A cross-country qualitative study on contraceptive method mix: contraceptive decisionmaking among youth

Abstract

Background Youth ages 15 to 24, who comprise a large portion of sub-Saharan Africa, face a higher burden of unmet contraceptive need than adults. Despite increased international and national commitments to improving young people’s access to contraception, significant barriers impede their access to a full range of methods. To further explore these barriers among youth in Kenya, Nigeria, and Uganda, we conducted a qualitative study to capture the challenges that affect contraceptive method decisionmaking and complicate youth access to the full method mix. Methods To understand factors that impact young people’s contraceptive decisionmaking process across all three countries, we conducted a total of 35 focus group discussions with 171 youth ages 15 to 24 and 130 in-depth interviews with key stakeholders working in youth family planning. Questionnaires aligned with the High Impact Practices in Family Planning’s elements of adolescent-friendly contraceptive services. Data were coded with MAXQDA and analyzed using a framework for contraceptive decisionmaking to identify relevant patterns and themes. Results In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms, complicating their ability to take full advantage of other available methods. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, and only a few youth reported that they are completely unable to access contraceptives, other barriers still present a major deterrent for youth, including cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers. Conclusions Young people’s ability to fully exercise their method choice remains limited despite availability of services, leading them to take the path of least resistance. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.

The association of quality contraceptive counseling measures with postabortion contraceptive method acceptance and choice: results from client exit interviews across eight countries

“…Youth had a marginally higher mean score on the information exchange metric largely due to young abortion clients more often being told about a barrier method for protection against STIs compared to non-youth clients. Although our study did not find any discernable difference between youth and non-youth, there is strong evidence in LMIC that demonstrates that young people, in particular adolescents, have limited knowledge of contraceptive methods [38]. Youth often have misconceptions about the side effects of contraceptives on their health and future fertility [39][40][41] and poor understanding of how contraceptives work and how they should be used [39,42].…”

Contraceptive method use trajectories among young women in Kenya: A qualitative study

“…The decision to begin their contraceptive journey with condoms was influenced by several factors, but overwhelmingly the most common influences were related to the strong desire for a method that protected against both pregnancy and STIs, easy accessibility and low cost at pharmacies and shops, and a lack of knowledge about other methods. Use of condoms may be driven, in part, by wider social acceptability of young people using condoms which is rooted in the desire for a method that is used only when needed (coital dependent), not perceived to impact future fertility, as well as the appreciation of the dual protection they provide ( 10 , 15 , 17 ). Our study found that young women learn about condoms from a variety of sources, including teachers, peers, their partner and parents; this differs from the paper from Ouma et al which found that most young people learn about methods from peers and the internet ( 10 ).…”

“…Use of condoms may be driven, in part, by wider social acceptability of young people using condoms which is rooted in the desire for a method that is used only when needed (coital dependent), not perceived to impact future fertility, as well as the appreciation of the dual protection they provide ( 10 , 15 , 17 ). Our study found that young women learn about condoms from a variety of sources, including teachers, peers, their partner and parents; this differs from the paper from Ouma et al which found that most young people learn about methods from peers and the internet ( 10 ).…”

“…The factors that influence contraceptive use (including uptake, switching, discontinuation and contraceptive method choice) among young women are multifactorial. Numerous barriers and facilitators to contraceptive decision-making have been described in many countries across sub-Saharan Africa and include factors related to knowledge about contraception (10)(11)(12), social environment (13)(14)(15)(16), partner dynamics (10,11), concerns about side effects and method characteristics (11,12,17), as well as factors related to the supply environment, such as accessibility, privacy, cost, and method availability (10,16,(18)(19)(20). These factors influence whether young women or their partners use contraception or not, the circumstances under which they use contraception, what method young women and their partners use, when they adopt a method, or how long they use the method before discontinuing or switching.…”

Differences in contraceptive prices between and within family planning outlets in urban and semiurban Nigeria: a prospective cohort study

“… 8 Pharmacies and drug shops are often preferred because of privacy concerns, convenience, fast service, and perceived youth-friendliness. 9 , 10 , 11 In a mixed-methods study in Kenya, young people identified pharmacies as a preferred option that afforded privacy without the prohibitive costs of private facilities; many young people were willing to pay more for private pharmacy services to access high-quality, private care, citing pharmacies’ consistent pricing as an added benefit. 10…”