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

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Abstract Background Pregnancy complications and unsafe abortions are the leading causes of death among adolescent girls aged 15-19 years globally. Contraceptives have been proven to help prevent unwanted pregnancies, early pregnancies, as well as unsafe abortions. However, contraceptive use remains low, particularly in the least developed countries, including sub-Saharan Africa and Zambia specifically, thereby undermining the potential benefits of contraceptive use. This study sought to explore and understand the motivators and influencers of adolescent girls’ decision-making regarding contraceptive use. Methods We used thematic analysis to analyse qualitative data from 7 focus group discussions and 3 key informant interviews aged between 15-19 years in Chongwe, Lusaka, Kasama and Luwingu districts located in Lusaka and Northern provinces, respectively. NVivo version 12 pro (QSR International) was used to manage and organise the data. Results Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents), were key motivators for adolescents’ contraceptive use. Friends and peers also motivated them to use contraceptives. None-use was motivated by fear of side effects, and fear of infertility. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls’ contraceptive decisions. Conclusion Mixed messages from friends, family members, partners, churches and religious groups, some in favour and others against contraceptives, make adolescents’ decisions to use contraceptives complex. Therefore, it is vital to take an all-inclusive approach in developing interventions by incorporating the various influencers, including at institutional and policy levels, even as we seek to empower adolescents and give them autonomy to make contraceptive decisions.

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