FOCUS GROUP DISCUSSION TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya

District, Zambia
Instrument: Tool 2 — Focus Group Discussion (FGD) Guide for Adolescent Girls
FGD Group Number: FGD01
Number of Participants: 8
Facilitator: Gladys Kunda (202310003)
Note-taker: [Note-taker name not recorded]
Language: English
Audio Recording: Yes — consent obtained from all participants

PARTICIPANT REGISTER
First names used only — no surnames appear in the report. Codes assigned for
transcript reference.
R1 — Anne R2 — Cecilia R3 — Loveness R4 — Mary
R5 — Nancy R6 — Joy R7 — Adness R8 — Margaret

OPENING AND GROUND RULES

Facilitator introduced herself as a student researcher from Mulungushi University
and read out the ground rules: no right or wrong answers; speak one at a time;
confidentiality applies to all participants; no obligation to answer uncomfortable
questions; respectful disagreement is welcome; audio recording with consent and
no names in the report. All participants consented.

WARM-UP

QW1. Can each of you tell us your first name and one thing you enjoy doing in
your free time?
Participants introduced themselves by first name. Names recorded in participant register
above. Warm-up responses not transcribed in detail as per protocol.

SPECIFIC OBJECTIVE 1: Knowledge and Awareness of Contraceptive Methods

SECTION A: What Do Young Women in Roan Know?

QA1. As a group, what contraceptive methods do young women in Roan

Township know about? Let us make a list together.
 R1 [Anne]: Short-term methods — Sayana Press and Depo-Provera [injectable].
R2 [Cecilia]: They have already named the ones I know.
R3 [Loveness]: [Nodded in agreement — no verbal addition at this point.]
R4 [Mary]: Condoms.
R5 [Nancy]: I think those are all the main ones.
R6 [Joy]: [Agreed with what had been listed.]
R7 [Adness]: [Agreed with what had been listed.]
R8 [Margaret]: [Agreed with what had been listed.]
GROUP: All eight participants agreed that the methods named — Sayana Press,
Depo-Provera, and condoms — represent what is commonly known among
young women in Roan.

↳ Are there methods that most girls know about? Are there methods very few girls have
heard of?
R5 [Nancy]: I do not think all girls know about all of these methods. Some know
and some do not.
R8 [Margaret]: Some girls know these methods exist but they do not know the
different types — they just know the general idea.
GROUP: Others nodded in agreement with R5 and R8.

↳ Where do girls in Roan mainly learn about contraceptives?

R2 [Cecilia]: From the clinic.
R4 [Mary]: We have seen people come into the community to educate on family
planning. I have forgotten the name of the programme.
R5 [Nancy]: From home.
R6 [Joy]: Social media — TikTok and Facebook.
GROUP: All participants agreed that these sources — clinic, community
outreach, home, and social media — represent the main channels.

QA2. There are many stories and beliefs about contraceptives that go around
in communities. What have you heard — things people say contraceptives do
to your body?
R2 [Cecilia]: I have heard that family planning makes you gain weight — some
say it gives you a lot of appetite.
R4 [Mary]: Some say family planning leads to infertility.
R5 [Nancy]: Others say it delays a subsequent pregnancy.
FACILITATOR NOTE: R3, R6, R7, and R8 were present but did not add new beliefs at
this point — they listened attentively.

↳ Which of these do you believe to be true, and which do you think are rumours?
 R2 [Cecilia]: For me — I have noticed it myself. Before I had a child I was
smaller in body size, but after having a child and starting family planning, I gained
weight. So the weight gain — I believe that one is true.
R3 [Loveness]: Yes, it really does make you gain weight — I agree with that.
R6 [Joy]: For me, I think it depends on your body type. Some people who were
already bigger may actually become smaller after starting family planning. It all
depends on your body makeup — it is not the same for everyone.
R7 [Adness]: To be honest — it is true. I used to be bigger but ever since I
started I have reduced in weight. So it goes both ways.
FACILITATOR NOTE: R4, R5, and R8 did not add further comments on this probe. The
group generally agreed that weight change is a real and variable experience.

QA3. How do young women in Roan get information about contraceptives?

See responses to QA1 probes above — sources identified as clinic, community
outreach, home, and social media. Participants did not add substantially to what was
already captured.
↳ Is the information they receive enough to make a good decision?
↳ Who is the most trusted source of information — health workers, parents, peers,
teachers, or social media?
↳ Is there information that young women in Roan are not getting but need?
FACILITATOR NOTE: These probes did not generate extended individual responses in
this session. The group generally acknowledged that information is available but not
always sufficient or accurately understood.

SPECIFIC OBJECTIVE 2: Perceptions and Feelings

SECTION B: What Do Young Women in Roan Think and Feel?

QB1. In your community, what is the general attitude toward a young

unmarried girl who uses contraceptives?
R2 [Cecilia]: That is exactly what people think — they judge her.
R3 [Loveness]: We are perceived as being mischievous — as if we are up to no
good.
R4 [Mary]: People ask: why would she get family planning when she is not even
married?
R6 [Joy]: Most people think you are a prostitute if you are getting family
planning.
GROUP: All eight respondents agreed that unmarried girls are judged for
accessing family planning services.

↳ Is she respected or judged? Does it matter whether she is in school or not? Married or
unmarried?
 R2 [Cecilia]: For most people it does not matter — as long as you are not
married, they will judge you regardless of whether you are in school or not.
R3 [Loveness]: For others it does matter — especially when you have a clear
reason for using family planning, like child spacing. Then people may understand
better.
FACILITATOR NOTE: R4, R5, R7, and R8 were present but did not add distinct
positions. R1 and R6 also silent on this probe.

QB2. Let us talk about the role of men and boys. How do partners or
boyfriends influence whether a girl uses contraceptives or not?
R1 [Anne]: [Initial response — boys do not influence the decision.]
R2 [Cecilia]: Yes, they do have an influence — especially when they can see
that a method is working well for you without causing side effects. In that case
they support it.
R3 [Loveness]: They get involved when they ask you to use a short-term
method. Others suggest long-term — it depends on the man and your
relationship.
R4 [Mary]: No — for me, I just decide on my own.
GROUP: The remaining participants — R5, R6, R7, and R8 — agreed in unison
that the choice of method is generally the woman's own decision, based on what
is most convenient and suitable for her.

↳ Do boys support contraceptive use, or do they oppose it?

R1 [Anne]: Some are very supportive — they remind us of our return visit dates.
This is because they factor in child spacing and they can see the other child is
still young. They allow it.
R4 [Mary]: Personally, my partner tries to stop me — he says I am gaining
weight because of family planning. So I come here without telling him.
R5 [Nancy]: When you live with a man, they tend to stop you — some men want
you to keep having children. So basically we decide on our own first, and then tell
him. He might agree or he might not.
FACILITATOR NOTE: R2, R3, R6, R7, and R8 did not add to this probe directly but
listened attentively.

↳ Have any of you experienced — or heard of — a situation where a girl could not use
contraceptives because her partner refused?
GROUP: All participants agreed in unison that they have heard of situations
where women were stopped by partners.
R1 [Anne]: I have personally heard of a case where a woman was stopped from
getting family planning by her husband because of their religious beliefs.
R2 [Cecilia]: For others, I think it is cultural — their tribe and its norms do not
allow injections. So after a child finishes breastfeeding, the woman ends up
pregnant again.
 R4 [Mary]: Some men stop their wives by saying: you want to be promiscuous —
that is why you want family planning.
FACILITATOR NOTE: R3, R5, R6, R7, and R8 were present but did not add distinct
verbal contributions on this probe.

↳ Who do you think has more power in these decisions — the girl or the boy? Should it
be that way?
R3 [Loveness]: We women are the ones who suffer — if he leaves you
pregnant, you are the one preparing for birth alone.
R4 [Mary]: I think a man can also decide, especially if he can see the child has
grown and the family is ready [provided the opposing view].
GROUP: All respondents ultimately agreed that women have — and should have
— the greater power in contraceptive decisions, given they bear the
consequences of pregnancy.

QB3. What do churches and religious teachings say about contraceptives in

your community?
R1 [Anne]: My church says it is okay — but only if you are married.
R2 [Cecilia]: In my church, this topic is not even discussed.
R7 [Adness]: My church actually encourages family planning — especially at the
girls' meetings, where they talk about child spacing. So my church makes it
easier to access.
FACILITATOR NOTE: R3, R4, R5, R6, and R8 were present but did not provide distinct
verbal responses to this question.

↳ Does religion make it harder or easier for young women to use contraceptives? Have
any of you felt that your faith and your need to protect yourself were in conflict?
FACILITATOR NOTE: This probe did not generate extended verbal responses. Group
dynamics suggested some discomfort with the topic — body language noted by note-
taker.

QB4. If you imagine a girl your age who decides to go to the clinic to get
contraceptives — how do you think people in Roan would react?
R2 [Cecilia]: If you have already had a child, it is much easier — you do not feel
ashamed because the older women you find there actually encourage you to get
family planning. But if you have not had a child yet, it is very difficult. You feel
ashamed meeting all the elderly people there.
GROUP: All participants confirmed what Cecilia said — the experience at the
clinic is markedly different depending on whether the girl has already had a child.
All agreed there is shame involved for girls who have not yet had children.
↳ Would she feel safe making that decision publicly, or would she have to hide it? What
does this tell us about how the community views young women's reproductive choices?
 FACILITATOR NOTE: The group was largely in agreement that a girl would have to hide
the decision — making it publicly would invite community judgment and family conflict.

SPECIFIC OBJECTIVE 3: Barriers and Motivators

SECTION C: What Makes It Easy or Hard to Use Contraceptives?

The following responses were volunteered before the formal QC1 question was posed
— participants continued naturally from the QB4 discussion:
R1 [Anne]: Shame — some girls fail to come to the clinic because they think
others will assume they are sleeping around.
R2 [Cecilia]: Others face the perception that: your child has grown, why are you
still on family planning instead of having another baby? That pressure from others
makes some women stop.
R6 [Joy]: Others face coercion at home — a spouse who says: if you get family
planning, you will leave this house.

QC1. From what you know and have experienced, what are the biggest
obstacles that stop young women in Roan from using contraceptives?
↳ Is it cost? Distance to the clinic? Fear of parents finding out?
↳ Fear of side effects? Partner opposition? Cultural or religious pressure?
↳ Feeling embarrassed at the facility? Not being taken seriously by health workers?
R7 [Adness]: Health workers — especially student nurses — sometimes have a
bad attitude and do not take us seriously. That has been an obstacle.
FACILITATOR NOTE: Other participants nodded. No additional distinct verbal responses
were recorded for this set of probes — the group agreed broadly that all the listed
obstacles apply.

QC2. Has anyone here — or someone you know — ever had a bad experience
at a health facility when seeking contraceptives?
↳ What happened? Did the health worker treat you with respect and privacy?
↳ Did that experience affect whether you or others went back to the clinic?
↳ What would make health facilities more welcoming for young women?
FACILITATOR NOTE: This question was posed but responses were limited. R7 had
already referenced student nurse attitudes. No further specific accounts were shared in
this session.

QC3. On the other hand — what are the things that make young women in
Roan decide to use contraceptives?
R1 [Anne]: Child spacing — wanting a gap between children.
R2 [Cecilia]: When you are not ready to have a child yet.
 R3 [Loveness]: Just wanting to be prepared — in case something comes up in
life, it is better to be ready for any eventuality.
R5 [Nancy]: When you notice your life with your boyfriend or partner is not stable
— especially financially. That is when you opt to do it.
R6 [Joy]: I have also heard that some methods increase blood in the body —
that can be a motivation too.
R7 [Adness]: When you want to focus on your business and you know your child
is still young.
R8 [Margaret]: When you want to focus on your work and avoid an unplanned
baby.
FACILITATOR NOTE: R4 did not add a verbal contribution to this question. R1's 'child
spacing' response was the first and prompted others.
↳ Does seeing a friend use contraceptives successfully influence other girls?
FACILITATOR NOTE: Group generally agreed that peer experience is influential — a
friend having a positive experience encourages others.

QC4. If you were advising the government or health workers on what to

change to help young women in Roan access and use contraceptives more
easily, what would you say?
R1 [Anne]: Extend these services into the community — so that those who feel
ashamed about going to the clinic can access them in their homes and in the
community.
FACILITATOR NOTE: Other participants agreed with R1's recommendation. No further
distinct individual contributions were added to this question.
↳ What is the single most important change that needs to happen?
↳ What role should young women themselves play?
FACILITATOR NOTE: These probes did not generate additional responses beyond the
community outreach recommendation.

CLOSING

QZ1. Is there anything important about young women's experiences with

contraceptives in Roan Township that we have not talked about today?
FACILITATOR NOTE: No additional topics were raised. Facilitator thanked all
participants warmly. Confidentiality and use of data confirmed.

Time FGD ended: ________________ Total duration: ________________

FACILITATOR'S POST-FGD OBSERVATIONS

Group dynamics — who spoke most/least? Power dynamics?
 R2 (Cecilia) and R4 (Mary) were the most verbally active participants throughout.
R1 (Anne) contributed at key moments. R3 (Loveness), R6 (Joy), R7 (Adness),
and R8 (Margaret) contributed to specific questions. R5 (Nancy) made selective
but meaningful contributions. The group was generally cohesive with no overt
conflict. R3, R7, and R8 were quieter and may warrant individual follow-up.
Key themes that emerged most strongly:
(1) Stigma and community judgment as the primary barrier for unmarried girls. (2)
Partner influence as both a support and a barrier. (3) Variable weight change as
a real and accepted side effect. (4) Shame at the clinic when a girl has not yet
had a child. (5) Child spacing and financial instability as the main motivators. (6)
Community outreach as the preferred solution.
Points of disagreement or tension:
Mild tension on partner influence — R1 initially said partners do not influence the
decision; R2 and R3 pushed back with examples of supportive partners. R4 and
R5 presented a more complex picture of covert use. No open conflict.
Non-verbal observations:
Visible discomfort when religion and faith conflict were probed — some
participants shifted in seats and looked away. Lighter mood during warm-up and
during the motivators section. General nodding and vocal agreement ('all
agreed') was frequent and genuine.
Any important statements not captured in the recording:
Several participants spoke quietly to each other during pauses — content not
captured. Tone was generally open and trusting throughout.

FOCUS GROUP DISCUSSION TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 2 — Focus Group Discussion (FGD) Guide for Adolescent Girls
FGD Group Number: FGD02
Number of Participants: 10
Facilitator: Gladys Kunda (202310003)
Note-taker: Research Assistant
Language: English / some Bemba
Audio Recording: Yes — consent obtained from all participants

PARTICIPANT REGISTER
First names used only — no surnames appear in the report. Codes assigned for
transcript reference.
R1 — Natasha R2 — Brenda R3 — Fridah R4 — Charity R5 — Stella
R6 — Chanda R7 — Miriam R8 — Patricia R9 — Grace R10 — Esther
OPENING AND GROUND RULES
Facilitator introduced herself as a student researcher from Mulungushi University
and read out the ground rules: no right or wrong answers; speak one at a time;
confidentiality applies to all; right to pass on any question; respectful
disagreement welcome; audio-recorded with consent and no names in the report.
All ten participants consented verbally.

WARM-UP

QW1. Can each of you tell us your first name and one thing you enjoy doing in
your free time?
Participants introduced themselves. Selected warm-up responses below — others noted
informally.
R3 [Fridah]: I like plaiting hair in my free time.
R6 [Chanda]: I enjoy watching films and cooking.
R9 [Grace]: I like reading and helping at church on Sundays.
R10 [Esther]: Dancing — I am in a youth dance group.
FACILITATOR NOTE: Warm-up created a relaxed atmosphere. Participants laughed
and responded freely.

SPECIFIC OBJECTIVE 1: Knowledge and Awareness of Contraceptive Methods

SECTION A: What Do Young Women in Roan Know?

QA1. As a group, what contraceptive methods do young women in Roan

Township know about? Let us make a list together.
R1 [Natasha]: Condoms — that one everyone knows.
R2 [Brenda]: The three-month injection — Siyana or Depo. Most girls know that
one.
R3 [Fridah]: Emergency pills. The ones you take after.
R4 [Charity]: Jadelle — the one they put in your arm. Though not many young
girls know about it.
R5 [Stella]: The pill you take every day. Microgynon.
R6 [Chanda]: I have also heard of the IUD — the coil — but I do not know
anyone who has used it.
R7 [Miriam]: I just know condoms and the injection. That is all I knew before
today.
R8 [Patricia]: Same as Miriam — mainly condoms and Depo. And emergency
pills after something happens.
R9 [Grace]: I know about abstinence — that is also a method. And condoms.
 R10 [Esther]: I know about the pills and the injection. My older cousin told me
about them.
FACILITATOR NOTE: A reasonable spread of knowledge — some participants (R4, R5,
R6) knew a broader range including Jadelle and IUD; others (R7, R8, R9) knew only one
or two methods.

↳ Are there methods most girls know about? Are there methods very few girls have
heard of?
R2 [Brenda]: Condoms and Depo — almost every girl knows those. The long-
term ones like Jadelle and the IUD — very few.
R4 [Charity]: Jadelle is becoming known but people fear it because they say it
shows on your arm and parents will see.
R7 [Miriam]: I had never even heard of Jadelle before today. That is my first
time.
R6 [Chanda]: The IUD is almost unknown among girls our age. I only read about
it online.

↳ Where do girls in Roan mainly learn about contraceptives?

R1 [Natasha]: From friends — that is the main way. We talk among ourselves.
R3 [Fridah]: Social media. TikTok especially. There are videos that explain these
things.
R5 [Stella]: I got my information at the DREAMS programme. That was very
helpful.
R8 [Patricia]: From a health worker at the clinic when I went for something else.
She just started explaining.
R9 [Grace]: My mother told me about abstinence. Nothing else — just
abstinence.
R10 [Esther]: My cousin who is married. She sat me down and explained. She
said she wished someone had told her earlier.
R2 [Brenda]: Nobody sat me down properly. I just pieced it together from
different places over time.
GROUP: Consensus that no single source is dominant — information is
scattered and fragmented for most girls.

QA2. What have you heard — things people say contraceptives do to your
body?
R1 [Natasha]: That the injection makes you gain a lot of weight. Almost everyone
says this.
R2 [Brenda]: That you will not be able to have children after using them for a
long time. That is the biggest fear.
R3 [Fridah]: That the pill causes cancer. I heard that from my aunt.
 R4 [Charity]: That the emergency pill — if you take it too many times — blocks
your womb. People say three times maximum.
R5 [Stella]: That Jadelle causes heavy periods and your periods never stop
properly.
R6 [Chanda]: Some say the injection stops your periods completely — which
scares people because they do not know if they are pregnant or not.
R7 [Miriam]: I have heard they cause a lot of bleeding. And some say they make
you moody — your emotions go everywhere.
R8 [Patricia]: That they heat up your blood. I do not know what that means
exactly but the older women say it.
R9 [Grace]: My mother says they destroy your natural cycle and after you stop,
your body does not know how to function normally.
R10 [Esther]: Some say they cause headaches — very bad ones. A friend of
mine stopped because of that.

↳ Which of these do you believe to be true, and which do you think are rumours?
R1 [Natasha]: Weight change — I think that one is real. I have seen it happen.
But it does not happen to everyone the same way.
R5 [Stella]: At DREAMS they told us that infertility is mostly a myth — your
fertility returns after you stop. I believe that.
R3 [Fridah]: The cancer one I think is a rumour. But I am not sure enough to tell
others it is false.
R4 [Charity]: The heavy periods with Jadelle — I think that is real at the
beginning. My cousin had it.
R2 [Brenda]: Honestly I believe most of what my community says because I
have no way to check. Until someone with medical training tells me otherwise.
R9 [Grace]: I am not sure about any of them. That is the problem — we just do
not know who to believe.
R6 [Chanda]: I think the truth is probably somewhere in the middle. Some of
these things are real side effects that are being exaggerated by the community.

↳ Where do these stories come from — friends, elders, church, social media?
R8 [Patricia]: Mostly older women. They share their experiences and people
take it as fact.
R7 [Miriam]: And then social media spreads those stories even faster. One
person posts something and thousands share it.
R10 [Esther]: Church also. The pastor does not say it directly but implies that
contraceptives are harmful — as a way of discouraging girls from using them.

QA3. How do young women in Roan get information about contraceptives, and
is it enough?
 ↳ Who is the most trusted source — health workers, parents, peers, teachers, or social
media?
R5 [Stella]: Health workers — they have the training. But the problem is reaching
them. You have to actually go to the clinic.
R3 [Fridah]: I trust my older cousin more than a nurse I have never met.
Relationship matters.
R1 [Natasha]: Peers — because you can talk to them without shame. But the
information is not always accurate.
R9 [Grace]: I would trust a female teacher — if she was approachable and would
not judge.
R2 [Brenda]: Not social media — I have seen too many wrong things there. But
it is what most girls use because it is easy.
↳ Is there information young women in Roan are not getting but need?
R4 [Charity]: Yes — how each method actually works inside your body. Not just
'it prevents pregnancy' but how and why.
R6 [Chanda]: Where exactly to go and what to say when you get there. That
practical stuff nobody tells you.
R7 [Miriam]: What to do when there are side effects — who to call, what to take,
when to go back.
GROUP: Strong consensus that available information is insufficient, too
scattered, and often inaccurate. Practical, accessible, shame-free guidance is
what is missing.

SPECIFIC OBJECTIVE 2: Perceptions and Feelings

SECTION B: What Do Young Women in Roan Think and Feel?

QB1. In your community, what is the general attitude toward a young

unmarried girl who uses contraceptives?
R1 [Natasha]: People assume the worst immediately. They think she is sleeping
around.
R2 [Brenda]: She is called names — prostitute, loose woman. It does not matter
if she is just protecting herself.
R3 [Fridah]: Even her own family will turn against her if they find out. It brings
shame to the home.
R4 [Charity]: People ask: why does she need contraceptives if she is not
married? The assumption is that marriage is the only valid reason.
R5 [Stella]: It is unfair. A girl who protects herself is smarter and more
responsible — but the community punishes her for it.
R6 [Chanda]: Even at the clinic — sometimes the nurses look at you a certain
way if you are young and unmarried. You feel it.
 R7 [Miriam]: I have never used them but just thinking about going — the thought
of bumping into someone who knows my mother is enough to stop me.
R8 [Patricia]: In my compound, there is a girl everyone calls by a bad name
because she goes to the clinic regularly. It is very discouraging.
R9 [Grace]: From a faith perspective — the church sees it as admitting to sexual
sin. So you carry both community shame and spiritual guilt.
R10 [Esther]: But I think younger people — my age and younger — are starting
to think differently. Slowly.

↳ Is she respected or judged? Does it matter whether she is in school or not? Married or
unmarried?
R2 [Brenda]: Judged — always. The only exception is if you are married. Then it
is expected and even encouraged.
R5 [Stella]: Whether in school or not does not make much difference. Being
unmarried is the issue.
R4 [Charity]: Though I think if you are in school, some people understand more
— because they know a pregnancy would end your education. Some will say: at
least she is being smart.
R10 [Esther]: A very small number think that way. Most still judge. In school or
out of school — if you are not married, people will talk.

QB2. How do partners or boyfriends influence whether a girl uses

contraceptives or not?
R1 [Natasha]: My boyfriend knows I want to stay in school, so he is completely
supportive. He even reminds me of my injection date.
R2 [Brenda]: Some men are supportive when they understand child spacing. But
others see it as the girl giving herself permission to cheat.
R3 [Fridah]: My previous boyfriend was against it. He said if I loved him I would
not need contraceptives. I had to choose between him and protecting myself.
R4 [Charity]: I use without telling him. It is just easier that way. If he does not
know, he cannot object.
R5 [Stella]: The problem is boys are never educated about this. We go to family
planning sessions — boys don't. So they remain ignorant and make our lives
difficult.
R6 [Chanda]: My uncle stopped my cousin from going to the clinic — said it was
against their culture. She fell pregnant six months later.
R7 [Miriam]: Some men see it as the woman's responsibility — they do not want
to be involved but they also do not want her to get pregnant. So they just leave it
to us and then blame us if something goes wrong.
R8 [Patricia]: In my experience — the older the man, the more he thinks he
should control the decision. Young men who are educated are usually better.
 R9 [Grace]: I think a man who truly loves a woman will want her to be safe and
healthy. If he does not support her using contraceptives, that tells you something
about how he sees her.
R10 [Esther]: My sister's husband tracks her injection dates on his phone. He
wants to make sure she does not miss it. That is the kind of support every woman
deserves.

↳ Who has more power in these decisions — the girl or the boy? Should it be that way?
R3 [Fridah]: Ideally both should decide together. But in reality — the woman
should have final say. She is the one who will be pregnant.
R7 [Miriam]: In this community — the man has more power in practice, even
though he should not. Many women defer to the man.
R5 [Stella]: It should be the woman. No question. But we have to fight for that
right in most relationships.
R2 [Brenda]: And when the man leaves — which happens — the woman is left
alone with the pregnancy. So yes, she should have the final say.
GROUP: All ten participants agreed that women should have primary power in
contraceptive decisions — though several acknowledged that in practice, partner
influence often overrides this.

QB3. What do churches and religious teachings say about contraceptives in

your community?
R9 [Grace]: My church says absolutely no sex before marriage — so
contraceptives are off the table entirely for unmarried girls. It is considered
enabling sin.
R1 [Natasha]: My church does not say much directly — but the silence is telling.
It is an unspoken no.
R2 [Brenda]: Some churches have women's groups where family planning is
actually discussed — especially child spacing. Those churches are more helpful.
R4 [Charity]: My pastor once preached that contraceptives are a tool of the devil
to encourage immorality. That stayed with me for a long time and made me
afraid.
R5 [Stella]: I have separated my faith from this decision. I believe in God but I
also believe he wants me to be safe and finish school.
R6 [Chanda]: The church influences older community members most — and
those are the ones who control what happens to girls. So church attitudes filter
down even to those who do not attend.
R7 [Miriam]: I have felt the conflict personally. Going to church on Sunday
feeling guilty, and going to the clinic on Tuesday feeling judged. It is exhausting.
R8 [Patricia]: I think religion can be used differently. If churches taught that
protecting your health is a form of stewardship, girls would feel supported rather
than condemned.
 R3 [Fridah]: Some do — not many. But there are pastors who are more
progressive. We need more of them.
R10 [Esther]: At our youth group, the leader told us that abstinence is best —
but if you cannot abstain, please protect yourself. That balance made sense to
me.

↳ Does religion make it harder or easier? Have any of you felt your faith and your need
to protect yourself were in conflict?
R7 [Miriam]: Yes — constantly. That tension does not go away easily.
R9 [Grace]: For me, it has kept me from using contraceptives. Because the guilt
of the faith conflict is stronger than the fear of pregnancy — so far.
R5 [Stella]: I resolved it by reminding myself: I am not sinning by protecting
myself. I am being wise.
R4 [Charity]: I am still in the conflict, honestly. I pray about it.

QB4. If a girl your age decided to go to the clinic to get contraceptives — how
do you think people in Roan would react?
R7 [Miriam]: Even the thought of it scares me. I picture bumping into my
mother's church friend in the queue.
R1 [Natasha]: People react according to your situation. If you have a child — oh,
she is doing family planning, good. If you do not — what is she doing there?
R2 [Brenda]: Friends who are in the same situation would be supportive —
quietly. But family and community? No.
R3 [Fridah]: She would have to hide it. Going early in the morning when fewer
people are around. Or going to a clinic far from her home compound.
R4 [Charity]: I actually went to a clinic in a different part of town just so nobody
would recognise me.
R5 [Stella]: The reaction inside the clinic also matters — I have heard of nurses
who lecture young girls. That puts people off.
R6 [Chanda]: In a perfect world she would feel safe doing it openly. In Roan right
now — she would have to hide.
R8 [Patricia]: And the hiding itself is exhausting. You are managing your health
in secret, which adds stress.
R9 [Grace]: I have not gone yet because of this. The fear of being seen is the
biggest thing stopping me.
R10 [Esther]: But I went — and the nurse was kind. The actual experience was
better than the fear. The problem is the fear is so big you never get there.

SPECIFIC OBJECTIVE 3: Barriers and Motivators

SECTION C: What Makes It Easy or Hard to Use Contraceptives?

QC1. From what you know and have experienced, what are the biggest
obstacles that stop young women in Roan from using contraceptives?
R1 [Natasha]: The fear of judgment — from community, family, and sometimes
from health workers.
R2 [Brenda]: Misinformation about side effects. Girls hear terrible things and
decide not to risk it.
R3 [Fridah]: Not knowing what to say or ask when you get to the clinic. It is
embarrassing to admit you are sexually active.
R4 [Charity]: Partner opposition. If your boyfriend says no, many girls back
down.
R5 [Stella]: Religious guilt. You feel like you are doing two wrong things at once
— the sex and the contraception.
R6 [Chanda]: Distance and timing — getting to the clinic without someone
following you or asking where you are going.
R7 [Miriam]: Fear that your parents will find out. That is the number one fear for
school-going girls.
R8 [Patricia]: Health worker attitudes. Some nurses are kind but others make
you feel small. One bad experience stops a girl for years.
R9 [Grace]: Cost is also an issue for some — not everyone can afford the
transport to go even to a free clinic.
R10 [Esther]: And after you finally get there — the queue. You sit for hours and
you are terrified the whole time. Even if you get the contraceptive, the experience
discourages you from returning.

↳ Which of these is the most difficult to overcome?

GROUP: Discussion — multiple views expressed.
R7 [Miriam]: The fear of parents finding out — because you cannot control that.
You can manage your own fear but not your parents' reaction.
R5 [Stella]: I would say misinformation — because it poisons everything. You
cannot make a good decision if the information you have is wrong.
R4 [Charity]: Partner opposition — because it is another person. You can
educate yourself but you cannot educate him for him.
R2 [Brenda]: All of them together — that is the real problem. It is not one barrier,
it is five at the same time.

QC2. Has anyone here — or someone you know — had a bad experience at a
health facility when seeking contraceptives?
R4 [Charity]: Yes. I went once and the nurse asked me loudly — in front of
others — if my parents knew I was there. I left without getting anything.
R8 [Patricia]: A friend of mine was told by a nurse: you are too young for this, go
home. She never went back to that clinic.
 R3 [Fridah]: A student nurse at one facility had a very bad attitude — she was
sighing and rolling her eyes. It made the girl feel ashamed.
R10 [Esther]: My experience was actually good — the nurse was professional
and kind. She explained everything and gave me privacy. It does depend very
much on who you get.
R1 [Natasha]: That inconsistency is the problem. You do not know if you will get
a good nurse or a bad one. So the fear of getting a bad one stops you.
↳ What would make health facilities more welcoming for young women?
R6 [Chanda]: A separate room or separate day for young people — so we are
not sitting in the same queue as our mothers' friends.
R9 [Grace]: Training for nurses — teaching them to speak kindly and privately.
No judgmental comments, ever.
R5 [Stella]: A female health worker — always. A lot of girls feel more comfortable
with a woman.
R2 [Brenda]: Community outreach so you do not always have to go to the clinic.
A trusted person who comes to us.

QC3. What are the things that make young women in Roan decide to use
contraceptives?
R1 [Natasha]: Wanting to stay in school. That is the biggest motivator for me
personally.
R2 [Brenda]: Financial instability — if things are not settled with your partner,
you cannot afford a baby.
R3 [Fridah]: Child spacing — for those who already have children.
R4 [Charity]: Fear of what an unwanted pregnancy would do to your future.
R5 [Stella]: Education and awareness — when you know your options, you make
better choices.
R6 [Chanda]: Seeing a friend go through an unwanted pregnancy. That is a very
powerful lesson.
R7 [Miriam]: A supportive partner who encourages you and removes the fear.
R8 [Patricia]: Business goals — wanting to build something before having
children.
R9 [Grace]: I know someone whose life completely changed after an unwanted
pregnancy at 16. Seeing that made me think seriously about it.
R10 [Esther]: Having one good experience at the clinic — that first positive visit
changes everything. It removes the fear and you keep going back.

↳ Does seeing a friend use contraceptives successfully influence other girls?

GROUP: All ten participants immediately agreed — yes, strongly. Several spoke
at once.
R3 [Fridah]: Very much. If I see my friend is fine, is healthy, is still in school, has
not gained too much weight — I will go.
 R1 [Natasha]: Peer experience is everything. More than a pamphlet, more than a
nurse, more than social media.
R7 [Miriam]: When someone you trust says: I use this, I am fine — you believe
it.

QC4. If you were advising the government or health workers on what to

change, what would you say?
R1 [Natasha]: Bring services into the community. Mobile clinics, community
health workers who come to us. Remove the barrier of having to go somewhere
public.
R2 [Brenda]: Train health workers properly on how to treat young girls. One
unkind nurse does more damage than a broken supply chain.
R3 [Fridah]: Bring comprehensive family planning education into schools — not
just biology class, but real, practical sessions.
R4 [Charity]: Create dedicated adolescent clinic days — and make sure they are
confidential. No parents allowed to follow you in.
R5 [Stella]: Bring back DREAMS. That programme worked. We need it here
again.
R6 [Chanda]: Engage parents — educate them so they become allies, not the
main obstacle.
R7 [Miriam]: Include boys in family planning education. They are part of the
equation and nobody is talking to them.
R8 [Patricia]: Free contraceptives and free transport support for girls who cannot
afford to get to the clinic.
R9 [Grace]: Work with churches — not against them. If the pastor says family
planning is acceptable, the whole congregation will follow.
R10 [Esther]: Create peer support groups where girls who use contraceptives
successfully can mentor others. Real stories from real people.

↳ What is the single most important change? What role should young women play?
GROUP: Facilitator asked for a vote — participants were asked to name one
thing.
R2 [Brenda]: Community outreach — bring services to us.
R5 [Stella]: Education — correct information that dispels the myths.
R7 [Miriam]: Train health workers — the frontline matters most.
R9 [Grace]: Engage the church — because it controls community attitude.
R4 [Charity]: Dedicated adolescent spaces — privacy is everything.
FACILITATOR NOTE: No clear single winner — all five answers received support from
multiple participants. This reflects the multi-layered nature of the barriers.

CLOSING
QZ1. Is there anything important about young women's experiences with
contraceptives in Roan that we have not talked about today?
R5 [Stella]: The mental health side — the anxiety, the guilt, the constant hiding.
Nobody talks about what it costs emotionally to navigate this.
R7 [Miriam]: The boys. We have talked about what affects us but the
conversation has to include them.
R9 [Grace]: I just want to say — thank you for this space. I said things today I
have never said to anyone. This kind of space is exactly what girls here need.
R2 [Brenda]: Please make sure something changes from this research. Do not
just write a report and forget us.
FACILITATOR NOTE: Session closed warmly. Facilitator thanked all participants.
Confidentiality and use of data confirmed. Several participants stayed to talk informally
after the session ended.

Time FGD ended: ________________ Total duration: ________________

FACILITATOR'S POST-FGD OBSERVATIONS

Group dynamics — who spoke most/least? Power dynamics?
R1 (Natasha), R2 (Brenda), R5 (Stella), and R10 (Esther) were the most verbally
active — confident, articulate, and frequently building on each other's responses.
R4 (Charity) and R7 (Miriam) contributed meaningfully, often with the most
emotionally honest responses. R9 (Grace) was quieter but offered the most faith-
based perspective — distinctive and valuable. R3 (Fridah) and R8 (Patricia)
contributed at specific questions. R6 (Chanda) contributed less verbally but was
visibly engaged throughout. No dominant personality suppressed others — good
group balance.
Key themes that emerged most strongly:
(1) Stigma as the primary barrier — community judgment shapes almost every
decision. (2) Misinformation as deeply embedded and hard to displace without
trusted, relational sources. (3) Partner influence as both a barrier (opposition,
control) and a motivator (support, reminders). (4) Religious faith as a genuine
source of inner conflict for multiple participants — not just external pressure. (5)
Peer experience as the most powerful motivator for uptake. (6) Inconsistent
facility experiences — individual nurse attitude as a swing factor. (7) Practical
barriers: being seen in the queue, needing to hide the visit, cost of transport.
Points of disagreement or tension:
Tension between R9 (Grace — abstinence/faith position) and R5 (Stella —
pragmatic/self-protection position) throughout, though both were respectful. Mild
disagreement on who holds more power — partner or girl — with R7 noting that
theory and reality diverge. No hostility — diverse views were heard and valued.
Non-verbal observations:
 Visible emotional response when R4 recounted being asked about her parents by
a nurse — several participants reacted with recognition and discomfort. R9
paused noticeably before speaking at the faith-conflict probe — suggested
genuine internal tension. Laughter and ease during motivators section,
particularly around peer influence. Strong energy during recommendations — all
ten participants leaned forward.
Any important statements not captured in recording:
R4 whispered to R6 after the bad facility experience question: 'I did not say
everything.' Researcher noted this for potential follow-up IDI. R9 stayed after the
session and asked the facilitator privately about confidential access to
contraceptives — referred to nearest adolescent-friendly facility.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P19
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P19: Responsible decision-making. That is genuinely the first thing — not shame,
not secrecy. I grew up in a home where these things were discussed openly. My
mother is a nurse. So for me, contraceptives are just part of healthcare.
Probe: Where did you first hear about contraceptives?
P19: From my mother. She sat me down when I was about fifteen and explained
everything — the different methods, how they work, what the side effects are,
where to access them. She said: I would rather you come to me than make a
decision without information.

Q2. What contraceptive methods do you know of?

P19: A comprehensive list — combined oral contraceptive pill, progestogen-only
pill, Depo-Provera injectable, Jadelle implant, IUD, condoms — male and female
 — and emergency contraception. My mother explained all of them. I also read
more about them myself.

Q3. Can you tell me how each method works?

P19: The combined pill contains oestrogen and progestogen — it suppresses
ovulation, thickens cervical mucus, and thins the uterine lining so implantation is
less likely. Depo works similarly but is injectable and lasts three months. Jadelle
releases progestogen slowly over up to five years. The IUD is a physical device
— copper ones work by being toxic to sperm; hormonal IUDs also thicken mucus.
Condoms are barrier methods — they block sperm and also protect against STIs,
which the hormonal methods do not. Emergency contraception delays or
prevents ovulation if taken early enough.
Probe: Who do you think these methods are meant for?
P19: Anyone who is sexually active and making a conscious reproductive choice.
The idea that they are only for married women is a social construct, not a medical
guideline.

Q4. Where did you get most of your information?

P19: Primarily from my mother and from reading — medical websites,
reproductive health resources. I also attended some sessions through a health
programme at school. My information base is broader than most of my peers,
which I am aware creates a gap between my experience and theirs.
Probe: Was the information clear and easy to understand?
P19: Very. My mother has a gift for explaining clinical things in plain language.
And because she was not embarrassed by the topic, I was not either. That tone
matters enormously.

Q5. Are there things about contraceptives you are still unsure about?
P19: Not many — but I do wonder about very long-term use of hormonal
methods and whether there are effects we do not fully understand yet. I also want
to learn more about the copper IUD because it is the only non-hormonal long-
term option and I find that interesting.
Probe: What does the community say about what contraceptives do to the
body?
P19: I hear the same things my peers hear — infertility, cancer, weight gain,
blocked wombs. Because of my background I know most of it is exaggerated or
factually incorrect. But I understand why it circulates — when people do not have
accurate information, they fill the gap with stories. That is human nature.

Q6. Do most girls your age in Roan know about contraceptives?

 P19: They know the word and they know one or two names. But the depth of
understanding that I have — that is rare. Most girls have never had a
conversation with a trusted adult about this topic. That is the core problem.
Probe: Do they know enough to make a good choice?
P19: No. And the ones who think they know enough are often the most at risk —
because they are confident in information that is inaccurate. I worry about those
girls more than the ones who admit they do not know.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P19: Completely at ease. I use the pill and my mother knows. I have no guilt, no
fear, no conflict. I understand why other girls feel those things — the environment
creates them. But in my specific situation, I am fortunate that I do not have to
carry those feelings.
Probe: Would you feel differently if you were married?
P19: Not really. The method might change depending on what my husband and I
decided together. But the principle — using contraception to make a conscious
reproductive choice — would be the same.

Q8. What do your friends and peers think about girls who use contraceptives?
P19: This is where my experience diverges sharply from my home environment.
At school and in the community — I cannot tell most of my peers that I use the
pill. They would label me immediately. Some of my closest friends know and they
respect it — but they are not typical of the broader group.
Probe: Have you heard girls talked about negatively?
P19: Constantly. There is a girl in my class who is known to use contraceptives
— I will not say how people found out. She is called names every day. It is
relentless and it is cruel. And she is just being responsible.
Probe: Does what others think affect your choice?
P19: It affects how open I am about my choice — I am careful about who I tell.
But it does not affect the choice itself. I am secure enough in my understanding
and in my family support to not need community validation.

Q9. What does your family think?

P19: My mother knows and supports it. My father knows in general terms — he
and my mother had a conversation together. He was not enthusiastic initially but
 he trusts my mother's medical judgment. My younger sisters do not know yet —
they are too young. But my mother has said she will have the same conversation
with them when the time is right.
Probe: Should parents be involved in a girl's contraceptive decision?
P19: Ideally — yes. My mother's involvement made everything easier, safer, and
psychologically healthier for me. But I know my situation is the exception, not the
rule. The system cannot rely on parental support because most girls do not have
it. The health system has to be able to reach girls directly, confidentially, without
requiring parental permission. Both things need to exist.

Q10. What role does your partner play?

P19: He is aware I use the pill and fully supportive. We also use condoms
consistently because the pill does not protect against STIs. He was educated
enough to understand why both matter. He has said: your health is your decision
and I respect that.
Probe: Have you ever felt pressured?
P19: No. But I think part of why I attract partners who respect this is because I
am clear about it from the beginning. I communicate what I expect and I do not
apologise for it. Girls who are less confident or less informed are more vulnerable
to pressure.
Probe: Who should have the final say?
P19: The woman — always. In an ideal relationship, it is a joint decision. But the
right of final say belongs to the person whose body is most directly affected.

Q11. What does your church say about contraceptives?

P19: My church is moderate — the pastor does not preach against family
planning explicitly. We are encouraged to be responsible and make wise
decisions. That framing is much more helpful than churches that simply say: this
is forbidden.
Probe: Have you felt torn between faith and your choices?
P19: No. My faith and my choices coexist comfortably. I believe responsible
stewardship of one's health is entirely consistent with faith. But I recognise I have
had an unusual upbringing that allows me to hold these things together. Many
girls have not had that.

Q12. If a girl went to the clinic for contraceptives, how do people react?
P19: In this community — if she is unmarried, she will be judged. The clinic
experience itself depends entirely on who attends to her. I have had good
experiences because I know what I am there for and I am confident in asking.
Girls who are frightened and uncertain often get a worse reception — because
confidence signals to health workers that you belong there.
Probe: Have you felt ashamed at the facility?
P19: No — but I acknowledge that my confidence probably changes how I am
treated. I look like I know what I am doing. A girl who looks frightened and
uncertain may be treated very differently.
Probe: Does fear stop girls from accessing services?
P19: Enormously. The anticipation of judgment — at the clinic, in the community
— is often more powerful than the actual experience. Girls build the barrier in
their minds before they ever get there. That is what education and normalisation
would change.

Q13. What does it feel like to have power over this decision?
P19: Natural — because I have always had it in my home environment. But I am
aware that for most girls, this feeling of power is hard-won or absent entirely. The
girl who makes this decision alone, against her family, against her partner,
against her church — she is showing enormous courage. She deserves more
credit than she gets.
Probe: Do girls in Roan generally have that power?
P19: Not in any real sense. They may make the decision, but they make it in fear
and secrecy. That is not power — that is survival. True reproductive autonomy
means being able to make the decision openly, with support. We are very far from
that in Roan.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Which contraceptive are you currently using?

P19: The combined oral contraceptive pill — Microgynon. I have been on it for
about a year and a half. I also use condoms consistently for STI protection.

Q15. What would make it easier for girls in Roan to access contraceptives?
P19: A parent education campaign — teaching parents how to have this
conversation with their daughters before they need it. If more homes were like
mine, the problem would shrink dramatically. The health system cannot do it
alone. Parental allies are the most powerful resource there is.

Q16. How was your clinic experience?

P19: Straightforward and professional. The nurse was efficient and respectful. I
had my questions ready, she answered them, and I left with what I needed. I
 have never had a negative experience — but I attribute some of that to the
confidence I bring.

Q17. What stops girls from using contraceptives?

P19: Lack of a trusted adult with accurate information. That is the root of most of
the other barriers. Stigma, misinformation, partner opposition — all of these
would be more manageable if girls had one informed, supportive adult in their
corner. Most do not.

Q18. Have you had any side effects?

P19: Mild nausea for the first two weeks when I started. My mother warned me
about this so I was prepared. It resolved on its own. Nothing since then.

Q19. What would motivate more girls to use contraceptives consistently?

P19: Normalisation — through education, through community dialogue, through
healthcare that is kind and non-judgmental. And a parent education campaign. If
even a quarter of Roan's parents could have the conversation my mother had
with me — the outcome for girls in this community would be very different.
Probe: Who is most trusted?
P19: A parent — if they are informed and supportive. And a female health worker
who takes the time to build rapport. Rapport is everything.

Q20. Anything else?

P19: I am aware that my experience is unusual and I do not want it to be treated
as the norm. I am telling you what good looks like — so that you can see how far
most girls in Roan are from it. The gap between my experience and my peers'
experiences is the problem this research needs to address.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P20
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained
Researcher Note: This participant disclosed a history of sexual assault during the
interview. Responses have been transcribed sensitively. Participant was provided
with referral information for psychosocial support at the close of the session. All
standard ethical protocols were followed.

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P20: [Pause.] Protection. That is what it means to me now. A few months ago I
would have said I did not know much about it. But things happened and now I
know more than I wanted to learn so quickly.
Probe: Where did you first hear about contraceptives?
P20: At school — but only the basic things. After what happened to me, my
cousin took me to the clinic and the nurse explained everything. That was the first
time anyone really sat with me and went through it properly.

Q2. What contraceptive methods do you know of?

P20: Emergency pills — that was the first one I used. Then the nurse explained
Depo, condoms, and something called Jadelle. She gave me options and said it
was my choice.

Q3. Can you tell me what you know about how these work?
P20: Emergency pills — you take them after something happens, within three
days, and they prevent pregnancy. Depo — it is an injection every three months.
The nurse explained it stops the egg from coming out. For condoms — I know
they protect from pregnancy and diseases. Jadelle I do not know well yet.
Probe: Who are these methods meant for?
P20: Anyone who needs protection. That is all. Anyone who needs it.

Q4. Where did you get most of your information about contraceptives?
P20: From the nurse at the clinic, and from my cousin who came with me. My
cousin has been the only person who knows what happened to me. She was very
calm and she held my hand through the whole process.
Probe: Was the information clear and easy to understand?
 P20: Yes. The nurse was very gentle. She did not ask questions that made me
feel worse. She just explained, asked what I wanted, and helped me get it. I will
always be grateful for how she handled that day.

Q5. Are there things about contraceptives you are still unsure about?
P20: I wonder if what I am using now — I started Depo recently — will affect me
in the future when I want to have children. That question keeps coming back to
me. I want a family one day. I just need it to be on my own terms and at the right
time.
Probe: What does the community say about what contraceptives do to the
body?
P20: I have heard the things people say — infertility, weight gain, blocked
wombs. But after what I went through, I could not afford to let those fears stop me
from protecting myself. I needed to take the risk. The alternative was worse.

Q6. Do most girls your age in Roan know about contraceptives?

P20: Not really. I did not, before. I think most girls only get the information when
something forces them to look for it. That should not be how it works.
Probe: Do they know enough to make a good choice?
P20: No. And the information should reach girls before they need it urgently —
not after. No girl should have to learn about emergency contraception because of
an assault.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P20: I feel like they saved me — or at least, they gave me back a little control at
a time when everything felt completely out of my hands. Using Depo now is
something I chose. After something being done to me without my choice —
having any decision that is mine feels important.
Probe: Would you feel differently if you were married?
P20: [Long pause.] Marriage feels very far away right now. I do not think about it.
What I think about is getting through each day, finishing school, and recovering.
The rest can wait.

Q8. What do your friends and peers think about girls who use contraceptives?
 P20: I cannot think about that right now. I know people judge girls for going to the
clinic. But when you are in the situation I have been in, other people's opinions
become very small and very far away. Survival is what matters.
Probe: Does what others think affect your choice?
P20: No. Not anymore. It might have before. But experience changes what you
are willing to tolerate from other people's judgments.

Q9. What does your family think?

P20: My family does not know what happened to me. Only my cousin. My mother
would be devastated and I am not ready to handle her reaction on top of
everything else. It is a very heavy thing to carry alone — but I am managing.
Probe: Should parents be involved in a girl's contraceptive decision?
P20: Yes — in normal circumstances. But girls also need to be able to access
services without parental involvement when the situation makes that impossible.
If I had needed my mother's permission to go to that clinic, I might not have gone.
And then I would not have gotten the help I needed.

Q10. What role does your partner play?

P20: I do not have a partner. What happened to me was not a relationship. It was
done to me. [Pause.] The clinic nurse asked about partner support and I
explained. She was very understanding. She did not make me feel judged for my
situation.
Probe: Who should have the final say in contraceptive decisions?
P20: The girl. Always. Especially because sometimes the person who has put
you in need of contraception has not given you a choice. The decision about how
to protect yourself after that — that one must belong entirely to you.

Q11. What does your church say about contraceptives?

P20: My church is very traditional. I have not been back since it happened. I am
still working out how I feel about faith right now. It is complicated. I used to feel
very clear about what I believed. Now I am not sure of many things.
Probe: Have you felt torn between faith and your choices?
P20: Yes. I used to think — before — that I would never need to make decisions
like this. That abstinence was enough of a plan. And then something happened
that had nothing to do with my choices. That has changed how I think about a lot
of things. Including what faith means to me when the world does not follow the
rules you were taught.

Q12. If a girl your age went to the clinic for contraceptives, how do people
react?
 P20: They judge her. That is the truth. Even at the clinic — the attitude of the
person you encounter can either help or hurt you. I was lucky. The nurse I saw
was kind. But I have heard stories of girls being questioned and shamed. If that
had happened to me on that day, I do not know what I would have done.
Probe: Does fear stop girls from accessing services?
P20: It does. And for girls who have been through something traumatic — the
fear is even bigger. You are already fragile. You cannot absorb rejection or
judgment. Health facilities need to understand that some girls come to them
having already been through something very hard. The way they are received in
that moment can make or break everything.

Q13. What does it feel like to have power over this decision?
P20: It is the only power I have felt in a long time. And I am holding onto it.
Choosing to protect myself — going to the clinic, starting Depo, making a plan —
those have been acts of recovery for me as much as acts of healthcare.
Probe: Do girls in Roan generally have that power?
P20: Many do not. And the ones who are in situations like mine — girls who have
been harmed — they need it the most. The system needs to make sure those
girls can access services quickly, confidentially, and without having to explain
everything to get help.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Which contraceptive are you currently using?

P20: Depo-Provera — I started about two months ago. The nurse recommended
it because it is discreet, I do not have to take anything daily, and it gives me three
months of protection without anyone at home knowing.

Q15. What would make it easier for girls to access contraceptives?

P20: Kindness. That is the first thing. A clinic that feels safe — not frightening.
Where you know you will not be judged, where you will not be asked to explain
yourself in front of others, where the person behind the desk will treat you like a
person first. That is the most important thing.

Q16. How was your clinic experience?

P20: Because of the nurse who attended to me — it was the first moment of
genuine safety I had felt in weeks. She explained things calmly. She gave me
 options. She did not pressure me. She referred me for additional counselling
support. That experience is part of why I am still functioning.

Q17. What stops girls from using contraceptives?

P20: Fear — of judgment, of being seen, of side effects. And not knowing that
you have the right to walk into that clinic and ask for help without needing
anyone's permission. Many girls do not know they have that right. I did not know
until my cousin told me.

Q18. Have you had any side effects?

P20: Some spotting in the first month. The nurse said this is normal and it should
settle. I am monitoring it. So far nothing concerning.

Q19. What would motivate more girls to use contraceptives consistently?

P20: Knowing that the clinic is a safe place. That is the foundation of everything.
If girls knew — truly knew — that they would be treated with dignity when they
went for help, more would go. The fear of the clinic is often bigger than the fear of
pregnancy. That balance has to change.
Probe: Who is most trusted?
P20: A kind, female health worker. And a trusted peer or family member who can
accompany you. Nobody should have to walk into a clinic like that alone. I was
lucky my cousin came with me. Not everyone has that.

Q20. Is there anything else you would like to share?

P20: [Pause.] Please make sure the health system knows that some girls come
to them having already been through something very serious. They need
gentleness above everything else. Not forms, not questions, not judgment. Just
someone who says: you are safe here, and we are going to help you. That is all.

Researcher note: At the close of the interview, participant was provided with
information about available psychosocial support services and assured again of
the confidentiality of everything shared. She expressed gratitude for the space to
speak. Referral to counselling support completed.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P18
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P18: Survival. That is honestly what comes to my mind first. I am on my own in
many ways. I cannot afford to get pregnant. So contraceptives are not a lifestyle
choice for me — they are a necessity.
Probe: Where did you first hear about contraceptives?
P18: From a girl in my compound who was older than me — she was maybe 22
at the time. She sat me down one day after I told her I had a boyfriend and
explained everything. She said: do not be like me, I learned the hard way. She
had had two pregnancies by then.

Q2. What contraceptive methods do you know of?

P18: Depo — the three-month injection. Condoms. Emergency pills. And I have
heard of Jadelle but I do not fully understand it yet. A community health worker
also told me about the IUD but she said it is usually recommended for women
who have already had children. So I have not considered that one.

Q3. Can you tell me what you know about how each method works?
P18: Depo — I get it every three months from the clinic. It stops me from getting
pregnant during that time. The nurse explained it prevents the egg from being
released. Condoms — the barrier prevents sperm from reaching the egg and also
protects from diseases. Emergency pills — you take them within 72 hours after
unprotected sex. The community health worker explained each of these to me
quite well.
Probe: Who do you think these methods are meant for?
P18: Anyone who is sexually active and does not want to be pregnant. There
should be no age or marital status requirement for that.
Q4. Where did you get most of your information about contraceptives?
P18: From the community health worker who visits our area, and from that older
girl in the compound. Not from school — they were very vague. Not from my
grandmother — she would not even know how to begin that conversation. She
still believes menstruation is something you do not discuss openly.
Probe: Did anyone properly sit you down and explain?
P18: The community health worker did. She was the most thorough. She visited
our compound and I asked her everything I had been wondering about. She
answered without judgment and without making me feel like a bad person.
Probe: Was the information clear?
P18: Very clear. She used simple language and even drew a small diagram. That
was the first time I truly understood how Depo works inside the body.

Q5. Are there things about contraceptives you are still unsure about?
P18: What happens to my body when I stop. I have been on Depo for almost two
years now. When I eventually want children — will things go back to normal
quickly? The nurse said yes, but I would like to see that confirmed.
Probe: What does the community say about what contraceptives do to the
body?
P18: My grandmother's friends say terrible things — that the injection rots your
womb from the inside. That you will become barren. One said a young woman in
this area became mad because of family planning. I do not believe these things,
but when the people raising you say them, it still creates doubt.
Probe: Have you heard about infertility fears?
P18: Yes — that is the main one. It is everywhere. I have had to reason through it
myself because there is nobody at home I can talk to who would give me a
balanced view.

Q6. Do most girls your age in Roan know about contraceptives?

P18: They know enough to know they exist. But the quality of knowledge is very
poor. They know names, not mechanisms. And what they think they know is often
shaped more by fear stories than facts.
Probe: Do they know enough to make a good choice?
P18: No. And without a trusted adult to guide them — like I was lucky to have
with that community health worker — most girls are making decisions based on
half-truths and rumours. That is dangerous.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
 Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about using contraceptives?

P18: I feel settled about it. It took some time to get there — especially living with
my grandmother whose views are very different. But I made a decision based on
my own situation and my own reasoning. I am not in a position to raise a child
right now. Not financially, not emotionally. Contraceptives allow me to take care of
myself first.
Probe: Would you feel differently if you were married?
P18: If I were married and in a stable home, perhaps I would feel less urgency.
But the logic would be the same — you use contraceptives when you are not
ready for a child. The marital status does not change the underlying need.

Q8. What do your friends and peers think about girls who use contraceptives?
P18: The girls in my compound who know I use Depo — they respect it. Some
have come to ask me how to get it. So among my immediate circle, it is seen as
responsible. But in the wider community and especially among older people — it
is still heavily stigmatised.
Probe: Have you heard girls talked about negatively?
P18: Yes. One girl was publicly humiliated by an older woman who saw her at the
clinic. The woman started asking her questions loudly — does your mother know
you are here? The girl was so ashamed she left without being attended to.
Probe: Does what others think affect your choice?
P18: Not anymore. It did at the beginning. But I do not have the luxury of letting
community opinion override my own safety. I do not have parents to fall back on if
something goes wrong. I am responsible for myself.

Q9. What does your family think about young girls using contraceptives?
P18: My grandmother would be horrified if she knew. She believes a girl should
remain pure until marriage and that contraceptives encourage immorality. She is
a product of her time and I respect her. But I cannot follow her worldview when it
puts me at risk.
Probe: Have you ever tried talking to her?
P18: Once — indirectly. I raised the topic of a girl in the community who had
gotten pregnant and I suggested that information about family planning would
have helped her. My grandmother said: she should not have been doing those
things in the first place. That told me everything I needed to know about what that
conversation would look like if I made it personal.
Probe: Should parents or guardians be involved in a girl's contraceptive
decision?
 P18: In an ideal world — yes. A supportive parent is the best resource a girl can
have. But we do not all have that. For girls like me, the healthcare system and
community health workers have to fill that gap. And they need to do it without
judgment.

Q10. What role does your partner play in decisions about contraceptives?
P18: He knows I am on Depo and he supports it fully. He has never pressured
me to stop. In fact, he said: you are being responsible and I respect that. That
kind of response from a partner makes a real difference.
Probe: Have you ever felt pressured to use or not use?
P18: Not from my current partner. From a previous one — yes. He said using
Depo meant I was sleeping with other men. That relationship ended partly
because of that attitude.
Probe: Who should have the final say?
P18: The woman — without question. She carries the pregnancy, she raises the
child in most cases, she bears the consequences. She must have the final say.

Q11. What does your church or religious community say about

contraceptives?
P18: I attend church but not regularly. The church I go to is conservative — sex
before marriage is sin, contraceptives are not discussed. But I have made peace
with the fact that my circumstances require me to make practical decisions. I
believe in God and I also believe He understands context.
Probe: Have you felt torn between your faith and your choices?
P18: Early on, yes. But when you are living alone, responsible for yourself, with
no safety net — faith has to coexist with pragmatism. I pray. I also go to the clinic
every three months. Both things are true at once.

Q12. If a girl went to the clinic for contraceptives, how do you think people
would react?
P18: In this community — very poorly, if she is not married. But I have found that
the earlier in the morning you go, the fewer people are around. And going to a
clinic a little further from your own compound reduces the risk of being seen by
someone who knows you. I have learned to navigate it.
Probe: Have you felt ashamed or afraid at the facility?
P18: The first time — absolutely. I sat in the waiting area for forty minutes before
I could bring myself to speak to the nurse. But the nurse was kind and that
changed everything. After that first visit, it became routine.
Probe: Does that fear stop girls from accessing services?
 P18: It stops many. The fear is the biggest wall. And once you miss one visit
because of fear, you tell yourself you will go next month — and then the
protection lapses. That is how pregnancies happen even among girls who know
about contraceptives.

Q13. What does it feel like to have power over this decision?
P18: It feels like the one area of my life I have full control over. I cannot control
my economic situation. I cannot control what my grandmother believes. But I can
control whether or not I get pregnant right now. That matters enormously.
Probe: Do girls in Roan generally have that power?
P18: Girls who are in stable homes with supportive families — perhaps. Girls who
are in my situation — we have to fight for it. It is not handed to us. We have to
seek the information, navigate the clinic, manage the secrecy. That is a lot of
work just to stay safe.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Which contraceptive method are you currently using?

P18: Depo-Provera injection — every three months. I have been consistent for
almost two years now.

Q15. What would make it easier for girls to access contraceptives in Roan?
P18: More community health workers like the one who helped me. Women who
come to where girls are — not waiting for girls to summon the courage to go to
the clinic. The outreach model is the most effective for girls who are afraid or
isolated.

Q16. How was your experience at the health facility?

P18: After the initial nervousness — very positive. The nurse at the clinic is
professional and kind. She never makes me feel judged. She explains what to
expect, checks if I have had any concerns, and sends me home with a clear next
date. I trust her.

Q17. What stops girls from using contraceptives?

P18: Fear of being seen. Misinformation from the community. No trusted adult to
guide them. Partner opposition. Financial barriers — even transport to a free
 clinic costs money some girls do not have. And the emotional weight of keeping it
all secret. Those things together are overwhelming for many girls.

Q18. Have you had any side effects?

P18: My periods have become very irregular — sometimes I go two or three
months without one. At first that scared me. But the nurse explained it is a normal
response to Depo and not harmful. Once I had that reassurance, I stopped
worrying.

Q19. What would motivate more girls to use contraceptives consistently?

P18: Access to honest, accurate information from a trusted person — not a
pamphlet, not social media, but a real human being who knows what they are
talking about and does not judge. And more community health workers doing
outreach. That single intervention changed my life.
Probe: Who is the most trusted source of advice?
P18: A community health worker who has built a relationship with you over time.
Trust is not instant — it is built. Programmes that invest in long-term relationships
with girls in their own communities will always be more effective than one-off
clinic visits.

Q20. Is there anything else you would like to share?

P18: Girls who are orphaned or in difficult home situations are the most
vulnerable and the least reached. We do not have parents to advocate for us. We
do not always have the confidence to walk into a clinic alone. Programmes need
to specifically seek us out — not wait for us to come forward. We are the ones
who need this the most and the ones least likely to ask for it.

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 4 — Key Informant Interview (KII) with Community/Civic Leader
Participant Code: CL02
Participant Role: Ward Development Committee (WDC) Chairperson — Roan
Township
Years in Role: 8 years
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained
SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role in this community and how long you have
been serving in Roan Township.
CL02: I am the Chairperson of the Ward Development Committee here in Roan. I
have been in this role for eight years now. My committee covers community
welfare — we deal with issues ranging from infrastructure to social concerns.
Young people and women's wellbeing are areas I am personally passionate
about.
Probe: What community issues related to young people do you most
frequently deal with?
CL02: Adolescent pregnancy is at the top of the list. School dropout linked to
pregnancy. Drug abuse among young men and women. And increasingly, we are
dealing with cases of young girls who have attempted to terminate pregnancies
— sometimes with very dangerous consequences.

QA2. How serious is the concern of adolescent pregnancy here in Roan?

CL02: Extremely serious. I speak from personal experience as well as
professional — I myself fell pregnant as an adolescent, many years ago. That
experience shaped my entire outlook on this issue. When I see these girls, I see
myself. And I know how much better things could have been with the right
support and information.

QA3. How common is contraceptive use among adolescents in this

community?
CL02: Less common than it should be — and less common than people think.
The girls who are using contraceptives do so very quietly. So to the outside world,
it looks like very few are using them. But from conversations I have had — many
more are trying to access them than are visible.
Probe: Do most adolescent girls know about and have access to
contraceptives?
CL02: They know the word. They know one or two names. But real, usable
information — how to access, what to expect, how to manage side effects? No.
That level of knowledge is still rare.

SECTION B: COMMUNITY KNOWLEDGE AND AWARENESS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods
QB1. In your experience as a community leader, what do young people in Roan
know about contraceptives?
CL02: They know enough to know they exist. But not enough to use them
effectively. And the knowledge they do have is heavily filtered through community
myths — so much of what they know is actually incorrect.
Probe: Is the information they have sufficient for informed decisions?
CL02: Absolutely not. There is a huge gap between knowing a word and knowing
how to protect yourself. Most girls are trying to navigate that gap alone, without
support.

QB2. What beliefs or stories circulate about what contraceptives do to young

women's bodies?
CL02: Infertility is the dominant story. Any woman who has struggled to conceive
— someone in the community will link it to contraceptives she may have used
years ago. Whether or not that is true is irrelevant — the story becomes truth. We
also hear stories about contraceptives causing cancer, mental illness, and
physical deformity. These stories are powerful and they keep girls away from
services.

QB3. Where do young people get information about sexual health in Roan?
CL02: From each other, mostly. Peer-to-peer information — which is often
inaccurate. Some get it from social media — which is mixed in quality. A few have
a trusted adult at home or at school. And some access services through the
DREAMS programme when it was active. Now that DREAMS has closed in this
area, that safety net is gone.
Probe: What role do you or your committee play?
CL02: We try to create spaces for these conversations. We partner with the clinic
to hold community health days. We have women's groups where family planning
is discussed. But we are under-resourced and our reach is limited. We cannot be
everywhere.

SECTION C: COMMUNITY PERCEPTIONS AND ATTITUDES

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What is the general attitude in Roan towards unmarried adolescent girls
who use contraceptives?
CL02: Negative — largely. The community still operates on the assumption that a
girl who uses contraceptives is morally compromised. There is no recognition that
she might simply be making a responsible decision to protect herself. I find this
 deeply frustrating because I know from my own history what happens when girls
are not protected.
Probe: Has this attitude changed over time?
CL02: Slightly — among younger parents and among those who have seen the
consequences of unprotected sex up close. But the older generation, especially
religious elders, are still very resistant. Change is happening at a generational
pace — which is far too slow given the rate of adolescent pregnancies.

QC2. What does community culture teach about contraceptives and young
people?
CL02: That contraceptives belong in marriage. That using them outside of
marriage signals sexual immorality. And that infertility is a punishment for using
contraceptives before marriage. These are the cultural teachings that frame
everything. They are powerful and deeply held.

QC3. Do you personally believe young girls should have access to

contraceptives?
CL02: Without question — yes. I would go further and say it is a right. Access to
contraceptives is access to reproductive autonomy, and that is a basic human
right. The community may not be there yet, but I believe it personally and I
advocate for it in my work.
Probe: Why do you feel so strongly?
CL02: Because I was a girl in this community who did not have that information
or access. And I paid a price for it. I cannot watch another generation go through
that if there is anything I can do to prevent it.

QC4. What has the most influence over a young woman's decision to use or
not use contraceptives?
CL02: Her immediate social circle — her partner, her closest friends, and then
her parents. The community and the church exert a diffuse pressure, but the most
direct influence is from the people closest to her. If even one of those people is
supportive — a boyfriend, a mother, an older sister — it makes a significant
difference.
Probe: Do young women in Roan feel they have autonomy over this decision?
CL02: Most do not — not fully. They make the decision, but they make it in
secret, in fear, without support. That is not true autonomy. True autonomy would
mean they can make the decision openly and have it respected. We are far from
that here.

SECTION D: BARRIERS, MOTIVATORS, AND RECOMMENDATIONS

 Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. From your perspective, what are the main reasons adolescent girls do
not use contraceptives even when sexually active?
CL02: Fear of being found out — by parents, by partners, by the community.
Lack of accurate information — they rely on myths. And the assumption that
seeking contraceptives means admitting to being sexually active, which opens
them to judgment and punishment. So they take the risk of pregnancy rather than
the certain judgment that would come from being seen at a family planning clinic.
Probe: What role does religion play?
CL02: A very significant one. The church message is that sex before marriage is
sinful — so contraceptives are doubly sinful because they 'enable' that sin. Many
girls who are already sexually active continue to attend church and try to hold
both realities at once. The contradiction becomes too heavy and they either stop
going to church or stop protecting themselves. It is an impossible position.

QD2. Have you seen young women face negative consequences for using or
seeking contraceptives?
CL02: Yes. A girl in this ward was caught by her mother going to the clinic. Her
mother threw her out of the house. The girl came to me. We worked together to
bring the family back together, but it took months and was extremely painful. That
mother was not evil — she was scared and culturally conditioned. But the harm to
her daughter was real.
Probe: What does this tell you about how the community needs to change?
CL02: It tells me we need to start with parents — not just girls. If we educate girls
alone, they still go home to parents who punish them for what they have learned.
Parent education has to be part of the strategy.

QD3. What would you say to community members who oppose adolescent
contraceptive use?
CL02: I would ask them: would you rather your daughter be informed and
protected, or would you rather she be ignorant and pregnant at 16? Because
those are often the real choices. And I would invite them to sit with the girls who
have experienced unwanted pregnancies and hear their stories. Theory changes
slowly. Stories change people.

QD4. What motivates the girls in Roan who do use contraceptives despite the
pressure?
CL02: Ambition. The girls who use contraceptives despite everything are usually
the ones who have a clear vision for their future — they want to finish school,
 they want a career, they are not willing to let a pregnancy derail their plans. That
personal determination is a very powerful motivator.

QD5. What role should community leaders play in addressing adolescent

pregnancy?
CL02: We should be conveners — bringing together the health sector, schools,
churches, parents, and young people in structured dialogue. We should use our
authority to create spaces where these conversations can happen without
shame. And we should advocate loudly for policies that protect girls' right to
access reproductive health services.

QD6. What message would you give to the Ministry of Health?

CL02: Invest in community health workers. They are the bridge between the
clinic and the girl who is too scared to come in. Restore and expand programmes
like DREAMS. Mandate adolescent-friendly training for all health workers. And
please — create a formal policy that protects a girl's right to access
contraceptives confidentially, without requiring parental consent. That policy gap
is costing lives.

QD7. Anything else important for this research?

CL02: Listen to the girls. Not just the articulate ones who are easy to reach —
listen to the ones who are silent, who are frightened, who are in impossible
situations. They are the ones this research needs to serve most.

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 4 — Key Informant Interview (KII) with Community/Civic Leader
Participant Code: CL03
Participant Role: Secondary School Headteacher — Roan Township
Years in Role: 12 years (4 as headteacher, 8 as teacher)
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role in this community and how long you have
been serving.
CL03: I have been a secondary school teacher for twelve years — the last four
as headteacher of this school. We have approximately 800 students, of whom the
majority are girls. Reproductive health is something I deal with constantly — not
always directly, but through the consequences of early pregnancy, school
dropout, and the distress we see among our female students.
Probe: What community issues related to young people do you most
frequently deal with?
CL03: Adolescent pregnancy is the leading concern for me as a headteacher.
Every term, we have students who have to interrupt or end their studies because
of pregnancy. We also see issues around gender-based violence, peer pressure
related to relationships, and the mental health consequences of all of this.

QA2. How serious is the concern of adolescent pregnancy here in Roan?

CL03: It is our most pressing social challenge in this school. In an average term,
we lose between three and six female students to pregnancy — either they
withdraw voluntarily or their parents withdraw them. Even those who return after
delivery — many do not catch up sufficiently to perform well in exams. The
damage is long-term.

QA3. How common is contraceptive use among adolescents in your

observation?
CL03: Very difficult to say because it is so hidden. From what I observe — a
small number of our older students may be using contraceptives. But most are
not. The evidence is the pregnancy rates.
Probe: Do most girls in your school know about or have access to
contraceptives?
CL03: They know they exist. Our life skills curriculum mentions family planning
briefly. But the coverage is very light — and the curriculum avoids the practical
specifics because of concerns from parents and the community about
encouraging sexual activity.

SECTION B: COMMUNITY KNOWLEDGE AND AWARENESS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. In your experience, what do young people in Roan know about

contraceptives?
 CL03: At the surface level — the names and the basic concept of pregnancy
prevention. At the practical level — very little. They do not know how to use a
condom correctly. They do not know the difference between methods or which is
appropriate for them. There is a significant knowledge deficit.
Probe: Is that information sufficient for informed decisions?
CL03: Certainly not. And I say that as someone who is cautious about the school
going too far into this territory without parental support. But there must be a
middle ground between what we are currently doing and what these girls actually
need.

QB2. What beliefs or stories circulate in the community about contraceptives?

CL03: We see the impact of these beliefs directly. A student whose older sister
was on contraceptives for years and later had fertility challenges — she comes to
school carrying that story as fact. The infertility narrative is the dominant one. I
have had students tell me they refuse to use contraceptives because they do not
want to be barren. Those are fifteen-year-olds.

QB3. Where do girls at your school get information about sexual health?
CL03: Peer networks are primary. Social media is significant — and unfortunately
very unreliable as an information source. The school curriculum provides some
coverage — but as I said, it is conservative. And very few have parents who
speak openly about this.
Probe: What role does the school play in providing information?
CL03: We do what we can within the bounds of the curriculum and community
expectations. We have had visits from clinical health workers who conduct
sessions with students. These are always well attended and the students ask
very good questions when they feel safe. The challenge is the sessions are
occasional — not systematic.

SECTION C: COMMUNITY PERCEPTIONS AND ATTITUDES

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What is the attitude in Roan towards unmarried adolescent girls who use
contraceptives?
CL03: Harsh. Both among students and in the wider community. A girl who is
known to use contraceptives is assumed to be sexually promiscuous — and that
assumption is used to dismiss her. I have seen girls ostracised by peers for far
less. It creates a situation where the responsible choice is also the most socially
costly choice.
Probe: Has this changed over time?
 CL03: At the school level — very slightly. I have seen students become more
nuanced in their conversations about reproductive health over the years,
particularly among the older students. But at the community level, the attitudes
are largely the same as they were when I started here twelve years ago.

QC2. What does cultural tradition teach about contraceptives and young
people?
CL03: That sexual activity belongs in marriage and therefore contraceptives
belong in marriage. Outside of marriage — abstinence is expected. Contraceptive
use is read as an admission of sexual activity, which is read as moral failure. The
logic is circular and very hard to break.

QC3. Do you personally believe young girls should have access to

contraceptives?
CL03: As an educator, I believe in comprehensive information — including about
reproductive health. As a community member, I am aware that this view is not
universally shared. My personal position is that an informed girl who can protect
herself is always better than an uninformed girl who cannot.
Probe: Why?
CL03: Because I have sat with girls who were pregnant and terrified and had no
options. No information, no support, no access to services. The cost of ignorance
is measured in broken futures. I have seen too many to believe ignorance is
protective.

QC4. What has the most influence over a young woman's decision about
contraceptives?
CL03: At school age — peers, then romantic partners, then parents. The school
is an influence too — but indirectly, through culture and curriculum. Religious
institutions also play a role, particularly for girls from strongly faith-based families.
Probe: Do young women feel they have autonomy here?
CL03: Minimal autonomy in practice. They may have a private desire to protect
themselves, but executing that desire requires navigating enormous social
obstacles. The girl who has true autonomy in this regard is the exception, not the
rule.

SECTION D: BARRIERS, MOTIVATORS, AND RECOMMENDATIONS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. From your perspective as a school leader, what are the main reasons
girls do not use contraceptives even when sexually active?
 CL03: First — they do not know enough. The information they have is incomplete
and often inaccurate. Second — they are afraid. Afraid of side effects, afraid of
being seen, afraid of what parents will say. Third — they lack access. Getting to
the clinic without someone noticing is genuinely difficult for a school-going girl.
And fourth — they may not have the language or the confidence to ask for what
they need.
Probe: What is the hardest to address from a school perspective?
CL03: The access barrier — because schools cannot provide contraceptives. We
can educate, we can refer, we can create a safe space. But the girl still has to get
to the clinic on her own. And that journey, in this community, is filled with risk of
being seen.

QD2. Have you seen negative consequences for girls who sought reproductive
health services?
CL03: Yes. A student of mine was taken out of school by her parents after they
found contraceptives in her room. She was not pregnant — she was protecting
herself. But her parents saw it as evidence of immorality and she paid the price
academically. I fought to have her readmitted. We eventually succeeded, but it
took months and the girl lost a term.

QD3. What would you say to parents or community members who oppose
adolescent contraceptive access?
CL03: I would first listen — because their concerns come from real cultural
values and real fears. And then I would show them the data on adolescent
pregnancy rates and the school dropout consequences. I would ask them: is this
outcome what you want for your daughter? Most parents, when they see the
alternative clearly, are open to a more nuanced position.

QD4. What motivates the girls who do use contraceptives despite social
pressure?
CL03: Academic ambition. The girls who protect themselves are almost always
the ones with clear goals — they want to pass their exams, go to college, have a
career. They see pregnancy as an obstacle to that and they act accordingly.
Ambition is protective.

QD5. What role should schools play in addressing this issue?

CL03: A much more active one than we currently play. Schools should be
delivery points for comprehensive sexuality education — not watered down, not
just biological facts, but real, practical, age-appropriate information. Schools
should have formal links with health facilities so that referrals are smooth and
confidential. And teachers should be trained to be trusted adults that students can
 approach. Right now, very few teachers play that role because they have not
been prepared for it.

QD6. What message would you give to the Ministry of Health?

CL03: Partner with schools formally. Do not just send a health worker once a
term for a single session. Create a sustained, school-integrated reproductive
health programme. Train school counsellors in adolescent reproductive health so
they can be the first point of contact. And fund school-clinic collaboration —
because the handoff between education and health services is currently broken.

QD7. Anything else important for this research?

CL03: Please include boys in this research. The boys who are impregnating
these girls — nobody is talking to them. Nobody is holding them accountable or
equipping them with knowledge. The entire burden of reproductive health falls on
the girl. That is not fair and it is not effective.

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 3 — Key Informant Interview (KII) with Healthcare Provider
Participant Code: HP04
Participant Name/Role: Community Health Worker (CHW), Roan Township
Outreach Programme
Years in Role: 2 years
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role and the reproductive health services you
provide to adolescents.
HP04: I am a Community Health Worker assigned to Roan Township. My work is
outreach — I go into the community, into compounds and homes, to provide
health education and basic services. For family planning, I distribute condoms,
 provide contraceptive counselling, and refer girls to the clinic for methods like
Depo or Jadelle.
Probe: For how long have you been doing this?
HP04: Two years now. Before this I was a clinic volunteer.
Probe: How many adolescent girls do you typically reach per month?
HP04: It varies — but I try to reach at least 30 to 40 girls every month through
home visits and group sessions at community gathering points.

QA2. How would you describe contraceptive use among adolescents in Roan?
HP04: Slowly improving — but still very low. Many girls know they need
protection but do not know how to get it without someone finding out. My
outreach work tries to bridge that gap.
Probe: Has it changed over the years you have been working?
HP04: Yes. When I started, girls were very resistant — they would not even want
to talk. Now they approach me. Some even come to me privately when they need
a referral. That shift has been significant.
Probe: Which methods are most requested?
HP04: Condoms and emergency pills — because I can give those directly without
needing a clinic appointment. For long-term methods, I refer them. Most are too
nervous to go to the clinic on their own.

SECTION B: ADOLESCENT KNOWLEDGE — PROVIDER PERSPECTIVE

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. How would you describe the knowledge of adolescents you work with?
HP04: Very patchy. Some know a lot — those who attended DREAMS or have an
older relative who spoke openly. Most know very little and what they do know is
often mixed with community myths.
Probe: Are there particular methods they are unfamiliar with?
HP04: Long-term methods. Most girls have never even considered the IUD or
Jadelle. They think those are only for women who have already had children.
That is not true — but it is a very common belief.

QB2. What misconceptions do you encounter most often?

HP04: That contraceptives cause permanent infertility — this is the biggest one.
Many girls believe that using Depo for even a short period will prevent them from
ever having children. The second is that contraceptives cause cancer or other
serious disease. I spend a lot of time correcting these things.
Probe: Do fears about side effects come up frequently?
HP04: Always. Weight gain, heavy bleeding, no periods — these fears are
enormous. And because girls do not have trusted people to clarify, they accept
the myths as fact.

QB3. Do adolescents have enough accurate information to make an informed

choice?
HP04: Not when they first come to me. But after a good counselling session —
yes, they are in a much better position. The challenge is reaching them before
something goes wrong.

SECTION C: ADOLESCENT PERCEPTIONS — PROVIDER OBSERVATIONS

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What do you observe about attitudes of adolescents when they come to
you for information?
HP04: They come very quietly. Always looking over their shoulder — afraid
someone they know will see them talking to me. The ones who come in groups
are slightly more comfortable. The ones who come alone are very tense until they
realise I am not going to judge them.
Probe: Do you see differences between married and unmarried adolescents?
HP04: Very much so. Married adolescents speak more openly and even bring
their husbands sometimes. Unmarried girls are secretive and often refuse to
share their name even when I explain confidentiality.

QC2. From what adolescents share, what role do partners play?

HP04: Partners are a huge factor. Many girls tell me their boyfriend does not
support contraceptive use — he thinks it means she does not trust him, or that
she will sleep with others. It is completely backwards reasoning but it is very
common.
Probe: Do family members play a role?
HP04: Parents are mostly a barrier at this stage. Very few girls have parents who
encourage them to use contraceptives. Most are hiding from parents, not being
supported by them.
Probe: Do religious pressures come up?
HP04: Yes. Many girls say their church teaches that contraceptives are sinful.
Some refuse to take even a condom because of that. I try to separate the health
message from the religious debate and focus on harm reduction.
QC3. How do you approach confidentiality in your outreach work?
HP04: Very carefully. I never carry anything visible that would identify a girl as a
family planning client. When I go to a home, I visit several homes in the same
area to avoid the appearance of specifically targeting one girl. And I never
discuss one girl's situation with anyone in the community.
Probe: Have you lost clients due to confidentiality fears?
HP04: Yes. A few girls who were coming to me stopped when their boyfriend or a
neighbour asked questions about why they were always talking to me. That fear
is very real.

SECTION D: BARRIERS, MOTIVATORS, AND SERVICE-LEVEL FACTORS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. What are the main barriers you encounter in your outreach work?
HP04: The biggest is secrecy — girls cannot get contraceptives without hiding
from someone. Partners, parents, neighbours, even health workers — everybody
seems to be a potential judge. The second is misinformation about side effects.
The third is distance — some girls cannot get to the clinic without explaining to
their family where they are going.
Probe: Which barrier is hardest to overcome?
HP04: The partner barrier. I can correct misinformation and I can help a girl get to
the clinic. But I cannot change her boyfriend's mind for her. When a boyfriend
says no, many girls comply — even against their own better judgment.

QD2. Have you seen situations where health worker attitudes discouraged
girls?
HP04: Yes — not at the clinic I refer to, which is good. But I have heard from girls
that at other facilities, nurses said things like: 'Why are you here at your age?' or
'Does your mother know?' Those comments send girls away and they do not
come back.

QD3. What motivates girls to seek help from you or from the clinic?
HP04: Trust. Once a girl trusts you, she will come back and she will send her
friends. I have built relationships with some girls over months — and now they
are my unofficial community ambassadors. They bring others to me because they
trust me.

QD4. What changes at community or facility level would most improve

outcomes?
 HP04: More community health workers in outreach roles — we remove the
barrier of the clinic entirely. And strong training for all health workers on
adolescent-friendly communication. One dismissive nurse undoes months of
outreach work. It has to be consistent.
Probe: What is already working well?
HP04: Home visits. Girls are far more comfortable talking in their own space than
in a clinic. If we can bring services to them, the uptake improves dramatically.

QD5. Is there anything else important for this research to understand?

HP04: The conversation has to include boys. As long as we only talk to girls and
leave boys out of family planning education, we will always have the partner-
pressure problem. Boys need to understand that supporting a girl's contraceptive
choice is a sign of respect, not suspicion.

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 3 — Key Informant Interview (KII) with Healthcare Provider
Participant Code: HP05
Participant Name/Role: Registered Nurse, MCH — Roan Township Clinic
Years at Facility: 6 years
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role and the reproductive health services you
provide to adolescents.
HP05: I am a registered nurse stationed in the MCH [Maternal and Child Health]
unit. I have been here for six years. We provide all family planning methods —
short and long term — as well as prenatal care and child health services.
Adolescents are a significant portion of our family planning caseload.
Probe: How many adolescent clients per month on average?
HP05: Currently between 50 and 70 per month seeking family planning
specifically. This has grown considerably since I started six years ago — partly
 due to sensitisation efforts and partly because of the adolescent-specific day we
introduced.
Probe: What age range do you typically see?
HP05: The youngest we have seen is 14. Mostly between 15 and 22. We do see
14- and 15-year-olds but they are a minority.

QA2. How would you describe contraceptive use levels among adolescents in
Roan?
HP05: It is increasing — but still below what it should be given the pregnancy
rates we see. We are making progress, but slowly. The social barriers are
enormous and they are outside our control as a health facility.
Probe: Which methods are most requested?
HP05: Overwhelmingly the short-term methods — Depo and the combined pill. A
few come for Jadelle. Almost no adolescents request the IUD — the fear of that
method is very strong among young women who have not had children.

SECTION B: ADOLESCENT KNOWLEDGE — PROVIDER PERSPECTIVE

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. How would you describe adolescent knowledge of contraceptives at first

presentation?
HP05: Generally poor. Most come in knowing one or two method names and very
little else. By the time they leave, they know much more — because counselling
is mandatory before we dispense anything. But that starting point is quite low.
Probe: Are there methods they are completely unfamiliar with?
HP05: The IUD is almost unknown among adolescents here. Many are also
unfamiliar with the patch or the ring — though those are less available. Jade is
gaining some recognition but mostly from word of mouth, not formal education.

QB2. What misconceptions do you encounter most frequently?

HP05: The infertility myth — it is relentless. No matter how many times we
explain that modern contraceptives do not cause permanent infertility, girls come
in already convinced it is true. The second is the idea that contraceptives cause
cancer. And the third — that using Depo means your periods will stop forever. We
address these every single day.
Probe: Where do these misconceptions originate?
HP05: Community gossip, mostly. A woman has difficulty conceiving and
someone links it to the Depo she used years ago. The story spreads and
becomes community truth. It is very difficult to fight.
QB3. Do adolescents leave with enough information to make a good choice?
HP05: Yes — when they actually come. The problem is the girls who never make
it through the door because of fear or misinformation. We can only help the ones
who arrive.

SECTION C: ADOLESCENT PERCEPTIONS — PROVIDER OBSERVATIONS

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What do you observe about adolescent attitudes when they come for
contraceptives?
HP05: It ranges enormously. Some come in matter-of-fact and confident —
especially if they have an older sister who has coached them. Others are terrified
and can barely speak. The first visit is always the hardest. Most who return for
their follow-up are calmer.
Probe: Do married and unmarried adolescents behave differently?
HP05: Markedly. Married girls are more relaxed and often come with a plan —
they know what they want and they know why. Unmarried girls are tense,
frequently checking if anyone they know is nearby, and sometimes leave before
reaching the front of the queue.

QC2. From what adolescents share, what role do partners play?

HP05: Partners are frequently a complicating factor. I would say at least a third of
the girls I see are using contraceptives without their partner's knowledge. They
are protecting themselves covertly because the partner either does not support it
or would become angry if he knew. That is a very uncomfortable situation for
these girls — but I respect their decision to protect themselves regardless.
Probe: Do you see cases where a girl stops because of a partner?
HP05: Regularly. A girl will be doing well on Depo, coming back every three
months — and then she disappears. When we follow up through outreach, we
often find out the partner found out and put pressure on her to stop.

QC3. How do you handle confidentiality?

HP05: Strictly. Adolescents are seen in a private room. We do not discuss their
cases in public. We do not notify parents without the girl's consent — unless
there is a safeguarding concern. Zambian law requires parental consent for
minors under 16 in certain contexts, but we navigate that carefully to maintain
trust.
Probe: Has the facility ever lost adolescent clients over privacy concerns?
 HP05: Yes. On a few occasions a nurse made an unguarded comment in the
waiting area and a girl heard it and never returned. We have taken steps to
address that — but human error will always be a risk.

SECTION D: BARRIERS, MOTIVATORS, AND SERVICE-LEVEL FACTORS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. What are the main barriers to adolescent contraceptive use that you
observe?
HP05: At the community level — stigma and misinformation. At the family level —
parental opposition and partner opposition. At the facility level — staff attitude,
privacy concerns, and being seen in the queue. All of these barriers stack on top
of each other. A girl has to overcome several layers just to get through our door.
Probe: Which is hardest to address?
HP05: Stigma — because it is everywhere and we cannot directly control it from
within the facility. We can address facility-level barriers. We cannot change
community attitudes overnight.

QD2. Have facility attitudes ever discouraged adolescents?

HP05: I have to be honest — yes. Not from me personally, but I have seen
colleagues, particularly older nurses, say things that were discouraging.
Comments like 'at your age you should not be here' or sighing when a very young
girl comes in. I have had direct conversations with colleagues about this. It is an
ongoing challenge.

QD3. What motivates girls to return to this facility?

HP05: A non-judgmental experience the first time. If a girl feels respected and
cared for, she comes back. She also tells a friend. The opposite is equally true —
one bad experience spreads widely through the community and keeps other girls
away.

QD4. What systemic changes would most improve outcomes?

HP05: Several things: a clear national policy that explicitly protects adolescent
access to contraceptives without mandatory parental consent. Better integration
of family planning into school health programmes. Mandatory training for all
health workers in adolescent-friendly service delivery. And more funding for
community-level outreach so we can reach girls before they come to the facility.
We are doing our best within our walls, but so much happens outside them.
QD5. Is there anything else important for this research to capture?
HP05: Data. We need better data on the adolescent girls who do not reach us —
who turns back before the clinic, who stops using, why they stop. Right now we
track what happens inside the facility. We have almost no information about the
girls who never make it here. That is where the real gap is.

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 3 — Key Informant Interview (KII) with Healthcare Provider
Participant Code: HP06
Participant Name/Role: Clinical Officer — Adolescent Sexual and Reproductive
Health, Roan Township
Years in Role: 3 years (includes 1 year school-based outreach)
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role and the reproductive health services you
provide to adolescents.
HP06: I am a clinical officer with a specific focus on adolescent sexual and
reproductive health. My work is split between the clinic — where I see adolescent
clients for family planning, STI screening, and counselling — and outreach,
particularly in schools. I am part of a small team that goes into secondary schools
to provide health education.
Probe: How long have you been in this role?
HP06: Three years total. The school outreach component was added about a
year ago.
Probe: How many adolescent clients per month?
HP06: At the clinic — around 35 to 45 for family planning. Through school
outreach we reach far more — maybe 100 to 150 students per school visit,
though that is education rather than direct service provision.

QA2. How would you describe contraceptive use among adolescents in Roan?
 HP06: Low relative to need — but improving. The schools outreach has made a
difference. When I went into schools two years ago, contraceptive use was
almost invisible. Now some of those girls are coming to the clinic.
Probe: Which methods are most requested?
HP06: Emergency pills are disproportionately popular — which tells you
something about the nature of contraception for adolescents here. It is often
reactive rather than preventive. Condoms and Depo are also common. Very few
go for long-term methods.

SECTION B: ADOLESCENT KNOWLEDGE — PROVIDER PERSPECTIVE

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. How would you describe adolescent knowledge of contraceptives?

HP06: Before outreach — very limited. After outreach — significantly better. The
school sessions allow for questions in a group setting where girls feel less
exposed. I can see the lightbulb moments in those sessions that I do not always
see in clinical one-on-ones.
Probe: Are there particular gaps?
HP06: Long-term methods remain very poorly understood. Also, the distinction
between contraception and protection from STIs — many girls think condoms are
only for STIs and that contraceptives like Depo protect them from everything.
That is a dangerous misconception.

QB2. What misconceptions do you encounter most frequently?

HP06: Infertility is the big one — universal. Then there is the belief that hormonal
contraceptives work like an abortion — that they do not prevent pregnancy but
rather destroy it after the fact. This makes some girls completely refuse hormonal
methods on moral grounds.
Probe: How do you address this?
HP06: With patience and clear diagrams. I explain the mechanism — how it
works on ovulation or the uterine lining to prevent implantation before pregnancy
has occurred. Most girls respond well once they understand the physiology rather
than the myth.

QB3. Do adolescents leave with adequate information to make an informed

choice?
HP06: Yes — when they come through the clinic. Through school outreach, we
give education but not personal counselling. We always encourage them to follow
up with the clinic for personalised guidance.
SECTION C: ADOLESCENT PERCEPTIONS — PROVIDER OBSERVATIONS
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What do you observe about adolescent attitudes when they come for
services?
HP06: A spectrum. Girls who have had school education are measurably more
confident. They ask specific questions, they know what they want, they are not
easily embarrassed. Girls who have not had that education are much more
tentative. It confirms for me that early education makes a genuine clinical
difference.
Probe: Do you see differences between married and unmarried adolescents?
HP06: Married girls come in more confident about their right to be there.
Unmarried girls often frame their request apologetically — 'I know I shouldn't be
here but...' That framing breaks my heart every time. They absolutely have the
right to be there.

QC2. From what adolescents share, what role do partners play?

HP06: Partners are the single most underaddressed factor in adolescent
reproductive health in this community. Health systems focus almost entirely on
the girl — but the boy is half the equation. I have started advocating for us to
incorporate male engagement sessions in our outreach. We will not solve this by
only talking to girls.
Probe: Do religious pressures come up in consultations?
HP06: Frequently. I have developed a standard approach — I respect the faith
position, acknowledge it openly, and then frame the conversation around harm
reduction. I say: I understand your faith, and I also care about your health. Those
two things can coexist.

QC3. How do you approach confidentiality?

HP06: As a non-negotiable. Every client — regardless of age — has a right to
confidentiality in their health care. I follow the protocols, I use private consultation
spaces, and I never share information without consent. For under-16s, there is
some nuance around legal consent, but we handle that sensitively and in the
girl's best interest.

SECTION D: BARRIERS, MOTIVATORS, AND SERVICE-LEVEL FACTORS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation
QD1. What are the primary barriers you observe?
HP06: Stigma is number one — both community-level and facility-level stigma.
Then misinformation. Then lack of access to services without detection — girls
cannot go to the clinic without someone wondering why. Then partner opposition.
These are consistent across every adolescent I see.
Probe: Most difficult to overcome?
HP06: Community-level stigma. It is deeply cultural and changes slowly. The
other barriers — misinformation, facility access — these are more amenable to
targeted interventions. Stigma requires a generational shift.

QD2. Have you observed facility attitudes discouraging adolescents?

HP06: Yes — and I document these when I observe them. One common one:
reception staff asking why a young girl is there, in a tone that communicates
judgment. Another: asking 'are your parents aware?' in a way that feels
accusatory rather than supportive. I have raised these issues with clinic
management. It is a culture change challenge.

QD3. What motivates girls who do come?

HP06: Having had prior education — either through DREAMS, schools outreach,
or a trusted person. Girls who arrive informed are ten times more likely to follow
through. The girl who arrives terrified with no information — she is the one who
turns back.

QD4. What changes would most improve the situation?

HP06: Comprehensive sexuality education in all schools — not optional, not
watered down. A rights-based policy protecting adolescent access to
contraceptives. Male engagement in family planning education — boys need to
be part of this conversation. And resource allocation for outreach, not just clinical
services. The clinic is too passive — we need to go to where the girls are.

QD5. Anything else important for this research?

HP06: Push for intersectoral collaboration. Health, education, community
leadership — these sectors need to work together on this. No single sector can
solve it alone. And please — include the voices of the boys in future research.
We are missing half the picture.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT
Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P11
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P11: To me, it is a way of preventing unwanted pregnancies. Something that
helps you to decide when you want to have a baby.
Probe: Where did you first hear about it?
P11: From my older sister. She is married and she told me about it when I was
asking questions about how married couples manage their children.

Q2. What contraceptive methods do you know of?

P11: I know condoms, the three-month injection which they call Siyana, and also
the emergency pill. My sister also mentioned Jadelle — she said they put
something in your arm.

Q3. For each method, can you tell me what you know about how it works?
P11: For condoms — they prevent both pregnancy and diseases like HIV. For
Siyana — my sister gets it every three months at the clinic and it stops her from
getting pregnant. For the emergency pill — you take it after you have had
unprotected sex, within three days. For Jadelle — it is inserted in the arm and
lasts much longer, maybe three to five years.
Probe: Who do you think these are meant for?
P11: Honestly, I used to think they were only for married women. But my sister
told me that is not true — anyone who is sexually active can use them to protect
themselves.
Q4. Where did you get most of your information about contraceptives?
P11: Mostly from my sister and also from school — they touched on it briefly in
life skills class.
Probe: Did anyone sit you down and properly explain contraceptives to you?
P11: My sister did. She sat me down and explained everything quite well. She
said she wished someone had told her earlier before she got married.
Probe: Was the information clear and easy to understand?
P11: Yes, very clear. My sister explained in simple language. School was not so
detailed.

Q5. Are there things about contraceptives you are not sure about?
P11: Yes. I am not sure about the pill you take every day — like, what happens if
you miss a day? Does it still work? Nobody has really explained that clearly to
me.
Probe: Have you heard things from the community that you are not sure are
true?
P11: Yes. People say the injection makes you gain too much weight and that after
using it for years you will struggle to conceive. My sister says that is not entirely
true, but I am still not sure.

Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P11: Some do and some don't. Those who have older sisters or a mother who
talks openly — they know. But many girls are just left in the dark.
Probe: Do they know enough to make a good choice?
P11: No. Knowing the name of something and knowing how to use it properly are
very different things. Most girls just know the name but not the details.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P11: I think they are a good thing — especially for someone who is already in a
relationship. If you are doing it, you might as well protect yourself. An unwanted
pregnancy can ruin your whole life.
Probe: Would you feel differently if you were married?
 P11: If I were married, I would feel even more comfortable. Because then it is an
accepted thing. But even now, I think it makes sense to be protected.

Q8. What do your friends and peers think about girls who use contraceptives?
P11: It is mixed. Some of my friends are like me — they think it is a smart
decision. But others say it encourages promiscuity. They say if you are using
contraceptives, you are just giving yourself permission to sleep around.
Probe: Have you heard girls talked about negatively because of using
contraceptives?
P11: Yes. In my neighbourhood there is a girl who goes to the clinic for
contraceptives and people talk. They say she is loose. It is very unfair because
she is just trying to protect herself.
Probe: Does what other people think affect your own choice?
P11: A little bit, yes. I would not want people to think badly of me. But at the end
of the day, I think my health and my future matter more than what others say.

Q9. What do people in your family think about young girls using
contraceptives?
P11: My sister is the only one I can talk to about it. My mother — she would not
even want to discuss it. She thinks if you talk about contraceptives with a young
girl, you are encouraging her to have sex.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P11: I wish they would be involved — but in a supportive way. Not to judge or
punish. If parents just listened and helped, many girls would be safer. But
unfortunately, most parents here are not like that.

Q10. What role does your partner play in decisions about contraceptives?
P11: I do not have a steady boyfriend at the moment. But from what I have seen
with friends — some boyfriends are supportive and some are not. Some even
refuse to use condoms and tell girls not to worry about it.
Probe: Who should have the final say?
P11: The girl. Definitely. Because she is the one who would be pregnant. The boy
just walks away — it is the girl who suffers.

Q11. What does your church say about contraceptives?

P11: My church is against sex before marriage, so they would be against
contraceptives too. But the pastor has never specifically addressed it — it is more
of an unspoken thing.
Probe: Have you ever felt torn between your faith and the need to protect
yourself?
P11: Yes. I pray and I go to church, and then I see what is happening in the real
world. I think God understands that we are human. But it still gives me a guilt
feeling sometimes.

Q12. If a girl your age decided to go to the clinic to get contraceptives, how do
you think people would react?
P11: They would talk. Especially if they see her in the family planning queue.
People would assume the worst. They would not think she is being responsible
— they would think she is being promiscuous.
Probe: Have you ever felt ashamed or afraid of being seen at a facility for
contraceptives?
P11: I have not personally gone yet. But thinking about it — yes, I would feel
nervous. Especially if I saw someone from church or one of my mother's friends.

Q13. In your view, what does it feel like to have power to decide whether to use
contraceptives or not?
P11: It would feel empowering. Like you are taking charge of your own body and
your own future. Not waiting for someone else to decide for you.
Probe: Do girls your age in Roan have that power?
P11: Some are getting there. But most are still controlled by what their family,
boyfriend, or community thinks. Real freedom to choose is still quite rare here.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive method?

P11: No, I have not. I have not been sexually active yet. But I want to be
prepared with the right information before I am.

Q15. What would make it easier for girls your age to access contraceptives?
P11: If there was somewhere confidential and friendly — maybe a youth-specific
space at the clinic, or even a trusted community health worker who comes to
schools and can talk to girls privately.

Q16. Have you ever tried to get contraceptives from a health facility?
 P11: No. But I have thought about going with my sister when she goes for her
injection, just to learn.

Q17. What are the main things that stop girls your age from using
contraceptives?
P11: Fear of judgment — from community, from family. Also not knowing enough
— if you don't know what to ask for, you feel silly going. And the fact that it feels
like you are admitting you are having sex, which opens you up to criticism.

Q18. Have you or someone you know stopped using a contraceptive?

P11: A friend of mine stopped the pill because she was getting terrible
headaches. She was not sure if it was the pill or something else, so she stopped
to be safe.

Q19. What would motivate more girls to use contraceptives consistently?

P11: More open conversations. If it was normalised to talk about it — at school,
at home, at the clinic — without shame, more girls would feel comfortable. Also,
more information about each method so girls can choose what works for them.
Probe: Who is the most trusted person to get advice from?
P11: An older female relative — like a sister or aunt — who has been through it.
And also a female health worker. Someone who will not judge you.

Q20. Is there anything else you would like to share?

P11: I just think young girls deserve honest information. Not the version where
adults hide things from us because they think we will misuse it. Trust us with the
truth and we will make better decisions.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P12
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained
SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P12: For me it is very real — it is not something from a textbook. It means I will
not get pregnant again before I am ready. I already have one child and that was
enough of a lesson.
Probe: Where did you first hear about it?
P12: At the clinic, after I gave birth. The nurse told me I should go on family
planning so I do not get pregnant again too soon. That was the first time anyone
really explained it to me properly.

Q2. What contraceptive methods do you know of?

P12: I know the three-month injection, Depo. I also know the implant — Jadelle
— the one put in the arm. And condoms. And the pills. I think I know most of them
now because the nurse explained.

Q3. For each method, can you tell me what you know about how it works?
P12: Depo — you get it every three months. It stops ovulation so you cannot get
pregnant. Jadelle — they insert it under the skin of your arm and it stays for up to
five years. Condoms — they block the sperm. Pills — you take them every day to
stop the egg from being fertilised.
Probe: Who do you think these are meant for?
P12: Anyone. I do not care what people say — if you are having sex, you should
be able to protect yourself. Married or not.

Q4. Where did you get most of your information?

P12: After delivery — the nurse at the clinic. She was very good. She explained
each method and asked me which one I wanted. That was the most information I
have ever received at once.
Probe: Was the information clear and easy to understand?
P12: Very clear. She did not judge me. She just explained as if it was normal —
which it should be.

Q5. Are there things about contraceptives you are still not sure about?
 P12: I wonder sometimes about the long-term effects. Like if I use Depo for five
or six years, will I be able to conceive normally later? The nurse said yes, but I
still think about it.
Probe: What does the community say about contraceptives and the body?
P12: They say terrible things. They say Depo makes you fat and ugly. They say it
stops your periods forever. They say you will never have children again. I do not
believe most of it because I have seen women on Depo who are healthy and still
have more children later.

Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P12: No — honestly, not really. I only got proper information after I was already
pregnant. Before that I knew almost nothing. That is the problem. The information
comes too late.
Probe: What are they not getting?
P12: Practical information. Not just the names — how to use each method
correctly, where to get them without being embarrassed, and what happens if
there are side effects.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P12: I feel very positively about them now. They gave me back control over my
life. My child is still young and I cannot afford another pregnancy right now —
financially, emotionally, in every way.
Probe: Would you feel differently if you were married?
P12: Not really. The reason I use contraceptives is practical — I want to decide
when I have another child. Marriage does not change that logic for me.

Q8. What do your friends think about girls who use contraceptives?
P12: Most of my friends who are mothers — they think it is completely sensible.
Those who have not had children yet — some of them still think it means you are
loose. They will change their mind when they get pregnant unexpectedly.
Probe: Have you personally been talked about negatively?
P12: Yes. Some women in my compound say things. But I have a child to take
care of — I cannot afford to live for what others say about me.
Probe: Does it affect your choice?
P12: No. Absolutely not.

Q9. What does your family think?

P12: My mother is the one who encouraged me to go on family planning after I
gave birth. She said she wished she had done the same. So my family is actually
supportive — which I know is not the case for most girls.
Probe: Do you think parents should be involved?
P12: If they are supportive, yes — absolutely. But if they are going to judge and
punish, then a girl is better off with a trusted health worker. The goal is for the girl
to be safe, not to punish her.

Q10. What role does your partner play?

P12: He does not support it. He says I am going to the clinic too much. He thinks
using contraceptives means I want to sleep with other men. It is frustrating and
ridiculous.
Probe: Have you felt pressured to stop?
P12: Yes. He has asked me to stop several times. But I have not stopped. My
body, my decision. I cannot let him pressure me into another pregnancy I am not
ready for.
Probe: Who should have the final say?
P12: The woman. One hundred percent. She is the one who carries the
pregnancy, delivers the baby, and most of the time is left to raise the child alone.

Q11. What does your church say about contraceptives?

P12: I do not really attend church regularly, so I cannot say much. But from what I
hear, churches are generally against it. I understand the principle — but I live in
the real world.

Q12. If a girl goes to the clinic for contraceptives, how do people react?
P12: People talk. But I think it is getting slightly better — especially for girls who
already have a child. People are less harsh then. For a girl who has not had a
child yet, they are very judgmental.
Probe: Have you felt ashamed at the facility?
P12: No. Not now. Maybe the first time I was nervous. But the nurses there are
kind — they make you feel like what you are doing is responsible, which it is.

Q13. What does it feel like to have power over this decision?
 P12: It feels like freedom. Genuine freedom. Before I was just going along with
whatever happened. Now I have a say in my own body and my own future. It is a
very different feeling.
Probe: Do girls in Roan generally have that power?
P12: Most do not — especially the younger ones who still depend on their
parents and are afraid of judgment. I had to go through a pregnancy to get this
power. I wish I had it earlier.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Which contraceptive are you currently using?

P12: Currently I am on Depo — the three-month injection. I have been on it since
three months after my delivery. So about fourteen months now.

Q15. What would make access easier for girls in Roan?

P12: More community outreach. Bring the services to where the girls are —
schools, community centres, even door to door. Not everyone can get to the clinic
without someone noticing.

Q16. How was your experience at the health facility?

P12: Very good — especially the postpartum care nurse. She was the first person
in my life to talk to me about these things without judging me. I respect her for
that.

Q17. What stops girls in Roan from using contraceptives?

P12: Fear and ignorance — in equal measure. Fear of what people will say and
ignorance of what is actually available. Those two things together keep girls
unprotected.

Q18. Have you had any side effects?

P12: My periods became irregular and sometimes I go months without one. At
first that scared me, but the nurse said it is normal with Depo. I have accepted it.

Q19. What would motivate more girls to use contraceptives consistently?

 P12: Hearing real stories from girls like me — not textbook information. If
someone sat with a group of girls and said: this is what happened to me, this is
how contraceptives helped me — that would be more powerful than any leaflet.
Probe: Who is most trusted?
P12: Other young women who have been through it. Peer support is very
powerful.

Q20. Anything else to share?

P12: Just — please do not make girls feel ashamed for trying to protect
themselves. That shame is the real danger. It pushes girls away from the very
services that could help them.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P13
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P13: Honestly, the first thing that comes to my mind is something that is not for
me. It is for people who are doing things they should not be doing.
Probe: Where did you first hear about it?
P13: At school. They talked about it in science class. But we did not go into much
detail.

Q2. What contraceptive methods do you know of?

 P13: I know condoms. And I have heard of pills. That is about all I know.

Q3. Can you tell me what you know about how these work?
P13: For condoms, I know they are worn to prevent pregnancy. For pills, I only
know that women take them — I do not know exactly how they work.
Probe: Who do you think these are meant for?
P13: For married people. That is what I believe.

Q4. Where did you get most of your information about contraceptives?
P13: From school — just a little. And from listening to older girls talking. But I
have never sought out information myself.
Probe: Did anyone sit you down and properly explain contraceptives?
P13: No. My mother has told me that the best thing is to abstain. She has never
told me about contraceptives.
Probe: Was the little information you received clear?
P13: Not really. It was very vague.

Q5. Are there things about contraceptives you are not sure about?
P13: Many things. I have heard that they can affect your body badly. I have heard
they stop you from having children when you grow up. I do not know what is true.
Probe: What does the community say about contraceptives?
P13: That they are dangerous. That they are for bad girls. And that they ruin your
body for the future.

Q6. Do most girls your age in Roan know about contraceptives?

P13: Some do — those who are already in relationships. But girls like me who
are focused on school, not really.
Probe: Do they know enough to make a good choice?
P13: I think we all need more information. But the best choice for someone my
age is to abstain.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

 P13: I do not think they are right for a girl my age. I am a Christian and I believe
that the right time for such things is after marriage. I have decided to wait.
Probe: Would you feel differently if you were married?
P13: Maybe. But even then, I would pray about it first and talk to my husband.

Q8. What do your friends think about girls who use contraceptives?
P13: Most of my close friends think the same as me. But I know there are girls in
school who use them secretly. We do not really talk about it with them.
Probe: Have you heard girls talked about negatively?
P13: Yes. Very badly sometimes. People say very harsh things about them. I feel
sorry for them because some of those girls are just trying to protect themselves,
even if they are doing something wrong.
Probe: Does it affect your choice?
P13: It confirms my choice to abstain — I do not want to be talked about like that.

Q9. What does your family think?

P13: My mother is very clear — no sex before marriage, no contraceptives. My
father has never spoken to me about it. It is just understood in my home.
Probe: Do you think parents should be involved?
P13: Yes — but I think the message from parents should be to encourage
abstinence first. If the girl is already in trouble, then maybe parents need to step
in and help. But first, abstinence.

Q10. What role would your partner play — if you had one?
P13: I do not have a boyfriend. I am focused on school. But if I had one, I would
expect him to respect my decision to wait.
Probe: Who should have the final say?
P13: The girl. Because she is the one who bears the consequence.

Q11. What does your church say about contraceptives?

P13: Very clearly — no sex before marriage, so no contraceptives for young
people. My pastor speaks about purity often. I agree with that message.
Probe: Have you ever felt torn between faith and the need to protect yourself?
P13: Not yet. Because I have not been in that situation. But I imagine it would be
very difficult for a girl who is already in a relationship and going to church.

Q12. If a girl your age went to the clinic for contraceptives, how do you think
people would react?
 P13: Very badly. Even the nurses sometimes are not nice to young girls who
come in. I have heard stories. And in the community — people would talk for a
long time about it.
Probe: Have you felt afraid or ashamed about this topic generally?
P13: Not for myself — because I have not done anything. But I feel ashamed
even discussing it sometimes. It is a sensitive topic.

Q13. What does it feel like to have power over this decision?
P13: I feel like I have that power — and I am using it to say no to sex and no to
contraceptives. That is also a form of power.
Probe: Do girls in Roan generally have that power?
P13: Not all. Some are pressured by their boyfriends. Some are in difficult
situations at home. I am lucky that my family is stable and I feel safe.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive?

P13: No. And at this point in my life, I do not intend to.

Q15. What would make it easier for girls to access contraceptives — even
though that is not your personal choice?
P13: If health workers were kinder and more private about it. And if there was a
space for young people specifically. Not mixed with adults.

Q16. Have you tried to get contraceptives from a facility?

P13: No.

Q17. What stops girls from using contraceptives?

P13: For some it is religion. For some it is fear of side effects. For others it is the
embarrassment of going to the clinic. And for some — they just do not know
enough about them.

Q18. Do you know anyone who stopped using contraceptives?

P13: A girl from my class started using pills and then stopped after two months
because she kept forgetting to take them and then she got scared she was
pregnant. Luckily she was not.
Q19. What would motivate more girls to use contraceptives consistently?
P13: Better information — and someone to guide them without shaming them.
Even though I choose not to use them, I understand other girls are in different
situations. They need support.
Probe: Who is the most trusted person?
P13: A kind, female health worker. And maybe a trusted older woman in the
community.

Q20. Anything else to share?

P13: I just hope that whatever decisions girls in Roan make, they have enough
information to make them safely. Abstinence is best — but if someone cannot
abstain, they should at least be protected.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P14
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P14: Immediately I think of options — choices about when to have children. For
me it is not a scary word at all.
Probe: Where did you first hear about it?
 P14: At the DREAMS programme. They were very open about everything — they
explained types, how they work, where to get them. It was the most useful
session I have attended.

Q2. What contraceptive methods do you know of?

P14: Quite a few — condoms, the pill, Depo injection, Jadelle implant, the IUD
which goes inside, and emergency pills. I know all of these.

Q3. Can you tell me how each works?

P14: Condoms — physical barrier, protects against pregnancy and STIs. Pill —
taken daily to prevent ovulation. Depo — injection every three months, also
prevents ovulation. Jadelle — implant in the arm, lasts up to five years. IUD —
device placed in the uterus. Emergency pill — taken within 72 hours after
unprotected sex.
Probe: Who are they meant for?
P14: Anyone who is sexually active and wants to prevent pregnancy. Age and
marital status should not matter — if you are having sex, you deserve protection.

Q4. Where did you get most of your information?

P14: DREAMS programme, social media, and also some YouTube videos I have
watched on reproductive health. I try to stay informed.
Probe: Was the information clear?
P14: Very clear — especially from DREAMS. They answered every question,
even the embarrassing ones, without making us feel bad.

Q5. Are there things you are still not sure about?
P14: I am a bit uncertain about the IUD — I have heard it can cause heavier
periods and some pain. I would want to speak to a nurse before I ever tried that
one.
Probe: What does the community say?
P14: The usual things — that contraceptives cause infertility, that they are sinful,
that they make you gain weight. I know most of it is not accurate, but it is still out
there.

Q6. Do most girls your age in Roan know about contraceptives?

P14: Some do — but they mostly know the basics. The girls who attended
DREAMS have a much better understanding. Those who did not attend — they
know much less.
Probe: Do they know enough to make a good choice?
 P14: Not enough. There is a big gap between knowing a name and knowing how
to use something correctly and consistently.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P14: Very positively. I think they are one of the most important tools a young
woman can have access to. They allow you to stay in school, plan your future,
and protect your health.
Probe: Would you feel differently if married?
P14: Not really. The reasoning is the same whether married or not — you want to
decide when and whether to have children.

Q8. What do your friends think?

P14: My close friends are mostly like me — we have talked about it openly. But I
know that outside our small group, the attitude is still very judgmental. Girls are
called names just for being responsible.
Probe: Have you heard girls talked about negatively?
P14: Yes. The names are always the same — prostitute, loose, shameless. It is
very unfair. A girl who protects herself is more responsible than one who does not
— but the community sees it the opposite way.
Probe: Does it affect your choice?
P14: No. I would rather be judged and safe than praised and pregnant.

Q9. What does your family think?

P14: My family does not know I am using contraceptives. My mother would not
agree. She believes I should not be having sex at all — which I understand, but I
also live in the real world.
Probe: Should parents be involved?
P14: Ideally yes — but only if they are going to be supportive. If they are just
going to punish and shame, then the girl is better off going to a health worker
directly.

Q10. What role does your partner play?

 P14: He is very supportive. We discuss it together and he always makes sure we
have condoms. He respects that I am also on the pill as a backup. He says it is
both of our responsibility.
Probe: Who should have the final say?
P14: Both — but if there is a disagreement, the girl's voice should be final. It is
her body.

Q11. What does your church say?

P14: Church says no sex before marriage. But I have separated my personal
faith from this decision. I believe in God but I also believe God wants us to be
wise and safe.
Probe: Have you felt torn?
P14: Early on, yes. But I have made peace with my decision. I am still a good
person. I am still a good Christian. I am just also being realistic.

Q12. How do you think people would react if a girl went to the clinic?
P14: Negatively — especially in this community. But I think younger health
workers are getting better. The challenge is usually older community members
and parents.
Probe: Have you felt ashamed at a facility?
P14: The first time — a little nervous. But the nurse was professional and kind.
After that it felt normal.

Q13. What does it feel like to have power over this decision?
P14: It feels like adulthood. Like you are taking yourself seriously. I am not
waiting for someone to decide for me — I am making a responsible choice for my
own life.
Probe: Do girls in Roan have that power?
P14: More than people think — quietly. A lot of girls are making these decisions
privately even if they do not talk about it openly. The secrecy is the problem, not
the choices.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Which contraceptives are you currently using?

 P14: I use condoms consistently and I also take the pill. I use both as a double
protection. I have been doing this for about eight months.

Q15. What would make access easier for girls?

P14: More youth-friendly spaces — separate from general clinic queues. And
perhaps more mobile health services or community health workers who come to
schools.

Q16. How was your clinic experience?

P14: Positive overall. The nurse did not judge me — she explained everything
and gave me a follow-up date. I felt respected.

Q17. What stops girls from using contraceptives?

P14: Primarily stigma and lack of information. And then the practical barriers —
having to go to the clinic without anyone knowing, long queues, unsupportive
health workers sometimes. It is a lot to navigate when you are already scared.

Q18. Have you had any side effects?

P14: Mild nausea with the pill at the beginning. It went away after the first month.
Nothing serious.

Q19. What would motivate more girls to use contraceptives consistently?

P14: More programmes like DREAMS. Honest education without shame. And
community dialogues where these conversations can happen openly — including
with parents.
Probe: Who is most trusted?
P14: A DREAMS mentor or peer educator. Someone around your own age who
has been trained and who understands your situation.

Q20. Anything else?

P14: Bring back DREAMS. It changed my life and the lives of the girls I know
who attended. That kind of programme is exactly what this community needs
more of.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P15
Interviewer: Gladys Kunda (202310003)
Language: English / some Bemba
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P15: I don't know much about it. I just know it is something to do with... stopping
babies. [Pause.] That is all I really know.
Probe: Where did you first hear about it?
P15: From older girls in the compound. They were talking about it and I was just
listening.

Q2. What contraceptive methods do you know of?

P15: Condoms. That is the main one I know. And I think there are pills — I have
seen them at the chemist.

Q3. Can you tell me what you know about how these work?
P15: Condoms — you wear them to not get pregnant. For pills — I honestly do
not know how they work. I have never used them.
Probe: Who do you think they are for?
P15: I always thought they were for grown-ups. Married people.

Q4. Where did you get information about contraceptives?

P15: Mostly from listening to others. Not from anyone explaining to me directly.
Probe: Did anyone ever sit you down and explain?
P15: No. Nobody has ever talked to me about it properly.
Probe: Was even the little you heard clear?
P15: Not really. I am still confused about many things.
Q5. Are there things you are not sure about?
P15: Everything, honestly. I do not even know where to start. I just know that
people say contraceptives are dangerous and that you should be careful.
Probe: What does the community say?
P15: That they damage your womb. That you will not have children. That they are
sinful. I hear these things a lot.

Q6. Do girls your age in Roan know about contraceptives?

P15: Some do. But girls like me who are quiet — we do not know much. And we
are afraid to ask.
Probe: Do they know enough to make a good choice?
P15: No. Definitely no.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P15: I am scared of them. I have heard they have many side effects. I would not
want to take something that hurts my body.
Probe: Would you feel differently if you knew more about them?
P15: Maybe. If someone explained everything properly and I understood what I
was getting into — maybe I would feel differently.

Q8. What do your friends think about girls who use contraceptives?
P15: They say those girls are not good. That they are doing things they should
not be doing. So most girls hide it if they are using.
Probe: Have you heard girls talked about negatively?
P15: Yes. It makes me feel that it is better not to use them — just to avoid the
talk.
Probe: Does that affect your choice?
P15: Yes. Very much.

Q9. What does your family think?

P15: My mother has never talked to me about this. It is not something we discuss
at home.
Probe: Do you think parents should be involved?
P15: Yes, I think so. But my mother would be very angry. So I would not go to
her.

Q10. What role does your boyfriend play?

P15: I have a boyfriend. He has been putting pressure on me to have sex. He
says if I love him I will. He has said he does not like condoms. It is very stressful.
Probe: Have you felt pressured?
P15: Yes. A lot of pressure. I do not know what to do sometimes.
Probe: Who should have the final say?
P15: The girl. But sometimes it does not feel like we have a say.

Q11. What does your church say about contraceptives?

P15: My church says no sex before marriage. So contraceptives would be
against that. But I am not sure what I believe anymore.

Q12. If a girl went to the clinic, how do people react?

P15: Very badly. And even the nurses — I have heard they are not always kind.
They make you feel embarrassed.
Probe: Would you feel afraid?
P15: Yes. Very afraid. I would not know what to say or how to ask.

Q13. What does it feel like to have power over this decision?
P15: I do not feel like I have much power right now. My boyfriend is pressuring
me, my family does not talk about it, I do not know enough. I feel quite lost.
Probe: What would need to change for you to feel more in control?
P15: Someone to talk to. Someone who would explain and not judge. A safe
place to ask questions and get honest answers.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive?

P15: No.
Q15. What would make access easier for girls?
P15: A safe place where nobody knows you. Where you can ask questions
without being judged. Not a normal clinic with everyone watching.

Q16. Have you tried to get contraceptives from a facility?

P15: No. I would not even know how to start.

Q17. What stops girls from using contraceptives?

P15: Fear of side effects. Fear of what people will say. Not knowing enough. And
also, some girls are afraid their parents will find out. All of these things together
— it is just too much.

Q18. Do you know anyone who has stopped using contraceptives?

P15: A girl I know stopped because she was getting bad headaches and her
boyfriend told her the pills were making her sick. She listened to him and
stopped.

Q19. What would motivate more girls to use contraceptives?

P15: If someone came to school and taught us in a safe way. Not in a way that
makes us feel like bad people. Just — here is the information, here are your
options, here is where you can go. That would help a lot.
Probe: Who is most trusted?
P15: A female teacher or a female health worker. Someone patient and kind.

Q20. Anything else?

P15: I just want to say that girls like me — we are not bad. We are just confused
and not given enough help. Please find ways to reach us.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P16
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained
SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P16: Planning — for me that is the key word. It means I get to plan when I have
children rather than leaving it to chance. As a married woman, that is very
important to me.
Probe: Where did you first hear about it?
P16: Before I got married, my aunt sat me down and explained many things
about married life, including family planning. She said this was something I would
need to know and she was right.

Q2. What contraceptive methods do you know of?

P16: I know the IUD, the implant, Depo injection, the pill, condoms, and the
emergency pill. I have researched these myself as well — I read about them
before deciding which one to use.

Q3. Can you explain how each works?

P16: The IUD — it is placed in the uterus and prevents fertilisation. It can last up
to ten years. The implant goes under the skin of the arm and releases hormones
for up to five years. Depo is an injection every three months. The pill is taken
daily. Condoms are used during intercourse as a barrier. Emergency pill within 72
hours.
Probe: Who are they meant for?
P16: Anyone who wants to choose when they have children — married or not.
The conversation about who 'deserves' contraceptives is outdated.

Q4. Where did you get most of your information?

P16: My aunt, the clinic, and I also researched online. I wanted to make sure I
chose the right method for my body.
Probe: Was the information clear?
P16: Yes. The nurse at the clinic was excellent. She explained the pros and cons
of each method and did not rush me.
Q5. Is there anything you are not sure about?
P16: I sometimes wonder about what happens when I want to have children —
how soon fertility returns after removing the IUD. The nurse said it returns quickly,
but I would like to see more evidence of that in real life.

Q6. Do most girls your age in Roan know about contraceptives?

P16: The unmarried girls — less so. Married girls tend to have more access to
information because the clinic actively engages with us. But unmarried
adolescents are often left out.
Probe: Do they know enough to choose wisely?
P16: Not the younger ones. There is a lot of fear and misinformation. More
comprehensive education is needed at school level — not waiting until after
marriage or pregnancy.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P16: I feel grateful for them. I got married at 18 and I was not ready to have a
baby immediately. Contraceptives allowed me and my husband to get settled
first. We plan to start a family when we are more financially stable.
Probe: Would you feel differently if you were not married?
P16: I think even if I were not married, I would feel the same way — the logic is
identical. You protect yourself when you are not ready for a child.

Q8. What do people in your community think about girls using contraceptives?
P16: For married women like me, it is mostly accepted. For unmarried girls, it is
very different. They are judged harshly. The community seems to think
contraceptives are only legitimate within marriage.
Probe: Have you heard girls talked about badly?
P16: Yes. And some of them are just trying to protect themselves. The double
standard is very real.

Q9. What does your family think?

P16: My husband knows and fully supports it. My aunt knows and agrees. My
mother-in-law, however, is a challenge. She keeps asking when we will have
children and she does not know we are using family planning — she would be
very unhappy if she knew.
Probe: Should parents be involved?
P16: Yes — but constructively. My aunt's involvement was the best thing that
happened to me. If every girl had someone like that, it would make a big
difference.

Q10. What role does your husband play?

P16: He is fully supportive. We made this decision together. He came to the clinic
with me the first time, which the nurse said was rare for a man to do.
Probe: Who should have the final say?
P16: Ideally it is a joint decision in a healthy relationship. But ultimately, the
woman's body is the woman's choice.

Q11. What does your church say?

P16: My church is somewhat conservative. But I have heard the pastor say that
family planning within marriage is a personal decision. So there is some flexibility
there — unlike what unmarried girls face.
Probe: Have you felt torn between faith and this decision?
P16: Not really. I am married, so the moral conflict is minimal for me. But I feel
deeply for unmarried girls who face that conflict every day.

Q12. How do people react when a girl goes to the clinic?

P16: For married women — mostly fine. For unmarried girls — they are
scrutinised, sometimes by health workers too. There are nurses who say things
that make young girls feel ashamed.
Probe: Have you personally felt ashamed at the facility?
P16: No — but I am married, so my status protects me in ways it would not
protect an unmarried girl.

Q13. What does it feel like to have power over this decision?
P16: It feels like I am the architect of my own life. My husband and I decide
together — nobody else's opinion can override that. That feeling is incredibly
liberating.
Probe: Do girls in Roan generally have that power?
P16: Married girls are getting there. Unmarried girls — much less so. The social
barriers are still very strong for them.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
 Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. What contraceptive are you currently using?

P16: I have an IUD — I chose it for reliability and because I did not want to worry
about daily pills or injections every three months. I have had it for about a year
and I am very happy with it.

Q15. What would make access easier for girls generally?

P16: For unmarried girls specifically — reducing stigma at facility level and
creating a separate, private space where they can be seen without
embarrassment. And more community champions who talk openly about this.

Q16. How was your clinic experience?

P16: Excellent. The nurse was thorough, respectful, and made sure I understood
everything before inserting the IUD. I felt like a patient who was taken seriously.

Q17. What stops girls from using contraceptives?

P16: For unmarried girls — stigma, fear of parents, and often unsupportive health
workers. For married girls — mostly mother-in-laws and religious pressure. The
barriers are different but both are real.

Q18. Have you had any side effects?

P16: Heavier periods for the first three months. The nurse warned me about this
so I was prepared. It has since settled down.

Q19. What would motivate more girls to use contraceptives consistently?

P16: Hearing from other women like me — not health workers reading from a
pamphlet, but real women sharing real experiences. And more visible community
support so girls do not feel alone.
Probe: Who is most trusted?
P16: A trusted female relative who has actually used contraceptives herself.
Experience speaks louder than theory.

Q20. Anything else?

P16: Please include married adolescent voices in this research too. We are often
left out of conversations about adolescent reproductive health — as if marriage
automatically solves everything. It does not.
End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P17
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P17: I think about protection and the future. After a scare I had last year — I
thought I was pregnant but I was not — I started thinking very seriously about
this. Contraceptives now mean security to me.
Probe: Where did you first hear about it?
P17: At school in life skills. But it was only after my scare that I really started
paying attention and looking for proper information.

Q2. What contraceptive methods do you know of?

P17: After researching, I know quite a few now — condoms, emergency pills, the
three-month injection called Depo or Siyana, the Jadelle implant, and the daily
pill. I also heard about the IUD.

Q3. For each method, what do you know about how they work?
P17: Emergency pill — taken within 72 hours to prevent fertilisation. Depo —
injection every three months. Jadelle — inserted in the arm and lasts years. IUD
— device in the womb. Condoms — barrier method. Daily pill — prevents
ovulation when taken every day. I researched all of these after my scare.
Probe: Who are they meant for?
 P17: I used to think married women. Now I know they are for any sexually active
person. I wish I had known that earlier.

Q4. Where did you get your information?

P17: After my scare I went to the clinic and spoke to a nurse privately. She
explained everything. I also looked things up on my phone. Those two together
gave me a clear picture.
Probe: Was the information clear?
P17: Yes — especially from the nurse. She did not judge me for coming in. She
said she was glad I came before something bad happened.

Q5. Are there things you are still unsure about?

P17: I am still learning about the long-term methods. I have heard people say the
implant can cause mood changes. I want to confirm whether that is true before I
try it.
Probe: What does the community say?
P17: The usual — that you will not have children, that it damages your body.
Most of it I now know is exaggerated. But it still affects girls who do not have
access to correct information.

Q6. Do girls your age in Roan know enough?

P17: No — I was one of them not long ago. It takes a wake-up call, like the one I
had, for most girls to actually seek out information. That is not how it should be.
Probe: What are they missing?
P17: Practical, honest information about how each method works, what to
expect, and where to get them without shame.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives now?

P17: Very differently from before. Before my scare, I thought they were not my
concern. Now I see them as essential. I should not have to wait for a near-
disaster to start protecting myself.
Probe: Would you feel differently if married?
P17: No. The reasoning is the same. You want to choose your timing. Marriage
does not make the question disappear.
Q8. What do friends think about girls who use contraceptives?
P17: My friends who know what I went through have changed their attitudes too.
Those who have not been through it still think contraceptives are for girls who are
doing wrong. A real experience changes your perspective very fast.
Probe: Have you been judged?
P17: When word got out that I had a scare — yes, people talked. Nobody knew I
was not actually pregnant. The shame was real even for something that did not
even happen. That tells you how harsh this community can be.
Probe: Does it affect your choices?
P17: Not anymore. I will not let shame put me at risk again.

Q9. What does your family think?

P17: My mother does not know the full story. She knows I had some health
concern and went to the clinic — I did not tell her what it was. My father is very
strict and would be devastated. So I keep this very private.
Probe: Should parents be involved?
P17: In a perfect world — yes. But this community is not there yet. Until parents
can have these conversations without anger and punishment, girls will keep
going around them.

Q10. What role does your partner play?

P17: He was part of the scare — though he does not know how serious I found it.
He is reluctant about condoms. He says they reduce feeling. I have started using
Depo so I do not have to depend on him.
Probe: Have you felt pressured?
P17: Yes. He is the reason I was unprotected in the first place. But now I have
taken matters into my own hands.
Probe: Who should have the final say?
P17: The girl — because she is the one who would be pregnant. No question.

Q11. What does your church say?

P17: My church says no sex before marriage. But I am already in this situation
and I have made a decision to protect myself. I still believe in God. I just also
believe God does not want me to destroy my future.
Probe: Have you felt torn?
P17: Yes. My faith and my reality are in conflict. But I have chosen to be
responsible over being shamed by a principle that does not match where I am in
life.
Q12. How do people react when a girl goes to the clinic?
P17: Harshly. But I think girls who have been through a scare stop caring about
the reaction. You get practical very quickly when you are scared.
Probe: Have you felt ashamed at the facility?
P17: The first time I went — very scared. But the nurse's kindness took that
away. She told me: it is good you came. Not: what are you doing here.

Q13. What does it feel like to have power over this decision?
P17: Like I got my life back. After the scare, I felt completely out of control. Now I
feel like I am back in the driver's seat.
Probe: Do girls in Roan have that power?
P17: Some are beginning to. But it usually takes a crisis to get there. We should
not have to wait for a crisis.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Are you currently using a contraceptive?

P17: Yes — Depo injection. I have been on it for four months. I get it from the
clinic.

Q15. What would make access easier for girls?

P17: Private, judgment-free spaces — even mobile clinics or outreach workers
who come to schools before a girl ends up in a crisis like mine.

Q16. How was your experience at the clinic?

P17: Positive. The nurse was kind and professional. She did not make me feel
judged — she made me feel smart for coming.

Q17. What stops girls from using contraceptives?

P17: Not enough urgency until something goes wrong. And then fear of judgment
if you go to get help. Also, partners who refuse to cooperate. All of it together
keeps girls vulnerable.

Q18. Any side effects?

 P17: My period has become irregular. Sometimes I spot between periods. The
nurse said this is expected and should settle. It has not bothered me much.

Q19. What would motivate more girls to use contraceptives consistently?

P17: Real stories from peers. Not lectures — peer conversations where girls can
speak honestly without judgment. If I told my story to a group of girls, I think it
would reach them better than any health pamphlet.
Probe: Most trusted source?
P17: A peer who has been through something similar. And a kind nurse.

Q20. Anything else?

P17: Start the conversation before the crisis. Do not wait until girls are already in
trouble to give them information.

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 4 — Key Informant Interview (KII) with Community/Civic Leader
Participant Code: CL01
Participant Role: Senior Councillor, Kafuwa Ward, Roan Township
Years in Role: 5 years (elected 2021)
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role in this community and how long you have
been serving in Roan Township.
CL01: I am the Senior Councillor for Kafuwa Ward, Roan constituency, here in
Roan Township. I have been a Councillor for the past five years — I was elected
into office in 2021.
Probe: What community-related issues do young people most deal with?
CL01: Mostly it is drug abuse and the prevailing diseases that young girls and
boys are facing now.
QA2. From your position as a Councillor, how serious is the concern of
adolescent pregnancy here in Roan?
CL01: Here in Roan, I can say it is on the rise — because of the drug abuse,
which leads them to do all sorts of things. Yes, among our young girls it is a
serious concern.

QA3. In your observation, how common is contraceptive use among

adolescents in this community?
CL01: Not very common. We are having pregnancies that are breaking out and
everything. I can say it is not very commonly used.
Probe: Do most adolescent girls in Roan know or have access to
contraceptives?
CL01: They fairly know. They have limited access, I should say.

SECTION B: COMMUNITY KNOWLEDGE AND AWARENESS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. In your experience as a Councillor, what do young people in Roan

Township know about contraceptives?
CL01: According to our survey and study, most young girls know contraceptives
as the pills they take when they have unprotected sex. I think there is not much
knowledge going deeper than that.
Probe: Is that information enough for them to make informed decisions?
CL01: When it comes to this matter, I think that is where the challenge is. They
don't have enough information.

QB2. What beliefs or stories circulate in this community about what

contraceptives do to young women's bodies?
CL01: There is a belief that when they take contraceptives, it would be hard for
them to have children in the future. So parents mostly discourage them — they
would rather their daughters shun away from contraceptives.

QB3. Where do young people in Roan specifically get information about sexual
health?
CL01: We used to have the DREAMS programme — they were conducting safe
spaces for our young girls. It was helpful, but at the moment it is no longer
operational. The Ministry of Health clinics also help. They do.
Probe: As a community leader, what role do you or your committee play in
providing information?
CL01: We try. We have the Youth Committee, which deals with issues to do with
young people. We have young people facilitating programmes. But due to limited
funds at the moment, we are not doing much.
Probe: Is this topic openly discussed in the community?
CL01: In my constituency, these are things that people normally don't openly talk
about. But when someone comes in confidence, yes — we have trained
counsellors who can talk with them privately.

QB4. What messages about contraceptives are shared in your community

gatherings?
CL01: Mostly condoms for both young boys and girls. Also, when people from the
Ministry of Health come, they teach our young girls and boys about different
types of contraceptives.
Probe: Do those messages help people make more informed decisions?
CL01: They do help. The intent is to help. And I can safely say — those who are
willing to learn and listen, it does help them.

SECTION C: COMMUNITY PERCEPTIONS AND ATTITUDES

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What is the general attitude here in Roan Township towards unmarried
adolescent girls who use contraceptives?
CL01: Mostly they are frowned upon — people think they are promiscuous. Why
can't they just keep themselves? Meaning they've been having unprotected sex.
So it is more like a private matter people wouldn't want to openly discuss.
Probe: Has this attitude changed over time or is it deeply held?
CL01: By and by — it is now my fifth year — I can say they are slowly adapting.
With more information, they are beginning to think it is the right thing to do.

QC2. What does this community's cultural tradition teach about contraceptives
and sexual health among young people?
CL01: When you talk of culture, contraceptives are confined mostly in the
marriage sector. Unmarried people cannot openly talk about taking
contraceptives.

QC3. Do you personally believe young girls should have access to

contraceptives?
 CL01: Yes. In this era, one cannot be too careful. In my personal opinion, young
girls should have access to contraceptives — enough information and access to
these contraceptives.
Probe: Why do you say so?
CL01: They will protect themselves from unwanted pregnancies. We have had
cases where someone falls pregnant and calls us in the middle of the night —
she was trying to terminate the pregnancy and the situation has worsened. If
young girls had access to contraceptives, we would not have such issues.

QC4. In your view, what influences a young woman's decision to use or not
use contraceptives most — parents, partners, peers, church, or health
system?
CL01: I would say the young girl herself and also the parents. Because if the
decision is made from home, it will stand.
Probe: Do young women feel they have autonomy to make their own
reproductive health decisions?
CL01: Those who are of age make informed decisions for themselves regardless
of what peers or church say. But those who are just coming up need parental
guidance. In some cases, the healthcare provider would suggest putting a young
person on contraceptives — but you also need consent from the parents because
others are minors.

SECTION D: BARRIERS, MOTIVATORS, AND RECOMMENDATIONS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. From your perspective as a community leader, what are the main reasons
adolescent girls in Roan do not use contraceptives even when sexually active?
CL01: There are stories where someone used contraceptives and when she got
married, five years later she has not been able to conceive. So they would rather
shun away because of the anticipated marital life ahead.
Probe: Does culture or religion play a role?
CL01: Yes — mostly religion. Religion will just say outright: you cannot do this. It
is against the Bible. Those who do it are deemed sinners.
Probe: Which barrier is most difficult to overcome?
CL01: The one to do with the partner. A young girl can be convinced and have
enough information — but there is another person involved. The partner has his
own belief system, and if it is still rigid, it will not play out.
QD2. Have you ever seen a situation where a young woman faced negative
social consequences for using or seeking contraceptives?
CL01: Yes. A person who has made an informed decision is able to live with it —
but as time passes, they become a laughing stock. People say: look at her body
now, look at what is happening. She listened and those things would not have
happened. Society blames contraceptives for things that may be unrelated —
someone may not conceive not because they were on contraceptives, but society
always has an opinion.
Probe: What does this tell you about how the community needs to change?
CL01: We are in a modern world. We need to embrace these things — they are
here to help us. All we need is correct information and we are good to go.

QD3. What would you say to families or community members who oppose
adolescent contraceptive use?
CL01: They do that because of past experiences and what they have seen. But I
would say: take time to study about these things — they are not as bad as we
deem them to be. By and by, when they try to understand, they are helpful.

QD4. What motivates the young women in Roan who do use contraceptives
despite social pressures?
CL01: In Kafuwa, I would say mostly because people have come to a realisation
that others will always talk and have an opinion. They have seen the benefits of
contraceptives and made up their minds — this is safe for me, I have enough
information, I have dealt with the myths, this is the right thing.
Probe: What gives them that confidence?
CL01: Self-actualisation, self-realisation. They realise who they are — it is no
longer about peer pressure. Mostly those who have reached a certain age where
they are able to make choices for themselves.
Probe: What age are you thinking of?
CL01: We now have young girls at 14 or 15 who are sexually active. In the past it
was not so, but now we need to come to terms with this. Someone who is in
school can get pregnant and be disturbed from education. We need such
information and such remedies. But for those who are 13 to 15 or 16 — according
to the laws of our land, they are not yet adults to make fully informed decisions.

QD5. What role do you believe community leaders should play in addressing
adolescent pregnancy and improving reproductive health in Roan?
CL01: We partner with the Shayisa Band Clinic. They come and hold safe spaces
for our young girls — just last week at Fissansa Primary School. In those safe
spaces, topics on health, reproductive health, and contraceptives are all tabled
out. Young girls can freely express themselves without being judged. What this
 community needs for young girls is information. Once they have enough quality
information, they will make decisions regardless of what people say.

QD6. What message would you give to the Ministry of Health about what the
community needs regarding adolescents and contraceptive use?
CL01: First, I want to commend them — they have been instrumental. But we
can do more. Let us empower the community workers and activists who are
already there and ready to help. Let us allocate more funds towards health. And
let us continue conducting research on the ground — not making decisions from
a distance. I would also urge collaboration with the church. People take what they
hear from their churches as sacred information, so I would appeal to local
churches in Roan to work together with civic leaders in addressing these issues.

QD7. Is there anything else you feel is important for this research to
understand?
CL01: You have touched on most areas. I would just reiterate: we need
collaboration between civic leaders, the Ministry of Health, and the church. That
partnership is essential.

End of interview. Participant thanked for time and insights. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 3 — Key Informant Interview (KII) with Healthcare Provider
Participant Code: HP02
Participant Name/Role: Margaret Kasongo — Community-Based Worker
(CBW/CBG), Chiesa Clinic
Years at Facility: First year as community communicator
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role here and the reproductive health services
you provide to adolescents.
 HP02: I am a CBW [Community-Based Worker] here at Chiesa Clinic. The role I
play is helping adolescents with sexual health, family planning, talking about
various clinic services, condom distributions, and many others.
Probe: For how long have you been working here?
HP02: This is my first year working at the facility as a communicator.
Probe: How many adolescent clients seek family planning services per month
approximately?
HP02: Usually per month — when you look at the adolescents, the young girls —
we have usually 25; monthly it varies between 18 and 25. They just vary.
Probe: What is the age range?
HP02: Some girls are 17, others are 18 — let me just say 17 up to maybe 22,
around about there. Those are the adolescents we usually have.

QA2. How would you describe the general level of contraceptive use among
adolescents in this community?
HP02: The impact has been seen — many types of contraceptives have been
distributed and these girls have actually accepted to be using contraceptives.
Probe: Has this changed over the years?
HP02: Yes. In years back, these girls were afraid of using contraceptives. But
after sensitising them, teaching them the benefits and everything, most came on
board and are now accessing them.
Probe: Which methods do adolescents most like to use?
HP02: Adolescents — when you look at them and when you explain — usually
go for the short-term ones.
Probe: Why do you think they go for short-term methods?
HP02: Most of them, although they get these medicines, they are under the
influence of their peers. A few come for long term — but very few; otherwise most
of them go for short term.

SECTION B: ADOLESCENT KNOWLEDGE OF CONTRACEPTIVES —

PROVIDER PERSPECTIVE
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. In your consultations with adolescent clients, how would you describe
their knowledge and understanding of different contraceptive methods?
HP02: Looking at the adolescents here, they are still learning — it is a gradual
process. When you teach them, somebody will say 'let me go for that'. But all the
same, they are coming up because they have accepted.
Probe: Do they understand how methods work?
HP02: Actually, what we usually do before we even distribute these medicines —
we teach them first. We talk about benefits, side effects, and everything.

QB2. What misconceptions about contraceptives do you most commonly

encounter?
HP02: Usually when they come with misunderstandings, they will tell you: no,
when I continue getting this, I want to be able to bear children when I want them.
My fertility — others say it will be gone permanently. So we keep on teaching
them that no, this is not how it is. But misconceptions are there.

QB3. Do adolescent clients have enough accurate information to make an

informed choice?
HP02: It is not only us the CBWs who give them information. When things are
difficult, we even rush to the clinical officer — the system charges [clinician] —
who makes sure to consolidate what we have taught them.

SECTION C: ADOLESCENT PERCEPTIONS — PROVIDER OBSERVATIONS

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What do you observe about adolescent attitudes when they come to seek
contraceptives?
HP02: As of now, since they are enlightened, these people are just coming with
open arms, open minds. They just want it because they have now understood the
use and benefits of contraceptives. Most of them appear very confident —
someone will just say: my days are over, may I have my contraceptives?
Probe: Do you notice differences between married and unmarried
adolescents?
HP02: There is not much difference except that they group themselves — the
married ones move in one bunch and the others in another. But otherwise it is
one and the same.

QC2. From what adolescent clients share, what role do partners and family
members play in their contraceptive decisions?
HP02: That is where we have a little challenge — most parents are not for the
idea of their girls getting contraceptives, especially school-going children. They
tell us: no, the children will learn this and that. It is a challenge when it comes to
parents. Very few men actually come on board with their partners. But the way
these girls keep coming frequently, we simply assume the partners are
supporting them.
Probe: Do religious pressures come up during consultations?
HP02: Yes, that challenge is there. Some churches do not allow contraceptives
— mention condoms and it is even worse.

QC3. How do you approach the issue of confidentiality when an adolescent

comes for contraceptives?
HP02: In the first place, we talk to them one-on-one because some cannot come
out in a group. On a one-on-one basis, we talk to them and we keep everything to
ourselves.
Probe: Do adolescents express fear of their parents finding out?
HP02: A few, yes. Some parents in the community are our colleagues, so we talk
to them as well. And yes, the fear of parents finding out has made some girls shy
away from contraceptives.

SECTION D: BARRIERS, MOTIVATORS, AND SERVICE-LEVEL FACTORS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. What do you see as the main barrier that prevents adolescents in Roan
from accessing and using contraceptives?
HP02: First, they are afraid their parents may come to get contraceptives on the
same day they are coming. Also the age group — someone says: 'that person is
a friend of my mother, what is she going to say?' So that has become a barrier.
This is why we are trying to separate them — adolescents will be coming on their
own designated date.
Probe: From the supply side — availability, cost, waiting times?
HP02: At our facility, we have programmed in a way that these children come on
a fixed date. For example on Tuesdays, the entire system focuses only on family
planning — making sure everybody gets what they want.

QD2. Have you encountered situations where facility attitudes discouraged an

adolescent from seeking contraceptives?
HP02: Not at this facility — no. Nobody here is against providing these services.

QD3. What motivates adolescents to seek contraceptives at this facility?

HP02: The service given to them — they are received, spoken to. The education
we give them — that is what keeps them coming.
QD4. What changes would most improve adolescent access and consistent
use of contraceptives here in Roan?
HP02: Looking at it economically, that is also a barrier — someone needs to keep
coming every time. I think looking at the policy, maybe something must be put in
place — perhaps an incentive to motivate them to keep coming.
Probe: What is already working well?
HP02: Having a fixed day designated for adolescents. The way things have been
drawn up, people have accepted and they keep coming. The services are okay.
Probe: What is the single most important change needed?
HP02: Our goal is simply to make sure girls don't get pregnant before they are
ready — because their bodies should be ready for pregnancy.

QD5. Is there anything else about adolescent contraceptive use in Roan that is
important for this research to understand?
HP02: I think it is the continuation of sensitisation — mobilising them, sensitising
them, letting them know. They know what is happening.

End of interview. Participant thanked for time and insights. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 3 — Key Informant Interview (KII) with Healthcare Provider
Participant Code: HP03
Participant Name/Role: Sister Nissi — In-Charge, Kalama Health Facility
Years at Facility: More than 3 years
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role here and the reproductive health services
you provide to adolescents.
HP03: I am the in-charge here at Kalama. We welcome our adolescents and
provide reproductive health services — condoms, short-term and long-term family
planning methods, and any other services based on the preference of the
adolescent.
Probe: For how long have you been working here?
HP03: More than three years.
Probe: On average, how many adolescent clients seek family planning
services per month?
HP03: Per month, we attend to 40 to 60 adolescents. Between 40 and 60,
because this area is very populated.
Probe: What is the age range of adolescent clients you typically see?
HP03: We start from 15 to 20.

QA2. How would you describe the general level of contraceptive use among
adolescents in this community?
HP03: If we range it — it is on average. There are certain ones who are not yet
accepting contraceptives. And then there are those who are sexually active and
want to use them. So it is on average.
Probe: Which methods are adolescents most likely to request?
HP03: For adolescents, the most common is the pills and the three-month
injection — because mostly they don't want the long-term methods. They fear the
issue of infertility in the future. So they prefer short-term methods just for that
period.

SECTION B: ADOLESCENT KNOWLEDGE OF CONTRACEPTIVES —

PROVIDER PERSPECTIVE
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. How would you describe adolescent clients' knowledge and

understanding of contraceptive methods?
HP03: Before we even start providing contraceptives, we educate them. We
counsel and then test — because before any contraceptive, they are supposed to
go through HIV testing. In the process of educating, they usually get the
information they need.

QB2. What misconceptions or myths about contraceptives do you most

commonly encounter among adolescents?
HP03: The issue of infertility. The issue of causing abortions — some feel
contraceptives cause abortions. Some feel they cause weight gain. Those are the
most common misconceptions.

QB3. Do adolescent clients have enough accurate information to make an

informed decision?
 HP03: Yes, they do — because, as I mentioned, we educate them before we
even provide the contraceptive. We ensure they receive adequate information
before they decide.

SECTION C: ADOLESCENT PERCEPTIONS — PROVIDER OBSERVATIONS

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What do you observe about adolescent attitudes and feelings when they
come to seek contraceptives?
HP03: Mostly they appear unsure — because in our setup, services are usually
provided alongside older women. That is why at our facility, we have ensured
they have their own room where we provide counselling, testing, and provision.
They even have their own specific day, so we prevent the shyness of coming to
the facility.
Probe: Do they come alone or with someone?
HP03: Mostly they come with friends. Some come with their parents — especially
their mothers. But mostly with friends.
Probe: Do you notice differences between married and unmarried
adolescents?
HP03: The difference is there. Those who are married usually use the long-term
methods. But those who are still in school and not married prefer the short-term
ones.

QC2. From what adolescent clients share, what role do partners and family
members play in their contraceptive decisions?
HP03: We usually have situations where a lady decides to start a contraceptive
— and then you discover that in the process she stops coming for reviews and
continuation, because the partner has refused or the mother has discovered that
she has been on a family planning method.
Probe: Are there cases where parents accompany adolescents and how do
they react?
HP03: Those accompanied by their parents — the reaction is not that bad
because consent is coming from the parent. For those who do it without parental
consent, that is where we receive some reactions — but not as bad as it used to
be.

QC3. How do you approach the issue of confidentiality for adolescent clients?
HP03: For confidentiality — like I already mentioned, we have a dedicated
adolescent room. That is where we do all the adolescent activities — counselling,
teaching, testing, everything. It is just for adolescents.
SECTION D: BARRIERS, MOTIVATORS, AND SERVICE-LEVEL FACTORS
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. What do you see as the main barrier that prevents adolescents in Roan
from accessing and using contraceptives consistently?
HP03: One of the barriers is the issue of parents' involvement. When parents are
not involved, the barrier is that girls will be hiding when coming to the facility —
and they will end up missing the important days for continuing their contraceptive
method.

QD2. Have you encountered situations where facility attitudes discouraged an

adolescent from seeking contraceptives?
HP03: Not really.

QD3. What motivates adolescents to seek contraceptives at this facility?

HP03: When they come, we start with learning activities — play activities,
dancing, illustrations. Because of the way the teaching is provided, they are
encouraged most of the time to come. They will even come early. The learning
starts early and they go back with something.

QD4. What changes at the facility, policy, or community level would most
improve adolescent access and consistent use of contraceptives?
HP03: Here in Roan, we have discovered that information reaching parents of
adolescents — encouraging them to come for any type of family planning — has
not yet been disseminated as it should be. The current policy actually encourages
parents to accompany adolescents for any type of family planning. That would
prevent the consequences of abortion, early pregnancies, and dropouts from
school. If parents were more involved, the outcome would improve.

QD5. Is there anything about adolescent contraceptive use in Roan that is

important for this research to understand?
HP03: I think everything has been talked about.

End of interview. Participant thanked for time and professional insights.

Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P07
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P07: It is something that stops pregnancy — something you take to avoid
pregnancy.
Probe: Where did you first hear about family planning?
P07: The first time I heard about family planning was in school. A peer pressure
club came in to talk about contraceptives.

Q2. What contraceptive methods do you know of? Can you name them?
P07: Emergency pills and the injection they get for three months. That is all.

Q3. For each method, can you tell me what you know about how it works?
P07: For the emergency pills — once you have unprotected sex, you can take
them within 72 hours. For the injection — you can get it and it lasts for three
months; once the three months is done, it no longer works.
Probe: Are there things about contraceptives you are not sure about?
P07: There is also a pill that comes in more like a tree [implant — likely Jadelle]. I
don't have much information about that.
Probe: Have you ever heard some methods make girls infertile, or are not
suitable for young girls?
P07: Yes. I have even heard that excess use of contraceptive pills, if you have
never had a child, can cause blindness.
Probe: Is there information you feel young girls are not getting?
 P07: The issue of taking them before you have had a child. It is said you cannot
be taking contraceptives daily if you don't have a child. That information has been
hidden from young girls.

Q4. Where did you get most of your information about contraceptives?
P07: From friends. I also have a health personnel who happens to be a friend, so
I am able to get from that person.

Q6. In your experience, do most girls your age in this community know about
contraceptives?
P07: I can say they do. They know.
Probe: Do they know enough to make a good choice?
P07: On that one, I am not sure.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P07: First, I can say it is not a good idea if you don't have a child. It is better if
you stay away from it or rather use condoms to avoid having a pregnancy.
Probe: Would you feel differently if married?
P07: If they are trying to do child spacing, it is okay.

Q8. What do your friends and peers think about girls who use contraceptives?
P07: In this generation, they think they are just trying to pay allowance — trying
to avoid pregnancy. Just paying allowance.
Probe: Have you heard girls talked about negatively for using contraceptives?
P07: Yes.
Probe: What names are used for such girls?
P07: Prostitutes.

Q9. What do people in your family think about young girls using
contraceptives?
P07: They think it is not a good idea for a girl child to be using contraceptives.
Probe: Have you ever talked to your mother or guardian about contraceptives?
 P07: No.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P07: Yes. Though African parents say no — they can't allow that. They say your
child must be decent.

Q10. What role does your partner play in decisions about contraceptives?
P07: Way back when I had one, he was not in support of the contraceptive thing.
Probe: Have you ever felt pressured to use or not use?
P07: Yes. I was told not to be using contraceptives — for anything that might
happen, you might get swollen [sic — unclear reference] and other complications.
Probe: Who should have the final say — a girl or a boy?
P07: I think it should be a girl. Because if you end up getting pregnant, you are
not even sure if the person will be supportive or not. So it is up to a girl.

Q11. What does your church or religious community say about

contraceptives?
P07: I am not sure. But I think religious beliefs can influence someone about
using contraceptives — yes, they can.

Q12. If a girl your age decided to go to the clinic to get contraceptives, how do
you think people would react?
P07: They would react negatively. Why, at your age, are you starting to use
contraceptives? She would be judged.
Probe: Have you ever felt ashamed or afraid of being seen at a facility for
contraceptives?
P07: Very much. What are you doing here? Why are you getting that? You are
young.
Probe: Do you think that fear stops girls from accessing contraceptives?
P07: Yes. That is why most girls do not visit clinics. They would rather go to a
private chemist to avoid being judged.

Q13. In your view, what does it feel like to have power to decide whether to use
contraceptives or not?
P07: A girl chooses life at that stake — it is you to decide what you want as a girl,
where you want to be in the next five or three years.
Probe: Do girls your age in Roan have that power?
P07: Yes, they have. But the problem comes in with parents and society. Overall,
a girl child must have the power to decide.
SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS
AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive method?

P07: I used the Implanon [implant]. I just used it once and it reacted — I started
having long periods. Then I stopped.

Q15. What would make it easier for girls your age to access and use
contraceptives in Roan?
P07: If people and health workers stopped being too judgmental. It would be
easier for a girl to access.

Q16. Have you ever tried to get contraceptives from a health facility?
P07: No.

Q17. What are the main things that stop girls your age in Roan from using
contraceptives?
P07: Cultural beliefs and the community being too judgmental.

Q18. Have you or someone you know stopped using a contraceptive?

P07: Yes — myself, as explained above [stopped due to side effects].

Q19. What do you think should motivate girls to use contraceptives

consistently?
P07: There is no motivation on that one. As young girls, you should just stay
away from contraceptives.
Probe: Who is the most trusted person to get advice from?
P07: A parent. Because parents always want what is best for us.

Q20. Is there anything else you would like to share?

P07: No.

End of interview. Participant thanked. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT
Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P08
Participant First Name: Christine (pseudonym retained as used in recording)
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P08: When I hear the term family planning, I think it is the controlling of couples
or partners on how many children they should have.
Probe: Where did you first hear about it?
P08: At school — secondary school.

Q2. What contraceptive methods do you know of?

P08: Condoms and contraceptive pills. I don't know the exact name of the pills.

Q3. For each method, can you tell me what you know about how it works?
P08: For pills — I actually don't know how they work or for how long. For
condoms — I think it is to prevent one from getting pregnant, especially a female.
Probe: Who do you think these contraceptives are meant for?
P08: I think when you are sexually active — yes, it is meant for you. Anyone, as
long as they are sexually active.

Q4. Where did you get most of your information about contraceptives?
P08: I was attending a program at DREAMS. That is where I got the information
from.
Probe: Did anyone sit you down and properly explain contraceptives to you?
P08: No.
Probe: Was the information you received clear and easy to understand?
P08: Yes, most of it I understood.

Q5. Are there things about contraceptives you are not sure about?
P08: Yes. I don't know how to take them — is it after sex or before sex? I get
confused on the types as well.
Probe: Have you heard that some methods make girls infertile?
P08: Yes.
Probe: Have you heard that some methods are not suitable for young girls?
P08: No, I have never heard that.
Probe: What does the community say about what contraceptives do to the
body?
P08: I think they have the wrong idea. They think that you will not have children
maybe for years.

Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P08: No. Because I have seen a lot of young girls getting pregnant — meaning
they do not know.
Probe: Is there information young girls in this area are not getting?
P08: Yes. I think having sex early without knowledge is a serious problem — you
see an 18-year-old girl getting pregnant and it is really bad.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P08: I think for me, if I am sexually active, it is good for me. My own opinion.
Because I don't want to get pregnant.
Probe: Would you feel differently if you were married versus not married?
P08: No — the feeling would be the same either way.

Q8. What do your friends and peers think about girls who use contraceptives?
P08: They have a bad opinion. They think maybe these girls are prostitutes —
that they sell themselves.
Probe: Have you heard girls talked about negatively?
 P08: Yes. They call them prostitutes.
Probe: Does what other people think affect your own choice?
P08: No, it doesn't.

Q9. What do people in your family think about young girls using
contraceptives?
P08: We have not really talked much about that area in my family.
Probe: Have you ever talked to your mother or guardian about contraceptives?
P08: No.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P08: No — because it is my choice.

Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P08: I don't have one. But I think a partner should support the use of
contraceptives.
Probe: Have you ever felt pressured to use or not to use?
P08: No, I have never been pressured.
Probe: Who should have the final say — a girl or a boy?
P08: The girl. Because it is my body.

Q11. Does religion influence your personal feelings about using

contraceptives?
P08: It doesn't. It has not occurred.

Q12. If a girl your age decided to go to the clinic to get contraceptives, how do
you think people would react?
P08: I think they would judge her.
Probe: In your own case, would you feel ashamed or afraid?
P08: I would not. If I am sexually active and I know I don't want to get pregnant
and I don't want to use condoms — I would just go there and get. But for other
girls who fear going, yes, that fear will stop them from getting help.

Q13. In your view, what does it feel like to have power to decide whether to use
contraceptives or not?
P08: I think it would make me feel better — deciding whether to use or not.
Probe: Do girls your age have that power in Roan?
P08: No. From my own observation, they do not.
Probe: What would need to change for them to have that power?
P08: They should be more educated on sexual life — productive sexual life.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive method?

P08: No.

Q15. What would make it easier for girls to access contraceptives in Roan?
P08: Going to the clinic or hospital. That would make it easier.

Q16. Have you ever tried to get contraceptives from a facility?

P08: No.

Q17. What are the main things that stop girls your age from using
contraceptives?
P08: [Recording end — response not fully captured.]

End of interview. Participant thanked. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P09
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained
SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P09: When I hear the word contraceptive or family planning, what comes to my
mind is just a method or a way on how to plan on having kids or how to space
them.
Probe: Where did you first hear about it?
P09: I heard about this word for the first time in class at school. They talked
about it briefly — saying there are contraceptives and family planning methods.

Q2. What contraceptive methods do you know of?

P09: The most common ones I know are condoms and pills.

Q3. For each method, can you tell me what you know about how it works?
P09: For condoms — from what I know, this is just a rubber worn by the male
during intercourse to prevent pregnancy. For pills — these are taken by a woman
to prevent pregnancy.
Probe: Who do you think these are meant for?
P09: For married people. Family planning is meant for married people.

Q4. Where did you get most of your information about contraceptives?
P09: From school. Most of it was from school.
Probe: Did anyone sit you down and properly explain contraceptives?
P09: No, I have never had anyone sit me down and properly explain them.
Probe: Was the information from school clear and easy to understand?
P09: Yes, it was clear and easy to understand.

Q5. Are there things about contraceptives you are not sure about?
P09: Yes. I have heard so many things from the community — some say when
people start contraceptives, they cannot have children in the future. Others say if
you are taking contraceptives, you might still get pregnant. There is just a lot of
confusion.
Probe: What have people in your community said about what contraceptives
do to the body?
P09: [Same as above — community fears about infertility already explained.]
Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P09: Not really — 50-50. Some know and others don't. I think it depends on what
they are exposed to.
Probe: Do they know enough to make a good choice?
P09: I feel they don't know enough. They need more information about
contraceptives and family planning.
Probe: What kind of information specifically?
P09: They need information on whether contraceptives can cause further
difficulties in having a pregnancy in the future, or changes to the body, or damage
to their health. Also, how to properly use condoms and contraceptives —
because some are abusing them due to lack of information. Most girls my age
who know about these things go to drug stores to buy them rather than going to
the clinic.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P09: For a girl my age to use — it is definitely a bad idea. It promotes... how do I
put it... it gives freedom or access to actually be sleeping around with people
knowing you won't get pregnant. For people my age, that is not okay.
Probe: Would you feel differently if you were married?
P09: Yes, my feelings would definitely be different. When married it is legal and it
is okay — I need to plan how to have my children so I don't have one after the
other.

Q8. What do your friends and peers think about girls who use contraceptives?
P09: Yes, initially girls my age do not really feel good about it. That is why most
girls who use contraceptives hide them — because it is like advertising: I am
doing this stuff I am not supposed to be doing. It is shameful.
Probe: What words or names are used for such girls?
P09: I think there are names, yes — I don't want to mention them because I don't
know exactly what they are called in this context.
Q9. What do people in your family think about young girls using
contraceptives?
P09: My mum is very much against contraceptives. She doesn't encourage or
tolerate any mention of it. She has spoken to me about it a couple of times — but
since she doesn't encourage it, she doesn't give me the actual information.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P09: I do think parents should be involved because these decisions go a long
way — especially if you make a bad decision at my age.

Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P09: He does not oppose. It depends — for condoms, he is okay with them.
Some pills, also okay.
Probe: Have you ever felt pressured to use or not use?
P09: No.
Probe: Who should have the final say?
P09: A girl. Because the consequence of pregnancy lies with her — she is the
one carrying it. So she has the final say.

Q11. What does your church or religious community say about

contraceptives?
P09: The church is absolutely against contraceptives because, as the Bible says,
no sex before marriage. So they are not in support.
Probe: Have you ever felt torn between your faith and the need to protect
yourself?
P09: Yes, several times. As the Bible says no sex before marriage — but we are
all human and we are tempted to do certain things. So if I am doing that, I also
need some guarantee or safety to know that even if I am doing this, I am safe
from pregnancy and other diseases.

Q12. If a girl your age decided to go to the clinic to get contraceptives, how do
you think people would react?
P09: They would react badly. Most parents don't encourage kids our age to be
involved in sexual activities — they try to hide the entire fact that sexual activities
exist. So my family would definitely not be happy, nor would my friends support
me.
Probe: Have you ever felt ashamed or afraid of being seen at a health facility
for contraceptives?
P09: Yes, very much.
Probe: Does that fear stop girls from getting help?
P09: Yes, it does. Imagine going to get contraceptives and bumping into
someone you know who works there. The embarrassment. In the process, you
stop.

Q13. In your view, what does it feel like to have power to decide whether to use
contraceptives or not?
P09: It feels good. It gives you a choice and freedom to say: I can either use or I
cannot use.
Probe: Do girls your age in Roan have that power?
P09: I think most of them do.
Probe: What would need to change for more girls to feel in control?
P09: First, parents should be involved in a child's sexual life — not us hiding
away from parents. And at the clinics, more privacy. Right now, you just walk in
there and say 'I need this' with everyone around. Obviously I would feel
embarrassed and go back.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive method?

P09: Yes — I have used a condom before, for some months. I got it at the clinic.

Q15. What would make it easier for girls your age to access contraceptives?
P09: If there were health persons working in the community giving us condoms
— instead of me having to go to the clinic, that would really help.
Probe: Are contraceptives available near where you live? Can you get them
without parents knowing?
P09: It is hard to get them without the parent's permission or anyone finding out.
But they are there — it is just hard getting them.

Q16. Have you ever tried to get contraceptives from a health facility?
P09: Yes. Initially when I went there, I was trembling — I did not know how to
approach the whole thing. But after I gathered the courage to say I had come for
contraceptives, I was received with privacy. Everything was explained — how
contraceptives work, the dos and don'ts — and I was attended to nicely.
Q17. What are the main things that stop girls your age in Roan from using
contraceptives?
P09: The fear of side effects — because we don't have enough information about
certain contraceptives, we only know about condoms and some pills. Also the
fear of parents finding out, or an elderly respectable person seeing you — that
would stop most girls.

Q18. Have you or someone you know stopped using a contraceptive?

P09: Yes — the parents found out she was using contraceptives.
Probe: What side effects have you heard about or personally experienced?
P09: Personally experienced irregular periods. Heard that when you start using
contraceptives you may have difficulties getting pregnant in the future. Also heard
about weight gain and problems with eating.

Q19. What do you think would motivate more girls to use contraceptives
consistently?
P09: Education on contraceptives would go a long way — on how to use them,
the types that exist, what they do, and the side effects. That would really help.
Probe: Who is the most trusted person to get advice from?
P09: A health worker.
Probe: What would need to change at the health facility?
P09: A little more privacy.

Q20. Is there anything else you would like to share?

P09: As much as contraceptives are not okay for girls my age, the world we are
exposed to nowadays is more advanced than the world our parents lived in. Most
young girls nowadays are getting sexually active, so it is better to educate us
about it than to hide the fact that contraceptives exist.

End of interview. Participant thanked. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P10
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P10: Contraceptives — these are family planning methods that help you to plan if
you want to have a child or not.
Probe: Where did you first hear about it?
P10: At the clinic first — oh, I heard it from school. Yes, from school.

Q2. What contraceptive methods do you know of?

P10: I know of pills like Microgynon and self-planning pills. I also know Siyana
[Depo-Provera injectable] and Jadeo [Jadelle implant].

Q3. For each method, can you tell me what you know about how it works?
P10: For the pills like Microgynon — these are oral contraceptives. When you
want to prevent pregnancy, they are taken daily. One case has a number of pills
and you take one every day before you have sexual intercourse with someone.
We also have emergency pills — these are taken after you have sexual
intercourse with someone, but within 72 hours.
Probe: Who do you think these contraceptives are made for?
P10: I think they are made for anyone. Inasmuch as a person is sexually active,
they can access these contraceptive pills to prevent pregnancy if they don't want
to become pregnant.

Q4. Where did you get most of your information about contraceptives?
P10: I first heard about contraceptives in school, but I got most of the information
at the clinic — because I went there to get some family planning contraceptives.
Probe: Was the information clear and easy to understand?
P10: Yes, it was easy to understand depending on the type of contraceptive I
wanted.

Q5. Are there things about contraceptives you are not sure about?
 P10: Yes. I need a clearer understanding because we respond differently to these
contraceptives. Others complain they can't see their periods; others say they
have very long periods; others say that long use of contraceptives can lead to
infertility.
Probe: What have people in your community said about what contraceptives
do to the body?
P10: Others say contraceptives make you gain weight. Others say you become
infertile. Others say they have dangerous effects on the body.

Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P10: Yes, they do — because many need to go to the clinic, especially at the
staging clinic, because the number of pregnancies among adolescents was so
high.
Probe: Is there information young girls in this area are not getting?
P10: Yes. I think I can even include myself — there is enough need to know more
about contraceptives. Even I have doubts, as I said earlier. There are things I
hear in the community about contraceptives that I want someone to clear up for
me.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P10: Personally, I think it is a good idea. It reduces the chances of having
unwanted pregnancies. As a school-going person, it also protects me from having
a pregnancy that would hinder my ability to go to school.

Q8. What do your friends and peers think about girls who use contraceptives?
P10: In my case, other people feel I am young and cannot use contraceptives —
they label girls who use them as prostitutes. But if I know it is something that is
protecting me, then I have to take it.
Probe: Have you heard girls talked about negatively for using contraceptives?
P10: Yes, most of the time. I have heard people point out and say: that one, she
gets oral pills from the clinic, she gets Depo from the clinic. That is the language
they use in the community.
Q9. What do people in your family think about young girls using
contraceptives?
P10: To be honest, even for me, my mother is not aware and my family members
are not aware that I am using contraceptives — because this is not something
they would welcome, looking at my age. I think they believe contraceptives are
only meant for married people.
Probe: Do you think parents should be involved in a girl's contraceptive
choice?
P10: Yes, I think parents should be involved. They should give full information
and also encourage their daughters so as to prevent unwanted pregnancies. As
much as girls and parents are not aware, we are sexually active and we tend to
hide it. But if the information came from our parents, they would tell us why it is
important to have this contraceptive method.

Q10. What role does your partner play in decisions about contraceptives?
P10: My partner is very supportive. Looking at our ages — we are both young, he
is only 22. I have told him I only want to get pregnant when the time is right. Even
when my injection has expired, he normally buys the emergency pills because he
knows I can become pregnant.

Q11. What does your church say about contraceptives?

P10: I am a Christian and Christians most of the time go against sex before
marriage. So I think my church doesn't welcome the idea of contraceptives
among adolescents.
Probe: Have you ever felt torn between your faith and the need to protect
yourself?
P10: Yes. There is always a guilt that comes into your mind — I am not supposed
to have sex. But in as much as you are saying that and doing it, there is no better
option of protecting yourself than to use contraceptives.

Q12. If a girl your age decided to go to the clinic to get contraceptives, how do
you think people would react?
P10: The community always paints adolescents as black sheep and acts as if we
don't listen. I think that is not something they would support. This is where I urge
the community to be sensitised about the importance of girls accessing these
contraceptives. For now, they would not welcome the idea.
Probe: Have you ever felt ashamed or afraid of being seen at a health facility
for contraceptives?
P10: Yes, most of the time. I even tend to hide from people because I think they
will see me and start talking negatively about my actions and decisions. Most of
the time, I feel shy.
Probe: Does that fear stop girls from getting help?
P10: Yes. I think that is what is hindering most of us from getting help.

Q13. In your view, what does it feel like to have power to decide whether to use
contraceptives or not?
P10: At the end of it all, it is myself we are talking about and I don't want to
become pregnant. Regardless of what people say, I would still go for it —
because if I depend on people's criticism, I will end up messing up things for
myself. So I choose myself over critics.
Probe: Do you think girls in Roan have that power?
P10: I would not say that entirely — but quite a number of girls my age I meet at
the clinic to access services. So I think some have it, some don't.
Probe: What would need to change for more girls to feel that power?
P10: More sensitisation. Engage the public, engage the parents, engage the
religious leaders — and tell them the need for this. Because even as much as
they are saying no to these things, we are sexually active.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive method?

P10: Yes. I have used Siyana [Depo-Provera injectable] and Microgynon pills. For
Microgynon, I used it for the first three months — then I decided that was enough
and switched to the injectable, where I just get injected every three months and
forget about it.

Q15. What would make it easier for girls your age to access contraceptives?
P10: If family planning were not only provided in clinics — if they also put up safe
spaces where girls can access family planning freely without being judged.

Q16. Have you ever tried to get contraceptives from a health facility?
P10: Yes — normally that is where I get them.
Probe: How are you treated by health workers?
P10: Yes, I feel comfortable. The nurses that provide family planning are
welcoming — they encourage the use of family planning and give us enough
information. I feel welcomed and I don't feel shy because they have created a
room and a rapport to talk to us about it.
Q17. What are the main things that stop girls your age from using
contraceptives?
P10: [Implied from earlier responses — fear of judgment, stigma from community
and family, lack of awareness among peers.]

Q18. Have you or someone you know stopped using contraceptives?

P10: Because of having very long periods or not having periods at all — that has
been the reason for stopping.

Q19. What do you think would motivate more girls to use contraceptives
consistently?
P10: If the parents are engaged in the use of contraceptives — that would
promote more girls. Even we would be getting information from our parents. If
there is need, girls can be able to access family planning methods without any
fear.

Q20. Is there anything else about your experience or feelings on contraceptive

use you would like to share?
P10: No — I don't have any fears. From the time I started taking contraceptives, I
have never experienced any serious side effects. I feel I have been given enough
information, so I don't have anything to add.

End of interview. Participant thanked for time and openness. Confidentiality

confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 4 — Key Informant Interview (KII) with Community/Religious
Leader
Participant Code: RL01
Participant Role: Pastor / Minister of the Gospel, Roan Township
Years Serving in Roan: 5 years
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained
SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role in this community and how long you have
been serving people in Roan.
RL01: I have been serving the town of Roan for the past five years. Since I came
from Mpika, went to Lusaka, and now I am in the Copperbelt Province of Zambia.
The work I have been doing here at Roan is to preach the word of God and
encourage the young people to be inclined to the Bible — so that they can know
more about God and also shine away from things like drug activities and other
issues.
Probe: What community issues related to young people do you most
frequently deal with?
RL01: The challenges we face in the community with young ones is that many
have been exposed to drugs. Some smoke cigarettes; we hear about other
substances; and we also hear about sexual activities. These have been our major
challenges in the community.

QA2. From your position as a religious leader, how serious is the concern of
adolescent pregnancy here in Roan?
RL01: On that one, pregnancies here at Roan — we have been seeing quite a
number going high due to a lack of understanding among these adolescents.
Parents bring them to our offices and try to counsel them, but the children now
believe they know it all. This has been a major concern to the extent that
adolescent pregnancies are rising. Some are dropping out of school even though
the government has introduced free education. These teenagers are at a stage
where they want to be experimental — they want to feel what others feel. Some
who are in church and some who are not — some get pregnancies due to peer
influence. We keep preaching the word of God and encouraging parents not to
stop talking to their children.

QA3. In your observation, how common is contraceptive use among

adolescent girls in this community?
RL01: According to what I have gathered, some of the contraceptives
administered to young girls are due to some of them engaging themselves in
prostitution. Their parents are not even aware that their children are using
contraceptives. The group influence is strong — they meet their colleagues and
are advised wrongly. We also have another challenge where some parents — out
of love for their child and wanting to protect their future — have taken their child
to the clinic to give them contraceptives. After trying everything else, they say: I
just want a better future for this child. So some parents are the ones who engage
their children in contraceptive use.
SECTION B: COMMUNITY KNOWLEDGE AND AWARENESS
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. Do young people in this community know about contraceptives from

your own experience?
RL01: Yes, they know about contraceptives. They know.
Probe: Do they have enough information to make informed decisions?
RL01: According to what I have gathered, the information is not sufficient — they
don't even know the side effects. Once what happens is they have just been
introduced to contraceptives, but the people who introduced them did not do a
good job of explaining — because all they know is that it just prevents pregnancy.
Even some pharmacies in Roan Township — a child goes and buys, and the
pharmacist just says this chemical works like this and that. They do not express
the full outcome or the other side of the medicine.

QB2. Apart from the community and pharmacy, where do young people get
information about sexual health?
RL01: There was a time the health services brought a programme talking about
abstinence — those programmes were very good. The Ministry of Health tried to
advise children to stay away from sexual activities. They also introduced
condoms for those who cannot abstain — and there were major concerns not
only about pregnancies but also stopping them from getting HIV and AIDS and
STIs. As the church, we also tried — but we are zero tolerance; we do not advise
youths to engage in sexual activities.
Probe: Is this topic openly discussed in a faith setting?
RL01: As a church, we have the Youth Ministry. We select some young people at
the adolescent stage and have discussions — what we call relationship
discussions. For those preparing for marriage, we tell them the truth; we tell them
they should not engage in premature activities. For those who are not at that
stage, we find topics that steer them away from sexual immorality.

SECTION C: COMMUNITY PERCEPTIONS AND ATTITUDES

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What is the general attitude in Roan towards unmarried adolescents who
use contraceptives? Are they respected or judged?
RL01: Normally, those who use contraceptives are not easily identified — it is
very difficult to know that someone uses them. What normally happens is that it
only becomes known when it is brought to our attention — when friends talk,
 when someone tells us this child has been using. Then as church leaders, we
come in, find out why they are using. Some confirm it is peer influence; others
say they became sexually active and wanted to prevent pregnancy.
Probe: What does the community believe contraceptive use says about a
young woman's character?
RL01: The community believes that when a child begins to use contraceptives, it
will hinder their fertility — they may not conceive. They also believe that any child
using contraceptives is up to something. That is what they believe.

QC2. In your view, who has the most influence over a young woman's decision
to use or not use contraceptives?
RL01: It depends on how the child has been exposed. Whoever exposes the
child first — that is who they will incline their ears to. If the Ministry of Health
speaks to them first, they will believe the Ministry of Health. If it is about the
church or community, they will believe whoever introduced these things to them
at first.

QC3. Do you personally believe young girls should have access to

contraceptives?
RL01: As a minister of the Gospel — 100% no.
Probe: Why not?
RL01: Because as a minister of the Gospel, we believe that sexual activity is not
for singles — it is for married people. This is the reason why anyone who is not
married is 100% free from contraceptives — I cannot allow or support that
because it is against the Bible and against my faith. We also have church
constitutions that do not even allow married people to use contraceptives — they
believe that when God created that activity, He created it for the purpose of giving
God glory and multiplying. That is why I say no to singles.

SECTION D: BARRIERS, MOTIVATORS, AND RECOMMENDATIONS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. From your perspective as a religious leader, what are the main reasons
adolescent girls in Roan do not use contraceptives even when sexually active?
RL01: Some do not use because it has not been introduced to them. Others have
come to know about the side effects — someone has told them these things will
damage your body — and so they intend not to use them. Others find their own
way to avoid pregnancy without contraceptives, but we cannot tell what that way
is.
QD2. Have you ever seen a situation where a young woman faced negative
consequences for using contraceptives?
RL01: For now, I cannot be specific — no one has ever come to me saying they
have a challenge directly from using contraceptives. I have only encountered an
older couple who used contraceptives and when they wanted to have a child after
stopping, it took them time to conceive. For the young ones, no one has come to
me specifically with such an experience.

QD3. What role do religious leaders have to play in addressing adolescent

pregnancy in this community?
RL01: Our major role is to introduce Christ to them. Once the word of God has
been preached and the youths follow it, they will shine from evil. We always tell
the youths the truth about our Lord and Saviour. The word of God is the only
weapon we use to speak to these children — we believe it is what gives them
good character.

QD4. What partnership between religious leaders and health service providers
would you like to see?
RL01: The partnership I can see is that there is no harm in the Ministry of
Health's teachings. I would say we can partner with them — we keep talking to
the young people and the Ministry of Health keeps talking to them. We can also
meet with the Ministry of Health. We had a challenging situation once — a child
was brought to us: she was pregnant and HIV positive. The man who
impregnated her was not positive. The families were in conflict. What we did was
engage both families and the Ministry of Health together for counselling — and
after that the families came together.

QD5. What message would you give to the Ministry of Health about community
needs regarding adolescents and contraceptive use?
RL01: Whenever they are administering these services, they should ensure they
explain both sides — the good part of contraceptives and also the side effects.
They should not hide. Tell the young people the truth: when you are using this, it
will do you good in this area — but there is also another part that can harm you.
Tell them both sides honestly.

QD6. Is there anything else you feel is important concerning this topic?
RL01: It is a good topic. I would just ask that the Ministry of Health continue
increasing their programmes — like the ones we used to have here talking about
abstinence. They should continue making platforms to talk to these adolescents.
That would be a great privilege to the community.
End of interview. Participant thanked for time and insights. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P02
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P02: Family planning — I think these are methods we use so that we don't get
pregnant.
Probe: Where did you first hear about it?
P02: I heard the word at school. They taught us this in Biology.

Q2. What contraceptive methods do you know of? Can you name them?
P02: I know kondomu [condoms], Siyana [Depo-Provera/injectable], and Jepo
[Jadelle/implant]. Also Aoteari [IUD].
Probe: Which ones do you know by their local name here in Roan?
P02: We use the same names — kondomu, Siyana, Jepo, and Aoteari.

Q3. For each method, can you tell me what you know about how it works?
P02: For kondomu, I know it prevents one from getting pregnant and also from
HIV and AIDS. For Siyana and Jepo, I know they prevent pregnancy, but I am not
sure if they also protect from getting diseases.
Probe: For how long does it protect against pregnancy?
P02: I used Siyana once. They told me it can prevent pregnancy for three
months.
Probe: Who do you think it is meant for?
 P02: Someone told me it is mainly meant for married people.

Q4. Where did you get most of your information about contraceptives?
P02: I got it from my friend. We were discussing family planning at school.
Probe: Did anyone sit down and properly explain contraceptives to you?
P02: No.
Probe: Was the information you received clear and easy to understand?
P02: Some of it was clear. Some I did not understand properly.

Q5. Are there things about contraceptives you are not sure about?
P02: Yes. My friend was telling me that if I use contraceptives before giving birth,
I will have difficulty getting pregnant in the future.

Q6. In your experience, do most girls your age in Roan Township know about
contraceptives?
P02: Some of them do.
Probe: Do they know enough to make a good choice?
P02: More information should be given to us young girls. We don't know very
much about it, and we fear going to the clinic.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P02: Sometimes I feel it is good because it prevents me from getting pregnant.
But sometimes I feel bad because I am engaging in sexual activities before
marriage.
Probe: Why do you feel that way?
P02: At church, they tell us it is a sin to engage in sexual activities before
marriage.
Probe: Would you feel differently if you were married?
P02: Yes. I would be more comfortable because I know these things are for
married people.

Q8. What do your friends and peers think about girls who use contraceptives?
 P02: They feel that if we use contraceptives, we are promiscuous — that we
have a lot of boyfriends and engage in sex a lot.
Probe: Does what other people think affect your own choice?
P02: Sometimes it does.

Q9. What do people in your family think about young girls using
contraceptives?
P02: My parents cannot even allow me. It is my secret.
Probe: Have you ever talked to your mother about contraceptives?
P02: I tried once. She just told me that when you get married, these things will be
explained to you.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P02: I feel they should be involved. But in my own case, it is impossible — I have
never even discussed such a topic with them.

Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P02: He supports. He always makes sure he comes with condoms whenever we
are meeting.
Probe: Have you ever felt pressured to use or not to use contraceptives by a
partner?
P02: Yes, sometimes he pressures me — especially when I have just finished my
period. He does not want to use condoms with me. He believes I cannot get
pregnant during my safe days, but I do not feel comfortable with that.
Probe: Who do you think should have the final say — a girl or a boy?
P02: Both of us should decide what is right together.

Q11. What does your church or religious community say about

contraceptives?
P02: [See tail of recording — religion section.]

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation
Q17. What are the main things that stop girls your age in Roan from using
contraceptives?
P02: Fear of being judged. Cultural beliefs. And also fear of side effects.

Q18. Have you or someone you know stopped using a contraceptive method?
P02: No.

Q19. What do you think would motivate more girls your age in Roan to use
contraceptives consistently?
P02: Maybe more sensitisation in schools where the girls are found, so that
teachers explain the advantages of each family planning method.
Probe: Who is the most trusted person to get advice from?
P02: I think a teacher.
Probe: What would need to change at the health facility?
P02: Maybe they can make a separate section for us young ones. Or they should
bring a policy that allows young girls who are sexually active to access
contraceptives without being judged.

Q20. Is there anything else about your experiences or feelings that you would
like to share?
P02: No. We have talked about everything.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P03
Interviewer: Gladys Kunda (202310003)
Language: English / Bemba mix
Audio Recording: Yes — consent obtained
Note on Recording Quality: Significant portions of this recording contain
unintelligible or repetitive audio. Usable content has been transcribed below. Some
exchanges were not recoverable.
SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P03: It is contraceptive. [Pause.] I don't have the method to prevent it. It is a
contraceptive.
Probe: Where did you first hear about it? / How long ago?
P03: Three months. Maybe five years. [Unclear response — recording unclear in
this section.]

Q5. What have people in your community said about what contraceptives do to
your body?
P03: Girls don't stop attending [school/menstruating — unclear context].

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives — good or bad idea for a
girl your age?
P03: It's not good. It's very bad.
Probe: Why?
P03: Because it makes your birth process long. It's not good. It's very bad.
Probe: Would you feel differently if you were married?
P03: No.

Q8. What do your friends and peers think about girls who use contraceptives?
P03: They think they are very old and they are not used to them. [Explanation
unclear — recording quality limited.]

Q9. What do people in your family think about young girls using
contraceptives?
P03: [Unclear — recording unintelligible in this section.]
Probe: Have you ever talked to your mother or guardian about contraceptives?
P03: No.
Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P03: No [does not have one]. In case you don't have one — for your friends'
boyfriends, do they support them? [Interviewer reframing.] They support.
Probe: Have you ever felt pressured to use or not to use by a partner?
P03: No.

[Remaining sections of this recording are not recoverable due to audio quality issues. No
further usable data extracted from this transcript. Researcher note: Consider whether to
repeat interview with this participant.]

End of recoverable transcript content for P03.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P04
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P04: I think there are ways on how to prevent someone from getting pregnant.
That is what comes to my mind.
Probe: Where did you first hear about it?
P04: At school.

Q2. What contraceptive methods do you know of?

 P04: The abuse [abstinence — likely mishear]. I think the condoms. [Also
mentioned POC/pills.]
Probe: Which ones do you know by their local name?
P04: Condoms.

Q3. For each method, can you tell me what you know about how it works?
P04: For condoms — we learnt at school that it helps prevent transmission of
sexually transmitted diseases. For the pill [POC], they said it also helps with
unwanted pregnancies.

Q4. Where did you get most of your information about contraceptives?
P04: Social media and friends.
Probe: Did anyone sit down and properly explain contraceptives to you?
P04: No.
Probe: Was the information from social media clear and easy to understand?
P04: It is not clear. I need someone to fully explain to me.

Q5. Are there things about contraceptives you are not sure about?
P04: Yes. I remember at school they mentioned there are side effects, so I need
to learn more about them.
Probe: Have you heard that some contraceptives make girls infertile, or are not
suitable for young girls who have not had children?
P04: People in my community have said if you are not married, contraceptives
are not good for you. They are not safe.

Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P04: Yes, they know. Considering the people I am around, I think they have ideas
about contraceptives.
Probe: Do they have enough knowledge to make a good choice?
P04: No. I think they just know the names — condoms, pills. They don't really
know what is involved in those contraceptives. They need to be guided more on
how to use them.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices
Q7. How do you personally feel about contraceptives?
P04: I think it is a bad idea for a girl like me who is not married to use them.
Probe: Would you feel differently if you were married?
P04: I think if I were married, I would consider contraceptives to be good. They
would help me if I don't want to have a child at that time — I would prefer being
on contraceptives.

Q8. What do your friends and peers think about girls who use contraceptives?
P04: Yes, they are talked about negatively. They say she is not married and is
using contraceptives that might disturb her fertility.
Probe: What words or names are used for girls who use contraceptives?
P04: [Names mentioned but withheld — participant hesitated to state them
openly.]
Probe: Does what other people think affect your own choice?
P04: Yes. Even if there were situations where I was sexually active and wanted to
protect myself, the way they name those people who use contraceptives also
affects me.

Q9. What do people in your family think about young girls using
contraceptives?
P04: I have never talked to them about it. But in general, I think they would say
that girls are not supposed to be using those.

Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P04: He emphasises using condoms.
Probe: Have you ever felt pressured to use or not to use?
P04: At one point I felt pressured.
Probe: Who should have the final say — a girl or a boy?
P04: I think a girl. Because if someone gets pregnant, the girl is going to be
pregnant — so a girl should have the final say.

Q11. What does your church or religious community say about

contraceptives?
P04: They say they are bad if you are not married. They are bad for your health.
Probe: Does religion influence your personal feelings?
 P04: Yes. They say you are not supposed to use contraceptives, but I know I am
in a relationship... [Recording continues — torn between faith and need to protect
herself.]

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q15. What would make it easier for girls your age to access contraceptives in
Roan?
P04: Yes, I can get them [from a nearby clinic].

Q16. Have you ever tried to get contraceptives from a health facility or clinic?
P04: No.

Q17. What are the main things that stop girls your age in Roan from using
contraceptives?
P04: Because we are being judged. From what I hear from friends, if you go to
the clinic they will criticise you — you are young, you are not yet married, you
cannot be using contraceptives.

Q18. Have you or someone you know stopped using a contraceptive method?
What was the reason?
P04: Yes — someone I know stopped. The reason was that she started
developing side effects. Also, it was not easy for her to access certain
contraceptives she wanted because she was shy going to the hospital, so she
needed to buy them herself.

Q19. What do you think would motivate more girls your age to use
contraceptives consistently?
P04: If they have more knowledge and people who can guide them on how to
use those contraceptives.
Probe: Who is the most trusted person to get advice from?
P04: I think a parent and a teacher.
Probe: What would need to change at the health facility?
P04: They should not be judging us for being young. That is what makes us shy
away from getting contraceptives and ending up with unwanted pregnancies.
Q20. Is there anything else you would like to share?
P04: No.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P05
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the words 'contraceptive' or 'family planning', what comes
to your mind?
P05: Something that prevents pregnancy.
Probe: Where did you first hear about it?
P05: At school.

Q2. What contraceptive methods do you know of?

P05: I know about three. There is condom. Morning after. And jadeo
[Jadelle/implant]. I think that is all.

Q3. For each method, can you tell me what you know about how it works?
P05: For condoms — they just prevent sperm from entering.
Probe: Who do you think these contraceptives are meant for — married
women, young girls, or anyone?
P05: They are for anyone. Because there is no restriction — when you go to buy
a condom from a shop, they don't ask if you are married or not. But at the
hospital, they do ask.
Q4. Where did you get most of your information about contraceptives?
P05: From school and social media.
Probe: Did anyone sit down and properly explain contraceptives to you?
P05: At school they did, yes.
Probe: Was the information clear and easy to understand?
P05: Yes, it was clear.

Q5. Are there things about contraceptives you are not sure about?
P05: Yes. Like — can an injection, what is that called, Siyana [Depo-Provera],
can it prevent STIs? I am not sure about that.
Probe: Have you ever heard that some methods are not suitable for young
girls who have not yet had children?
P05: Yes, I have.
Probe: What have people in your community said about what contraceptives
do to your body?
P05: They say that they reduce fertility.

Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P05: I think they do.
Probe: Do they know enough to make a good choice?
P05: No, they don't.
Probe: What kind of information are they not getting?
P05: They need to be educated more about these contraceptives. They have to
know the advantages and the disadvantages.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives?

P05: For me, no — it is not a good idea.
Probe: Why?
P05: Because I have never given birth before. So I cannot use contraceptives.
Probe: Would you feel differently if you were married?
 P05: I am not sure about that.

Q8. What do your friends think about girls who use contraceptives?
P05: They call them prostitutes.

Q9. What do people in your family think about young girls using
contraceptives?
P05: I am not sure.
Probe: Have you ever talked to your mother or guardians about
contraceptives?
P05: Not really.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P05: I think yes, they should — because they are still at their parents' house, so
parents are responsible for them. They should know everything the girl is doing.

Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P05: [Confidential.] He does not support it.
Probe: Have you ever felt pressured to use or not to use?
P05: No.
Probe: Who should have the final say — a girl or a boy?
P05: [Response on recording — not fully captured in usable portion.]

Q13. In your view, what does it feel like to have power to decide whether to use
a contraceptive or not?
P05: It can feel nice.
Probe: Do you think girls in Roan have that power?
P05: I think yes.

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q14. Have you ever used a contraceptive method?

P05: Right now, no.
Q15. What would make it easier for girls your age to access contraceptives in
Roan?
P05: I think they should just be given out in the community — especially
condoms — instead of going to access them at the clinic.

Q16. Have you ever tried to get contraceptives from a health facility?
P05: No.

Q17. What are the main things that stop girls your age from using
contraceptives?
P05: Some think they have bad side effects. Some [fear] parents. And some feel
embarrassed at the facility. Many who need contraceptives cannot go to the clinic
because they are afraid of being judged.

Q18. Have you or someone you know stopped using contraceptives?

P05: No, I don't know anyone.

Q19. What do you think would motivate more girls in Roan to use
contraceptives consistently?
P05: I am not sure.
Probe: Who is the most trusted person to get advice from?
P05: I think a health worker and a peer. You can be more comfortable with a
health worker — and a peer.

Q20. Is there anything else you would like to share?

P05: No.

End of interview. Participant thanked for time. Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P06
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P06: Family planning — these are methods that people use to avoid getting
pregnant.
Probe: Where did you first hear about it?
P06: I never heard about family planning from any person. I just read about it
from a particular book.

Q2. What contraceptive methods do you know of?

P06: Intrauterine devices. Condoms. And also Diana [Depo-Provera/injectable].

Q3. For each method, can you tell me what you know about how it works?
P06: The intrauterine device is inserted into a female's private part so as to avoid
getting pregnant. A condom is worn by a male or female so as to avoid getting
pregnant. Diana is more like an injection.
Probe: Who do you think these contraceptives are meant for?
P06: Everyone. Because nowadays people engage in sex even when they are
young.

Q4. Where did you get most of your information about contraceptives?
P06: I just read from a book and heard about it on social media.
Probe: Did anyone sit down and properly explain contraceptives to you?
P06: Not really.
Probe: Was the information you read clear and easy to understand?
P06: It was clear.

Q5. Are there things about contraceptives you are not sure about?
P06: I think they don't work. [Participant uncertain.]
Q6. In your experience, do most girls your age in Roan know about
contraceptives?
P06: I am not sure.
Probe: Do you think they have enough knowledge to make a good choice?
P06: I think they are not getting the proper information.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives — good or bad?

P06: It is both a good and a bad idea. It is a good idea because it prevents young
girls from getting pregnant. It is also a bad idea because girls nowadays use
contraceptives anyhow — some contraceptives like the intrauterine device do not
protect girls from sexually transmitted diseases such as HIV and AIDS,
gonorrhoea, and others.

Q8. What do your friends and peers think about girls who use contraceptives?
P06: No — I have not heard girls being talked about negatively because of using
contraceptives.
Probe: What words or names are used for such girls in your community?
P06: I have no idea.
Probe: Does what other people think affect your own choice?
P06: Sometimes yes.

Q9. What do people in your family think about young girls using
contraceptives?
P06: In my family it is not even allowed. Because — why would you take
contraceptives when we are not yet married?
Probe: Have you ever talked to your mother or guardian about contraceptives?
P06: Yes, I have talked to my mum about it. She has a negative thought about it
— a person who is not yet married cannot be taking contraceptives.
Probe: Do you think parents should be involved in a girl's contraceptive
decision?
P06: Yes. Because they have more experience about it and they know more —
they are able to explain what it is all about.
Q10. What role does your partner or boyfriend play in decisions about
contraceptives?
P06: He does support it. But I am against it — because I am not ready to engage
in sex at the moment. I think abstinence is better.
Probe: Have you ever felt pressured to use or not to use?
P06: Yes, there has been pressure.
Probe: Who should have the final say — a girl or a boy?
P06: A girl. Because she is more prone to getting pregnant compared to a boy.

Q11. What does your church or religious community say about

contraceptives?
P06: Church does not allow a person who is not married to use contraceptives
unless... [recording cuts — condition not fully captured].

SECTION D: BARRIERS AND MOTIVATORS TO CONTRACEPTIVE ACCESS

AND USE
Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

Q15. What would make it easier for girls your age to access contraceptives in
Roan?
P06: By going to the clinic nearby. Girls can get them without parents knowing —
either from the clinic or by buying over the counter.

Q16. Have you ever tried to get contraceptives from a health facility or clinic?
P06: No.

Q17. What are the main things that stop girls your age from using
contraceptives?
P06: Cultural beliefs. And sometimes the side effects.

Q18. Have you or someone you know stopped using contraceptive methods?
P06: No.

Q19. What do you think would motivate more girls to use contraceptives
consistently?
P06: If someone can come and explain to them about it.
Probe: Who is the most trusted person to get advice from?
 P06: A health worker and a parent. Parents have vast experience about it. And
the health worker is trained.

Q20. Is there anything else about your experiences you would like to share?
P06: [No further response recorded.]

End of interview. Participant thanked for time. Confidentiality confirmed.

KEY INFORMANT INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 3 — Key Informant Interview (KII) with Healthcare Provider
Participant Code: HP01
Participant Name/Title: Sister Taonga (Registered Nurse, MCH)
Facility: Health facility, Roan Township, Luanshya District
Years at Facility: 10 years
Interviewer: Gladys Kunda (202310003)
Audio Recording: Yes — consent obtained

SECTION A: CONTEXT AND ROLE

QA1. Please tell me about your role here at this facility and the kind of
reproductive health services you provide to adolescent clients.
HP01: I am a registered nurse, stationed in MCH [Maternal and Child Health]. We
do family planning, booking, and all the services — including child health clinics.
All the services in the department are attended to there.
Probe: For how long have you been working here?
HP01: Ten years.
Probe: On average, how many adolescent clients seek family planning
services per month?
HP01: Usually, I think 30 to 40.
Probe: What is the age range of adolescent clients you typically see?
HP01: I can say 16 to 24.
QA2. In your experience working here in Roan Township, how would you
describe the general level of contraceptive use among adolescents?
HP01: They do come. We do have a good number.
Probe: Has this changed over the years?
HP01: Yes. Way back we had few clients, but now I think due to sensitisation and
everything, the number has increased.
Probe: Which methods are adolescents most likely to request?
HP01: I think usually it is the short term — they get either condoms, pills, or
Siyana [Depo-Provera/injectable].
Probe: What do you think is the reason they go for short-term methods?
HP01: I think it is easier. For long-term methods, they are scared maybe their
parents would know — if they put something that will definitely show on their
hand [implant visible on arm]. But with pills, they can just hide them and drink
without anyone noticing. So I think that is why they go for those.

SECTION B: ADOLESCENT KNOWLEDGE OF CONTRACEPTIVES —

PROVIDER PERSPECTIVE
Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods

QB1. In your consultations with adolescent clients, how would you describe
their knowledge and understanding of contraceptive methods available?
HP01: I think they are still learning, but a lot get information from the community.
By the time they are coming, they have a bit of knowledge on what they are
coming to get. But sometimes when they come through, that is when they come
to learn. Sometimes they come with knowledge from the community, but when
you start asking questions, you realise — oh, my friend told me that — and then
eventually we teach them.
Probe: Are there particular methods they are very unfamiliar with?
HP01: For some, yes — because all they know is the three months [injectable].
The majority just know the three months, or the pill, or the condom. They don't
know there are other methods they can access.

QB2. What misconceptions or myths about contraceptives do you most

commonly encounter among adolescent clients?
HP01: Some say once you start — especially for long-term methods — periods
do not stop. You have prolonged periods or heavy bleeding. And for some, they
say once you start, you will not have children in the future.
Probe: Do you also hear fears about side effects such as weight gain, heavy
periods, or effects on future pregnancies?
 HP01: Yes.

QB3. Do adolescent clients who come here have enough accurate information
to make an informed choice about contraceptives?
HP01: Yes, they do — [by the time we are done with them].

SECTION C: ADOLESCENT PERCEPTIONS — PROVIDER OBSERVATIONS

Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

QC1. What do you observe about adolescent attitudes and feelings when they
come to seek contraceptives?
HP01: Some feel shy, especially when they come through and find that there are
people they know — they will even move away. Sometimes they will go away and
come back another day when it is less busy.
Probe: Do they come alone or with someone? Do you notice differences
between married and unmarried adolescents?
HP01: Those that are married are free. They know that at least they have a
home. But those who are single — they are the ones who come in feeling shy.
Some come with friends, but some come alone.

QC2. From what adolescent clients share with you, what role do partners and
family members play in their contraceptive decisions?
HP01: With partners — sometimes they just come on their own, maybe because
she is just scared of getting pregnant. With family members, I think we have had
a few where parents have brought a child — but such cases are very few. On a
scale of one to ten, I would say one to two.
Probe: Do you see cases where a girl wants contraceptives but her partner
opposes it?
HP01: Yes. Some come and get everything covertly because they do not want
their partner to know they are using family planning. We have also had two or
three who do not come on the family planning day — they come on a different
day and say: if I come on the regular day, my boyfriend or husband will follow me
and ask why I am using family planning.

QC3. How do you approach the issue of confidentiality when an adolescent

client comes in for contraceptives?
HP01: Usually we give privacy — not just for adolescents, for everyone who
comes through. We give enough space. We do not talk to them in a group. We
 call them one-on-one in the room so that we communicate privately. They are not
in a big group of people where everyone can hear.
Probe: Have you lost adolescent clients because of privacy or confidentiality
concerns?
HP01: No.

Probe: Do community or religious pressures come up during consultations?

HP01: Maybe — they will say [their family or church] will notice and stop them
from using contraceptives. Some mention this, but it is not a major recurring
theme in consultations.

SECTION D: BARRIERS, MOTIVATORS, AND SERVICE-LEVEL FACTORS

Specific Objective 3: To examine barriers and motivators associated with contraceptive
access and utilisation

QD1. What do you see as the main barriers that prevent adolescent girls in
Roan from accessing and using contraceptives consistently?
HP01: I think the fear of them meeting aunties here — relatives, or even their
mother or child — at the facility. I think that is the main one I can speak to.
Probe: From the supply side — availability of methods, facility hours — are
these barriers?
HP01: For supplies we have been having them throughout. For hours, we do
family planning on a daily basis. We always tell them that if it is not a designated
family planning day, they can come in the afternoon. We do it on a daily basis —
as long as there is nothing stopping us.
Probe: Which barrier do you consider the most significant?
HP01: I think it is the fear of stigma — just being scared of being seen.

QD2. Have you ever encountered situations where attitudes at the facility
unintentionally discouraged an adolescent from seeking contraceptives?
HP01: I think everyone here is oriented on adolescents and we do discuss that —
if any adolescent comes through, we give them whatever they want. But it is only
about that overall attitude towards who is coming in. [Suggesting facility staff are
supportive but community stigma remains the main issue.]

QD3. What motivates adolescent girls to seek contraceptives at this facility

when they do come?
HP01: I think even the approach — the way we receive them. That also
encourages them. We do not chase them away. We welcome them when they
 come, provide whatever they want, give them encouragement, and counsel them
on whatever might be there.

QD4. What changes at the facility, policy, or community level would most
improve adolescent access to contraceptives in Roan?
HP01: I think maybe teaching parents and the community about everything to do
with adolescents — so they understand why we are giving family planning to
adolescents. If we teach the community, then even when a girl comes home after
visiting the facility, people won't shout at her or look down on her for it. Maybe
teaching the community more comprehensively about what adolescents are
supposed to have access to.
Probe: What is already working well that should be expanded?
HP01: We have been giving family planning in the community. If we increase the
people doing family planning outreach in the community, it would be easier for
girls to get contraceptives there without having to come in to the facility.

QD5. Is there anything about adolescent contraceptive use in Roan that you
feel is important for this research to understand, which we have not yet
discussed?
HP01: I think everything has been talked about.

End of interview. Interviewer thanked participant for time and professional insights.
Confidentiality confirmed.

IN-DEPTH INTERVIEW TRANSCRIPT

Study: Adolescent Voices on Contraceptive Choices in Roan Township, Luanshya
District, Zambia
Instrument: Tool 1 — In-Depth Interview (IDI) with Adolescent Girl
Participant Code: P01
Interviewer: Gladys Kunda (202310003)
Language: English
Audio Recording: Yes — consent obtained

SECTION B: KNOWLEDGE AND AWARENESS OF CONTRACEPTIVE METHODS

Specific Objective 1: To assess adolescents' knowledge and awareness of available
contraceptive methods
Q1. When you hear the word 'contraceptive' or 'family planning', what comes
to your mind?
P01: It is a way of preventing pregnancy — a form of managing the way you want
to have children.
Probe: Where did you first hear about it?
P01: [Participant did not respond directly to this probe.]

Q2. What contraceptive methods do you know of? Can you name them?
P01: The injection they give so that it will prevent someone from having a
pregnancy. Then condoms. There is also the natural method — counting the
days, the safe days.
Probe: Which ones do you know by their local name here in Roan?
P01: I don't know any local names. I think condoms — that is what they usually
use.

Q3. For each method you have named, can you tell me what you know about
how it works?
P01: For the injectable — I have a relative who said that it is done at a health
facility by a professional. They inject that thing so that in case of anything, for
example if a family says they want a gap of three years before another child, that
thing will prevent pregnancy even in the middle of intimacy.
Probe: Who do you think it is meant for — married women, young girls, or
anyone?
P01: I think it is meant for married women. Personally, using it as a young person
— it is not, I can say it has not been true to us.

Q4. Where did you get most of your information about contraceptives?
P01: I got it from a health facility. Also, at church — in Girls' Brigade — they
inform us about the dangers of contraceptives. And also from scrolling on social
media; they talk about it there.
Probe: Was the information clearly explained to you by someone?
P01: In my own experience, a health worker explained it quite a bit. But nobody
has just sat me down specifically to explain contraceptives properly. No.

Q5. Are there things about contraceptives you are not sure about — things that
confuse you or that you have heard but are not certain are true?
P01: I have heard that some methods prevent STDs or STIs, not the other. But in
the actual sense, I don't know if it works or it doesn't. I am not sure.
Probe: Have you heard that some methods make girls infertile, or are not
suitable for young girls who have not yet had children?
P01: I have. For that morning-after pill — the more youths use it, they just keep
taking it before meeting a boyfriend. It is misused. That thing should be taken not
more than three times a year, but they overuse it. So the uterus might get
blocked, or you might become barren. You might face miscarriages in the future
without knowing it is connected to overuse of that pill.

Q6. In your experience, do most girls your age in Roan Township know about
contraceptives?
P01: Yes, they do. They know, but the information is not very much — not
sufficient. You find that they know this thing works so they just take it, without
asking for actual advice about dangers and safety. Some know but are just
ignorant about it. They are abusing it knowing it is bad, but they continue anyway.
Probe: Do they know enough to make a good choice?
P01: On my part, I know that these contraceptives are not good. So personally,
my choice is to use contraceptives at the right time — and to do that, I avoid guys
who just want to play around. For girls who don't know enough, they should be
told more about these things so they can at least try to restrain themselves.

SECTION C: PERCEPTIONS AND FEELINGS ABOUT CONTRACEPTIVE

CHOICES
Specific Objective 2: To ascertain adolescents' perceptions and feelings about
contraceptive choices

Q7. How do you personally feel about contraceptives — is it a good or bad

idea for a girl your age to use them?
P01: For me, it is a bad idea. The first reason is that I am spiritually centred. I
believe there is a time for everything. Being a youth does not mean you have to
do everything others are doing. There is self-control for people who are rooted in
God — if they are really true to themselves, they say this thing is for after
marriage. That is how I feel.
Probe: Would you feel differently if you were married?
P01: In marriage, it is okay. There are men who want seven children — then you
can say let us have a minimum of five. For two years, let us go without. So it is
good in marriage so that you have the number of children compared to what your
husband would want.

Q8. What do your friends and peers think about girls who use contraceptives?
P01: Some say it is okay — they are trying to prevent themselves from dropping
out of school, because if she gets pregnant she won't continue her education and
 the community will pin her down. So they say it is good in the sense that it
prevents those consequences, though it can bring diseases. Then others say no
— why should girls use contraceptives when they are still a child? Grow up, your
bones get strong, then you can do what adults do.
Probe: Have you ever heard girls being talked about negatively because they
use contraceptives?
P01: Yes. I passed by some young men and they were saying these girls are
prostitutes — they even call each other over to confirm it. The names they use
are bad, so I won't say them. But usually they call them prostitutes.
Probe: Does what other people think affect your own choice?
P01: No.

[Interview continues — remaining sections on family, partner, religion, barriers, and

motivators to be transcribed from recording continuation.]