Graduation Year

2023

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Claudia Parvanta, Ph.D.

Co-Major Professor

Russell Kirby, Ph.D.

Committee Member

Cheryl Vamos, Ph.D.

Committee Member

Ndola Prata, M.D., MPH

Keywords

Contraception, Family Planning, Teenages, Pregnancy, Africa, Youth

Abstract

Introduction: Globally, 17 million adolescent girls—ages 15-19-- give birth every year, which affects educational and professional outcomes such as school completion, future employment, and economic empowerment. In Benin, adolescent girls have a substantial unmet need for sexual and reproductive health (SRH) information and services. More specifically, the need for hormonal contraceptive products and services, as well as accurate, age-appropriate, and comprehensive sexuality education, is not met universally.

Objective: This research objective is to understand personal, behavioral, and environmental barriers and facilitators to the access and uptake of modern contraceptive methods among adolescents in Benin. This will inform recommendations for improving access and services for adolescents in Benin.

Methods: This is a qualitative study using “Social Cognitive Theory” to 1) understand the experiences of adolescent girls and young women, 15-19 years old, while seeking, accessing, and utilizing contraceptives, and 2) identify community-based interventions addressing unmet needs. In-depth structured interviews of 30 adolescents and key informant interviews with 16 “stakeholders” were conducted and analyzed using computer-assisted qualitative data analysis software (MaxQDA).

Results: Adolescent girls’ access to hormonal contraceptives is influenced by a wide range of cognitive, behavioral, and environmental factors. Advanced knowledge, positive perceptions, and positive expectancies about contraceptives are important cognitive factors influencing the intention and use of contraceptives. Negative perceptions and myths lead to adolescents’ hesitancy toward contraceptive use.

Peers, Partners, Parents, Priests (religious or traditional leaders), and Providers (5P) are key influencers of contraceptive use. Peers and siblings were the primary sources of information for sexual and reproductive health and contraceptives. Peers represent a supportive social network where adolescents can openly discuss sexual and reproductive health and contraceptive questions, concerns, misconceptions, and experiences.Partners, family, and community members’ opinions, approval, or disapproval influence contraceptive use. These opinions typically influence adolescents because they are shared by trusted persons (relatives and peers) or authority figures (parents, health providers, traditional and religious leaders). However, adolescents’ internal reinforcements such as pursuing and completing school or training are significant motivators of contraceptive use. Service costs, the lack of confidential services, and provider bias prevent adolescents from seeking and using health services. Despite challenges in accessing information and services, most respondents were confident in their ability to consistently use contraceptives, as prescribed and indicated by medical providers if these barriers are removed.

Implications and Recommendations for Public Health It is critical to partner with and equip girls with comprehensive SRH information and skills, provide access to affordable and confidential services; and train healthcare providers to be unbiased and friendly. Stakeholders must address social and cultural norms by educating and engaging parents and community members in reproductive and broader health programs while creating an enabling environment and policies supportive of girls' SRH, and holistic empowerment.

Download

Share

COinS