title: Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana.
abstract: BACKGROUND
  Adolescent pregnancy remains a public health concern, with diverse serious consequences, including increased health risk for mother and child, lost opportunities for personal development, social exclusion, and low socioeconomic attainments. Especially in Africa, teenage pregnancy rates are high. It is important to find out how girls without pregnancy experience differ in their contraceptive decision-making processes as compared with their previously studied peers with pregnancy experience to address the high rate of teenage pregnancies.
  
  
  METHODS
  We conducted semi-structured in-depth interviews with never been pregnant girls (N = 20) in Bolgatanga, Ghana, to explore the psychosocial and environmental factors influencing the sexual decision making of adolescents. Themes such as relationships, sex, pregnancy, family planning and psychosocial determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behavior guided the development of the interview protocol.
  
  
  RESULTS
  Results showed that the girls did talk about sexuality with their mothers at home and did receive some form of sexual and reproductive health education, including the use of condoms discussions in school. Participants reported high awareness of pregnancy risk related to unprotected sex, were positive about using condoms and indicated strong self-efficacy beliefs towards negotiating condom use. The girls also formulated clear future goals, including coping plans such as ways to prevent unwanted pregnancies to reach these targets. On the other hand, their attitudes towards family planning (i.e., contraceptives other than condoms) were negative, and they hold boys responsible for buying condoms.
  
  
  CONCLUSIONS
  An open parental communication on sexuality issues at home, comprehensive sex education in school and attitude, self-efficacy, risk perception towards contraception, alongside with goal-setting, seem to be protective factors in adolescent girls' pregnancy prevention efforts. These factors should be targets in future intervention programs at the individual, interpersonal, and school and community levels.
authors.affiliation: Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands. john.krugu@maastrichtuniversity.nl.|Adolescent Sexual & Reproductive Health Unit, Youth Harvest Foundation, Bolgatanga, Ghana. john.krugu@maastrichtuniversity.nl.
authors.forename: J K
authors.initials: JK
authors.lastname: Krugu
authors.affiliation: Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands.
authors.forename: F E F
authors.initials: FE
authors.lastname: Mevissen
authors.affiliation: Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Prinsen
authors.affiliation: Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands.
authors.forename: R A C
authors.initials: RA
authors.lastname: Ruiter
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D017280:Condoms / Q000009:adverse effects; D003268:Contraception Behavior / Q000208:ethnology; D003657:Decision Making; D005193:Family Planning Services / Q000193:education; D005260:Female; D005869:Ghana; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D007398:Interpersonal Relations; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000208:ethnology / Q000523:psychology; D011275:Pregnancy, Unwanted / Q000208:ethnology / Q000523:psychology; D036301:Qualitative Research; D060728:Reproductive Health / Q000193:education / Q000208:ethnology; D021841:Safe Sex / Q000208:ethnology; D020377:Self Efficacy; D012736:Sex Education
keywords: Adolescents; Condom use; Contraception; Determinants; Ghana; Teenage pregnancy