from the man involved have been found to largely inform women’s abortion decision-making (Chibber et al., 2014; E. Freeman et al., 2018). Additionally, other men (male family members and friends) also act as shared decision makers and facilitators to abortion care by paying for it, arranging for it or accompanying women to obtain it (E. Freeman et al., 2018). Studies in Burkina Faso, Zimbabwe, Uganda, and South Africa found that men do not want women to have abortions. They exert their influence by withholding support, denying paternity, threatening or committing violence, or abandoning the 16 woman (E. Freeman et al., 2018; Moore et al., 2011). Conversely, Zambian adolescent girls reported adverse consequences following their fathers finding out about their pregnancy. These adverse consequences included physical violence, being forced to terminate the pregnancy and being forced to leave home (E. Freeman et al., 2018). As a consequence, women keep their pregnancies secret and discretely seek abortions (mostly unsafe abortions) so as to minimize difficulties that could accompany telling the man about the abortion (E. Freeman et al., 2018; Moore et al., 2011). Abortion decision making is particularly difficult for adolescents. This because they are not only dealing with a stressful life event of unwanted pregnancy, they are simultaneously dealing with psychosocial challenges presented by both the pregnancy and adolescence (Olivari et al., 2015). This is further complicated by laws that require parental notification and consent before a minor obtains abortion or restrict abortion (Zabin & Sedivy, 1992). The circumstances around abortion decision making are not typically part of the media discourse (Nixon et al., 2017). Notably absent or marginalized is abortion as a positive or legitimate choice and the role played by men in women’s abortion trajectories and especially men who are co-conceivers of pregnancies being aborted (Hallgarten, 2018; Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015; Purcell, Hilton, & McDaid, 2014; Sisson & Kimport, 2016). Furthermore, there is an underrepresentation of women’s financial and social circumstances as factors informing abortion-decision-making (Larsson, Eliasson, Allvin, Faxelid, Atuyambe, & Fritzell, 2015; Sisson & Kimport, 2016). Moreover, there is barely any portrayals of women’s mental and physical health and how these affect the responsibility of raising a child (Larsson, Eliasson, Klingberg Allvin, et al., 2015). 17 Women do not have similar experiences with abortion decision-making. The absence of the perspectives of women who have experienced abortion is likely to contribute to feelings of internalized stigma and/or isolation among women who obtain abortion. It further limits the discursive options available to women who would otherwise not dare ask about abortion elsewhere. Showing the mix of reasons behind abortion-decision making is likely to assist other women in articulating the choice for themselves. It can further reduce the feeling of isolation. Having these multifaceted stories is an opportunity to educate women on their rights as well as how to get legal or illegal safe abortions. It is also likely to increase society’s understanding of abortion (Wayne, 2017). Abortion is dangerous and thus appropriately restricted. The World Health Organization (WHO) has identified unsafe abortion as a serious public health problem since 1967. Estimating the incidence of induced abortion is difficult due to under reporting, misclassification and lack of centralized registries (Shah et al., 2014a). Nonetheless, an estimated 25.1 million women had unsafe abortions annually between 2010-2014 with 24.3 million (97%) of these living in developing countries (Ganatra et al., 2017; Glasier et al., 2017). Of this unsafe abortions, 6.2 million occurred in Africa (Ganatra et al., 2017). Majority of those affected by unsafe abortion are the economically disadvantaged and the young (especially adolescents) (Glasier et al., 2017; The Lancet, 2007). An estimated 2-5 million adolescents in SSA undergo unsafe abortion each year (The Lancet, 2007). West and East Africa are documented as the most affected in terms of high prevalence rates of induced abortions among adolescents (Olufunke et al., 2014). A 2014 Nigerian study revealed that 60.7 % of the participants aged 13-20 had ever had an abortion (Olufunke et al., 2014). In Uganda, an estimated 57,000 abortions took place among adolescents in 2013 (Sully et al., 2018). 18 Unsafe abortions carry health, social and economic consequences as mentioned elsewhere in this chapter. These consequences vary depending on the context and the environment. They are usually a reflection of existing conditions of abortion provision, safety and legality (Singh, 2010a). Studies have found that the mass media in countries with liberal abortion laws often exaggerates the risks associated with abortion (Sisson & Kimport, 2014). Pro-life advocates call for abortion restrictions on the basis of the physical and psychological harms supposedly caused by the procedure (Seale, 2002; Ziegler, 2013). Studies by Hallgarten (2018), Conti & Cahill (2017), the International Campaign for Women's Right to Safe Abortion (2017) and Sisson & Kimport (2014) reveal that the depictions of the long-term adverse physical and psychological health consequences attributed to abortions, including death are higher in the American media than in real life. Furthermore, they found an exaggeration in the rates of women who obtain abortion as portrayed in the media (Conti & Cahill, 2017; Hallgarten, 2018; Sisson & Rowland, 2017a). Portraying abortion as riskier than it in fact is contributes to the pervasive and false rhetoric that abortion is dangerous thus upholding conservative, hegemonic structures. Such portrayals have led to the introduction of new restrictions that act as barriers to women’s access to legal abortion services in countries such as Hungary, Russia, US, Slovak Republic, and Canada. These barriers include mandatory and biased counseling requirements, third-party consent and notification requirements, waiting periods, limitations on the range of abortion options, unregulated conscientious objection by health care providers and limitations on abortion funding (Adler et al., 2003; Finer & Fine, 2013). Unfortunately, punitive laws single out poor women and other disadvantaged groups such as adolescents and women in rural areas (Cornwall et al., 2008; Singh, 2010a). For instance, in Cuba, Denmark, Italy, Norway, Turkey 19 and in some states in the United States, access to abortion services is more limited for adolescents than for adults. The most common restriction is the requirement for parental involvement or written parental consent (Adler et al., 2003). In contexts with restrictive abortion laws, such as in most African countries, the media has been criticized for framing abortion through political and social lenses deemphasizing its public health significance (Conti & Cahill, 2017). Abortion is framed as undesirable and appropriately restricted (Sisson, 2017). Coverage of abortion legislation in Kenya, Uganda, United States of America (USA), and Britain focuses on individual judiciary cases. These cases describe how women, health care providers and other accomplices have been arrested, sentenced or jailed for undergoing or procuring an abortion (Larsson, Eliasson, Klingberg Allvin, et al., 2015). Mostly, the media is used to shame women for choosing abortion and healthcare providers for providing abortion care services. Despite these negative media depictions of abortion in contexts with legal restrictions, media has been used to argue for liberalization of abortion laws. The media, as one of the sites of societal legal mobilization that operates independently of legal mobilization in the legislature and the courts has been used to advocate liberal abortion laws. Estimates of the incidence of unsafe abortion and the associated morbidity and mortality have been used to advocate for the liberalization of abortion legislation (C. Macleod et al., 2018; Seale, 2002) as shown by our data in Chapter 5 of this dissertation. Furthermore, evidence of significant decrease in abortion- related complications and deaths following the legalization of abortion in countries such as USA, Canada and Romania has been used to support the case for need of abortion law liberalization (Gebreselassie et al., 2005; Sisson et al., 2017). Thus in recent years there have been legislative advances in various countries reflecting the recognition of the dire public health implications of 20 criminalizing abortion (Cornwall et al., 2008; Finer & Fine, 2013). Kenya is no exception as demonstrated in the “expansion of women’s rights to safe and legal abortion in Kenya” section in chapter 2 and the findings presented in chapter 5 of this dissertation. These trends towards liberalization of abortion in developing countries as well as introduction of restrictive abortion laws in modern developed countries have made the issues of adolescents’ access to official abortion services become more salient (Adler et al., 2003). It has further brought to light the health consequences of unsafe abortion among adolescents, making it necessary to assess the way the media presents abortion. This is because media framing has been found to influence personal attitudes and subsequently personal decisions regarding the issues being presented (Altshuler, Gerns, et al., 2015). Examining media content will reveal the media’s role in promoting or undermining adolescents’ sexual and reproductive health and rights. Abortion right discourse The rights discourse in the media was initially framed as the woman’s right to choose. This frame which aims at addressing concerns about the status of women in society is still a prevailing media frame (Tsetsura, 2013). It attracts attention to women’s problems and aims at improving the current situation of women in society. Previous studies reveal that the rights to choose framework focuses on women’s right to privacy, self-determination (women’s right to decide whether, when, and how to have children) and bodily integrity (Eisenman, 2010; Sutton & Borland, 2013). This frame is salient when there are calls for change in the legality of abortion in a country. Over time the ‘rights’ discourse took two positions; a woman’s right to choose and the right to life of the fetus (Jones & Chaloner, 2013). Literature reveals some consensus over the rights that women possess as stated above but the same cannot be said about the rights of the 21 fetus. Fetal rights discourse can be broadly categorized into three; the conservative perspective where the fetus has a right to life from the moment of conception, the moderate perspective where the fetus comes into possession of the right to life at some point during pregnancy and the liberal perspective where the fetus does not have a right to life (Gibson, 2004). The human rights of the fetus discourse is prominent in developed modern societies where abortion is legalized and women reproductive rights are upheld. This discourse is popular among pro-life supporters who use it to oppose permissive laws with the hope of recriminalizing abortion (Boyle, 2004). In Peru, the Philippines, Canada, Mexico and the United States, human rights arguments are being used to invoke the concept of fetal rights (Hessini, 2005; Mugyenyi, 2013; Singer, 2016). In these contexts, the abortion debate is characterized as the rights of women being pitted against those of the fetus (C. I. Macleod & Hansjee, 2013). The abortion debate has further shifted from the question of whose rights will prevail, the woman’s or the fetus, to who will decide, women or the government (Rohlinger, 2002; Shaw, 1990, 2010). The argument over who should legitimately control abortion, the circumstances under which it should be permitted (if at all), and how and where it should be practiced, takes place on various platforms, an influential one being the news media (Feltham-King & Macleod, 2016). Pro-choice advocates argue that it is a woman’s life and body, and therefore she has a moral right to choose what happens to her (and her family or potential family’s) well-being without the oversight and control of any external factors (the state, physician, religious leaders, etc.) that are largely patriarchal. They argue that women’s autonomy should be respected in situations where women are deemed competent enough to make informed decisions (Jones & Chaloner, 2013; Peters, 2014). Pro-choice advocates essentially disregard patriarchal protection, a concept outlined in chapter two of this dissertation. 22 However, there have been contested arguments over the ability of adolescents to make informed abortion decisions. This has led to legislation mandating parent/adult involvement in most countries where abortion is permissible to teenagers (Adler et al., 2003). Abortion coverage and the audience Television has been found to be a particularly powerful and prominent source of sexual behavior and reproductive health information (Damme & Biltereyst, 2013; Kinsler et al., 2019). This is especially true among adolescents because this information is not readily available in their immediate environment and also because they spend a considerable amount of time on TV (Livingstone & Lunt, 2001; Manganello et al., 2010). The impact of media framing of abortion is multi-level as above-mentioned. It is dependent on a complex combination of potential long-term and short-term processes that are actively negotiated by audiences, the contexts in which television is consumed and the audience’s broader lifeworld’s (Scott & Dietz, 2016). A key component to how the audiences relate to the media they consume is gender. Men and women have been found to consume media differently both in terms of the amount as well as the content (Bunker & Bryson, 2016). Studies investigating effects of sexual and reproductive health content often focus on adolescent girls because they are labelled potential victims of sexualized media content (Damme & Biltereyst, 2013). Previous studies have not investigated adolescent boys’ engagement with sexual and reproductive health coverage and specifically abortion coverage. It is therefore not clear what effect these gender differences have on audience construction of program meaning, especially in the case of abortion coverage. Examining media’s constructs of abortion is crucial to understanding how it might be interpreted and experienced in everyday life (Conti & Cahill, 2017; Purcell, Hilton, & McDaid, 2014; Sisson & Kimport, 2016). This is particularly imperative among the adolescent population 23 to whom media is a leading source of sex education at a period in life when they are negotiating and constructing norms and values (Damme & Biltereyst, 2013). With barely any documented literature on abortion coverage in the Kenyan news media, it becomes necessary to not only understand how sexual reproductive health and specifically abortion is portrayed in the news media but to also how adolescents experience these media content in context-specific ways. This study aims at contributing to this body of literature with a focus on the broadcast media. Traditional mass media, especially television, continues to play a significant role in the lives of young people despite the disruptions in the media landscape occasioned by the transition of the news industry away from traditional television broadcasting into digital spaces (Dhiman, 2023; Liedke & Wang, 2023; Poyntz & Pedri, 2018). Digitalization has facilitated the integration of television with the broader internet aiding in the multiplicity of television content (Godwin, 2023). Mainstream television broadcasters are making their news available to their viewers through their websites and social media platforms with television now being consumed across multiple platforms (Fotopoulos, 2023; Godwin, 2023). Amidst the proliferation of digital media, most news consumers choose to access the news from local TV stations through the digital pathways including smartphones, tablets, smart TVs, and computers (Fotopoulos, 2023; Poyntz & Pedri, 2018; Shearer et al., 2024). The ever-expanding digitalization process has redefined what it means to “watch television” as the consuming content now exists simultaneously across many platforms (Poyntz & Pedri, 2018). Nonetheless, mainstream television continues to hold a place among young people’s media choices, continues to make up a significant portion of adolescents overall media usage worldwide, and still holds its place in shaping young people’s experiences and learning (Fotopoulos, 2023; Poyntz & Pedri, 2018; Shearer et al., 2024). 24 Research Gap Media, and TV specifically, offers an important lens through which abortion messages can be framed to encourage adolescents to adopt informed and healthy behaviors (Allen & Solomon, 2016; Bergmann et al., 2010; Mocarski & Bissell, 2016; Perlman et al., 2013; Vorpahl & Yang, 2018; Wang & Singhal, 2016). This is due to TV’s popularity and its influence on adolescents (Altshuler, Gerns Storey, et al., 2015; Baba et al., 2005; Sisson, 2017). However, we know little about how the news media frame abortion messages aimed at influencing young people’s reproductive health choices. This requires attention because media framing of abortion messages could have a significant impact on public attitudes to abortion (Conti & Cahill, 2017), thus ultimately strengthening or undermining adolescents reproductive health and rights (Sisson & Rowland, 2017a). Previous studies predominately conducted in the USA have offered insights on abortion content in the media. They reveal that abortion coverage is; limited on TV (Laar, 2010), largely negative (Nixon et al., 2017), deemphasizes its public health and reproductive rights aspects (Sisson et al., 2017), dominated by people and interest groups who lack personal experience with abortion (Chandra-Mouli et al., 2013) and homogenized in nature due to the limited coverage of people who are directly affected by abortion as well as the oversimplification or disregard of women’s reasons for seeking abortion (Aduy, 2006; Bartholomé et al., 2015; Laar, 2010; Ogunyemi, 2011). What is lacking from literature is the impact of such portrayals on women and especially adolescents who are most affected by unsafe abortion, on public opinion generally as well as the political actions around abortion. Additionally, less is known about abortion messages aimed at younger demographics such as adolescents (Patel & Johns, 2009) as well as the gendered differences of the effects of 25 abortion coverage (Olufunke et al., 2014). Studies segregated along gender lines could be important given the likelihood of males and females of different ages responding differently to behavioral intentions (Ekstrand et al., 2005; E. Freeman et al., 2018; Salam, Das, et al., 2016; Salam, Faqqah, et al., 2016) . Previous studies reveal that men have been largely ignored as agents in the reproductive health sphere (Moore et al., 2011). It is important to understand the perceptions and experiences of men and particularly adolescent boys regarding abortion coverage. This is because as co-conceivers of pregnancies being aborted (Wang & Singhal, 2016), they play a key role (in)directly on women’s abortion trajectories (E. Freeman et al., 2018; Moore et al., 2011). In Kenya, limited attention has been paid to abortion messages in the news media despite the high prevalence of unsafe abortion and numerous critical discourse moments surrounding abortion. To the best of my knowledge, no previous studies have investigated media framing of abortion messages aimed at adolescents in Kenya (Kafu et al., 2021). This is despite a growing interest in ASRHR among scholars, health care professionals and policy makers (FHI360 & Ministry of Health, 2011; Mitchell et al., 2006; Wachira et al., 2016). Interest in ASRHR is cultivated by the magnitude of pregnancies as well as the prevalence of maternal morbidity and mortality among this population. Also lacking in literature are insights into abortion frame building and consequently how the portrayal of abortion in the Kenyan news media potentially influences adolescents’ perceptions of abortion (Kafu et al., 2021). Objectives This study therefore seeks to: Objective 1: Investigate the framing of abortion in TV news items on three leading Kenyan TV outlets over a period of 3 years. 26 Objective 2: Examine adolescents’ (18-24yrs) perceptions of media’s framing of abortion on Kenyan televised news media. Significance of the study Mass media and specifically television presents a great avenue for mitigating unsafe abortions, especially among the younger demographics. Television is a powerful and prominent source of sexual reproductive health information for adolescents (Jaworski, 2009). Besides the adolescence period provides considerable opportunity for behavior to be shaped in positive ways (Pringle et al., 2018). During adolescence the socio environment plays a significant role in identity formation, development of value systems and internalization of modes of conduct (Sedlander et al., 2019). Information on the types of abortion messages being broadcast by the local media, the perspective these messages are framed from, the sources of these frames, the persons/institutions these messages are aimed at and the impact of these messages on the audience, is crucial. This is because such information is likely to promote the understanding of real causes of unsafe abortion, consequently enhancing the process of developing and implementing practical solutions to this problem. Thus, by examining the media framing of abortion, findings from this study have potential to facilitate more critical reflection and discussions on (un)safe abortion especially among adolescents, with a probable effect on journalistic framing of abortion as well as on health and social policies around abortion. Additionally, examining adolescents’ experiences and perceptions of abortion coverage in the Kenyan broadcast media will be crucial to understanding how adolescents interpret and experience these abortion discourses in their everyday life (Purcell, Hilton, & McDaid, 2014). This will inform the development of effective interventions tailored towards addressing 27 unintended pregnancies, preventing unsafe abortion, and promoting adolescents’ maternal health while factoring in the current legal and social-cultural contexts. For news media to be an effective avenue for mitigating unsafe abortion among adolescents, the abortion content must be developed with an adolescent audience in mind (Dowshen et al., 2015). Unsafe abortion as a public health problem is likely to be effectively alleviated if it connects more rigorously with the everyday lives and existential realities of individuals, groups, communities and societies (Lang & Rayner, 2012). Overall, the study findings will be informative to those who wish to develop media that could be used to promote safe abortion as well as advocate for sexual reproductive health rights, especially among adolescents. Justification of the study Although the portrayal of abortion in news media is an emerging field of research, previous studies have been limited in number and scope. Previous studies predominantly quantitative and majorly conducted in the USA assert a lack of theoretical and methodological diversity. This has led to limited comprehensive understanding of media framing of abortion messages (Borah, 2011). Methodologically, scholars have called for less descriptive strategies and more qualitative approaches to framing analysis research in order to advance the theory of framing as a major concept within the field of communication (Matthes, 2009; Mellado, 2015). Studies have urged future researchers to take up the use of intersectional frameworks of analysis such as integrating content analysis with interviews (In-Depth Interviews, Focus Group Discussions, etc.) to further explore framing research (Mastin et al., 2007). 28 Theoretically, scholars have observed that framing is a process that has most of its analytical power when studied as an integrated model (De Vreese, 2012). This entails mapping the media and audience framing process (framing, frame building and framing effects) in an integrative approach. This study sought to lay groundwork for future studies in news media framing of abortion messages by moving beyond the traditional approach of only interrogating media items to further exploring framing from the perspectives of media consumers. This was achieved by triangulating content analysis and focus group discussions. This is a unique contribution to literature as the study empirically assessed the framing and framing effects subsets of the framing model. This study moved beyond examining media content independent of content effect on audience. Additionally, this study has laid groundwork for future studies in framing of abortion messages in news media in Sub-Saharan Africa (SSA), a study area that is generally lacking in literature. It is important to note that it was beyond the scope of this study to assess the frame- building aspect of the framing process. Scope of the study This study aimed at exploring framing of abortion messages on televised news items in Kenya as a partial model of framing. This entailed examining the framing and framing effects subsets of the framing process. The first objective was grounded in the framing aspect of the framing process, which focused on the media content. We sought to investigate framing of abortion messages in TV news items from three leading Kenyan TV outlets over a period of 3 years. The main domains of interest were the constructs of the framing theory. We examined what was being said, by who, why and who the message was directed to. We further explored the type of stories told and the 29 emotions appealed to. Additionally, we developed a checklist, and the variables of interest included content, frequency of abortion messaging, type of news item, placement of abortion coverage and the trends (what informs the timing of the coverage). This phase of the study was conducted in Nairobi, the capital city of Kenya and home to most local news media organizations. Specifically, we targeted three leading local media outlets namely Citizen TV, NTV and KTN. These television stations were selected based on their popularity among Kenyan audiences (Ken, 2016). We purposively sampled 55 abortion news items aired between January 2016 and December 2019 across these three media outlets. Content analysis was used to analyze these news items as demonstrated in Chapter 3 of this dissertation. Our content analysis revealed that abortion is politicized and largely framed negatively in the Kenyan televised news media as shown in Chapter 4. Moreover, we found that unsafe abortion is framed as a public health problem that largely and adversely affects adolescents. This public health angle was used to advocate for measures to mitigate unsafe abortion, especially among the young population as presented and discussed in Chapter 5. The second objective was based in the frame effects aspect of the framing process, which focuses on effects of media content on the audience. We sought to examine adolescents’ perceptions and experiences with media’s framing of abortion on Kenyan televised news media. Our main domains of interests were adolescents’ experiences with and perception of abortion coverage, and recommendations on improving abortion coverage aimed at adolescents in Kenya as outlined in Chapter 3 of this dissertation. This phase of the study was carried out at Moi University which is a public university located in Kesses location of Uasin Gishu County. Specifically, we targeted male and female university students aged between 18 and 24 years. We conducted four virtual Focus Group 30 Discussions (FGDs) among 37 university-going adolescents for the period November – December 2020. The groups were homogenous in nature (2 female FGDs, 2 male FGDs) with each group comprising of 8-12 participants. Thematic analysis of this data presented in Chapter 6 revealed media audiences perceive abortion coverage as largely negative and predominantly depicting unsafe abortion as largely and adversely affecting adolescents. This mirrors the content analysis findings presented in Chapter 4. Chapter 7 provides summary of the key findings from our study and offers suggestions on the way forward. We conclude that there is need for comprehensive abortion coverage in the Kenyan televised news media. This is likely to positively influence abortion-decision making and care seeking processes, reduce abortion-related stigma as the public better understands women’s abortion realities, and enhance advocacy for implementation of the abortion law based on the understanding of abortion as a public health problem. Conclusion While unsafe abortion has been identified as a serious public health problem that disproportionally affects adolescents, television presents a great avenue for mitigating unsafe abortions, especially among this younger demographic. Television can be used to frame abortion messages in a manner that creates awareness and motivates discussions around abortion. Consequently, this builds an enabling environment for adolescents to access information and services, as well as exercise their autonomy within the context of informed and supportive communities. Such potentialities make television a critical ground for inquiry. However, not much attention has been paid to abortion messages in the news media with Kenya not being an exception despite the high prevalence of unsafe abortion among adolescents in Kenya. Documented literature, predominantly from USA, suggests that for most part abortion coverage 31 in the news media is subject to consistent negative framing, is not all inclusive and barely presents medical facts. The prevailing frames on television include abortion as a perversion that goes against family values, abortion as murder and society’s responsibility to protect the most vulnerable from murder, and abortion as dangerous to women’s health. Sporadically, abortion is framed as a woman’s right to privacy, self-determination and bodily integrity. With media as a site for the expression and reconstruction of societal discourses, it becomes necessary to examine Kenyan news media’s construct of abortion and to further explore how this might be interpreted and experienced in everyday life especially among the adolescent population to whom media is a leading source of sex education at a period in life when they are negotiating and constructing norms and values. The next chapter provides some background on women’s sexual reproductive health and rights, with a focus on abortion within the Kenyan context. 32 CHAPTER TWO THE KENYAN SOCIO-CULTURAL SCENE Introduction Adolescents’ sexual and reproductive health and rights (ASRHR) cannot be ignored given the significant number of adolescents around the globe that are sexually active. This is especially because of the subsequent consequences of early sexual debut including unwanted pregnancies, exposure to STIs, unsafe abortions often with negative sequelae, etc. The negative consequences of adolescents’ sexual behavior, especially unsafe abortion, has been associated to the limited and, in some places, no access to SRH information and services. As previously mentioned in chapter one, mass media and specifically the news media has a great potential of supporting adolescents to realize optimal SRH. The success of mass media interventions largely depends on the framing of the messages, which is influenced by the existing socio-cultural setting and political histories of a given society. This includes the legal status of abortion; social and cultural understandings of women and the fetus, the role of women, the right to privacy; and definitions of what responsible sexual and reproductive behavior entails. Therefore, to understand media’s role in the promotion or erosion of ASRHR within the Kenyan context, it becomes necessary to demonstrate how religion, culture, patriarchy, and law interact with women’s place in society and especially their sexual reproductive health. This chapter therefore brings to the fore the intersectional dynamics between forces such as religion, colonialism, patriarchy, and law, and how these control and order female sexuality and fertility. It links the history of the African female figure to the social structures that arose due to religion and colonialism. It illustrates how the hierarchical gender roles introduced by the colonial state in politics, economics, religion and culture, and retained at 33 independence continue to influence women’s sexual and reproductive health and rights, especially abortion. The Kenyan Socio-Cultural Scene Kenya is a land rich in cultural and ethnic diversity where people and cultures from Africa, Europe, the Middle East, and East Asia have been meeting for hundreds of years (Sobania, 2003). With a population of approximately 52 million people drawn from at least forty two ethnic groups (Kenya National Bureau of Statistics [KNBS], 2024), Kenya boasts an incredibly vibrant tapestry of cultures and practices (Oppong & Oppong, 2004). The Kenyan population typically identifies primarily with its ethnic group. Despite this, it is impractical to detail the culture and customs of each ethnic group in Kenya given the cultural and ethnic diversity as well as the ever-changing cultures and customs as they have been since time immemorial (Sobania, 2003). There are elements of continuity and change in culture and customs among the various ethnic groups (Sobania, 2003). Cultures adapt and evolve as they encounter rapidly changing societies (Thiong’o, 1993). In this chapter, I present a general understanding of cultural traits common to Kenyans without dwelling on the comprehensiveness of individual ethnic groups’ culture and customs. Hence, my reference to the term ‘Kenyan(s)/locals/indigenous people’ highlights the widely shared aspects of cultural ideology among most people in Kenya. This does not indicate a lack of awareness of the cultural and customs diversities among these groups. I touch briefly on some important aspects such as religion, family, gender, and social customs while highlighting some of the social, economic, and political forces that have shaped this culture. Culture defined as a 'reserve of meaning' (Lull, 2001, p. 18) is a product of a peoples' history (Thiong’o, 1993). It reflects a peoples’ history and embodies a whole set of values by 34 which a people view themselves and their place in time and space (Thiong’o, 1993). It is a repository of all the values that have evolved by the different social strata in that society over time. It develops within the process of a people wrestling with their natural and social environment. Distinct from the economy and political life of society which change relatively more rapidly, culture is more conservative. It thus tends to appear unchanging, hence the talk of 'our values ' by different societies. Kenyans, just like other Africans (Sobania, 2003), regard culture as essential to their lives and future development. It embodies their philosophy, worldview, behavior patterns, and institutions. Just like other cultures, the Kenyan society and its peoples’ cultures have undergone continual change as far back as history and prehistory can tell (Middleton, 1995). These changes have not just been instigated by the country’s internal social dynamic but also by her relations with other countries on the continent and beyond (Sobania, 2003; Thiong’o, 1993). Literature reveals that Kenya’s external contact with other societies at various levels- economic, political, social and cultural – has predominantly not been on the basis of equality but of dominance and domination (Thiong’o, 1993). Due to this external domination, the cultural changes that Kenya has experienced have not risen from the working out of the conflicts and tensions within or from the organic development of the Kenyan society, but have been forced upon Kenya externally (Thiong’o, 1993). Centuries of overwhelming economic, political, social and cultural power of religious and colonial overrule has resulted in the deformation, crippling and dying out of some traditional Kenyan cultural values especially in regards to gender and sexuality (Middleton, 1995; Thiong’o, 1993). 35 Religion and women’s sexuality in Kenya Religion plays a role in shaping beliefs and attitudes towards certain cultural practices (Tsanga, 2011). In precolonial times, it permeated every aspect of an individual’s life in the indigenous African society. It was and is a system of thought and action shared by the community, which also caters for the individual by giving out a frame of orientation and an object of devotion (Theuri, 2013). As a pillar of culture, religion made African societies productive by restraining its adherents from destructive tendencies and actions (Theuri, 2013). As Africa interacted with other continents, foreign religions were introduced to the continent. In Kenya, Islam was introduced in the seventh century by Arabic traders who came by ship to coastal ports, conducting trade with people living along the shores of the Indian Ocean (Oppong & Oppong, 2004; Tamale, 2020). It gradually became incorporated into Kenyans ways of life (Tamale, 2020). Christianity was popularized much later, in the eighteenth century and re- introduced in the East African Coast in 1844 by the Rev. Dr Ludwig Krapf and others who served with Church Missionary Society, an Anglican society from England (Tamale, 2020). The propagators of foreign religions totally disregarded the existing religious consciousness of the locals (Gathogo, 2008). Pioneer missionaries, for instance, believed that Africans were backwards and without any knowledge of religious beliefs (Nyanzi, 2011b). Ignoring Africans worldview, they condemned African worship of ancestors or spirits, dismissing African religious discourses as fetish, infidel, pagan, witchcraft and lacking in substance (Gathogo, 2008; Nyanzi et al., 2011). To subdue, uproot indigenous religions and societies, and entrench a new faith, they taught that the African religion was satanic and should be discarded altogether (Munyao & Tanui, 2021). This culminated in the decline of traditional religious institutions and practices. 36 Furthermore, pioneer missionaries disregarded the traditional African gender differences between men and women; differences that were based on rank and/or age. Through their religious ideals, missionaries entrenched patriarchal domination that has served to perpetuate women’s inequality in both the public and the private sphere (Njagi, 2013; Oboler, 1985). They enforced a new moral order wherein men were positioned to occupy the public sphere by tying up social, cultural, political and economic power to maleness (Oyewumi, 1997). Women on the other hand women were oriented towards the family environment where they would perform their “natural” duties of nurturing and caring in private (Tamale, 2020). Domesticity and reproduction were promoted as the defining character