School-going adolescent girls’ preferences and views of family planning services in Phalombe district, Malawi: A descriptive, cross-sectional study

Abstract

Background Low uptake of family planning services by adolescent girls remains a public health concern. An estimated 120 out of every 1,000 girls aged 15 to 19 years are having unplanned pregnancies in the sub-Saharan region. Between January and June 2020, the Phalombe District of Malawi reported 3,030 adolescent pregnancies. At this stage, most Malawian schools were closed due to the COVID-19 pandemic. The high rate of adolescent pregnancies prompted the Ministry of Health to provide emergency contraceptives to reduce the number of unplanned pregnancies among adolescents. The provision of emergency contraceptives would be effective if girls were willing and able to access these family planning services. We thus explored the views of school-going adolescent girls regarding their preferences for modern family planning methods including emergency contraceptives in Phalombe, Malawi. Methods This was a cross-sectional, descriptive study, where quantitative data were collected using a structured questionnaire. Participants included randomly sampled school-going adolescent girls from eight purposively selected secondary schools and eight randomly selected primary schools. All the schools were sampled from three purposively selected Traditional Authorities namely Nkhulambe, Jenala and Nkhumba which had reported high numbers of adolescent pregnancies. We analyzed the GeoPoints for schools and health facilities using ArcGIS, while adolescent girls’ views were analyzed using STATA. Results Participants included 388 adolescent girls, ranging in age from 10 to 19 years (median age = 15.5 years, SD = 1.9 years). Participants were hesitant to use contraceptives because they were afraid of being stigmatized and embarrassed, had to travel long distances to reach the service center, knew little about modern family planning and were afraid of medical complications. Conclusion The uptake of family planning services by adolescent girls can be improved by bringing healthcare services closer to schools and homes. Family planning services should employ health workers who are non-judgmental and who are able to remove the stigma associated with family planning. Health workers should at any given opportunity, address the misconceptions and beliefs that adolescents have towards contraceptives. Community sensitization and health talks should be done to improve adolescent girls’ understanding of family planning services.

“I fear those things”: non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala, Uganda

“…Our participants had concerns regarding the use of hormonal methods which they believed to cause infertility, as has been documented in many studies ( 28 – 30 ). This is largely attributed to misconceptions they had about the possible side effects caused by these methods.…”

“…Preference to use condoms has been noted in other studies ( 27 , 32 ). This could be because condoms are easily accessed, cheap and probably the most promoted method of family planning after abstinence among young adolescents, particularly of school-going age ( 27 , 28 ). Given that our study enrolled young people who perceived themselves to be at high risk of HIV infection due to their involvement with multiple sexual partners, they probably used condoms both as contraceptives but also to avoid other outcomes such as HIV and STIs.…”

Modern Contraceptive Use in Adolescent and Young Women: A Systematic Literature Review

“…( 14) , (16) One study only includes the use of emergency contraceptive methods at 18.3% and female concomitant at 80.3%, without including the use of other contraceptives. (21) In qualitative research, it was found that 6 out of 14 respondents used MMC, 3 used traditional methods and 5 did not use any. (9) From the 15 selected articles, 42 predictors of contraceptive use among adolescents were obtained, consisting of 30 internal factors and 12 external factors.…”

“…Modern contraceptive use among adolescents originated from the Americas at 82.5%,(13) the African 6-78%,(14)(18) , (9) (19) and the Asian 42%. (21) The most common contraceptive method used pill 83%(13) and condoms 54-80.3%. (8) ( 18) -( 9)There are several countries with low rates of modern contraceptive use (<10%) among adolescent, despite having several family planning policies.…”