University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Background: In Malawi, 45% of adolescent girls and young women (AGYW) report their pregnancies as unintended or mistimed, yet uptake of modern contraception remains low. Adolescence and young-adulthood are periods when individuals begin to make health-related decisions independently but are still largely influenced by those around them. Understanding how social interactions impact AGYW contraceptive use might explain low levels of contraceptive uptake beyond individual and environmental factors and guide effective strategies to engage AGYW and their social networks in reproductive health interventions. Methods: Two studies were conducted using data from Girl Power (GP), a one-year intervention for sexually active AGYW (age 15-24) in Malawi. Study one used cross-sectional analyses to examine whether contraceptive communication and social norms (descriptive and injunctive) were associated with contraceptive outcomes and how associations differed by source of social influence, marital status, and parity (N=942). Study two used longitudinal mediation analyses to examine whether exposure to GP, and to contraceptive-specific empowerment sessions within GP, was associated with contraceptive outcomes and whether associations were mediated by contraceptive communication (N=517). Results: In study one, contraceptive communication and descriptive norms were associated with non-barrier contraceptive use. However, associations differed across sources of social influence, marital status, and parity. Contraceptive communication with partners was important for all; communication with peers was important for single AGYW, regardless of parity; and communication with older women in the family was important for single, childless AGYW. Descriptive social norms were important for single AGYW, regardless of parity. There was no association among contraceptive communication, social norms, and condom use. In study two, exposure to contraceptive-specific empowerment sessions was positively associated with non-barrier contraceptive use and the relationship was mediated by contraceptive communication with partners. Exposure to contraceptive-specific empowerment sessions was also positively associated with condom use but the relationship was not mediated by contraceptive communication with any source. Conclusions: These findings inform reproductive health interventions situated in sub-Saharan Africa by highlighting the variation in sources of social influence for AGYW non-barrier contraceptive use. Interventions for AGYW that encourage contraceptive communication in general, but especially with partners, have the potential to increase non-barrier contraceptive use.Doctor of Philosoph
