Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana

Sneha Challa, Abubakar Manu, Emmanuel Morhe, Vanessa K. Dalton, Dana Loll, Jessica Dozier, Melissa K. Zochowski, Andrew Boakye, Richard Adanu, Kelli Stidham Hall

Research output: Contribution to journalArticlepeer-review

59 Citations (Scopus)

Abstract

Little is known about the multilevel social determinants of adolescent sexual and reproductive health (SRH) that shape the use of family planning (FP) among young women in Africa. We conducted in-depth, semi-structured, qualitative interviews with 63 women aged 15–24 years in Accra and Kumasi, Ghana. We used purposive, stratified sampling to recruit women from community-based sites. Interviews were conducted in English or local languages, recorded, and transcribed verbatim. Grounded theory-guided thematic analysis identified salient themes. Three primary levels of influence emerged as shaping young women’s SRH experiences, decision-making, and behaviors. Interpersonal influences (peers, partners, and parents) were both supportive and unsupportive influences on sexual debut, contraceptive (non) use, and pregnancy resolution. Community influences included perceived norms about acceptability/unacceptability of adolescent sexual activity and its consequences (pregnancy, childbearing, abortion). Macro-social influences involved religion and abstinence and teachings about premarital sex, lack of comprehensive sex education, and limited access to confidential, quality SRH care. The willingness and ability of young women in our study to use FP methods and services were affected, often negatively, by factors operating within and across each level. These findings have implications for research, programs, and policies to address social determinants of adolescent SRH.

Original languageEnglish
Pages (from-to)434-450
Number of pages17
JournalWomen and Health
Volume58
Issue number4
DOIs
Publication statusPublished - 21 Apr 2018

Keywords

  • Adolescents
  • family planning
  • reproductive health
  • sexual health
  • social determinants of health
  • social ecological model

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