ArticlePloS one2021
"Spoiled" girls: Understanding social influences on adolescent contraceptive decision-making in Kenya.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Implementation components and delivery structures of adolescent peer navigation as a workforce model: a scoping review.BMC global and public health · 2026Pooled it
- Trial
- A Systematic Review of Barriers and Facilitators to the Uptake and Adherence of Injectable PrEP Among Adolescent Girls and Young Women in Sub-Saharan Africa.AIDS and behavior · 2026Review
- Socio-ecological influences on sexual and reproductive health service use: Young adults and provider perspectives from Soshanguve, South Africa.African journal of primary health care & family medicine · 2026Article
- Barriers and facilitators to community-based, peer-led sexual and reproductive health intervention for adolescent girls and young women in northeastern Uganda: A qualitative study.PLOS global public health · 2026Article
- Measuring social norms endorsement and normative influence on contraceptive use among youth (15-24) in northeastern Uganda.Frontiers in global women's health · 2026Article
- Silenced, stigmatised and struggling: early childbearing, minority stress and mental distress among pregnant and parenting adolescent girls in an urban informal settlement in Kenya - an explanatory qualitative study.BMJ public health · 2026Article
- Co-design of a digital health intervention to provide pharmacy-based, person-centered contraceptive decision support for youth in Kenya.PLOS global public health · 2026Article
- Increasing young people's use of sexual and reproductive health services in government health facilities in rural Kenya.PloS one · 2026Article
- From fertility intentions to contraceptive behaviour: evidence among women with children in Malawi.Frontiers in reproductive health · 2026Article
- Article
- Opening the black box of agency in contraceptive decision-making: A cross-country qualitative study of a complex process.SSM. Qualitative research in health · 2025Article
- An in-depth interview study of women's perspectives on the effects of contraceptive use on future fertility in Ethiopia and Kenya.SSM. Qualitative research in health · 2025Article
- Understanding the cost of pharmacy-delivered HIV pre- and post-exposure prophylaxis service delivery in Kenya: findings from pilot studies.BMC health services research · 2025Article
- The State of Person-Centered Measurement for Family Planning Need and Use: A Scoping Review.Studies in family planning · 2025Article
- The role of social networks in motivating access and use of contraceptives among adolescent girls and young women living in resource-constrained settings in Cape Town, South Africa.Reproductive health · 2025Article
- Exploring opportunities to enhance the quality of pharmacy-based contraceptive service delivery for adolescents and young women in Kenya: a multimethod qualitative study.BMC health services research · 2025Article
- Exploring Adolescents' Contraceptive Preferences and Trade-Offs: Findings From a Discrete Choice Experiment in Kenya.Studies in family planning · 2025Article
- Proposed changes to framework to assess contraceptive autonomy based on phased in-depth interviews in northwest Tanzania.Reproductive health · 2025Article
- Improving measurement of girls and young women's reproductive experiences: qualitative findings from research in Kenyan family planning clinics.BMJ public health · 2025Article
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Authors and funding
8 authors at 3 institutions in 2 countries.
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Abstract
objectivesDespite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social influences on their decision-making align and compete. We examined the social context of contraceptive decision-making among Kenyan female adolescents.
methodsUsing community-based sampling, we conducted 40 in-depth interviews and 6 focus group discussions among sexually-active or partnered adolescent girls and young women aged 15-19 in the Nyanza region of Kenya. We analyzed the data in Dedoose using an inductive, grounded theory approach, and developed a conceptual model from the data illustrating social influences on adolescent contraceptive decision-making.
resultsParticipants viewed adolescent pregnancy as unacceptable, and described severe social, financial, and health consequences of unintended pregnancy, including abortion under unsafe conditions. Yet, their contraceptive behaviors often did not reflect their desire to delay pregnancy. Contraceptive decision-making was influenced by multiple social factors, centering on the intersecting stigmas of adolescent female sexuality, pregnancy, and contraceptive use, as well as unequal power in sexual relationships. To prioritize pregnancy prevention, adolescents must navigate conflicting social norms and power dynamics, and put their perceived future fertility at risk.
conclusionsContraceptive decision-making among Kenyan female adolescents is strongly influenced by opposing social norms within families, communities, and sexual relationships, which compel them to risk stigma whether they use a contraceptive method or become pregnant as adolescents. These findings put into perspective adolescents' seemingly incongruent pregnancy preferences and contraceptive behaviors. Interventions to address adolescent unintended pregnancy should focus on supporting adolescent decision-making agency, addressing fertility-related contraceptive concerns, and promoting innovative contraceptive access points rather than increasing contraceptive prevalence.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.