Improving measurement of girls and young women's reproductive experiences: qualitative findings from research in Kenyan family planning clinics.

INTRODUCTION: Girls and young women's reproductive health and autonomy are shaped by multiple interconnected factors. Quantitative research, including widely used measurement scales, may overlook or misrepresent key dimensions of girls and young women's experiences, limiting our ability to understand, characterise and advance their reproductive health and rights. Strengthening measurement tools can yield deeper insights and drive more effective policies and programmes. METHODS: We conducted a qualitative study exploring girls and young women's (aged 15-19 years) experiences accessing and using family planning services and contraceptive methods in Uasin Gishu County, Kenya. This included reflexive thematic analysis of 35 in-depth interviews and seven focus group discussions (FGDs) with 42 girls and young women, along with five FGDs with 27 family planning clinic providers. RESULTS: We identified three dimensions of girls and young women's family planning experiences that challenge existing reproductive health scales. First, reproductive intentions were complex. Second, with support, girls and women asserted their agency and resisted barriers to autonomy. Third, health policies, clinic infrastructure, cultural, religious and social beliefs, and key institutional actors-such as healthcare providers and teachers-inhibited girls and young women's contraceptive access and use. CONCLUSIONS: Qualitative insights can help refine existing scales and guide the development of new ones. Scales should strive to capture diverse reproductive intentions, acknowledge agency and resistance and account for structural and systemic influences. Alongside expanded qualitative research, improving quantitative approaches will yield more person-centred, holistic and context-inclusive insights into girls and young women's reproductive health and lives.