Mumbi Chola

Background: Globally, the unmet need for contraception among adolescent girls is high and is driven by barriers to access and utilisation of contraceptives. Understanding adolescent girls’ experiences with accessing and using contraceptives is crucial because it influences their decision to use and willingness to continue using health products and services. While determinants of contraceptive use have been extensively researched globally, few studies explore how adolescent girls experience contraceptive use in Zambia using qualitative methods. Therefore, this study aimed to understand Zambian adolescent girls’ experiences using contraceptives. Methods: Thematic analysis was used to analyse data generated from 7 focus group discussions and three in-depth interviews with adolescent girls aged 15 to 19 years in 4 districts in Zambia. NVivo version 12 pro (QSR International) software was used to manage and organise the data. Results: Results revealed that adolescents’ experiences concerning contraceptives across the continuum of care are shaped by various factors, including knowledge of contraceptives which comprises sources of information and contraceptives; experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives; perspectives about existing contraceptives; and preferred types of contraceptives. Conclusion: The multifactorial interaction relating to adolescents’ personal experience, their community and the environment in which they access contraceptive services all contribute to their overall experience and influence their contraceptive decisions. Therefore, qualitative studies exploring adolescents’ experiences with accessing and using contraceptives are vital for tailoring interventions responsive to the contraceptive needs of this age group.

Despite its documented benefits, contraceptive use among adolescents remains low, particularly in low-and middle-income countries. This study aimed to decompose the main factors contributing to the changes in contraceptive use among adolescent girls in Zambia over the period 1996 to 2014. Data on adolescent girls aged 15-19 years from Zambia Demographic and Health Survey data were analysed using multivariate decomposition analysis of change. Stata 15/MP (Stata-Corp LLC) was used for analysis, at a 95% confidence level. A p-value of 0.05 was used to determine statistical significance. The sample included 9,072 adolescent girls. Contraceptive use increased by 3% from 7.6% in 1996 to 10.6% in 2013/14. Change in modern contraceptive use among adolescents was mainly due to differences in coefficients (changes in population behaviour). Increases in age contributed to the change in contraceptive use, resulting in 2.94% and 9.33% increases for 17- and 18-year-olds respectively. Marriage or living with a partner contributed the largest change (44%) while living in a rural area accounted for approximately 20%. Interventions targeting improving contraceptive use in adolescents should be responsive to the needs of various age groups, places of residence, and educational levels for maximum benefits.

Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls’ contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). 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 motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. 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. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents’ decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents’ decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10–19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

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.

Background: Despite high levels of pregnancy and childbearing among adolescents in Africa, contraceptive use remains low. Examining variations in contraceptive use among adolescent girls is vital for informing programs to improve contraceptive utilisation among this segment of the population. This study aimed to examine the patterns, trends, and factors associated with contraceptive use among adolescents in Zambia over the period 1996–2014.Methods: The study involved an analysis of data from 1996, 2001/2, 2007 and 2013/14 Zambia Demographic and Health Surveys focusing on adolescent girls aged 15–19 years. Analysis entailed descriptive statistics and estimation of multilevel logistic regression models examining variations in contraceptive use among adolescent girls over time. Estimates withp-values less than 0.05 were considered statistically significant.Results: Results showed that contraceptive use remains low and ranged from 7.6% in 1996 to 10.9% in 2013/14, reflecting a change of 3.3 percentage points over 18 years. Over the 18 years, contraceptive use was significantly associated with age, level of education, and marital status. Older adolescent girls and those with higher levels of education were significantly more likely to use contraception compared to younger ones and those with lower levels of education. Although initially significant (AOR 0.556, 95% CI 0.317, 0.974 in 1996), rural-urban differences disappeared between 2001/2 and 2007 but re-emerged in 2013/14 (AOR 0.654, 95% CI 0.499, 0.859). Across all survey years, adolescents who were married or living with a partner were significantly more likely to use contraceptives compared to those who were not married.Conclusions: The findings suggest the need for targeted interventions to improve contraceptive use among sexually active adolescent girls in the country in general, and those who are disadvantaged in particular.

Background: Iron and Folic Acid are two of the micronutrients recommended for pregnant women to support optimal maternal outcomes with regard to preventing anaemia and foetal birth defects. It is difficult to establish if women provided with iron and folic acid supplementation in Zambia benefit from it and how well it is implemented. The overall objective of this study was to determine the levels of uptake and compliance to iron and folic acid in pregnancy among women of child-bearing age in Zambia, with a focus on both supply and demand factors.Methods: A cross sectional, mixed method study was done. Data was collected in August and September 2015 from six of the 14 districts in which Scaling Up Nutrition interventions were being undertaken as well as Lusaka district. A household survey covering 402 males and females of child-bearing age, 27 key informant interviews amongst key stakeholders and 12 focus group discussions at community level were conducted.Results: Antenatal clinic attendance was almost universal (98.7%); the majority of both men (92.1%) and women (97.4%) had heard messages about iron and folic acid supplementation; the majority (96.5%) of women reported having taken iron and folic acid tablets during their last pregnancy, with 61.3% starting in the second trimester, 27.2% during the first trimester, and 7.7% in their third trimester. Eighty-five per cent (80.5%) of the women reported that they had taken all the tablets they were given with about 13.4% not taking all the tablets received.Conclusions: Root cause analysis, using both qualitative and quantitative findings, showed that the main challenges faced were long distances to health facilities and high transport costs; some women not being reached with supplementation messaging; lack of formalised and uniform training around delivery of antenatal messages across health care workers; women not attending antenatal monthly to replenish supplements; and forgetfulness to take the drugs daily. While male involvement may be a supportive factor, it sometimes hinders women from accessing antenatal services. Results showed that both uptake and compliance to iron and folic acid supplementation in pregnancy in Zambia were sub-optimal.

Background: The SAFE strategy (surgery for trichiasis, antibiotics for active infection, facial cleanliness and environmental improvement) is the World Health Organization (WHO) recommended guideline for the elimination of blindness by trachoma by the year 2020. Objective: While evaluations on the implementation of the SAFE strategy have been done, systematic reviews on the factors that have shaped implementation are lacking. This review sought to identify these factors. Methods: We searched PUBMED, Google Scholar, CINAHL and Cochrane Collaboration to identify studies that had implemented SAFE interventions. The Consolidated Framework for Implementation Research (CFIR) guided development of the data extraction guide and data analysis. Results: One hundred and thirty-seven studies were identified and only 10 papers fulfilled the eligibility criteria. Characteristics of the innovation – such as adaptation of the SAFE interventions to suit the setting and observability of positive health outcomes from pilots – increased local adoption. Characteristics of outer setting – which included strong multisectoral collaboration – were found to enhance implementation through the provision of resources necessary for programme activities. When community needs and resources were unaccounted for there was poor compatibility with local settings. Characteristics of the inner setting – such as poor staffing, high labour turnovers and lack of ongoing training – affected health workers’ implementation behaviour. Implementation climate within provider organisations was shaped by availability of resources. Characteristics of individuals – which included low knowledge levels – affected the acceptability of SAFE programmes; however, early adopters could be used as change agents. Finally, the use of engagement strategies tailored towards promoting community participation and stakeholder involvement during the implementation process facilitated adoption process. Conclusion: We found CFIR to be a robust framework capable of identifying different implementation determinants in low resource settings. However, there is a need for more research on the organisational, provider and implementation process related factors for trachoma as most studies focused on the outer setting.

Contraceptive use among adolescents remains consistently low globally. Numerous studies have been done investigating factors that contribute to low contraceptive prevalence rates in this special population. It is particularly vital to understand decision-making processes that adolescents undergo when deciding whether or not to use contraceptives. Therefore, this scoping review seeks to map available evidence on decision-making processes in contraceptive use among adolescents. We will conduct a scoping review to explore, describe and map literature on the adolescent decision-making regarding contraceptive use. The primary search will include peer-reviewed and review articles. Databases, including PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct and Scopus, will be searched for articles that meet the eligibility criteria. Keyword searches will be used, and for articles included after title screening, abstract and full articles will be screened by two independent reviewers with a third as a decider on any disputes. Content analysis will be used to present the narrative account of the reviews. Understanding how adolescents make decisions about whether or not to use contraception is essential for improving contraceptive prevalence rates in this special population. It is envisioned that the results from this review will highlight key evidence on how adolescent make decisions regarding contraceptive use as well as gaps and opportunities for future research. It will also be important in enhancing and re-focusing adolescent sexual and reproductive health policies and programmes.