Family planning (FP) is widely recognized for its role in reducing maternal and infant mortality as well as enabling women, men and couples to choose when and if they would like to have children [1]. Yet, about 218 million women of reproductive age in low- and middle- income countries (LMIC) report that they would like to avoid a pregnancy but are not using a modern family planning method, a concept commonly referred to as unmet need for modern contraception [1]. Unmet need is high among young people in sub-Saharan Africa (SSA) and as a result, approximately 37% of pregnancies among adolescent girls ages 15–19 and 27% of pregnancies among women ages 20–24 in SSA are unintended [1, 2]. To address these issues, the global community has recognized the importance of ensuring that the sexual and reproductive health needs of young people are met through enabling access to high quality family planning care for all [3, 4, 5, 6]. Given that young people often experience many key life transitions between ages 15–24, such as initiation of sexual activity, marriage and childbearing [7, 8, 9], it is critical that they have access to information and services to meet their evolving reproductive health needs in this period [3, 4, 5].
Kenya, the site of this study, has been the focus of international attention in recent years due to concerns about high levels of teenage pregnancy, recently considered to be exacerbated by the global COVID-19 pandemic [10, 11]. The 2014 Kenya Demographic Health Survey (KDHS) shows that 15% of young women ages 15–19 have already begun childbearing and 3% were pregnant with their first child [12]. Kenyan women and men typically have their first sexual experience in their teenage years and women’s median age for first birth is 20.3 years [12]. These overall estimates mask differences by region, wealth status and education level, with sexual initiation and age at first birth occurring earlier for young people living in rural areas, of lower wealth status and with less education [7, 8, 9, 12]. Additionally, the adolescent and youth years are characterized by evolving family planning needs depending on age, relationship status, life goals and fertility desires [13, 14]. Modern contraceptive use in Kenya among young women ages 15–24 who are in union is almost 10 percentage points higher than that of unmarried sexually active young women (56% vs. 48%) [9]. Further, contraceptive method mix among young women in union is dominated by injectables and implants whereas unmarried, sexually active young women use a similar set of methods with highest use of injectables, followed by implants and condoms [9]. Contraceptive use and method mix are often not reported for men, though some studies have shown that young men report using predominantly condoms for dual prevention of pregnancy and sexually transmitted infections [15, 16].
It is well established, both globally and in Kenya, that a woman’s social environment, inclusive of her family, peers and community, plays an important role in influencing reproductive behaviors [17, 18, 19, 20, 21, 22]. An individual’s behavior can be influenced through interactions with her or his social network, whereby broader social networks can serve as a source of new information and ideas and have been shown to be associated with contraceptive use [21, 23, 24]. Additionally, behavior can be influenced by social norms which guide social conduct and dictate what individuals should and should not do [25]. There is growing interest in exploring the role of social norms on FP behaviors, including modern contraceptive use [26, 27, 28, 29, 30]. In a review by Costenblader and colleagues (2017), the authors demonstrated that in all 17 included studies, which spanned the globe, there was a significant relationship between social norms supportive of contraceptive use and increased contraceptive use [26]. Yet few studies examined the role of social influences on contraceptive method choice, that is, not just the decision to use or not to use a method, but also the choice of method type. A study undertaken in Thailand in 1994 found that women with a more extended social network, defined as having more extended kinship ties, were more likely to use modern contraceptives and further, predicted use of oral pills, intrauterine device (IUD) and injectables increased as the number of kinship ties increased [24]. Using social network analysis, studies in Cameroon [31] and Bangladesh [32] found that there was a relationship between the method used by the respondent and the methods used by members of her social network, in that women were frequently connected to others who used similar methods. These studies reflect that a woman’s own contraceptive method choice is sensitive to the methods that her network members use.
The global community has long recognized the importance of including men in programs and research on FP, in part because spouses or partners are important decision makers regarding reproductive behaviors. Men have been shown to positively and negatively influence contraceptive use through couple communication, procurement of contraceptive methods, reinforcement of myths and stereotypes about contraceptive users and contraceptive methods and even restricting their partner from using contraceptives [33, 34, 35, 36]. Qualitative research from rural Malawi shows that social influences function differently for men and women, with men making conclusions about contraceptive use in their community based on their own observations whereas women relied on direct conversations with their social network to inform their conclusions [37]. Further, a longitudinal study from rural Kenya has shown that men’s social networks may be more influential on men’s contraceptive use decisions as compared to the influence of women’s social networks on their contraceptive use [22]. This points to the need for more research on social influences on contraceptive use and choice among men.
Overall, the role of social influences on contraceptive use and method choice is understudied among young people in sub-Saharan Africa. This gap is notable given that adolescence and young adulthood is the time when social influences, particularly peers, are important and influential [38, 39]. Peers may play both a positive and negative role in influencing behaviors, as they have been shown to be a trusted source of information about family planning and at times model positive behaviors, but yet have also been found to share incorrect information, perpetuate myths and reinforce social norms that dictate when and if young people, particularly young women, should engage in sexual activity [33, 35, 40, 41]. Existing evidence among young people supports that peers influence contraceptive use [33, 35] and specifically condom use [42, 43, 44, 45], but given that Kenya’s contraceptive method mix among young people includes a range of methods, including implants, injectables and condoms, it is important to better understand if social influences are associated with method use and choice, including commonly used hormonal methods. In this context of high teenage pregnancy and substantial evidence on the role of social influences on contraceptive use among women of reproductive age, it is important to understand the role of social influences on contraceptive method choice among both young women and men. This knowledge can inform programmatic strategies seeking to provide full, accurate information to young people and their peers to support young people’s use of the method of their choice.
This paper aims to address these gaps by utilizing data from young women and men ages 15–24 years in Kenya. Using rich data collected in 2018 and 2019, this paper explores the influence of perceptions of peers’ use of contraceptives on contraceptive method use and choice among sexually experienced young women and men.