Table 2 Additional Participant Quotes by Theme

Broad awareness that early pregnancy can be harmful to adolescent girls

We tell them that if they happen to deliver using the normal way, the passage area may tear and they may begin to urinate uncontrollably. Due to such a problem, one may never get married. That is what we tell them. Initiation Counselor; ZDB01

If they become pregnant whilst still young, when they go to give birth, a knife is used to cut their belly and remove the baby inside them because it is impossible to deliver normally. Initiation Counselor; ZDB01

It is not good to give birth before 18; there are serious complications that happen when you give birth before 18, I tell them they can die, they can miscarry. M/FG; YAA02

If a girl has sex with a man she will get pregnant or HIV and other sexually transmitted diseases. She may even become barren or die from complications of giving birth if the mother is under 18. M/FG; YAA02

They say when you get pregnant before 18 you go through a lot of complications, because the body parts are not yet strong enough or matured to give birth. 14-year-old girl; XKB02

Girls who give birth while young [before age 18] can give birth through Cesarean and can have a pre-mature birth. 18-year-old girl; XGA01

Gender norms and poverty encourage early sexual debut

At [age] 8 they have already started sleeping with men to get financial and material support to get their needs met. M/FG YAA03

Sometimes girls do have many relationships because they want money to fulfill their heart’s desires. MF/G; YCA02

Most men in this village do business and they take that as an advantage that they have money and can propose any young girl and the girls don’t say no because they are attracted to the money they are given. MF/G; YCC01

Most of them expect us to have sex with them whenever they feel like having, and when they get them [girls] pregnant they start telling them to abort. 18-year-old girl; XKA04

They impregnate a girl and he starts to reject the pregnancy and the boy starts insulting the girl. A girl cannot deny [sex] because she is afraid that the boy will not be giving money to her. 15-year-old-girl; XBA01

Many boys want to be in a relationship with you because you are still at school, they promise so many things that they don’t fulfill. What they want is to have sex with you and get you pregnant, at the end they deny the pregnancy. 15-year-old girl; XBC01

Female education is valued, but threatened by pregnancy

[I dropped out of school because] my parents were not able to provide my needs, personal needs. I was admiring my friends so I decided to have a relationship to give me money to fulfill my heart’s desires and later found myself pregnant. M/FG; YCB03

I have learned that you are not supposed to start having sex while still in school. You are supposed to start after finishing secondary school. [If you have sex] you can get pregnant and drop out of school; you can get HIV/AIDS. 14-year-old-girl; XKA01

The boys impregnate a girl and then leave her. She has to leave school. Girls may want to return [to school] after, but that is very difficult. 14-year-old girl; XKB02

My parents could not afford to raise money to pay school fees for all of us in the family, I dropped out and got pregnant. M/FG; YCA01

Desire for outside experts as teachers and role models

Yes, there will be a change [fewer pregnancies among girls under 18] because they will realize the importance of a message coming from people who live far away. M/FG; YDA02

When they [GAIA women, counselors, etc.] are educating us, many people especially girls, gather so this helps us to exchange information and we learn more. 16-year-old girl; XBS01

When the social counselors come into the picture, they [girls] tend to begin valuing such advice as true and helpful. M/FG; YDA02

Girls admire the life of the one telling them [social counselor/ role model], therefore they listen and do according to what they have been advised, thinking that perhaps their lives will become more like the life of the counselor. M/FG; YDA02

There must be regular meetings about these issues in the villages and role models must come as a way of convincing the girls. M/FG; YFB01

If mentorship programs can be added, girls can get encouraged to learn from them, concentrate in school and become like them. M/FG; YCC01

A range of impediments to contraceptive use exist

I tell them contraception ways can look attractive but they are dangerous to girls who are not yet married. They have their own side effects that can make them never to bear children in the future. M/FG; YKB03

We don’t tell them the use of condoms [at initiation ceremonies], condoms are not trustworthy… Condom doesn’t make any sense to me. Initiation counselor; ZFA02

It’s not necessary for them between 10 to 18 years of age [to learn about contraception]. They are supposed to wait until their time comes… In initiation camps, no one can tell them the use of condoms or contraception. Initiation counselor; ZFC01

Girls should learn, but they should not be given contraceptives, because using contraception will make them to have problems in future, like damage to the uterus. 18-year-old-girl; XBA02

13-year-old girl; XBB01

SRH education starts too late

If they hear more about this [SRH] at a tender age, it disturbs their school plans. It really gives problems to those under 18 of age because the information reaches their shallowest point of their mind due to immaturity. MF/G; YFA01

Actually, it [providing SRH information] is only when we start observing their movements. For example, a child could just leave the house… and returns very late. She sometimes answers in a challenging manner when questioned and sometimes gives rude remarks [indicating she has begun to have sex]. M/FG; YDC02

At [age] 8 they have already started sleeping with men, so according to me age does not matter but maybe if parents start advising them while they are still young even before they reach 8. M/FG; YCC01

Most parents start counseling their children at 15, missing it at 10, 11, 12, 13, 14. To start counseling them at 15, it’s too late, and within 2–3 years you will find out that she is pregnant. So maybe the counseling can start as early as 8 years old. M/FG; YCB03

I tell them that when they have come of age, starting to experience their menstruation period, it means they are now in a danger zone, but actually I don’t sit them down to tell them the actual details because it’s not appropriate at this stage. MF/G; YFA01

Initiation practices that encourage sexual activity

If you go for initiation, they told you to sleep with a man after you have been initiated. So if you didn’t have any idea before, you want to try sex because you have been initiated. 18-year-old-girl; XBA02

At traditional initiation camps, they [girls] are told to bend and dance in a sexual manner. When that girl comes out of the initiation camp she will begin having sex because that is what she has been taught. They are taught how men perform in bed. Initiation counselor; ZDB01

We tell them to remove dust after finishing an initiation to cleanse themselves. Removing dust is our traditional way of doing things where by on the day of releasing the girls from the camps, men are arranged to have sex with them in that way they have been cleansed. Initiation counselor; ZCC02

They are taught that after initiation they should go and have sex for the first time, which is called sexual cleansing. Initiation counselor; ZZA01

M/FG; YWA02

I think girls must not be sent to camps because when they come back they are completely changed, they go astray. But if a parent can take part in the counseling process it can be good. M/FG; YAA02