MGHD 2024

Background: Globally, Sub-Saharan Africa holds the highest adolescent fertility rate with severe consequences to both mother and child. In Neno district, Malawi, despite the free availability of family planning services in all 14 health facilities, the uptake of these services by adolescents aged 15-19 remains remarkably low at 10%. Despite the availability of various research on similar topics, the research gap in surveying a rural setting like the Neno district and including the experiences of male adolescents and other vital stakeholders, recognizing the intersectionality of adolescents' family planning issues, still needs to be filled. Objective: To explore the barriers, facilitators, and preferences for the uptake of family planning methods among adolescents aged 15-19 in the Neno district by July 2024. Methods: This was a phenomenological qualitative study. Purposive sampling was used to enroll 23 participants who included both female and male adolescents aged 15-19 who had used family planning methods in the past 6 months, the parents/guardians of such adolescents, healthcare workers and Youth Community Based Distribution Agents (YCBDA) who attend to such adolescents, religious and traditional leaders. In-depth interviews and focus group discussions were carried out in Chichewa and English after obtaining informed consent. The interviews were recorded, transcribed, and translated into English where applicable. This was followed by an open reading and then a codebook development using Dedoose (9.2.12). Thematic analysis was then used to organize the codes into categories and then themes. Results: A total of 23 transcripts were obtained. The study results highlighted the perspectives of the participants on adolescent’s low uptake of family planning methods in the district. The study identified 4 themes based on the socio-ecological model used, which were, “socio cultural environment, informational gaps, and health facility environment contributed to low uptake of family planning methods among adolescents”, “adolescent FP method uptake was significantly promoted by individual and external factors”, “adolescent specific choices included their FP methods, source of information and desired interventions”, and “adolescent's individual and socio-economic challenges arising from unsafe sex practices was a shared understanding”. Conclusion: The study identified a complex interplay of individual, interpersonal, community and health facility level barriers and facilitators to the uptake of family planning methods among adolescents aged 15-19 in Neno district. Socio-cultural environment, informational gaps, and health facility environment were reported as barriers while adolescent family Planning method uptake was significantly promoted by individual and external factors. Building up on the current efforts by PIH Malawi to improve the uptake of family Planning methods, an intersectional approach in adolescent family planning programming is needed to address the highlighted barriers and adopt the preferences of the adolescents. It is also important to prioritize interventions that promote dual protection, community involvement and social behavioral change

Background: Adolescent sexual and reproductive health (SRH) is a global challenge, particularly in low- and middle-income countries (LMICs) where 90% of the 1.2 billion adolescents reside (WHO, 2024). In Sub-Saharan Africa, adolescent birth rates are high, with many unintended pregnancies ending in unsafe abortions (UNICEF, 2024; Sully et al., 2020). Despite Rwanda's efforts to improve adolescent SRH through national strategic plans and youth- friendly health facilities, utilization remains an issue, particularly in the Gatsibo district (MOH [Rwanda], 2018, Gender Monitoring Office, 2020). This study explores adolescents' experiences with SRH services utilization to inform targeted interventions and policies in Rwanda. Methods: A qualitative phenomenological study was conducted in the Kabarore sector, Gatsibo district. In-depth interviews (IDI) were conducted with seventeen adolescents consisting of 10 female and 7 males aged 10-19 years old. Thematic analysis was used to identify key themes and subthemes related to barriers and facilitators to SRH service utilization. Results: Five major themes emerged from the analysis: 1) Cultural norms and religious beliefs along with a lack of open communication with parents deter adolescents from seeking SRH services; 2) Adolescents’ insufficient knowledge and negative perceptions significantly limit their SRH service utilization; 3) Unfriendly SRH services provided by judgmental HCP heavily discourages adolescents from seeking SRH services; 4) SRH commodities were often unavailable, inaccessible, and inadequate infrastructures and 5) Effective SRH interventions/programs and strong peer support positively influences adolescents' utilization of SRH services. These findings draw attention to the lived experiences of adolescents and emphasize the importance of addressing these barriers to enhance SRH service accessibility and quality. Conclusion: This study highlights the complex interplay of factors affecting adolescents' utilization of SRH services in Gatsibo District. The findings underscore the need for multifaceted interventions addressing knowledge gaps, negative perceptions, and systemic barriers while leveraging positive peer influence and effective SRH programs. These insights can inform policy and practice to improve SRH service utilization among adolescents in similar settings.