title: What Influences Adolescent Girls' Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh.
abstract: BACKGROUND
  Bangladesh has the highest rate of adolescent pregnancy in South Asia. Child marriage is one of the leading causes of pregnancies among adolescent girls. Although the country's contraceptive prevalence rate is quite satisfactory, only 52% of married adolescent girls use contraceptive methods. This qualitative study is aimed at exploring the factors that influence adolescent girls' decision-making process in relation to contraceptive methods use and childbearing.
  
  
  RESULTS
  We collected qualitative data from study participants living in Rangpur district, Bangladesh. We conducted 35 in-depth interviews with married adolescent girls, 4 key informant interviews, and one focus group discussion with community health workers. Adolescent girls showed very low decision-making autonomy towards contraceptive methods use and childbearing. Decisions were mainly made by either their husbands or mothers-in-law. When husbands were unemployed and financially dependent on their parents, then the mothers-in-law played most important role for contraceptive use and childbearing decisions. Lack of reproductive health knowledge, lack of negotiation and communication ability with husbands and family members, and mistrust towards contraceptive methods also appeared as influential factors against using contraception resulting in early childbearing among married adolescent girls.
  
  
  CONCLUSIONS
  Husbands and mothers-in-law of newly married adolescent girls need to be actively involved in health interventions so that they make more informed decisions regarding contraceptive use to delay pregnancies until 20 years of age. Misunderstanding and distrust regarding contraceptives can be diminished by engaging the wider societal actors in health intervention including neighbours, and other family members.
authors.affiliation: Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: A S M
authors.initials: AS
authors.lastname: Shahabuddin
authors.affiliation: Unit of HIV/AIDS Policy, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Christiana
authors.initials: C
authors.lastname: Nöstlinger
authors.affiliation: Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Delvaux
authors.affiliation: James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
authors.forename: Malabika
authors.initials: M
authors.lastname: Sarker
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Azucena
authors.initials: A
authors.lastname: Bardají
authors.affiliation: Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Vincent De
authors.initials: VD
authors.lastname: Brouwere
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Jacqueline E W
authors.initials: JE
authors.lastname: Broerse
mesh_terms: D000293:Adolescent; D001459:Bangladesh; D002648:Child; D003267:Contraception / Q000523:psychology* / Q000706:statistics & numerical data; D003657:Decision Making; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008393:Marriage; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult