The mediating role of partner communication on contraceptive use among adolescent girls and young women participating in a small-group intervention in Malawi: A longitudinal analysis

ABSTRACT

Though effective reproductive health interventions have been developed for adolescent girls and young women (AGYW) in sub-Saharan Africa, few have explored whether specific components of the interventions are responsible for observed changes in behaviour. Data for this longitudinal mediation analysis come from a quasi-experimental, sexual and reproductive health study conducted among AGYW (age 15–24) in Malawi. We assessed the extent to which the relationship between attending communication-specific small-group sessions and contraceptive use at one-year was mediated by contraceptive communication with partners at six months, using a bootstrapping procedure to estimate indirect effects. Of 358 participants, 44% attended communication-specific small-group sessions, 37% communicated with partners about contraception at six months, and 21% used non-barrier contraception at one-year. Participants who attended communication-specific small-group sessions had increased contraceptive communication with partners at six months (aOR = 1.48, 95% CI: 1.07–2.38) and increased non-barrier contraceptive use at one-year (aOR = 3.53, 95% CI: 1.86–6.69). The relationship between attending communication-specific small-group sessions and non-barrier contraceptive use at one-year was partially mediated by contraceptive communication with partners at six months (indirect effect = 0.04, 95% CI: 0.01–0.07). Our results suggest that contraceptive communication with partners is modifiable through interventions and important for AGYW non-barrier contraceptive uptake.

KEYWORDS:

• Partners
• communication
• adolescents
• contraception
• longitudinal mediation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

NLB was supported by the National Institutes of Health Fogarty International Center (R25 TW009340) and National Institute of Allergy and Infectious Diseases (T32 AI00700140). NER was supported by funding from the National Institutes of Mental Health (R00 MH104154). The Girl Power study is funded by Evidence for HIV Prevention in Southern Africa (EHPSA), a DFID program managed by Mott MacDonald.