How do negative views on contraception affect young women’s choices?

Unwanted pregnancy is a major challenge in Nigeria for adolescents and young people. One Nigerian study with female students (ages 15–24) found 68% had had an unwanted pregnancy and 64% had had an abortion. But while all the students knew about contraception only 25% had ever used it. Other evidence suggests that young women in Nigeria do not use contraception because other people disapprove of it.

This disapproval is linked to something called a ‘social norm’. A social norm is what people in a group consider as the right or wrong kind of behaviour.

Researchers looked at whether social norms in Nigeria that see contraception as wrong affect either young women’s motivation to use it or their ‘ability’ to do so.

The design of public health schemes that aim to increase young women’s motivation to use contraception will be different from those that aim to increase young women’s ability to use contraception, so understanding this is important.

This study defines ability as not knowing where to get contraception from, not feeling confident to get contraception, feeling embarrassed about using contraception, facing problems when talking to a partner about contraception or convincing a partner to use it.

As well as looking at negative social views on contraception, the study also looked at negative views about sex before marriage. This is because deciding whether to start having sex and deciding whether to use contraception are decisions that are linked.

Data from 1,916 adolescent girls and young women (ages 14–24) from Lagos, Kaduna and Kano who took part in household surveys in 2018 was analysed. Of these, 618 were either married, living with a man or had a boyfriend. The findings are based on these young women only.

Around one third (27%) used contraception. Of these, around two thirds (64%) were using condoms. 'Traditional' approaches, such as the withdrawal and rhythm methods, were not seen as contraception.

Researchers found that many young women do not use contraception due to views that sex before marriage and contraceptive use are wrong. But these social norms were only found to affect ability rather than motivation.

This means that health schemes that increase young women’s ability to use contraception are more likely to be effective than schemes that address motivation. The researchers describe this as a “welcome finding” because people’s ability is easier to change than their motivation.

The research also looked at other factors that might affect contraceptive use. Young women with low levels of income were less likely to use contraception than young women with more income. But this was due to young women being less able to use contraception, rather than being less motivated.

As the researchers used existing survey data, it is not possible to define cause and effect. The findings also rely on people giving honest answers, which not everybody does.

Many public health schemes already aim to increase people's ability to use contraception. They do this by offering practical solutions, such as making contraceptives cheaper and easier to access, and supporting couples to feel less embarrassed about discussing contraception. More approaches like this could help to reduce unwanted pregnancy among young women and – if couples use condoms – HIV and STIs.