Adoption of Contraceptives and Unintended Pregnancies Amongst Adolescent Girls in Nyando Sub-county, Kenya

Abstract

Use of contraceptives is one of the pillars of preventing unintended pregnancies amongst adolescent girls globally. The risk of mistimed and unwanted pregnancy is high among adolescents as compared to older women. Adolescent pregnancy is identified as one of the reasons for unsafe abortions, mother and child morbidity as well as mortality and even girls dropping out of school. Regardless, effective contraceptive use among adolescents in low and middle income countries remains low and poorly documented. The study assessed the adoption of contraceptives and unintended pregnancies amongst adolescent girls in Nyando Sub-county. The study objectives were: to establish how socio-demographic factors influence adoption of contraceptives amongst adolescent girls; to determine how contraceptive methods applied prevent unintended pregnancies amongst adolescent girls; to investigate how culture influences adoption of contraceptives amongst adolescent girls; and to determine how access to contraceptives influences adoption of contraceptives amongst adolescent girls in Nyando sub- County. The Health Belief Model (HBM) was applied to understand adolescent contraceptive use. A cross-sectional design and assisted questionnaires were used to collect data. The study targeted adolescent girls (10-19 years) visiting maternal health and child welfare clinics within Nyando Sub-County. Cluster sampling was used where two out of the five wards within Nyando Sub-County were randomly selected to act as the main cluster. All health facilities offering reproductive health services were considered as the next set of clusters where all eligible participants were nominated and consented until 400 respondents were attained. The data was analyzed using excel and IBM SPSS version 20 program and presented in the form of frequency tables, with mean, median and standard deviation and p-values indicated as applicable. All ethical considerations were observed throughout the conduct of the study, with the study being reviewed and approved by the institutional ethics review committee of Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH IERC) and the National Commission for Science, Technology and Innovation (NACOSTI). From the study findings, the mean age of respondents was 16 years. From the study findings, a majority (86.3%) of the respondents were already sexually active by age 15. Only 17% of the respondents were married, with all respondents having attained some basic education. The study found out that the majority of adolescent girls got information about contraceptives through their friends. The majority of adolescents also started using any form of contraceptive either after sexual debut or delivery or following an abortion. The study area is predominantly Christian, and this did not have a negative influence on adoption of contraceptives by adolescents. Despite the acknowledged availability of contraceptive methods, and reported use by the majority of respondents upon sexual debut, the majority of respondents had either visited the health facility for antenatal care or child welfare clinic, meaning the contraceptive methods applied (majorly male condoms) did not effectively prevent occurrence of unintended pregnancies in the subcounty. Myths and fear of side effects, real or perceived, were reported to negatively influence adoption of contraceptive use by adolescents. Lack of knowledge about how contraceptives work was also documented as a key challenge to adoption of contraceptives amongst adolescents. The study recommends that social relationships should be tapped and players empowered in order to share accurate contraceptive information. This is informed by the fact that the majority of respondents were influenced and introduced to contraceptives by friends and mothers, yet at the same time parental disapproval was cited as an impediment to adoption of contraceptives. Evaluating the role of social media is also recommended.