"I was just concerned about getting pregnancy”: Attitudes toward Pregnancy and Contraceptive Use Among Adolescent Girls in Thika, Kenya

Abstract

Abstract Background Adolescent girls and young women (AGYW) have a high incidence of unplanned pregnancies especially in low resource settings. AGYW assess overlapping risks of pregnancy, contraception, and STIs as they navigate relationships. Few studies have examined how AGYW consider comparative risks of their decisions around sexual and reproductive health in this context and how risk perception influences contraceptive use. Methods The Girls Health Study (GHS) is a longitudinal cohort study in Thika, Kenya assessing HSV-2 incidence in a cohort of AGYW aged 16–20 with not more than one lifetime sexual partners. Twenty in-depth interviews (IDIs) and 5 focus group discussions (FGDs) were conducted with a purposively selected subset of sexually active AGYW enrolled in the parent cohort. IDI interview guide focused on perspectives and decision-making around sexual and reproductive health. IDIs were conducted in both English and Kiswahili, transcribed and coded using inductive and deductive approaches to identify emergent themes. Results Participants described unintended pregnancies as undesirable, and AGYW reported prioritizing contraceptive methods that were effective and reliable in pregnancy prevention, even if not effective in preventing STI/HIV infection. Misconceptions about long-acting reversible contraceptives (LARCs), injectables, and daily oral contraceptive pills strongly disincentivized their use, with many AGYW citing concerns about infertility and structural damage to reproductive organs as deterrents. Though unlikely to use daily or long-term contraceptive methods in anticipation of sexual activity, participants reported that AGYW relied heavily on emergency contraceptive (EC) pills to prevent pregnancy immediately after unprotected sex. Conclusions Our research demonstrated that desire to avoid pregnancy was common, yet on its own was not enough to motivate uptake of long-term contraceptives. However, AGYWs generally favored the use of EC pills to prevent unintended pregnancy due to the EC pill’s convenience, cost-effectiveness and lower perceived risk of side effects. Understanding reasons for AGYW’s acceptance of the EC pill can help future interventions better target communication and counseling about contraceptives to influence key drivers of AGYW behavior and decision-making around sexual and reproductive health.