Ilene S. Speizer

In South Africa, adolescent girls and young women (AGYW) are engaged in early, condomless, and unprotected (from pregnancy) sex, which puts them at risk of unintended pregnancies and sexually transmitted infections. At the individual, interpersonal, and structural levels, AGYW experience barriers to their access to and use of contraception and condoms. This study employed a cluster-randomised factorial design to examine the impact of a multi-level intervention on contraceptive use behaviours among 802 women ages 16-24 in Tshwane, South Africa. The two intervention components were the Young Women's Health CoOp (YWHC), an intervention to increase participants' knowledge and skills, and a stigma and discrimination (S&D) reduction training at the facility level. Study facilities were randomised into the four study arms: YWHC only; S&D only; both YWHC and S&D; and control (standard of care). The study demonstrated that AGYW in the YWHC arm (RRR: 2.45; 95% CI: 1.05-5.70, p = 0.038) and those in the YWHC and S&D arm (RRR: 3.65; 95%CI: 1.56-8.50, p = 0.003) were more likely to have started a contraceptive method than to remain a non-user compared to those in the control arm over the 9-month follow-up period. However, those in the S&D training-only arm had lower odds of adopting a method over the follow-up period (OR: 0.63; 95% CI: 0.41-0.97, p = 0.037). These results demonstrate the importance of supporting AGYW with tailored messaging in a safe environment as part of sexual and reproductive health services.

Background: Burkina Faso is religiously diverse compared to its neighbors. Religion and religious leaders are often perceived as being against family planning (FP) use. That said, the literature on different religions and religious leaders’ position on FP does not demonstrate a uniform stance and there is a dearth of perspectives related to use among young people. Methods: Qualitative data for this study were collected in July 2022 in Ouagadougou and Bobo-Dioulasso, Burkina Faso. Focus group discussions (FGD) were conducted with Catholic, Protestant, and Muslim young women who were aged 18–24 and were current users of FP. In-depth interviews (IDI) were conducted with pro-FP Catholic, Protestant, and Muslim religious leaders. The FGD and IDI data were translated and transcribed into French, thematically coded, and qualitatively analyzed. Results: Young women of all faiths generally perceived their religions were against FP use for anyone, and especially for unmarried women. There was some openness to FP use by married women for birth spacing, especially with the consent of the husband. When young women were asked about their reasons for using FP despite their perception of their religion’s position against it, married young women said they used FP due to financial and practical difficulties inherent to modern day life, and to promote a more harmonious family life. Unmarried young women used FP to avoid social stigma and to pursue their own studies. IDI with pro-FP religious leaders of all faiths demonstrated their support of FP; they spoke of its benefits. While religious leaders did not say their religion prohibits FP use, they expressed some conditions on their support of FP such as marital status, purpose of FP use, and type of method used. Conclusions: This study shows that while young Christian and Muslim women largely perceive their religion to be against FP use, other factors are considered in their decision to use. While religious leaders remain influential, for young women, societal level pressures are more pressing. Religious leaders and other stakeholders should consider the current needs of young people and their own evolving beliefs around FP in their messages to their communities.

Studies examining norms and behaviors around female genital mutilation (FGM) are needed to accelerate progress towards the elimination of this harmful practice. This study uses nationally representative data from a pilot FGM module among women ages 15–49 from Burkina Faso collected in 2023/2024. Three main outcomes related to attitudes, norms and behaviors are used to determine which women who themselves experienced FGM are early adopters of norms and behaviors for stopping the practice in the future. Of the 95% of women who know about FGM, 69.5% experienced FGM, with higher prevalence in rural (74%) than in urban (55%) areas. Results demonstrate that among women who experienced FGM, education level and living in a Christian-headed household are associated with having early adopter attitudes, norms, and behaviors. Conversely, girls and younger women (ages 15–24) are less likely to have early adopter attitudes, norms, and behaviors than their older counterparts (ages 35+). Further, in the analysis of whether women who experienced FGM themselves performed FGM on their daughter(s) or if they would consider FGM for a daughter, for those who do not have daughters, we find that those who are innovators and not practicing FGM are more educated and Christian. In addition, younger women are more likely to report that they would continue FGM than their older counterparts. Results are discussed in the context of strategies to eliminate FGM, particularly among women in communities where FGM is common.

The “intention to use” (ITU) contraception indicator has gained recent prominence as a proposed high‐level success metric for family planning (FP) programs and as a step toward identifying measures that better capture what women want. Although ITU offers advantages over traditional indicators like contraceptive prevalence and unmet need, its elevation as a key programmatic measure requires critical examination. In this commentary, we outline advantages of ITU to measure FP demand and offer critiques and considerations for reliance on ITU as a demand metric for measuring programmatic success. We argue that while ITU may be a step toward more person‐centered measurement, it is not inherently person‐centered. Rather than positioning ITU as an innovative person‐centered breakthrough, we argue it should be considered a transitional measure—a bridge toward more comprehensive indicators that capture the complexities of contraceptive decision‐making. We recognize the current lack of viable alternatives for programs seeking a singular person‐centered measure; when used, ITU should be complemented by additional topline indicators that capture access, agency, and preferences. With declining research funding and data infrastructure disruptions, it is important that ITU complement, not replace, efforts to develop the next generation of FP measurement that meaningfully reflects people's contraceptive realities.

Standard measures used to assess family planning (FP) program success, including unmet need and demand satisfied, fail to capture women's, men's, couples’, and adolescents’ own expressed preferences, needs, wants, and desires. Identification is needed of person‐centered fertility and FP measures that assess what individuals want, desire, need, and prefer without a researcher‐ascribed value of what is the right outcome. This scoping review examines how the concept of person‐centeredness has been employed as part of population‐based FP measurement. For this review, we defined measures as person‐centered if they assess directly a person's preferences, wants, and desires while at the same time assessing if the person can or wants to meet those preferences, wants, and desires. The review finds several studies that use or adapt standard measures of intention to use contraception and unmet need; however, a smaller number develop novel approaches that capture method preferences and satisfaction with methods to better capture individuals’ needs, wants, and desires as well as their ability to attain these needs, wants, and desires. Results are used to make recommendations going forward for the design and testing of improved person‐centered FP measurement at the global, national, and programmatic levels.

While religion is a key determining factor of contraceptive use, few studies examine how religion influences adolescent and youth contraceptive attitudes, beliefs, and use. We use recently collected (August–November 2022) qualitative data from Burkina Faso, Kenya, and Niger among young users of modern contraception who practice Christianity or Islam. In-depth interviews with married and unmarried young women ages 18–24 years were conducted in two sites in each country to obtain a mix of religions and method users. In each country, many young Christian and Muslim women perceived that their religion is not supportive of contraceptive use. Some nuances around perceived acceptability of use were identified in Niger and among Muslim women in Kenya particularly for married women for spacing or health reasons. Reasons given for using related to realities of life, personal choices, and that use is their prerogative and God will forgive them. Most married women felt there would be few consequences if their religious community learned of their use whereas unmarried young women feared more consequences from their religious and broader community. These findings demonstrate that while religion is important in all three study contexts, decisions around contraceptive use among the young women included were not necessarily influenced by their religious beliefs and practices. As a greater number of young people adopt contraception, with or without perceived religious support, social norms are likely to change leading to increased access to contraception for all young women, married and unmarried, when or if they need it.

Background: Numerous factors at the individual, interpersonal, and societal levels are related to contraceptive use (or non-use) among adolescents and youth. Little is known about the role of religion as an individual and community-level influencer of contraceptive use among young women. Methods: Using in-depth interviews with 24 young contraceptive users ages 18–24 who practice their Catholic, Protestant or Muslim religion in two cities in Burkina Faso, this study examines motivations and perceived consequences of contraceptive use. By including users of modern contraception who were both single and married, a range of perspectives are provided. Results: Generally, the young women interviewed who practice their religion and use contraception perceived that their religion was not supportive of contraceptive use. A few exceptions were provided, including perceived acceptance of use of some methods for married women for spacing purposes; this was specifically identified as acceptable among Muslim respondents. Sexual activity and contraceptive use were not acceptable by any of the religions for unmarried young women. That said, young women, both married and unmarried, reported their motivations for use that often related to their and their children’s health and the realities of life. Contraceptive use was considered a private matter which meant that the religious community would not find out about women’s use. Conclusions: Recognizing that some women are willing and able to use contraception even without the perceived support of their religious communities might help to push social norms to change and be more accepting of contraceptive use that meets young women’s and families’ circumstances.

Early marriage and childbearing put young women and their babies at risk of poor health and well-being. This study uses two rounds of longitudinal data from young women ages 15–19 in 2015–2016 and followed in 2018–2019 to determine factors associated with contraceptive use before a first pregnancy among young, married women in Bihar and Uttar Pradesh, India. Discrete time hazard models were used to analyze time to first use starting from the month of marriage. Overall, use of contraception prior to a first pregnancy was low in this sample (between 12 to 20% used before a first pregnancy). Young women who reported that someone discussed the importance of delaying a first birth at the time of marriage were significantly more likely to have used a method of family planning (FP) before a first pregnancy than those who did not receive this information. Further, women who discussed FP with their husband before a first pregnancy were more likely to use contraception. Finally, among recently married young women, those who experienced pressure to have a child were less likely to use before a first pregnancy. As young women recognize the advantages of delaying a first birth and adopt FP to meet their needs, social norms around early childbearing will slowly adjust and early use to delay a first pregnancy will become more normative.