Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: a qualitative study

Plain language summary There is limited data on modern family planning method use of young adolescents aged 10-14 years compared to older adolescents aged 15-19 years. The study assessed factors that influence modern family planning method decision-making and use among young adolescents aged 10-14 years. The Theory of Reasoned Action model was applied to understand the processes that influence modern family planning method decision-making and use among young adolescents. The study was conducted in 6 youth health-friendly services clinics and 12 youth clubs where adolescents access contraceptives. We conducted 2 focus group discussions and 26 in-depth interviews. The study involved sexually active, in and out of school young adolescents and influential decision-makers in reproductive health. The results are presented in a narrative format using themes identified during analysis in line with study objectives. The study discovered that modern family planning method decision-making is influenced by social factors; hormonal side effects of modern family planning methods and improper linkage between Sexual and Reproductive Health Rights and Education policies. The findings suggest the need to empower girls in decision-making. Address myths surrounding modern family planning methods. Then harmonize Sexual and Reproductive Health Rights and Education Policies in the country. Background The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15-19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15-19 years old) leaving out the young adolescents (10-14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years. Methods This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10-14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis. Results Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents' perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies. Conclusion The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.