Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: an application of the socio-ecological model

Abstract

Background: High rate of teenage pregnancy in Nigeria is potentially an indication of poor access to and utilization of contraceptives among this age group. This paper presents findings from in-depth exploration of perceived barriers to utilization of contraceptive services by adolescents. Methods: A qualitative study was conducted in six communities in Ebonyi state, southeast Nigeria. Eighty-one in-depth interviews and six focus group discussions were conducted. Respondents comprised policy makers, community leaders, health service providers and parents of adolescents. Pre-tested interview guides were used to collect information on perceived barriers to utilization of contraceptive services by adolescents. All interviews were audio recorded and transcribed in English. Data was analysed using thematic framework approach, and the socio-ecological model was adapted for data synthesis. Results: Individual level factors that limit access to contraceptives for adolescents include lack of awareness and poor knowledge, fear of side effects, low self-esteem, and inability to afford cost of services. Interpersonal (family-related) barriers to access include poor parent-child communication of sexual and reproductive health matters and negative attitude of parents towards to sexuality education for adolescents. Health systems barriers to accessing contraceptives for adolescents include lack of privacy and confidentiality, stock-out of contraceptive commodities, judgmental attitude of health workers, insufficient staff that are skilled in adolescent sexual and reproductive health. Gendered cultural norms, societal shaming and religious intolerance also preclude adolescents from accessing and using contraceptive services. Wider societal factors such as negative peer and media influence, absence of sexuality education in schools, lack of social networks in communities; and macro level factors such as poor economic conditions were also perceived to limit access to contraceptives for adolescents.

Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria

“…Adolescents mostly do not receive information from accurate sources such as experienced adults, parents and healthcare providers. Young people are most likely to receive and believe information they get through social media and friends as communication about SRH matters including contraceptives, barely occur in many African homes due to religious and cultural restrictions [ 6 , 29 ]. This finding corresponds with a Nigerian study by Envuladu et al which reported similar local/traditional methods used by women to prevent pregnancy [ 30 ].…”

“…Two FGDs were conducted in each community (giving a total of twelve) and participants ranged from 8 to 13 in number (see Table 1 below). A more comprehensive method of our study can be found in a published article [ 29 ].…”

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

“…68 When selecting a contraceptive method, particularly IPP/ IPA, there is an onus on the provider to sensitively navigate the consultation, build trust, elicit the patient's needs and preferences, and ensure the decision to commence contraception is both well informed and not coerced. [70][71][72] Adolescents may require additional sexuality education and, due to heightened barriers to access and experiences of medical and social stigma, 28 require a supportive healthcare climate to facilitate education and decision-making. 73 Receiving inadequate information during contraceptive counseling, and the subsequent impact on contraceptive decisions, has implications for the reproductive autonomy of adolescents.…”

“…Improving low rates of postpartum and post‐abortion care attendance, 22‐24 and subsequent use of contraception, has been the emphasis of a number of RRP‐focused interventions. Programs involving comprehensive follow‐up, home visits, education and family planning are the most effective for preventing repeat pregnancy and improving clinic attendance, 25,26 as these address social inequalities and improve poor health literacy and access to services 27‐29 …”

“…Programs involving comprehensive follow-up, home visits, education and family planning are the most effective for preventing repeat pregnancy and improving clinic attendance, 25,26 as these address social inequalities and improve poor health literacy and access to services. [27][28][29] Improving access to long-acting reversible contraception (LARC; intrauterine devices [IUDs] and subdermal implants) is increasingly being endorsed as an integral part of postpartum and post-abortion care, as these methods reduce the odds of a subsequent pregnancy compared with short-acting or no method of birth control. 18,21,30 The International Planned Parenthood Federation recommends LARC as a safe option for teenagers, 31 and the World Health Organization places no age-related eligibility restrictions on LARC methods.…”