Abstract
BackgroundDespite 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.MethodsIn 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.ResultsThe 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.ConclusionThis 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.
Highlights
Despite calls to increase contraceptive use among adolescents and youth, large gaps still exist, creating an unmet need for family planning
The presence or absence of side effects and concerns about the impact on future fertility were the most frequently discussed factors influencing method choice, with the reliability of the method closely following. Lifestyle fits such as privacy, cost, and accessibility were considered as influential in the overall decision of what method to choose. These influences were attached throughout to specific methods with short-acting methods being more likely to be associated with features that would detract from use, while implants were more frequently associated with features that would encourage use
The results of this study can be used by programs seeking to increase expanded method choice for adolescents and youth
Summary
Despite calls to increase contraceptive use among adolescents and youth, large gaps still exist, creating an unmet need for family planning. Despite the size of this population, adolescents and youth experience barriers at the policy, service delivery point, and community levels affecting their access to the sexual and reproductive health services they need, in low and middle income countries [1]. The setting for this study, faces similar reproductive health challenges as seen across Sub-Saharan Africa. In 2018, the total fertility rate in Nigeria was 5.3 children per woman [3], and urban adolescents and youth have a median 5.7 year gap between first sexual experience and first contraceptive use [3, 4]
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