Barriers and facilitators of reproductive autonomy of adolescent girls in western Uganda: a qualitative inquiry

Reproductive autonomy, the power to make decisions about and to control matters related to contraceptive use, pregnancy, and childbirth, is essential for women to attain their sexual and reproductive health and rights. We explored barriers and facilitators of reproductive autonomy among adolescent girls in western Uganda, a region marked by high rates of adolescent pregnancy and HIV prevalence. This qualitative inquiry involved 31 in-school and out-of-school adolescent girls aged 15 to 19 years, purposively selected from diverse communities within Fort Portal city, western Uganda. Data were collected through individual interviews between September and November 2024 and analysed using framework thematic analysis guided by the three dimensions of reproductive autonomy: decision-making, communication, and freedom from coercion. The findings show an intricate interaction of individual, relational, and structural factors that shape adolescent girls' reproductive autonomy, with commonalities and uniqueness based on schooling status. Key barriers included control by parents and partners in communication and decision-making, limited knowledge of girls on sexual and reproductive health, low self-efficacy to decide and implement decisions, financial dependence, and lack of life basics. Conversely, supportive relationships and schooling emerged as critical facilitators. In conclusion, enhancing reproductive autonomy requires multi-level and multi-faceted interventions to address the barriers while leveraging the facilitators. These should include household economic empowerment, parenting support programs, and policies that promote universal access to education.