Perceived drivers of teenage pregnancies and barriers to utilization of contraceptive methods among adolescents in Rwanda: perspectives of adolescents and healthcare providers

Background: Despite ongoing efforts to improve utilization of contraceptives among adolescents to address teenage pregnancies, significant gaps persist. Globally, approximately 12 million of adolescent girls aged 15–19 years give birth each year and this is particularly higher in low- and middle-income countries including Rwanda. Modern contraceptive use among sexually active adolescent girls and boys remain below 25% in Africa, compared to more than 70% in developed counties, illustrating a wide gap in access and utilization. This study explored key perceived drivers of teenage pregnancies and barriers of contraceptive utilization among adolescent girls and boys in Rwanda, aiming to inform strategies to enhance reproductive health services for this population. Methods: A descriptive phenomenological study was conducted from September to October 2023. Twelve focus group discussions among in school and out-of-school adolescents aged 12 to 19 years old and 15 key informant interviews among healthcare providers were conducted. Data were collected through semi-structured interviews and focus group discussions, supported by audio-recordings and field notes. The data were analyzed using thematic content analysis with Atlas ti. Version 8 to identify key patterns and insights. Results: The study revealed that alcohol consumption, family conflict and poverty were the key drivers of teenage pregnancy in Rwanda. The perceived barriers of utilization of contraceptive among adolescent girls and boys were perceived cause for infertility, concerns about poor condom quality, limited knowledge and awareness of contraceptive methods, insufficient skills in correct condom use, and limited availability and accessibility of contraceptives for adolescents. Conclusion: The findings of the study highlight the need for multi-sectorial intervention including policy aimed at reducing poverty, mitigating family conflict and strict enforcement of regulations to limit underage alcohol use. Addressing misconceptions about contraceptive related infertility, improving condom quality, and strengthening the availability and accessibility of contraceptives, alongside enhancing adolescents’ knowledge about contraceptives and skills in correct condom use are essential to reducing teenage pregnancy.