1
|
Ketye TJ, Babatunde GB, Mianda S, Akintola O. Provider perspectives on adolescent access to contraception in South Africa. Afr J Prim Health Care Fam Med 2024; 16:e1-e11. [PMID: 39099268 PMCID: PMC11304193 DOI: 10.4102/phcfm.v16i1.4537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. AIM This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. SETTING This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. METHODS Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. RESULTS Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. CONCLUSION Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution: This study highlights strategies that facilitate and hinder adolescents' access to contraception.
Collapse
Affiliation(s)
- Thabile J Ketye
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town.
| | | | | | | |
Collapse
|
2
|
Chola M, Hlongwana KW, Ginindza TG. Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3614. [PMID: 36834308 PMCID: PMC9961957 DOI: 10.3390/ijerph20043614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.
Collapse
Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| |
Collapse
|
3
|
Chola M, Hlongwana KW, Ginindza TG. Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2744. [PMID: 36768107 PMCID: PMC9915938 DOI: 10.3390/ijerph20032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
Collapse
Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| |
Collapse
|
4
|
Hailu S, Assefa N, Dingeta T, Abdurahman C, Adem M. Unmet need for contraception among married adolescent girls and young women in Haramaya Health and demographic surveillance system, Eastern Ethiopia. Front Glob Womens Health 2022; 3:999860. [PMID: 36420450 PMCID: PMC9678183 DOI: 10.3389/fgwh.2022.999860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 11/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Saba Hailu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Chaltu Abdurahman
- Department of Public Health, College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mewardi Adem
- Department of Public Health, College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| |
Collapse
|
5
|
Analysis of Unmarried Adolescents and Modern Contraceptives Initiation in Nigeria: Evidence from 2018 NDHS. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11070282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nigeria is one of Africa’s most populous countries. Nigeria’s population is expected to exceed 400 million by 2050, putting it among the top five most populous countries in the world. High birth rates, limited contraception use, and early marriage are the main causes of this rapid increase. In Nigeria, adolescents play a substantial role in these issues, with 117 births per 1000 girls aged 15–19 years. Data for this article comes from the 2018 Nigerian Demographic and Health Survey (NDHS). Our sample consisted of 1014 sexually active unmarried adolescents aged 15–19 years. Kaplan Meier’s curve, Log Rank Test, and Cox proportional hazards model were modeled to estimate the parameters at p > 0.05. Findings show that the average time to the first use of modern contraceptives after sexual initiation is two years. Initiating sex at age 15 or later, belonging to the richest household wealth quintile, and use of the internet is associated with the early initiation of modern contraceptive methods, while residing in the northwest region and being older are associated with a low incidence of modern contraceptive use. Results indicate a deferred initiation of modern contraceptives after first sexual encounter. It has become imperative for tailored interventions to improve the time of initiation of contraceptives, so as to reduce the associated burdens and consequences.
Collapse
|
6
|
Engelbert Bain L, Amu H, Enowbeyang Tarkang E. Barriers and motivators of contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies. PLoS One 2021; 16:e0252745. [PMID: 34086806 PMCID: PMC8177623 DOI: 10.1371/journal.pone.0252745] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, about 80% of young women either use a traditional method or do not use any form of contraception at all. The objectives of this review were to ascertain the barriers and motivators of contraceptive use among young people in Sub-Saharan Africa. MATERIALS AND METHODS We conducted electronic literature searches in PubMed, EMBASE, Ebsco/PsycINFO and Scopus. We identified a total of 4,457 publications and initially screened 2626 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 13 qualitative studies were retained for the final analysis based on the Joanna Briggs criteria for assessing qualitative studies. The systematic review is registered on PROSPERO with identifier CRD42018081877. RESULTS Supportive social networks, respect for privacy and confidentiality, ready availability, affordability and accessibility of contraceptives, as well as the desire to prevent unintended pregnancy and sexually transmitted infections were the motivators of contraceptive use among young people in sub-Saharan Africa. Despite these motivators, myriad of personal, societal, and health systems-based barriers including myths and misconceptions, known side effects of contraceptives, prohibitive social norms, and negative attitude of health professionals were the major barriers to contraceptive use among young people. CONCLUSION Sub-Saharan African countries with widespread barriers to contraceptive use among young people may not be able to achieve the Sustainable Development Goal 3.8 target of achieving health for all by the year 2030. Interventions intended to improve contraceptive use need to be intersectoral and multi-layered, and designed to carefully integrate the personal, cultural, organizational and political dimensions of contraception.
Collapse
Affiliation(s)
- Luchuo Engelbert Bain
- Lincoln International Institute for Rural Health (LIIRH), College of Social Science, University of Lincoln, Lincoln, Lincolnshire, United Kingdom
- Global South Health Research and Services, GSHS, Amsterdam, The Netherlands
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| |
Collapse
|
7
|
Tryphina Skosana M, Doriccah Peu M, Shirley Mogale R. Disconnections and exclusions of parents in the prevention of teenage pregnancy: A phenomenological approach. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|