Barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia: a formative qualitative study

OBJECTIVE: To assess barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia, in 2021. DESIGN: A grounded theory approach to the qualitative study was conducted between December 2020 and April 2021 in Gedeo zone, South Ethiopia. SETTING: The study was conducted in two urban and four rural schools, in Gedeo zone; Gedeo zone is one of the 14 zones in the Southern Nations, Nationalities, and Peoples' Region of Ethiopia. PARTICIPANTS: The study involved 24 in-depth interviews with secondary school adolescents and 28 key informants. The interviews were conducted with students, school counsellors, Kebele youth association coordinators, zonal child, adolescent, and youth officers, health workers, and non-governmental organisation workers. RESULTS: The findings were organised into four major themes that influence contraceptive use; these include; (1) Individual-related barriers such as knowledge, fear and psychosocial development. (2) Community-related barriers encompass fear of rumours, family pressure, social and cultural norms, economic vulnerability, and religious beliefs. (3) Health service-related barriers include the lack of adolescent-responsive health services, health workers' behaviour, and fear of health workers. Furthermore, (4) The school and service integration barrier was identified. CONCLUSIONS: Adolescents' contraceptive use was affected by various barriers ranging from individual to multisectorial levels. Adolescents note various barriers to using contraception and that, without contraception, sexual activity can lead to an increased risk for unintended pregnancy and its associated health risks.