Psychosocial determinants of contraceptive desire and use among sexually-active adolescent girls in Kenya and Nigeria: implications for girl-centered contraceptive programs

Introduction: The high rates of unintended and early pregnancies among adolescent girls in sub-Saharan Africa are concerning and are substantially contributed to by low contraceptive uptake. Contraceptive use can avert these pregnancies, but demand remains low. We investigated the influence of psychosocial determinants on three outcomes: desire for contraception, current use and preference-aligned use among sexually-active adolescent girls from Kenya and Nigeria. Methods: Our study involved data from household-based cross-sectional surveys in 282 primary sampling units in two Nigerian states and four Kenyan counties. Participants were adolescent girls aged 15–19 years. The data was collected after mapping and listing of the households where eligible participants resided. Six psychosocial determinants (contraceptive knowledge, perceived self-efficacy, contraceptive relevance and reproductive control, future aspirations and descriptive norms) were fitted into generalized linear mixed-effects models against the study outcomes. Results: Data from 2,327 participants were analyzed. The majority (81.5%) were married or living as married, 16.2% were attending school and 60% were Muslim. Three-quarters had ever given birth, 71% had sex weekly while 93.5% had desire for future conception. Overall, 46.0% expressed current desire for contraception, 37.2% were using contraception while 86.5% practiced preference-aligned contraceptive use. Controlling for selected covariates, contraceptive knowledge, perceived contraceptive relevance, self-efficacy and descriptive norms were positively associated with desire for and current use. Future aspirations and perceived reproductive control were not associated with all three outcomes. In the main analysis, no psychosocial determinant was associated with preference-aligned contraceptive use. Conclusions: Our study demonstrated modest desire for contraception and low contraceptive prevalence amidst high desired fertility, highlighting a critical opportunity for contextualized girl-centered programs. Such programs should focus on enhancing contraceptive knowledge, building self-efficacy, increasing perceived relevance and shifting descriptive norms to drive contraceptive demand and use. Investigated determinants could serve as intermediate outcomes tracked to monitor progress towards contraceptive use outcomes and to inform program adaptations. Despite the high preference-aligned contraceptive use demonstrated, this metric is nascent, and more research is warranted to establish its utility for evaluating programs.