Exploring barriers, facilitators, and preferences for the uptake of contraceptive methods among adolescents aged 15-19 years in Neno district, Malawi: a qualitative study

Adolescent contraception is important in reducing sexually transmitted infections and teenage pregnancies. However its uptake remains low at 10% in Neno district, despite various interventions promoting free access. A phenomenological qualitative study was carried out in the district to explore the barriers, facilitators and preferences for the uptake of contraceptive methods among adolescents aged 15-19. Five focus group discussions and 18 in depth interviews were carried out with adolescents, parents, healthcare workers, community leaders and youth volunteers. Data was collected in Chichewa, translated into English, and analysed using thematic analysis. Three key themes appeared: 1) a climate of restriction: stigma, misinformation, and systemic barriers; 2) agency and support: navigating pathways to contraceptive uptake; and 3) the paradox of acknowledged risk and sustained resistance. Adolescents in Neno faced socio- cultural barriers, health facility limitations and informational gaps, alongside individual and external facilitators like education and peer influence. Adolescent choices were shaped by ease of use, sexual desires and economic hardships. Therefore, an integrated approach involving healthcare workers, policymakers, and non-governmental organisations (NGOs) is crucial to improving contraceptive uptake in Neno.