Suchergebnisse

AbstractUnderstanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15–20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor structure, and logistic regression to examine construct validity through the relationship between empowerment scores and ability to mitigate risk of undesired pregnancy through consistent contraceptive use. Participants had a mean age of 17.5, and most were students (61 percent), were currently partnered (94 percent), and reported having sex in the past 3 months (70 percent). The final, 26‐item CFA model had acceptable fit. All subscales had Cronbach's alpha scores >0.7, and all items had rotated factor loadings >0.5, indicating good internal consistency and robust factor‐variable associations. The total SRE‐Kenya (SRE‐K) score was associated with increased odds of the consistent method used in the past three months (adjusted odds ratio: 1.98, 95 percent CI: 1.29–3.10). The SRE‐K scale is a newly adapted and valid measure of sexual and reproductive empowerment specific to adolescent girls and young women in an East African setting.

AbstractA focus on contraceptive preferences is essential to the provision of person‐centered care. Adolescent girls and young women (AGYW) in the WHO African Region experience disparities in contraceptive access and use and reproductive health outcomes. Despite increasing recognition of AGYW needs as unique, their preferences are understudied, limiting strategies to improve contraceptive care access and quality among marginalized youth populations. We designed and conducted a discrete choice experiment among five hundred 15–20‐year‐old AGYW in Kisumu, Kenya, to examine the relative importance of trade‐offs between contraceptive methods and service delivery attributes. Participants answered eight choice sets including three alternatives: two hypothetical contraceptive options characterized by seven attributes (effectiveness, bleeding pattern, duration of use, privacy, access location, counseling source, and cost) and a "no method" opt‐out. We used random‐parameters logit models to estimate preference weights and trade‐offs among alternatives. The bleeding pattern was the most important determinant of stated choice, with a strong preference for unchanged or irregular bleeding over heavier bleeding or amenorrhea. Participants preferred the lowest chance of method failure as well as the longest duration of use (one year) over daily use or use during/after sex. Parous AGYW were more likely to prefer the longest duration of use. The ability to keep method use completely private was also an influential choice, particularly among 15–17‐year‐olds. AGYW traded effectiveness and increased cost for preferred bleeding patterns and privacy. The opt‐out "no method" alternative was chosen only 2.7 percent of the time, indicating a strong preference for pregnancy prevention. Our findings highlight key insights for enhancing the person‐centeredness of contraceptive care for AGYW: Kenyan AGYW place a high value on preferred menstrual bleeding patterns, high method effectiveness, longer duration of use, and the ability to keep method use private. Preference data can inform programs, including contraceptive decision‐support interventions, to improve AGYW access to quality preference‐sensitive contraceptive services.