Challenges in Modern Contraceptive Utilisation Among Adolescents in Selected Parts of Mtendere Compound, Lusaka District, Zambia.

Zambia's relatively early age at sexual debut and a persistently high adolescent pregnancy rate of approximately 29%, modern contraceptive use among adolescent girls aged 15 to 19 remains low at 12.0% nationally, with utilisation being lower among urban adolescents (9.8%) than rural adolescents (13.7%).
A qualitative case study design was used, with Mtendere compound, Lusaka District, as the bounded case. A purposive sample of 30 adolescents aged 15 to 19 participated, comprising 14 individual semi-structured interviews (7 female, 7 male) and two gender-specific focus group discussions of eight (8) participants each.
The study identified key challenges adolescents face in contraceptive use within Mtendere compound, including compromised privacy, informal institutional gatekeeping, and discontinuation driven by compounding social pressures. Challenges rarely operated in isolation; compound density converted private health matters into family crises, informal gatekeeping by health workers exceeded actual policy, and the compounding of these pressures led some adolescents to discontinue methods already begun, choosing the risk of pregnancy over the social risk of seeking further support.
The study concluded that challenges interact simultaneously across individual, interpersonal, institutional, and community levels, rather than by any single barrier. Therefore, the study recommends redesigning facility layouts to reduce visibility, enforcing consistent age-of-consent policy, reconsidering peer-based staffing for youth-friendly services, and redesigning promotional materials to include unmarried adolescents.

Adolescent contraceptive use, access, values and perceptions, challenges, social-ecological model, Mtendere compound, Zambia.

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