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Background: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. Methods: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15–19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents. Results: Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents’ sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. Conclusions: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.
This study was part of a larger evaluation which aimed at providing baseline information on the key aspects of a digital adolescent SRH intervention, ‘In Their Hands’ (ITH). ITH in Kenya was a digital health program that aimed to increase adolescents’ use of high-quality SRH services through targeted interventions. The ITH programme provided SRH information while promoting adolescents’ use of contraception, pregnancy tests and testing for sexually transmitted infections (STIs) including HIV. The project was implemented in eighteen counties in Kenya, prioritized based on their burden of teenage pregnancies, unmet need for contraception among adolescent girls and incidence of STI and HIV infections. For the evaluation component, two counties were selected from the counties where the intervention had not begun at the time of the baseline study, one from Nyanza region (Homa Bay) and another from Rift Valley (Narok). This was a qualitative study involving adolescent girls, parents/adult caregivers and community health volunteers (CHVs). In Kenya, CHVs are lay members of the community sharing ethnicity, language and life experiences of the communities they serve. One needs to have a minimum of primary level education to qualify to be a CHV. They are given basic health training to support their community to improve their general health status including maternal health, nutrition, basic hygiene and other behavioral health interventions. The full training curriculum takes approximately three months. We conducted 45 in-depth-interviews (IDIs), 20 in Homa Bay County and 25 in Narok County with purposively selected adolescent girls aged 15–19 who were usual residents (lived in the study communities at least six months preceding the study). Additionally; eight focus group discussions (FGDs), four per county with parents/adult caregivers (all mothers); and another four (two in each county) were held with CHVs affiliated to health facilities that were selected for the ITH programme. Eligibility criteria for other adult FGD participants included having an adolescent girl aged 15–19 years. Participants’ characteristics varied by age, level of education, occupation, marital status and parity. Discussions were conducted in the local language and audio recorded following consent of the study participants. Interviewers were trained to facilitate the discussions and were provided with semi-structured interview and discussion guides for the IDIs and FGDs respectively. Face to face interviews were held with adolescent girls, and in groups for mothers and CHVs. IDIs were used to explore adolescent girls’ SRH concerns and services seeking behaviors including their views on contraception. The FGDs with the community (caregivers and parents) and CHVs were used to explore the community’s attitudes towards adolescent sexuality and their concerns on SRH services for adolescents including contraception for adolescent girls. To minimize discomfort and any unforeseen embarrassment surrounding the study topic, female moderators were engaged throughout the study. Additionally, female moderators freely and easily unlocked the real issues associated with adolescent girls’ SRH concerns thereby facilitating free and open feedback from the targeted respondents. Audio recordings from the IDIs were anonymized, labelled with unique identifiers and deleted from digital recorders once transcription was completed. The discussions were transcribed verbatim, translated into English, coded and analyzed thematically using NVivo version 12. A “thematic analysis” approach was used to organize and analyze the data, and to assist in the development of a codebook and coding scheme. A preliminary code book was developed using the interview guide and a set of IDIs and FGDs transcripts, and discussed among the research team. Data was analyzed by first reading the full transcripts of FGDs and IDIs, familiarizing with the data and noting the emergent themes and concepts. A thematic framework was developed from the identified themes and sub-themes, and then used to create codes for the raw data. Our qualitative analysis followed a pattern of association on the key identified themes, particularly focusing on narratives related to adolescent girls’ contraceptive use. “Misconceptions about contraception” in this study are defined as “widespread views about the effects and purpose of contraceptives that are not supported by any scientific evidence” [23], “sexual libertinism” on the other hand refers to the practice of adolescent girls pursuing their own personal sexual desires while disregarding societal expectations and norms. Our analysis and findings are presented in accordance with the Standards for Reporting Qualitative Research guidelines (SRQR) [24]. The protocol for this study was reviewed by African Population and Health Research Centre’s scientific and ethics committee and adjudged to be scientifically sound. The institutional review board (IRB) approval for the study was given by the AMREF Health Ethics and Scientific Review Committee (AMREF-ESRC P499/2018). Research permit for the study was granted by Kenya’s National Commission for Science, Technology and Innovation (NACOSTI). Additional approval was obtained from county and sub-county commissioners, Ministries of Health and Education in the respective counties; and other local administrators including, Chiefs, Assistant Chiefs and Village Elders. All participants gave written informed consent to participate in the study. For adolescents aged below 18 years and not emancipated, both parental/guardian consent and adolescent assent were obtained before starting the interviews.
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