Fertility awareness, perceived factors and approaches to improve contraceptive uptake among sexually active adolescent girls in Phalombe, Malawi: a mixed-methods study

Abstract

Background Unintended pregnancies are associated with a range of adverse health outcomes, particularly for adolescents. This study investigated adolescent girls’ level of awareness regarding their fertility. We also investigated the perceived factors and approaches to improving contraceptive uptake among adolescent girls in the Phalombe district of Malawi. Methods This mixed-methods study investigated factors and approaches to improve contraceptive uptake. The quantitative component used structured questionnaires to collect data from school-going adolescent girls in three traditional authorities in the Phalombe district, Malawi. The information was triangulated with qualitative data collected through focus group discussions with adolescent girls in the same setting. Results Structural barriers such as the desire for contraceptive service delivery by peers significantly increased the odds of contraceptive uptake (AOR: 4.80, 95% CI: 1.31–17.32, P value: 0.008) over those who did not want peers to deliver contraceptives. Additionally, Catholic (AOR: 14.01, 95% CI: 2.50–78.47, P = 0.003) and other Christian faiths (AOR: 5.85, 95% CI: 1.20–28.25, P = 0.029) were more likely to use contraceptives than Muslim girls. Focus group discussions revealed that contraceptives should be available in schools in the same way that iron tablets are provided. Additionally, participants indicated that community midwives and health surveillance assistants should provide contraceptives within the communities to reduce distance. Most adolescent girls had little knowledge about their fertility period and did not know that their fertile period was halfway through their menstrual cycle. Conclusion Adolescent girls in the Phalombe district seemingly have low awareness and knowledge of their fertility, which may lead to unintended pregnancies. Structural barriers included non-youth-friendly contraceptive services. Adolescent girls are unable to access modern contraceptives, and there is a need for youth-friendly structures when delivering contraceptive services.