Peer-reviewed article
Psychosocial determinants of contraceptive desire and use among sexually-active adolescent girls in Kenya and Nigeria: implications for girl-centered contraceptive programs.
Musau A, Schlingemann S, Odeh R, Ndungu L, Bulama A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined what factors influence contraceptive desire and use among sexually active teenage girls aged 15-19 in Kenya and Nigeria. The research involved over 2,300 girls, most of whom were married or living as married. The study found that contraceptive knowledge, feeling confident about using contraception, seeing it as relevant to their lives, and what their peers do are all linked to girls wanting and using contraception. However, only 46% wanted contraception and 37% were using it, despite most girls having high fertility desires.
Key points
- 81.5% of participants were married or living as married, and three-quarters had already given birth
- Only 46% expressed desire for contraception and 37% were currently using it
- Contraceptive knowledge, self-efficacy, perceived relevance, and descriptive norms (what peers do) were positively associated with contraceptive desire and use
- Future aspirations and perceived reproductive control were not associated with contraceptive outcomes
- 86.5% practiced preference-aligned contraceptive use, though the study notes this metric needs further validation
Limitations
The study was cross-sectional, so it cannot establish causal relationships between psychosocial factors and contraceptive outcomes. The high proportion of married girls and girls already with children limits generalizability to all sexually active adolescents.
Abstract
INTRODUCTION: The high rates of unintended and early pregnancies among adolescent girls in sub-Saharan Africa are concerning and are substantially contributed to by low contraceptive uptake. Contraceptive use can avert these pregnancies, but demand remains low. We investigated the influence of psychosocial determinants on three outcomes: desire for contraception, current use and preference-aligned use among sexually-active adolescent girls from Kenya and Nigeria. METHODS: Our study involved data from household-based cross-sectional surveys in 282 primary sampling units in two Nigerian states and four Kenyan counties. Participants were adolescent girls aged 15–19 years. The data was collected after mapping and listing of the households where eligible participants resided. Six psychosocial determinants (contraceptive knowledge, perceived self-efficacy, contraceptive relevance and reproductive control, future aspirations and descriptive norms) were fitted into generalized linear mixed-effects models against the study outcomes. RESULTS: Data from 2,327 participants were analyzed. The majority (81.5%) were married or living as married, 16.2% were attending school and 60% were Muslim. Three-quarters had ever given birth, 71% had sex weekly while 93.5% had desire for future conception. Overall, 46.0% expressed current desire for contraception, 37.2% were using contraception while 86.5% practiced preference-aligned contraceptive use. Controlling for selected covariates, contraceptive knowledge, perceived contraceptive relevance, self-efficacy and descriptive norms were positively associated with desire for and current use. Future aspirations and perceived reproductive control were not associated with all three outcomes. In the main analysis, no psychosocial determinant was associated with preference-aligned contraceptive use. CONCLUSIONS: Our study demonstrated modest desire for contraception and low contraceptive prevalence amidst high desired fertility, highlighting a critical opportunity for contextualized girl-centered programs. Such programs should focus on enhancing contraceptive knowledge, building self-efficacy, increasing perceived relevance and shifting descriptive norms to drive contraceptive demand and use. Investigated determinants could serve as intermediate outcomes tracked to monitor progress towards contraceptive use outcomes and to inform program adaptations. Despite the high preference-aligned contraceptive use demonstrated, this metric is nascent, and more research is warranted to establish its utility for evaluating programs.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Girl-centered contraceptive programs focusing on enhancing contraceptive knowledge, building self-efficacy, increasing perceived relevance, and shifting descriptive norms
- Population
- Sexually-active adolescent girls aged 15-19 years in Kenya and Nigeria (n=2,327; 81.5% married or living as married)
Key finding
46.0% expressed current desire for contraception