Socio-structural influences on unintended pregnancy among girls aged 15-17 years in Papua New Guinea.

Abstract

Introduction: Unintended pregnancy among adolescent girls is a public health priority globally, particularly in Papua New Guinea (PNG), where low contraceptive use among young people has resulted in some of the highest adolescent fertility rates in the Asia-Pacific region. This paper investigates the socio-structural influences on adolescent girls' ability to prevent unintended pregnancies in PNG.

Methods: Qualitative research conducted between 2019 and 2021; inductive thematic analysis of in-depth interviews with 19 adolescent girls aged 15-17 years living in rural, peri-urban and urban research sites in PNG.

Results: Socio-structural influences were identified that increased the likelihood of unintended pregnancy: barriers to accessing health services for sexual and reproductive health (SRH) purposes; a lack of provision of SRH information and education in school or community settings, leading to misunderstanding of reproduction and fertility, pregnancy prevention and contraception; poor interactions with health service providers that discourage future service use; constrained intergenerational communications about sex, relationships and family planning between girls and adults based on norms and expectations associated with gender, age and marital status; reliance on informal peer and community information sources; lack of availability and accessibility to modern contraceptives; and a lack of adolescent-centred SRH services. Despite this, girls demonstrated agency through attempts to use modern and traditional contraceptive strategies to prevent pregnancy, often with the support of others within their familial and social networks. Their agency was constrained by a lack of school-based and community-based education about sex and relationships, and access to confidential, non-judgemental SRH services, where they can learn about and access modern contraceptives.

Conclusion: Adolescent girls' access to contraceptive services-at an earlier age, in time for their first sexual experiences-requires action in policy and community settings to elicit socio-structural change that is supportive of young women's SRH and well-being.