Condom negotiation among adolescent mothers in a resource-constrained setting: a COM-B analysis with implications for...

Condom negotiation among adolescents is a critical component of sexual and reproductive health, yet significant gaps persist between knowledge and behaviour. Traditional interventions focus on awareness and place less emphasis on how environmental pressures and internal emotional factors interact to disrupt negotiation. This qualitative study explores the behavioural determinants of condom negotiation among adolescent mothers, specifically examining how capabilities, opportunities, and motivations influence sexual health choices within the COM-B framework. Data collection focused on assessing participants' physical and psychological capabilities, external social and physical opportunities, and both automatic and reflective motivations regarding sexual negotiation. The findings reveal a core contradiction in adolescent behaviour; adolescent mothers possess sufficient capabilities, but these advantages are completely offset and negated in real-world situations. Under reflective motivation, most participants endorsed condom use. However, in real-sexual situations, external factors such as peer stigma and gender power inequalities, combined with negative automatic motivation and immediate impulses, consistently discourage negotiation. Thus, condom negotiation is a dynamic process shaped by external environmental constraints and internal emotions rather than simple personal skills; capability does not guarantee action. Consequently, sexual health interventions must move beyond basic skill-building to actively tackle social stigma, gender power dynamics, and immediate psychological barriers to protect adolescent well-being.