Key Social Norms Take-aways The study highlights how social norms around adolescent sexuality and contraception—especially beliefs that family planning is only for married women and that boys should be responsible for condom procurement—shape young women’s sexual decision-making. While many girls exhibited strong agency, clear future goals, and negotiation skills around condom use, normative stigma surrounding contraceptive use limited their access to and use of broader family planning methods. Addressing these restrictive norms is essential to empower girls with full autonomy over their reproductive choices.
Objectives To explore the psychosocial and environmental factors that influence sexual decision-making among adolescent girls in Bolgatanga, Ghana, who have not experienced pregnancy, and to identify protective elements that may help prevent teenage pregnancy.
Methods The study employed qualitative methods, conducting 20 semi-structured in-depth interviews with never-pregnant adolescent girls aged 14–19. The interviews explored themes such as relationships, sex, contraception, and decision-making, using a framework that included attitudes, knowledge, risk perception, self-efficacy, and social norms. Thematic analysis was applied using a grounded theory approach.
Results Girls reported open communication with mothers and peers about sex, although parental discussions were often limited to moral warnings. Most girls received at least some form of sex education at school, including condom use demonstrations. Participants had high awareness of pregnancy risks, strong self-efficacy to negotiate condom use, and positive attitudes toward condoms. However, there was widespread stigma and misinformation around family planning methods beyond condoms, which were viewed as inappropriate for unmarried girls. Condom responsibility was commonly assigned to boys, and none of the girls reported purchasing condoms themselves. All participants had clear life goals and employed strategies like condom use or avoiding relationships to avoid pregnancy and remain in school.
Conclusions Parental support, goal-setting, and comprehensive sex education appear to be protective against teenage pregnancy. However, harmful social norms around contraceptive use and gendered expectations about condom responsibility constrain girls’ ability to fully control their reproductive health. Interventions should include norm-change strategies that empower girls, engage parents, and promote broader acceptance of family planning use among unmarried adolescents.