Globally, sexual and reproductive health (SRH) of adolescents
remains a major public health concern. While many programmes and
interventions have been implemented to change young people’s SRH
risk behaviour or promote healthy behaviours, their impact on SRH
outcomes remains inconsistent. Decision-making theories, which lie
at the basis of most interventions and which focus primarily on
individual knowledge and behaviour, are often of limited explanatory
power in complex everyday situations, as is the case for SRH health
behaviour. They fall short of providing a causal explanation for action
as contextual factors, or competing interests, are usually unknown
and are not considered in rational choice models. Hence, if rational
choice theory is limited in explaining health-related decision-making,
other approaches are needed. Neo-institutional theories that address
institutions (i.e. rules, norms, and regulations present in the
household, community and society), investigating the influence of
regulatory frameworks on individual and collective action, are
potentially more fruitful for public health research. Hence, the main
objective of the study is to develop a context-sensitive theory around
the influence of institutions on individuals’ SRH choices. This will be
done through mixed methods research alternating in-depth
qualitative research with a cohort study. The study will focus on
young people's (15-24) family planning decision-making in Zambia.