Informed Consent Form (For Participants Aged 18–19 Years)
Study Title:
Factors Associated with Teenage Pregnancy: Complications, Knowledge and Use of
Family Planning, and Prevention Strategies
Introduction:
You are invited to take part in this research study. Before you decide, please read the
following information carefully. The purpose of this form is to help you understand what
participation involves so you can decide whether or not to take.
The study seeks to explore socio-demographic factors, complications during pregnancy,
knowledge and use of family planning, and prevention strategies associated with teenage
pregnancy among adolescents attending this health facility. If you agree to participate,
you will be asked to answer questions in a structured questionnaire. The interview will
take about 20–30 minutes and will be conducted privately to ensure confidentiality. There
are no major risks in this study. However, some questions may feel personal or sensitive.
You may choose not to answer any question that makes you uncomfortable. While you
may not directly benefit, your participation will help generate knowledge that may
improve reproductive health services for adolescents. All information you provide will be
kept confidential. No names will be recorded. Instead, a code number will be used. Data
will only be used for academic purposes. Your participation is voluntary. You can refuse
to participate or withdraw at any time without any consequences to the services you
receive at this facility.
Contact Information:
If you have questions about this study, you may contact:
Principal Investigator: Salome Onyango
Tel: +254711904922
I have read/been read the information above. I understand the purpose of the study and
what participation involves. I voluntarily agree to participate.
Signature/Thumbprint: _____________________________________________________
Date: ___________________________________________________________________
Researcher’s Signature: _______________________
Assent Form (For Participants Aged Below 18 Years)
Study Title:
Factors Associated with Teenage Pregnancy: Complications, Knowledge and Use of
Family Planning, and Prevention Strategies
Introduction:
We are doing a study to learn about teenage pregnancy. Because you are under 18, we
would like to ask for your permission (assent) to participate. Your parent/guardian will
also give consent for you to join. If you agree, you will be asked some questions in a
private place. This will take about 20–30 minutes. Some questions may feel personal, but
you don’t have to answer if you don’t want to. The study may not help you directly, but
the information will help improve health services for young people. Everything you say
will be kept private. No one will know your answers. You don’t have to take part if you
don’t want to. Even if you agree now, you can change your mind later.
Assent Statement:
I have been told about the study in a way I can understand. I know I can ask questions,
and I can stop at any time. I agree to take part.
Signature: ____________________________________________________________
Date: ____________________
Researcher’s Signature: _______________________
QUESTIONNAIRE
Study: Determinants of Teenage Pregnancy
Target: Female adolescents aged 13–19 years
Enumerator Header (Do not ask respondent)
E0. Date (DD/MM/YYYY): ___/___/____
E1. Questionnaire ID: ______
Section A: Socio-Demographic Characteristics
Q1. Exact age (in completed years): ___ (13–19)
Q2. Current school status: 1=In school, 2=Completed secondary, 3=Dropped out,
4=Never attended, 5=TVET/College
Q3. Highest education level attained: 1=None, 2=Primary incomplete, 3=Primary
complete, 4=Secondary incomplete, 5=Secondary complete, 6=post-secondary
Q4. Marital/union status: 1=Never married/in union, 2=Married/cohabiting,
3=Separated/divorced, 4=Widowed
Q5. Living arrangement: 1=Both parents, 2=Single parent, 3=Guardian/relatives,
4=Alone, 5=Partner/spouse, 6=Other (specify)
Q6. Main religion: 1=Christian, 2=Muslim, 3=Traditional/Other, 4=None
Q7. Approx. monthly household income (local currency): 1=Lowest tertile, 2=Middle
tertile, 3=Highest tertile, 9=Don’t know/No response
Section B: Reproductive History / Incidence
Q8. Have you ever been pregnant? 0=No → SKIP to Q12 | 1=Yes
Q9. Age at first pregnancy (years): ___ (If Q8=1 only)
Q10. Current pregnancy status: 0=No, 1=Yes
Q11. Number of lifetime pregnancies (gravidity): 0=None, 1=One, 2=Two, 3=Three or
more
Section C: Complications During Pregnancy
Q12. Did you experience any health problems/complications during your most
recent/current pregnancy? 0=No → Skip to Q14 | 1=Yes
Q13. Which complications did you experience? (Multiple responses)
a) Anemia b) UTI c) Hypertension/pre-eclampsia d) Hemorrhage/bleeding
e) Prolonged/obstructed labour f) Miscarriage/abortion g) Sepsis/infection
h) Low birth weight/prematurity i) post-partum depression j) Other (specify)
Q13K. Care sought for complications? 0=No care, 1=Public facility, 2=Private,
3=Pharmacy, 4=Traditional/other
Section D: Knowledge and Use of Family Planning (FP)
Q14. Have you heard of the following FP methods? (Multiple response, 0=No, 1=Yes)
a) Male condom b) Female condom c) Oral pills d) Injectables e) Implant
f) IUD g) Emergency contraception h) Fertility awareness i) Withdrawal/other
Q15. Ever used any modern FP method? 0=No, 1=Yes
Q16. Current FP use: 0=None, 1=Condom, 2=Pills, 3=Injectable, 4=Implant, 5=IUD,
6=Emergency only, 7=Traditional
Q16b. Main reason for non-use (if Q16=0): 1=Desire pregnancy, 2=Fear of side effects,
3=Opposition, 4=Lack of access/cost, 5=Lack of knowledge, 6=Religious, 7=Not active,
8=Other
Section E: Prevention Strategies
Q17. Exposure in last 12 months (0=No, 1=Yes):
a) School-based sexuality education b) Youth-friendly services c) Peer/community
education d) Media campaign
Q18. Parent/guardian communication about sex/FP (past 6 months): 1=Never, 2=Rarely,
3=Sometimes, 4=Often, 5=Very often
Q19. Perceived effectiveness of strategies (1–5 Likert):
a) School sexuality education b) Free access to LARCs c) Youth-friendly clinic
services
d) Cash/fee support e) Parent communication programs f) Community/faith
engagement
Q20. Which single strategy would work best? 1=School CSE, 2=LARC access, 3=Youth-
friendly services, 4=Media campaigns, 5=Parent programs, 6=Cash/transport,
7=Community/faith, 8=Other
