Influences on contraceptive method choice among adolescent women across urban centers in Nigeria: a qualitative study

Abstract

Background Despite calls to increase contraceptive use among adolescents and youth, large gaps still exist, creating an unmet need for family planning. Past research has focused on barriers to seeking a method. There is less understanding of the types of methods young women want and who and what influences these decisions. This study examines what method characteristics young Nigerian women prioritize when choosing a method to inform future family planning programming. Methods In 2018, eight focus group discussions (FGD) were conducted in the Nigerian cities of Ilorin and Jos with 83 young women ages 15–24. Participants were identified by community contacts and separated into groups by religion and marital status. The discussion guide utilized a vignette structure to understand the participants’ perceptions on contraceptive behavior and attitudes and misconceptions surrounding different types of methods. The FGDs were undertaken and analyzed by collaborative teams from the University of Ibadan and the University of North Carolina-Chapel Hill. A thematic analysis of the transcripts was performed using Atlas.ti, including two rounds of coding, and multiple reviews by the research team. Results The method characteristics associated with young women’s contraceptive decisions include: side effects, reliability, length of coverage, privacy, cost, and accessibility. Side effects, reliability, and privacy were described as negatively linked to short-acting methods whereas easy accessibility and low cost were positive characteristics of these methods. Long-acting methods were generally viewed as positive. Participants’ focus on side effects commonly resulted from concerns about the impact on future fertility. The characteristics prioritized by individuals change throughout their adolescence and as their marital status changes. Providers, peers, parents, and partners were all found to have an influence over method choice in different ways. The role of these influencers also changes over the adolescent years. Conclusion This study demonstrates that programs should prioritize expanding method choice to increase the number of available options to ensure all young women can access a method that fits their desired method characteristics. Programming should ensure that medically accurate information is widely distributed to harness providers, peers, parents and partners as a resource for information about specific methods.

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

“…For example, some parents, particularly mothers, feel very uncomfortable discussing sexuality and contraception with their own children who are of childbearing age due to cultural norms. Similar findings have been documented by Samandari et al in (28,37,38).…”

“…For example, some parents, particularly mothers, feel very uncomfortable discussing sexuality and contraception with their own children who are of childbearing age due to cultural norms. Similar findings have been documented by Samandari et al in Niger in 2019, Ezenwaka et al in Nigeria in 2020, and Sanchez et al in Nigeria also in 2021, who found barriers such as religious beliefs and lack of autonomy in contraceptive use by adolescents and youth ( 28 , 37 , 38 ).…”

“…Interpersonal and family barriers, dominated mainly by the negative influences of women's spouses, are also a source of barriers to contraceptive use by young married women. The power of the spouse in married women's decision to use modern planning methods has been documented in other studies in Guinea (30) and elsewhere in the subregion (6,(35)(36)(37). In the plan to reposition FP in Guinea, the strategies put in place did not consider the influence of this decision-making power (27).…”

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

“…Even though adolescent girls discuss contraceptive use with their intimate partners, these conversations are usually to provide approval for contraceptive use [ 20 , 51 ], which is linked to the unequal gender power dynamics in relationships, with males ultimately controlling the decision making on contraceptive use [ 51 ]. They also influence the choice of contraceptive method, which typically aligns with their preferred method [ 52 ].…”

Motivators and Influencers of Adolescent Girls’ Decision-making regarding Contraceptive Use in Four Districts of Zambia

“…Even though adolescent girls discuss contraceptive use with their intimate partners, these conversations are usually to provide approval for contraceptive use (18, 53), which is linked to the unequal gender-power dynamics in relationships with males ultimately controlling the decision-making on contraceptive use (53). They also in uence the choice of contraceptive method, which typically aligns with their preferred method (54).…”