Khiaokham, Lawitra
(2025)
Adolescent mothers’ experiences, perceptions, and decision-making regarding subdermal implants and injectables in Northern Thailand:a qualitative grounded theory study.
PhD thesis, University of Nottingham.
Abstract
Background: Adolescent repeat pregnancies remain a significant public health concern in low- and middle-income countries. In Thailand, only 37.6% of postnatal adolescents use modern contraception following childbirth or abortion (Health Data Centre, 2025). While national policies promote subdermal implants and injectables before hospital discharge, uptake remains limited. The reasons for non-use and early discontinuation—particularly within Thai sociocultural contexts—are underexplored. Although global research on postpartum contraceptive use is extensive, few studies have focused on Asian settings, which limits contextual relevance of international findings for the Thai setting.
Aims and objectives: This study explored the factors influencing postpartum contraceptive decision-making among adolescents in Northern Thailand, with specific attention to subdermal implants and injectables.
Method: A constructivist grounded theory approach was employed to explore the contraceptive experiences of postpartum adolescents aged 15–19. Data were collected through semi-structured, in-depth interviews with participants who had attended a postpartum appointment within one year of giving birth. The study was conducted in two hospitals offering free subdermal implants and injectables. Ethical approval was obtained from the University of Nottingham, Chiang Mai University, and the Health Promotion Centre Region 1. Data collection and analysis followed an iterative, comparative process consistent with grounded theory. Interview transcripts and field notes were analysed concurrently to develop a conceptual model of adolescent contraceptive decision-making.
Findings: Twenty-five adolescent mothers were interviewed between August 2020 and February 2021. Nineteen interviews were conducted in person, and six online due to COVID-19 restrictions. A core category was identified “Maintaining Social and Bodily Integrity: An Iterative Process of Responding to Situational Dynamics.” Contraceptive decision-making was conceptualised as a fluid, non-linear process shaped by personal priorities, interpersonal relationships, institutional constraints, and sociocultural norms. Four analytical categories underpinned the conceptual model: (1) Navigating and Interpreting Contraceptive Knowledge; (2) Seeking Balance between Competing Priorities; (3) Contraceptive Care Pathways within the Healthcare System; and (4) Relational and Cultural Influences on Contraceptive Decision-Making.
Adolescents demonstrated individual agency—defined as the capacity to act, decide, and adapt—through three intersecting and socially embedded pathways. Agency was enacted in ways that reflected autonomy and constraint, shaped by structural and interpersonal dynamics: (1) Proactive (individually initiated), (2) Service-oriented (institutionally shaped), and (3) Relationally mediated (influenced by family and community interactions).
Implications: This study presents a culturally grounded, youth-centred model that emphasises integrated care pathways, continuity of care, shared counselling, and family engagement, while foregrounding adolescents’ reproductive autonomy. By theorising agency as dynamic and multi-layered—across individual, institutional, and relational domains—the model offers a transferable framework for understanding adolescent reproductive decision-making. While context-specific, the model remains relevant for similar Southeast Asian settings and advances reproductive agency as a multi-level and context-sensitive process.
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