{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:57:45Z","timestamp":1789102665026,"version":"build-2803163510"},"reference-count":56,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls\u2019 contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents\u2019 contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls\u2019 contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents\u2019 decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.<\/jats:p>","DOI":"10.3390\/ijerph20043614","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T03:29:06Z","timestamp":1676863746000},"page":"3614","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Motivators and Influencers of Adolescent Girls\u2019 Decision Making Regarding Contraceptive Use in Four Districts of Zambia"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6488-113X","authenticated-orcid":false,"given":"Mumbi","family":"Chola","sequence":"first","affiliation":[{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa"},{"name":"Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khumbulani W.","family":"Hlongwana","sequence":"additional","affiliation":[{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa"},{"name":"Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9435-3488","authenticated-orcid":false,"given":"Themba G.","family":"Ginindza","sequence":"additional","affiliation":[{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa"},{"name":"Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"key":"ref_1","first-page":"152","article-title":"Improving Adolescent Access to Contraception in Sub-Saharan Africa: A REVIEW of the evidence","volume":"24","author":"Smith","year":"2020","journal-title":"Afr. J. Reprod. Health"},{"key":"ref_2","unstructured":"World Health Organisation (2022, August 30). Adolescent Health, Available online: https:\/\/www.who.int\/health-topics\/adolescent-health#tab=tab_2."},{"key":"ref_3","unstructured":"World Health Organisation (2019, April 09). Adolescent Pregnancy. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/adolescent-pregnancy."},{"key":"ref_4","unstructured":"Zambia Statistics Agency (ZSA), Ministry of Health (MOH), University Teaching Hospital Virology Laboratory (UTH-VL), and ICF (2020). Zambia Demographic and Health Survey 2018."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chola, M., Hlongwana, K., and Ginindza, T.G. (2020). Patterns, trends, and factors associated with contraceptive use among adolescent girls in Zambia (1996 to 2014): A multilevel analysis. BMC Womens Health, 20.","DOI":"10.1186\/s12905-020-01050-1"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2147\/OAJC.S320038","article-title":"A Qualitative Exploration of Factors Explaining Non-Uptake of Hormonal Contraceptives Among Adolescent Girls in Rural Ghana: The Adolescent Girls\u2019 Perspective","volume":"12","author":"Mevissen","year":"2021","journal-title":"Open Access J. Contracept"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/padr.12051","article-title":"Contraceptive Practice in sub-Saharan Africa","volume":"43","author":"Tsui","year":"2017","journal-title":"Popul. Dev. Rev."},{"key":"ref_8","unstructured":"United Nations (2015). Trends in Contraceptive Use Worldwide 2015, Department of Economic and Social Affairs PD, United Nations."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"258","DOI":"10.2471\/BLT.10.083329","article-title":"Low use of contraception among poor women in Africa: An equity issue","volume":"89","author":"Creanga","year":"2011","journal-title":"Bull World Health Organ"},{"key":"ref_10","unstructured":"Arthur, M.C. (2016). Sexual Behaviour and Contraceptive Knowledge and Use among Female Adolescents in Senior High School in Manhyia Submetro, Kumasi. [Ph.D. Thesis, Kwame Nkrumah University of Science and Technology]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"29737","DOI":"10.3402\/gha.v8.29737","article-title":"Patterns and trends of contraceptive use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria: Evidence from cross-sectional studies","volume":"8","author":"Hounton","year":"2015","journal-title":"Glob. Health Action"},{"key":"ref_12","unstructured":"PSI (2016). Sexual and Reproductive Health of Adolescents and Youth, PSI."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0140-6736(12)60478-4","article-title":"Maternal deaths averted by contraceptive use: An analysis of 172 countries","volume":"380","author":"Ahmed","year":"2012","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0140-6736(14)60792-3","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?","volume":"384","author":"Bhutta","year":"2014","journal-title":"Lancet"},{"key":"ref_15","unstructured":"Rutstein, S., and Winter, R. (2015). Contraception Needed to Avoid High-Fertility-Risk Births, and Maternal and Child Deaths That Would Be Averted, ICF International. DHS Analytical Studies."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S0140-6736(12)60827-7","article-title":"The economic consequences of reproductive health and family planning","volume":"380","author":"Canning","year":"2012","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s13524-012-0172-2","article-title":"Family planning and women\u2019s and children\u2019s health: Consequences of an outreach program in Matlab, Bangladesh","volume":"50","author":"Schultz","year":"2013","journal-title":"Demography"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12978-021-01259-9","article-title":"Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: A qualitative study","volume":"18","author":"Dombola","year":"2021","journal-title":"Reprod. Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Harrington, E.K., Casmir, E., Kithao, P., Kinuthia, J., John-Stewart, G., Drake, A.L., Unger, J.A., and Ngure, K. (2021). \u201cSpoiled\u201d girls: Understanding social influences on adolescent contraceptive decision-making in Kenya. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0255954"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/sifp.12174","article-title":"Contraceptive Conversations among Adolescent Girls and Young Women and Their Partners, Peers, and Older Female Family Members in Lilongwe, Malawi: A QualitativeAnalysis","volume":"52","author":"Bhushan","year":"2021","journal-title":"Stud. Fam. Plann."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2307\/2673818","article-title":"Why Nigerian adolescents seek abortion rather than contraception: Evidence from focus-group discussions","volume":"27","author":"Otoide","year":"2001","journal-title":"Int. Fam. Plan Perspect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1186\/s12978-020-01019-1","article-title":"Influences on seeking a contraceptive method among adolescent women in three cities in Nigeria","volume":"17","author":"Sanchez","year":"2020","journal-title":"Reprod. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0968-8080(06)27231-8","article-title":"Blood Blockages and Scolding Nurses: Barriers to Adolescent Contraceptive Use in South Africa","volume":"14","author":"Wood","year":"2006","journal-title":"Reprod. Health Matt."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An Ecological Perspective on Health Promotion Programs","volume":"15","author":"McLeroy","year":"1988","journal-title":"Health Educ. Q."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1080\/19325037.2011.10599184","article-title":"Positive youth development: An integration of the developmental assets theory and the socio-ecological model","volume":"42","author":"Atkiss","year":"2011","journal-title":"Am. J. Health Educ."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Engelbert Bain, L., Amu, H., and Enowbeyang Tarkang, E. (2021). Barriers and motivators of contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0252745"},{"key":"ref_28","unstructured":"Manet, H., Doucet, M.H., Bangoura, C., Dioubat\u00e9, N., El Ayadi, A., Sidib\u00e9, S., Millimouno, T.M., and Delamou, A. (2022, November 16). Factors Facilitating the use of Contraceptive Methods Among Urban Adolescents and Youth in Guinea: A Qualitative Study. Available online: https:\/\/assets.researchsquare.com\/files\/rs-1086553\/v1\/80db58fe-fcc1-4c44-9a91-c7db6df79933.pdf?c=1638813820."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2989\/16085906.2021.1914693","article-title":"\u201cI did not plan\u2009\u2026\u2009that is what hurts\u201d: Pregnancy intentions and contraceptive use among pregnant young women in KwaZulu-Natal, South Africa","volume":"20","author":"Coleman","year":"2021","journal-title":"Afr. J. AIDS Res."},{"key":"ref_30","first-page":"393","article-title":"Understanding \u201cBad Girl:\u201d qualitative findings on stigma and adolescent sexual and reproductive health in Ghana","volume":"92","author":"Hall","year":"2015","journal-title":"Contraception"},{"key":"ref_31","unstructured":"Amuyunzu-Nyamongo, M., Biddlecom, A.E., Ouedraogo, C., and Woog, V. (2005). Qualitative evidence on adolescents\u2019 views of sexual and reproductive health in Sub-Saharan Africa. Occas. Rep., 16."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Davids, E.L., Zembe, Y., de Vries, P.J., Mathews, C., and Swartz, A. (2021). Exploring condom use decision-making among adolescents: The synergistic role of affective and rational processes. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-11926-y"},{"key":"ref_33","first-page":"1","article-title":"Reasons for inconsistent condom use by young adults in Mahalapye, Botswana","volume":"10","author":"Luhaka","year":"2018","journal-title":"Afr. J. Prim. Health Care Fam Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1177\/1557988308322394","article-title":"Condom use for preventing STI\/HIV and unintended pregnancy among young men in Sub-Saharan Africa","volume":"3","author":"Bankole","year":"2009","journal-title":"Am. J. Mens. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/0272684X16685254","article-title":"Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review","volume":"37","author":"Blackstone","year":"2017","journal-title":"Int. Q Community Health Educ."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12978-021-01094-y","article-title":"A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya","volume":"18","author":"Ontiri","year":"2021","journal-title":"Reprod. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/curationis.v38i2.1528","article-title":"Perceptions of female teenagers in the Tshwane District on the use of contraceptives in South Africa: Original research","volume":"38","author":"Tabane","year":"2015","journal-title":"Curationis"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12978-022-01331-y","article-title":"Perceptions of peer contraceptive use and its influence on contraceptive method use and choice among young women and men in Kenya: A quantitative cross-sectional study","volume":"19","author":"Calhoun","year":"2022","journal-title":"Reprod. Health"},{"key":"ref_39","unstructured":"Burke Holly, M.C., and Ambasa-Shisanya, C. (2011). Qualitative study of reasons for discontinuation of injectable contraceptives among users and salient reference groups in Kenya. Afr. J. Reprod. Health, 15."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/sifp.12076","article-title":"\u201cThey Destroy the Reproductive System\u201d: Exploring the Belief that Modern Contraceptive Use Causes Infertility","volume":"49","author":"Sedlander","year":"2018","journal-title":"Stud. Fam. Plann."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12978-020-00973-0","article-title":"A rapid scoping review of fear of infertility in Africa","volume":"17","author":"Boivin","year":"2020","journal-title":"Reprod. Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ijgo.2013.07.014","article-title":"A qualitative assessment of Ugandan women\u2019s perceptions and knowledge of contraception","volume":"124","author":"Morse","year":"2014","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1080\/03630242.2016.1178684","article-title":"Perceptions and attitudes regarding sexually transmitted infection and family planning among adolescents in Northern Madagascar","volume":"57","author":"Klinger","year":"2017","journal-title":"Women Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1742-4755-11-24","article-title":"Intention to use long acting and permanent contraceptive methods and factors affecting it among married women in Adigrat town, Tigray, Northern Ethiopia","volume":"11","author":"Gebremariam","year":"2014","journal-title":"Reprod. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1363\/43e5117","article-title":"Acceptability of Contraceptive Self-Injection with DMPA-SC Among Adolescents in Gulu District, Uganda","volume":"43","author":"Cover","year":"2017","journal-title":"Int. Perspect. Sex Reprod. Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Nalwadda, G., Mirembe, F., Byamugisha, J., and Faxelid, E. (2010). Persistent high fertility in Uganda: Young people recount obstacles and enabling factors to use of contraceptives. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-530"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1080\/03630242.2017.1306607","article-title":"Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana","volume":"58","author":"Challa","year":"2018","journal-title":"Women Health"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Capurchande, R., Coene, G., Schockaert, I., Macia, M., and Meulemans, H. (2016). \u201cIt is challenging\u2026 oh, nobody likes it!\u201d: A qualitative study exploring Mozambican adolescents and young adults\u2019 experiences with contraception. BMC Womens Health, 16.","DOI":"10.1186\/s12905-016-0326-2"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1080\/26410397.2019.1652028","article-title":"Abortion and contraceptive use stigma: A cross-sectional study of attitudes and beliefs in secondary school students in western Kenya","volume":"27","author":"Otieno","year":"2019","journal-title":"Sex Reprod. Health Matt."},{"key":"ref_50","first-page":"27120","article-title":"\u201cThey will wonder what kind of a girl I am\u201d: Adolescent perceptions towards contraceptive use in Nairobi","volume":"3","author":"Kinaro","year":"2013","journal-title":"Adv. Sex. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12978-022-01440-8","article-title":"Applying a gender lens to social norms, couple communication and decision making to increase modern contraceptive use in Ethiopia, a mixed methods study","volume":"19","author":"Tamene","year":"2022","journal-title":"Reprod. Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40834-020-00146-1","article-title":"Influences on contraceptive method choice among adolescent women across urban centers in Nigeria: A qualitative study","volume":"6","author":"Sanchez","year":"2021","journal-title":"Contracept. Reprod. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1080\/03630242.2021.1917479","article-title":"Communication, social norms, and contraceptive use among adolescent girls and young women in Lilongwe, Malawi","volume":"61","author":"Bhushan","year":"2021","journal-title":"Women Health"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Mulubwa, C., Munakampe, M.N., Namakula, H., Hernandez, A., Ssekamatte, T., Atuyambe, L.M., Birabwa, C., Chemonges, D., Namatovu, F., and Makumbi, F. (2021). Framing Contraceptive Use Motivations Among Adolescents and Young Adults Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda. Front. Glob. Womens Health, 40.","DOI":"10.3389\/fgwh.2021.658515"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Tigabu, S., Demelew, T., Seid, A., Sime, B., and Manyazewal, T. (2018). Socioeconomic and religious differentials in contraceptive uptake in western Ethiopia: A mixed-methods phenomenological study. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0580-6"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.0029-6473.2003.00027.x","article-title":"Concept Analysis of Adolescent Decision Making and Contraception","volume":"38","author":"Commendador","year":"2003","journal-title":"Nurs. Forum."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/4\/3614\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:40:11Z","timestamp":1760121611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/4\/3614"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,17]]},"references-count":56,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20043614"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20043614","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,17]]}}}