A Qualitative Exploration of Factors Explaining Non-Uptake of Hormonal Contraceptives Among Adolescent Girls in Rural Ghana: The Adolescent Girls’ Perspective

Motivators and Influencers of Adolescent Girls’ Decision Making Regarding Contraceptive Use in Four Districts of Zambia

“…Intrapersonal motivators for non-use: The adolescents mentioned various side effects that they have experienced from using contraceptives. Similar side effects have been reported in other studies, including menstrual cycle irregularities [ 6 , 20 , 23 ], sickness, including abdominal pain [ 18 , 19 , 23 ], changes in weight (either extreme weight gain or loss) [ 6 , 19 , 21 , 22 , 23 ], menstrual cycle and colour of blood, spotting, constant bleeding [ 21 , 23 ], amongst others. Other issues mentioned include body weakness, dizziness, fainting, blood clots during menstruation, miscarriages, becoming epileptic [ 6 ], heavy bleeding [ 6 , 18 ], cancer [ 18 ], reduced libido [ 19 , 23 ], and paralysis [ 21 ].…”

“…Similar side effects have been reported in other studies, including menstrual cycle irregularities [ 6 , 20 , 23 ], sickness, including abdominal pain [ 18 , 19 , 23 ], changes in weight (either extreme weight gain or loss) [ 6 , 19 , 21 , 22 , 23 ], menstrual cycle and colour of blood, spotting, constant bleeding [ 21 , 23 ], amongst others. Other issues mentioned include body weakness, dizziness, fainting, blood clots during menstruation, miscarriages, becoming epileptic [ 6 ], heavy bleeding [ 6 , 18 ], cancer [ 18 ], reduced libido [ 19 , 23 ], and paralysis [ 21 ]. This fear stems from what those who have used contraceptives have experienced and also what those who have not used contraceptives have heard from those who have used them.…”

“…Where contraceptive use among adolescents becomes common knowledge, they may be ridiculed and labelled ‘bad girls’ who have loose morals, as reported in similar studies [ 27 , 30 , 48 , 49 ]. Such mocking and judgement from their peers may lead to exclusion from their social circles and them being at the centre of gossip among their peers, including those who are married [ 6 , 20 ]. Therefore, to avoid being the centre of ridicule, gossip, and victims of social exclusion and for them to maintain their social circles and social life, adolescents may lean towards the non-use of contraceptives, that is, if they do not opt to hide their usage of contraceptives.…”

“…Contraceptives have been proven to help prevent unwanted pregnancies, early pregnancies, and unsafe abortions [ 6 ]. However, contraceptive use remains low, particularly in the least-developed countries, such as those in Africa [ 7 , 8 , 9 ].…”

“…Various studies across Africa have shown that there are factors influencing adolescent girls’ decision to use contraceptives [ 6 , 18 , 19 , 20 ]. Among these are individual [ 6 , 21 , 22 ], parental [ 18 , 19 , 21 ], peer [ 20 , 21 ], partner [ 19 , 22 ], societal and community [ 6 , 18 , 20 ], and institutional and environmental [ 6 , 23 ] influences that contribute positively and negatively to adolescents’ decision to either use or not use contraceptives. In Zambia, however, there is limited information on what influences contraceptive decisions among adolescent girls aged 15–19 years.…”