Table 1 Summary of study characteristics: contraception and abortion knowledge, attitudes and practices among adolescents from low and middle-income countries

1

Wood & Jewkes, 2006 [26]

Blood Blockages and Scolding Nurses: Barriers to Adolescent Contraceptive Use in South Africa

South Africa:

Limpopo District (rural setting)

Qualitative methods

35 IDIs

5 FGDs (3–5)

Purposive sampling

Gender: Female

Sample size: 35 adolescents and 14 nurses

Age 14–20

Adolescent sexuality needs to be acknowledged to address the sexual needs of adolescents

2

Webb, 2000 [27]

Attitudes to ‘Kaponya Mafumo’: the terminators of pregnancy in urban Zambia

Zambia

5 urban districts

Lusaka, Kitwe, Ndola, Livingstone, Chipata

Mixed Methods

1100 School Narratives

20 FGDs (10–15)

Medical records

Urban

Gender: Female & Male

Sample size: 1500; pupils, nurses

Age: 10–24

Staff attitudes, lack of sufficient information about services, and few targeted interventions for the different categories of adolescents led adolescents to access clandestine reproductive health services. There was a need to increase access to information and services among adolescents.

3

Sowmini, 2013 [28]

Delay in termination of pregnancy among unmarried adolescents and young women attending a tertiary hospital abortion clinic in Trivandrum, Kerala, India

India (Urban & rural settings)

Qualitative methods

34 IDIs

Gender Female

Sample size: 34

Age: 10–24

Unmarried

This study revealed that many adolescents were in consensual sexual relationships with older males, some even experiencing pressure to engage in sexual activity. Knowledge and information and access to reproductive health services were meager, even among the sexually active adolescents.

4

Schuster, 2010 [29]

Women’s experiences of the abortion law in Cameroon: “What really matters.”

Cameroon

(Urban setting)

Qualitative methods

4 IDIs

Triangulated with hospital records and data from 65 other interviews.

Gender: Female

Sample size:4

Age: 15–21

Many adolescents who were in relationships with older men were at risk of being pressurized into engaging in sexual activity and had little control over their fertility. There was also ambiguity about the law and what services were available for the adolescents. With such conditions, some ended up resorting to illegal abortion.

5

Nzioka, 2001 [30]

Perspectives of adolescent boys on the risk of unwanted pregnancy and sexually transmitted infections: Kenya

Kenya

(Rural setting)

Qualitative methods

8 FGDs

Gender: Male

Sample size: 90

Age: 15–19

Most adolescents had restricted access to contraception such as condoms because they felt this would disclose their sexual activity which they worked hard to conceal. They also needed more information about contraception and abortion including counselling and referral to facilities that were confidential and anonymous.

6

Ritcher & Mlambo, 2005 [31]

Perceptions of Rural teenagers on teenage pregnancy

South Africa

Qualitative methods

32 IDIs with adolescents

Gender: Male and female

Sample size: 32

Age: 13–19

Most teens who fell pregnant did not intend to do so and as such; there were many misconceptions about pregnancy, sex and contraceptives. They attributed factors such as age, knowledge and skill to pregnancy. The risk of increased health problems due to lack of information needs to be addressed with more information and specialised services for the adolescents.

7

Macintyre et al., 2015 [32]

From disease to desire, pleasure to the pill: A qualitative study of adolescent learning about sexual health and sexuality in Chile

Chile

Qualitative methods

4 FGDs and 20 IDIs with adolescents and 7 IDIs with key informants

Gender: Male and Female

Sample size: 51

Age: 16–19

Many advances in sexual and reproductive rights have been reported; the study suggested that many taboos surrounding access to services were broken leaving an enabling environment for knowledge dissemination. However, challenges discussing sexual violence and emergency contraception were still reported and needed to be addressed.

8

Kennedy et al., 2014 [33]

“These issues aren’t talked about at home”: a qualitative study of the sexual and reproductive health information preferences of adolescents in Vanuatu

South Pacific

Qualitative methods using 66 FGDs with adolescents and 12 IDIs Key informants

Gender: Male and female

Sample size: 353

Age: 15–19

Comprehensive sexuality education to adolescents was seen to have lifelong protective effects on the adolescents’ health. The wide information gap among the adolescents could, therefore, be reduced with early sexuality education, through strengthening structures that offer this information.

9

Kennedy et al., 2013 [34]

“Be kind to young people, so they feel at home”: a qualitative study of adolescents’ and service providers perceptions of youth-friendly sexual and reproductive health services in Vanuatu

South Pacific

Qualitative methods using 66 FGDs with adolescents and 12 IDIs Key informants

Gender: Male and female

Sample size: 353

Age: 15–19

Adolescents were reported to face many barriers to accessing sexual and reproductive health services such as lack of confidentiality, skilled providers, and cultural barriers. Findings showed that most of the adolescents needed to be educated more to reduce the knowledge gap and to increase adolescent friendly service provision.

10

Ganatra & Hirve, 2002 [35]

Induced abortions among adolescent women in rural Maharashtra, India

India

Mixed methods:

Survey of 1717

FDGs and IDIs with 197 adolescents and other Key informants

Gender: Female

Sample size: 1717/ 197

Age: < 20

Adolescents faced significant barriers to access to contraception and abortion; such as untrained providers and lack of confidentiality. Unmarried adolescents had a greater unmet need, leading them to access informal services.

11

Char et al., 2011 [36]

Assessing young unmarried men’s access to reproductive health information and services in rural India

India

Mixed methods

4 FGDs and survey of 216 men

Gender: Male

Sample size: 354

Age:17–22

Rural adolescents were willing to receive information and services, but these were both lacking in their setting. Interventions need to focus on different categories of adolescents to improve access to information and services

12

Both & Samuel, 2014 [37]

Keeping silent about emergency contraceptives in Addis Ababa: a qualitative study among young people, service provider and key stakeholders

Ethiopia

Qualitative methods, using observations, IDIs with young people, IDIs with key informants and key stakeholders

Gender: Males and Females

Sample size: 112

Age: 15 to 29

Health care providers were significantly associated with how adolescents access and the amount of reproductive health information available to them. Health care provider attitudes need to be looked into to increase access to services by the adolescents.

13

Barua & Kurz, 2001 [38]

Reproductive health-seeking by married adolescent girls in Maharashtra

India

Mixed methods including survey and IDIs

Gender: Male and Female

Sample size: 466

Age: 15 to 19

Married adolescents’ contraception decisions were mostly influenced by families and significant others. Though abortions and contraception were more acceptable among these adolescents, they have reduced access due to their reduced decision making power.

14

Ilika A., & Igwegbe, A., 2004 [39]

Unintended pregnancy among unmarried adolescents and young women in Anambra state. Southeast Nigeria

Nigeria

Qualitative methods using IDIs.

Gender: Female

Sample size: 136

Age: 15 to 19

Adolescents presented high-risk sexual behaviour, unwanted pregnancy, unsafe abortions, Sexually Transmitted Infections, and HIV/AIDS. Discrimination from community, families and health care providers reduced access to services that could avert these peculiar challenges. A need for increased access to information and services was therefore stressed.

15

Otoide V. O., et al., 2001 [40]

Why Nigerian adolescents seek abortion rather than contraception: evidence from focus group discussions

Nigeria

Qualitative study, FGDs

Gender: Female

Sample size: 149

Age: 15 to 24

The effective educational strategy to improve sexual and reproductive health information levels among the adolescents was stressed, to correct the deep-rooted misconceptions about contraception and reproductive health among adolescents.

16

Silberscmidt, M & Racsh, V, 2001 [41]

Adolescent girls, illegal abortions and sugar daddies in Dar es Salaam: Vulnerable victims and active social agents

Tanzania

Qualitative, IDIs

Gender: Female

Sample size: 51

Age: 15 to 19

Despite international recognition of the importance of addressing adolescent sexual and reproductive health, access to clandestine abortions remains a challenge, pointing out to a need to increase efforts to address these issues among adolescents.

17

Dahlback et al., 2007 [42]

Unsafe induced abortions among adolescent girls in Lusaka

Zambia

Qualitative methods; IDIs

Gender: Female

Sample size: 34

Age: 13 to 19

Despite induced abortion being legal for over 30 years, unsafe abortions, especially among adolescents, remain high. Limited information, limited access to services, stigma attached to premarital pregnancy, were outlined as factors that will continue to lead adolescents into accessing clandestine abortions if not addressed adequately.

18

Nguyen et al., 2006 [43]

Knowledge of contraception and sexually transmitted diseases and contraception practices amongst young people in Ho Chi Minh City, Vietnam

Vietnam

Qualitative study; IDIs

Gender: Male and Female

Sample size: 16

Age: 15 to 24

Lack of youth-friendly sexual and reproductive health information and services have been attributed to an increased risk of unwanted pregnancy and unsafe abortion. A need to address their ever-changing sexuality to meet their access and knowledge needs was seen.

19

Nobelius et al., 2010 [44]

Sexual and reproductive health information sources preferred by out-of-school adolescents in rural southwest Uganda

Uganda

Qualitative methods; FGDs and 10 IDIs

Gender: Male and Female

Sample size: 31

Age: 13 to 19

Most interventions to increase knowledge of sexual and reproductive health were mostly targeted towards adolescents in school, leaving a much greater information gap among the out of school adolescents, who were more vulnerable due to reduced access to services. A need for interventions for out of school adolescents was seen.

20

Okereke, 2010 [45]

Assessing the prevalence and determinants of adolescents’ unintended pregnancy and induced abortion in Owerri, Nigeria

Nigeria

Mixed methods using a survey, FGDs and IDIs with key informants

Gender: Female

Sample size:555

Age: 15 to 19

Religious doctrines place many adolescents in a position to denounce utilisation of sexual and reproductive health services due to perceptions of the community as well as personal moral dilemmas, exposing them to reproductive health problems such as unintended pregnancy and abortion.

21

Plummer et al., 2006 [46]

Abortion and suspending pregnancy in rural Tanzania: An ethnography of young people’s beliefs and practices

Tanzania

Qualitative: participants observations in 9 villages for 7 weeks; FGDs and Interviews

Gender: Female and Male

Sample size:

Age:15 to 27

Strict legal sanctions led to adolescents accessing clandestine abortion services to terminate a pregnancy. Low usage of family planning and contraception were seen as the underlining factor that contributed to these risks.