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Background <p>Each year, about half of pregnancies in adolescents (15–19 years of age) are unintended, and the rate of adolescent pregnancy in sub-Saharan Africa is twice the global rate. Adolescent pregnancies have similar social determinants as those of HIV acquisition, resulting in adverse health outcomes for adolescent girls and young women (AGYW) and exacerbating adverse HIV-related health outcomes. To better understand reproductive choice for AGYW living with HIV (AGYWLWH), this study examined family planning attitudes, knowledge, and experiences among young women living with HIV in Moshi, Tanzania.</p> Methods <p>Young female participants previously enrolled in the SYV pilot trial were purposively sampled to understand their attitudes, knowledge, and experiences with family planning services through in-depth interviews and a focus group discussion. Participants with a pregnancy experience (PE) and those without (NPE) were recruited to explore contextually relevant factors shaping these constructs. Thematic analysis included inductive and deductive coding, a data reduction matrix, and memo writing to identify and synthesize themes.</p> Results <p>Of 16 enrolled participants, 13 had a pregnancy experience. The average age at first pregnancy was 20 years old, and almost two-thirds of participants experienced an unintended pregnancy (9/13). Participants shared that family planning services and hormonal contraception felt inaccessible until they had a pregnancy, often due to perceived social norms around sexual promiscuity or due to a fear of contraception-induced infertility. As a result, participants shared they did not feel well-informed about contraceptive options prior to their first pregnancy, while mentioning that contraceptive information pre-pregnancy often did not feel relevant. Therefore, no participants used hormonal contraception prior to their first pregnancy, and the most common method ever used was the male condom (8/16). After a first pregnancy, hormonal method use was more prevalent (9/13), and the most common hormonal method used was the implant (5/13). Almost all participants felt contraception was useful and promoted reproductive choice, citing the importance of birth spacing, particularly related to the successful prevention of maternal to child transmission. Despite perceived social norms related to family planning use pre-pregnancy, participants recommended AGYWLWH use family planning to achieve their personal and family composition goals, and they called for increased access to family planning information.</p> Conclusion <p>A perceived social norm to have a child before family planning use emerged as the primary barrier to AGYWLWH reproductive choice, and almost all participants shared that family planning services were useful and promoted their autonomy. Looking to future generations, participants recommended increased access to contraceptive information for adolescents and young adults to improve reproductive choice for AGYWLWH.</p>

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“She cannot use these methods before she has at least one child”: a qualitative study on family planning attitudes, knowledge, and experiences among adolescent girls and young women living with HIV in Moshi, Tanzania

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  • 发表日期：

    2026年8月4日

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  • Maeve F. Salm,
  • Happyness Ngowi,
  • Leonia Rugalabamu,
  • Emanueli Msuya,
  • Blandina T. Mmbaga,
  • Joy Noel Baumgartner,
  • Dorothy E. Dow

摘要

Background

Each year, about half of pregnancies in adolescents (15–19 years of age) are unintended, and the rate of adolescent pregnancy in sub-Saharan Africa is twice the global rate. Adolescent pregnancies have similar social determinants as those of HIV acquisition, resulting in adverse health outcomes for adolescent girls and young women (AGYW) and exacerbating adverse HIV-related health outcomes. To better understand reproductive choice for AGYW living with HIV (AGYWLWH), this study examined family planning attitudes, knowledge, and experiences among young women living with HIV in Moshi, Tanzania.

Methods

Young female participants previously enrolled in the SYV pilot trial were purposively sampled to understand their attitudes, knowledge, and experiences with family planning services through in-depth interviews and a focus group discussion. Participants with a pregnancy experience (PE) and those without (NPE) were recruited to explore contextually relevant factors shaping these constructs. Thematic analysis included inductive and deductive coding, a data reduction matrix, and memo writing to identify and synthesize themes.

Results

Of 16 enrolled participants, 13 had a pregnancy experience. The average age at first pregnancy was 20 years old, and almost two-thirds of participants experienced an unintended pregnancy (9/13). Participants shared that family planning services and hormonal contraception felt inaccessible until they had a pregnancy, often due to perceived social norms around sexual promiscuity or due to a fear of contraception-induced infertility. As a result, participants shared they did not feel well-informed about contraceptive options prior to their first pregnancy, while mentioning that contraceptive information pre-pregnancy often did not feel relevant. Therefore, no participants used hormonal contraception prior to their first pregnancy, and the most common method ever used was the male condom (8/16). After a first pregnancy, hormonal method use was more prevalent (9/13), and the most common hormonal method used was the implant (5/13). Almost all participants felt contraception was useful and promoted reproductive choice, citing the importance of birth spacing, particularly related to the successful prevention of maternal to child transmission. Despite perceived social norms related to family planning use pre-pregnancy, participants recommended AGYWLWH use family planning to achieve their personal and family composition goals, and they called for increased access to family planning information.

Conclusion

A perceived social norm to have a child before family planning use emerged as the primary barrier to AGYWLWH reproductive choice, and almost all participants shared that family planning services were useful and promoted their autonomy. Looking to future generations, participants recommended increased access to contraceptive information for adolescents and young adults to improve reproductive choice for AGYWLWH.