Behavioral barriers to the use of modern methods of contraception among unmarried youth and adolescents in eastern Senegal: a qualitative study

Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework

Introduction

Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State.

Methods

A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software.

Results

The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents.

Conclusion

The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.

"I was just concerned about getting pregnant": Attitudes toward pregnancy and contraceptive use among adolescent girls and young women in Thika, Kenya

BACKGROUND

Adolescent girls and young women (AGYW) have a high incidence of unplanned pregnancies, especially in low-resource settings. AGYW assess the overlapping risks of pregnancy, contraception, and STIs as they navigate relationships. Few studies have examined how AGYW consider the comparative risks of their decisions around sexual and reproductive health in this context or how risk perception influences contraceptive use.

METHODS

Twenty in-depth interviews (IDIs) and 5 focus group discussions (FGDs) were conducted with a subset of sexually active AGYW enrolled in the Girls Health Study (GHS), a longitudinal cohort study in Thika, Kenya, assessing HSV-2 incidence in a cohort of AGYW aged 16-20. Interview questions were focused on perspectives and decision-making around sexual and reproductive health. Interviews were conducted in both English and Kiswahili, transcribed, and coded using inductive and deductive approaches to identify emerging themes.

RESULTS

Misconceptions about long-acting reversible contraceptives (LARCs), injectables, and daily oral contraceptive pills strongly disincentivized their use among AGYW. Participants described pregnancy as undesirable, and AGYW reported prioritizing contraceptive methods that were effective and reliable in pregnancy prevention, even if not effective in preventing STI/HIV infection. Participants reported that AGYW relied heavily on emergency contraceptive (EC) pills for pregnancy prevention.

CONCLUSIONS

Though the goal of avoiding unintended pregnancy was common, this did not suffice to motivate the uptake of long-term contraceptives among AGYWs. Given the convenience, cost-effectiveness, and lower perceived risk of side effects, EC pills were more likely to be accepted as a form of contraception. Understanding the reasons for AGYW's acceptance of certain contraceptive methods over others can help future interventions better target communication and counseling about contraception and influence key drivers of AGYW behavior and decision-making around sexual and reproductive health.

Unmet need for contraception among married adolescent girls and young women in Haramaya Health and demographic surveillance system, Eastern Ethiopia

Background

The prevalence of unmet need for contraception is the highest in low- and middle-income countries (LMIC). Contraceptive use among young married or unmarried women is lower than that among older women in developing countries. Previous studies generalized the findings to all women of reproductive age and have not investigated psychosocial factors that influence contraceptive use. This study aimed to identify factors associated with unmet need for contraception among young married women in the Haramaya Health and Demographic Surveillance System (HDSS), eastern Ethiopia.

Methodology

A cross-sectional, community-based study of young married women aged 15-24 years was conducted. A simple random sampling method was used to select 550 young married women. Data were collected using a pretested structured questionnaire. Using adjusted odds ratio (AOR) with a 95% confidence interval (CI), factors associated with unmet need for contraception were identified using multivariable logistic regression analysis.

Results

The overall prevalence of unmet need for contraception was 154 (30.3%). Adolescents (15-19) (AOR = 2.05, 95% CI: 1.16-3.62), husbands' negative attitude toward contraception (AOR = 2.1, 95% CI: 1.05-4.46), and no previous use of contraception (AOR = 3.9, 95% CI: 2.29-6.71) were significantly and positively associated with unmet need for contraception. On the contrary, young women with secondary education or higher (AOR = 0.55, 95% CI: 0.28-1.084) were negatively and significantly associated with unmet need for contraception.

Conclusion

The prevalence of unmet need for contraception among young women in Haramaya was high. Unmet need was affected by age, husbands' attitude toward contraceptives, the educational status of women, and previous use of contraception. This study underscored the need to improve girls' educational status to empower them in making contraceptive use decisions with their partners. Programs should also engage male partners who are perceived as key decision-makers when it comes to contraceptive use.

Digital self-care for improved access to family planning and reproductive health services among adolescents in Rwanda: preliminary findings from a pilot study of CyberRwanda

Adolescents experience significant barriers, including stigma and discrimination, to accessing voluntary family planning and reproductive health (FP/RH) services in Rwanda. Self-care interventions have been shown to reduce social barriers to FP/RH care, but little is known about the effectiveness of digital self-care for adolescents, particularly in low-resource settings. This paper presents findings from a pilot study of CyberRwanda, a digital self-care intervention providing comprehensive sexuality education and confidential online ordering of contraceptives for school-aged youth in Rwanda through a rights-based approach. A mixed-methods pilot study was conducted from November 2019 to February 2020 to assess feasibility, acceptability, and engagement and to inform a future impact evaluation. Surveys were administered to a random sample of 158 students aged 12–19 years in three secondary schools. In-depth interviews were conducted with students, parents, teachers, pharmacists, district-level administrators, and youth centre staff. Descriptive statistics were calculated and qualitative data were analyzed using a thematic coding approach. One hundred and fifty-eight surveys and 28 interviews were conducted. Results revealed high demand for CyberRwanda in schools. Students were interested in engaging with the program and found the FP/RH content relevant to their needs. However, few purchased contraceptive products through the online ordering system. There are preliminary indications that CyberRwanda may improve access to FP/RH information. An extended implementation period and further research are needed to measure the long-term impacts of the program and evaluate whether this digital self-care intervention can increase uptake of contraceptive methods and reduce adolescent pregnancy among school-aged youth.

Barriers to Contraceptive Use Among Urban Adolescents and Youth in Conakry, in 2019, Guinea

Background: Despite efforts to improve access to family planning, contraceptive prevalence remains relatively low among adolescents and youth in Guinea. The objective of this study was to understand the barriers to the use of modern contraceptive methods among urban adolescents and youth (15–24 years) in Conakry, Guinea.

Methods: This was a qualitative study using an exploratory design. It was conducted in the capital city of Guinea, Conakry in 2019. Respondents included adolescents and youth aged 15–24 years, health care providers, and parents of adolescents and youth. In-depth individual interviews (IDIs) and focus group discussions (FGDs) were used to collect the data. Sixty IDIs and ten FGDs were planned in Conakry. These data were recorded and transcribed, when applicable, from the local languages into French in an anonymous manner. The data were analyzed using a mixed (inductive and deductive) thematic approach following the elements of the socio-ecological model.

Results: Overall, 56 IDIs and 10 FGDs were conducted with 136 participants and included in this analysis. Respondents were adolescents (16%), youth (30%), and key informants (54%) who were health care providers (public and private), decision-makers, parents of adolescents and youth, and neighbors. Among adolescent respondents, 75% were female, and of the youth, 61% were female. Our analysis indicates various and interrelated barriers that limit the access and use of contraceptives by adolescents and youth. These included the individual (fear of side effects, cost, and rumor-related misinformation), interpersonal or family (spouse perception and sexuality taboo and perception of sexual activity before marriage), sociocultural (religious prohibitions and ethnicity), and health care system (breakdown of contraceptive methods in public health facilities, perception of service delivery, provider attitudes, visiting hours, geographic proximity of services, and quality of training received by health care providers) barriers.

Conclusion: In our context, the use of modern contraceptive methods by adolescents and youth is influenced by an interaction of various barriers, including individual, interpersonal, sociocultural, and health care system factors. Strengthening contraceptive uptake interventions by involving different stakeholders, including adolescents, parents, religious, and community leaders, and improving the quality of sexual and reproductive health services would help in reducing barriers to contraceptive use among adolescents and youth.

Individual and community-level factors associated with modern contraceptive use among adolescent girls and young women in Ethiopia: a multilevel analysis of 2016 Ethiopia demographic and health survey

BACKGROUND

The importance of contraception use is immense for young girls of age 15-24 years. In literatures, there were significant attempts made to study factors associated with adolescent and young women contraception use in Africa. Despite the resulting interventions followed those studies, the contraception uses among youth population in Africa remained below average. Thus, this study is aimed to assess individual and community-level factors associated with contraceptive use in Ethiopian context to support further interventions.

METHODS

Our analysis was based on the secondary data from Ethiopia Demography and Health Survey (EDHS) 2016. Adolescent girls and young women (AGYW) aged 15-24 years were the target population. Means, standard deviations, and proportions were used to describe the study population. To control for the variations due to the differences between clusters, a series of multilevel logistic regression modeling steps were followed and determinants of contraceptive use were outplayed. All variables with bivariate p-value < 0.25 were included in the models and p-value < 0.05 was used to declare associations.

RESULTS

The prevalence of modern contraceptive use among AGYW in Ethiopia was 34.89% [95% CI, 0.32, 0.36]. Married adolescents were 2.01 times [AOR = 2.01, 95% CI = 1.39,3.16], having work was 1.36 times [AOR = 1.36, 95% CI = 1.06,1.71], living in urban areas was 1.61 times [AOR = 1.61, 95% CI = 1.16,2.45], being in middle wealth status was 1.9 times [AOR = 1.90, 95% CI = 1.32,2.65], being in rich wealth quintile was 1.99 time [AOR = 1.99, 95% CI = 1.35,2.68], and having TV exposure was 1.61 times [AOR = 1.6, 95% CI = 1.17,2.20] more likely associated with modern contraceptive uses.

CONCLUSION

The use of modern contraception among AGYW in the country remained appealing and factors like region, residence, marital status, wealth index, religion, working status, parity, husband desire children, ever aborted AGYW, and the television exposures were attributed for the poor improvements. Therefore, the enhancements that consult those factors remained remarkable in improving contraception use, while further increasing in educational engagement, access to health services, and economic empowerment of the AGYW might be the good advantages for the improvements.

Behavioral Insights Into Micronutrient Powder Use for Childhood Anemia in Arequipa, Peru

Childhood anemia remains a significant driver of morbidity in low- and middle-income countries, including Peru. To identify behavioral challenges to using micronutrient powder (MNP) that is given to supplement children's diets and prevent anemia, we applied a behavioral design approach to interviews and focus groups with 129 caregivers in Arequipa, Peru. We examined 3 key points in the decision-making process: accessing MNP through the health system; forming intentions to use MNP; and MNP use at the time of child feeding. Using the NUDGE (Narrow, Understand, Discover, Generate, Evaluate) approach, we identified the following behavioral barriers and facilitators: (1) caregivers' experiences with health care providers shaped their motivation to access MNP; (2) caregivers felt accessing MNP at clinics was inconvenient and created hassle factors; (3) caregivers' mental models about anemia prevention shaped MNP intentions and use; (4) caregivers' salient negative experiences could have caused them to stop giving MNP; (5) caregivers forgot to give MNP if they did not have cues to remind them but could be prompted with salient cues; and (6) caregivers were affected by emotional, cognitive, and attentional factors during feeding that were difficult to anticipate. Our results, based on a behavioral design approach, suggest opportunities to adapt current messaging, counseling, and education around MNP use. Adaptations include providing culturally relevant messages, leveraging caregivers' emotional and cognitive states, and encouraging small but impactful changes to feeding routines to address barriers to MNP use.