The Role of Partners, Parents and Friends in Shaping Young Women's Reproductive Choices in Peri-urban Nairobi: A Qualitative Study

"While accessing information about FP [family planning] from key influencers is important to women, they are thus exposed to the norms and misconceptions perpetuated in their normative context about FP before they make their final decision on using FP."

Contraceptive use among young women in Nairobi, Kenya, remains low despite high general knowledge of family planning (FP) methods. Women's FP decisions are influenced by social norms, the unwritten rules of appropriate actions within social networks, and are shaped by the advice and information of partners, parents, and friends. The aim of this study was to understand how key influencers uphold and transmit information and norms about FP and to explore how women in peri-urban Nairobi anticipate normative reactions or sanctions.

Phone interviews were conducted with 40 participants across 7 wards in Nairobi in November 2020, during the COVID-19 pandemic. Participants were 16 women (W) between 18 and 25 years of age, 10 partners (P), and 14 key influencers (KIs). To understand young women's experiences accessing information or FP methods, respondents were asked to reflect on their own experiences and/or the experiences of other women through the use of a vignette of a 23-year-old young woman named Wanjiku who lives in the same neighbourhood as participants with her parents and siblings and is considering using modern FP methods.

Thematic analysis revealed that the process of navigating social circles for trusted people to discuss FP with is an ongoing process, where women seek people who will keep their FP use secret to avoid shame and sanctions. Women weighed prescribed norms of chastity before marriage and the fear of disappointing their families by using FP to prevent shame or pregnancy alongside the risk of "suffering" associated with early pregnancy.

In making a decision about FP use, women consulted KIs - mothers, aunts, partners, friends, and/or healthcare providers (HCPs) - based on whom they deemed trustworthy to keep their FP use secret and described less trust to speak with men about FP in their social networks. Mothers understood the social risks of using FP and so could advise on its discreet use, and aunts were approachable sources of impartial information about FP. The main reason HCPs were identified as a trusted source of information was the sense they would preserve women's privacy. While women also describe the support they anticipate from friends as mixed, they highlight the importance of sharing anecdotal information or experiences in making FP decisions. Although women identified partners as key decision makers, they were aware that power imbalances might affect final FP choices. One of them said: "Some husbands think they are the only ones who can make decisions in the home. A woman has no right to talk." Women also said using FP could indicate a lack of trust in the relationship or might be perceived by partners as a license to have sex with multiple men.

The findings underscore the importance of FP interventions working with women's social networks and addressing social norms influencing women's decisions in using FP. Interventions to change FP norms should:

• Consider dynamics of secrecy, trust, and emotional closeness that affect FP discussions among women's networks. Such efforts should not be one-off, or only focused on education or awareness-raising activities with KIs but should, rather, engage with the relational context and ongoing nature of these conversations.
• Meet the need for further training to change norms that HCPs hold - in particular, beliefs about why unmarried women in particular access FP.
• Involve men in FP interventions, including efforts to address harmful norms and attitudes about FP.
• Conduct future research to explore which relational spaces are most effective to transmit accurate information to women deciding on whether or not to use FP, and further explore the norms held by KIs. In particular, longitudinal qualitative studies could be instructive in understanding the ongoing conversations women have with KIs in their social networks and how they navigate questions of shame and secrecy as they make decisions about FP.