Abstract
Background
The nonuse of modern contraceptives among sexually active Adolescent Girls and Young Women (AGYW) impacts their health, future aspirations, and overall well-being. Addressing nonuse is crucial in empowering AGYW to take control of their future. This study aimed to determine the proportion of sexually active AGYW who are not using modern contraceptives and the associated factors in selected districts of the Busoga subregion, Eastern Uganda.
Methods
The study used a cross-sectional design utilizing quantitative data from 490 randomly selected sexually active young people in the Busoga subregion. Data were collected through in-person interviews using a questionnaire designed using Kobo Collect software. A multivariable modified Poisson regression model was used to estimate prevalence ratios for the factors associated with the non-utilization of modern contraceptives.
Results
The mean age of respondents was 19.3 years (Standard Deviation = 6.7). Out of 490 sexually active adolescent girls and young women, 43.1% were not using modern contraceptives. The prevalence of non utilization of modern contraceptives was 33% higher among adolescent girls and young women who are not confident discussing contraceptives with peers and older Adults (APR = 1.331 95% CI:1.056–1.667) compared to those who were confident. Likewise, adolescent girls and young women who were not confident discussing about contraceptives with their partners had a 37% higher prevalence of non-utilization (APR = 1.373; 95% CI: 1.023–1.845) and those who found modern contraceptive service points inaccessible had a 38% higher prevalence of non-utilization (APR = 1.386; 95%CI: 1.021–1.845). On the other hand, the prevalence of non-utilization of modern contraceptives was 37% lower among marrieds (APR = 0.631; 95% CI:0.475–0.838) compared to singles, while the prevalence of non-utilization is 38% lower among those who interact with community health workers/Village Health Teams (APR = 0.623; 95%CI: 0.401–0.967) compared to their counterparts.
Conclusions
The nonuse of modern contraceptives among Adolescent girls and young women is high in eastern Uganda. Nonuse is influenced by sociodemographic factors and social norms. Interventions should enhance confidence building in discussing contraceptives through peer-led programs, make modern contraceptives more accessible, strengthen community-based outreaches and target young married people with tailored family planning awareness emphasizing the role of contraception.
Keywords: Modern contraceptives, Adolescent girls and young women, Busoga, Eastern Uganda
Background
Globally young people aged 10–24 years represent approximately 1.8 billion individuals, constituting a critical demographic for sexual reproductive health interventions [1]. Despite global efforts to improve sexual and reproductive health (SRH), the uptake of modern contraceptive methods among adolescent girls and young women (AGYW) in sub-Saharan Africa remains low [2, 3]. This low utilisation of modern contraceptives places AGYW at elevated risk of unintended pregnancies, unsafe abortions, and associated maternal morbidity [2, 4]. In Uganda, although contraception has been a priority area within national reproductive health programs, the contraceptive prevalence rate among AGYW aged 15–24 years remains low compared to other age groups with even lower rates observed in rural regions such as Eastern Uganda [5].
The nonuse of modern contraceptives among AGYW stems from individual, social, cultural, and structural barriers [6, 7]. In many settings, AGYW are disproportionately affected by poverty and educational disparities which constrain their autonomy and ability to make informed reproductive choices including contraceptive use.
Busoga region, Eastern Uganda characterized by the low contraceptive prevalence rate and high unmet need for contraception [5] presents a critical context for studying contraceptive non-use. Existing studies on modern contraceptives in eastern Uganda largely report on women of reproductive age rather than focusing on specific age [7]. Studies by Namaga [8], Naigaga [9] and Namasivayan [7] have focused on access to contraceptives, youth-friendly services, and provider-related barrier yet adolescent girls and young women in this region still often face systemic barriers to SRH services, including long distances to health facilities, stock-outs of contraceptives, and lack of confidentiality in service delivery. Moreover, socio-cultural norms that discourage contraceptive use contributing to the unmet need for contraception and a persistently high burden of adolescent pregnancies [7].
This study, therefore, sought to examine associated factors of modern contraceptive non-use among sexually active AGYW in the selected districts of eastern Uganda to inform programs that address barriers to uptake and promote adolescent sexual and reproductive health and rights.
Methods
Study setting, design and participant recruitment
The study was conducted in Busoga region due to the low contraceptive prevalence rate and high unmet need for contraception [5]. The region is home to more than four million people (4,363,295) mainly of the Basoga tribe, which is the second largest in Uganda [10]. The region spans about 10,000 square kilometres divided into ten districts [10]. Our study site Buyende and Luuka districts were selected based on teenage pregnancy rates and implementation of prevention of teenage pregnancy project where this data was drawn. Luuka is predominantly rural, with agriculture as the main economic activity, and is characterized by high poverty levels and limited access to health services. Buyende is one of least developed districts in Uganda and faces similar challenges, including poor infrastructure, high teenage pregnancy rates, and low contraceptive uptake [11].
Fig. 1.
Shows a map of the study area drawn using ArchMap10.4
Data source
The data for this study was collected between September and October 2024 as part of a midterm review of the prevention of teenage pregnancy project implemented in the two districts. Data were collected using a survey questionnaire developed in Kobo collect.
Sample size and sampling
Using the Kish Leslie formula for computing sample size for cross-sectional studies, a sample size of 490 participants was computed [12, 13]. A multi-stage sampling was used. First, we randomly selected Six sub counties out of 10 project implementing sub counties. This was followed by a random selection of two parishes from each sub county and then selected two villages per parish. In each of the villages, a list of the households with Adolescent girls and young women (AGYW) aged 10–24 years including teenage mothers was made with the help of the local council leader. From the list provided, we randomly selected 490 AGYW for interviews. The selected AGYW were assessed for inclusion in the study. They were asked whether they have had sexual intercourse in the last 12 months. We included all AGYW who had at least one sexual intercourse in the 12 months preceding the survey. All AGYW who had not had sexual intercourse in the last 12 months were ineligible for this survey. All AGYW that met the inclusion criteria were interviewed for the study. An Adolescent girl and young women selected who had not had a sexual intercourse within 12 months was skipped and next one selected. All participants provided consent to participate in the interviews including the 71 emancipated minors aged below 18 years who were teen mothers. A pretest was done on 30 AGYW from a non-sampled village to check the flow of questions and any difficulties with administration.
Measurements
Participants responded to a questionnaire that assessed demographic and socio-behavioral characteristics. Data were collected by 10 research assistants who had at least a diploma in social science-related courses and had participated in data collection before. The research Assistants underwent two training days, and a pretest was done on the third day. The questionnaire was translated into lusoga, a local dialect spoken in the two districts and pre-tested in a non-sampled village. Participants were asked when they were born to capture age in completed years. They were then asked about the highest level of education they completed. Participants were further asked about their marital status, whether they were single, married or cohabiting or separated. Participants were then asked to report their sexual activity by responding to the question, “In your lifetime, have you ever engaged in any sexual activity? Those who responded Yes to this question were further asked if they have had sexual activity in the last 12 months. All respondents who had had sexual activity in the last 12 months were eligible for this survey. Regarding disability status, they were asked whether they have any disability or impairment that limits the performance of hearing, speech, seeing or physical activities. They were asked whether they feel confident discussing contraceptive use with peers or older people. Participants were asked to mention the modern contraceptive methods they know, where to get them and whether they easily get access to contraceptives whenever they need them. For young people who have not used contraceptives, the question was asked in the future tense whether they think they would easily get access to contraceptives in the future when they need them. Those who have not used contraceptives were asked to select the reasons for nonuse from the list of options (fear of parents knowing, fear of stigma, never thought about it). Regarding discussions with partners, young people were asked whether they could talk to their partners about contraceptive use. Partners were referred to as boyfriend, husband or other intimate/romantic partners. For young people below 18 years, we asked whether they could discuss contraceptives with their partners in future relationships. About the contraceptive service point, young people were asked whether they had heard about a health centre providing modern contraceptives in the last year. They were asked further whether there is privacy at the health facilities and whether they trust the health facility and health workers to keep their information confidential. To understand their knowledge about contraceptives, participants were asked to name at least 3 modern contraceptives they know about and where they are provided. Finally, participants were asked whether they have interacted with community health workers (VHTs) and whether they have participated in any community outreach.
Measure of the outcome variable
The outcome variable “Nonuse of modern contraceptives” was derived from the question, “Have you ever used any modern contraceptive to prevent or delay getting pregnant?” The question was followed by another question asking participants to select the modern contraceptives they have ever used. The question had seven response options: never used, emergency contraceptive pill, Male/female condoms, oral contraceptive pills, injectable, Implant, and Intra Uterine Device. The contraceptive options were read to the participants, and they were asked to select any method they had ever used from the list. All young people who selected at least one method from the six options were considered users; otherwise, they were considered nonusers of modern contraceptive services”. Thus, the variable was recorded on a binary scale of 0 = Use and 1 = Nonuse.
Measure of explanatory variables
The explanatory variables for this study included age, education, disability status, marital status, confidence in discussing contraceptive use with peers, knowledge about contraceptives, access to contraceptives, discussion with partners about contraceptive use, Knowledge about contraceptive service point, Privacy concerns at the health facility, interaction with VHT and participation in community outreaches. These variables were selected based on previous studies and their hypothetical relationship with the non-use of SRH services.
Statistical analysis
Data were downloaded from Kobo Collect as an Excel file, cleaned, and exported to STATA17 for analysis. Descriptive and inferential statistical methods were used to summarize the data. The prevalence of non-use of modern contraceptives was presented as a percentage of sexually active AGYW who had never used any modern contraceptive method. We analyzed data at three levels and presented unadjusted and adjusted prevalence ratios, their confidence intervals (CI), and p-values at α = 0.05.
The univariate analysis determined the frequency and percentage distribution of young people according to sociodemographic characteristics. At the bivariate level, a cross-tabulation of the non-use of modern contraceptives and each explanatory variable was performed. The Pearson chi-square test was used to measure the significance of associations with each explanatory variable at the 5% significance level. All variables with a ρ value less than or equal to 0.05 were automatically considered for further analysis.
To determine the association between the nonuse of modern contraceptives and demographic and socio-behavioral factors, we used Prevalence Rate Ratios (PRR) rather than Odds Ratios because the independent variable (nonuse of modern contraceptives) was highly prevalent (> 10%) [14–16]. Odds Ratios tend to overestimate the strength of association in such scenarios [14]. Prevalence Rate Ratios were estimated using the Modified Poisson regression analysis model, with robust standard errors (9). The independent factors included in the adjusted analysis were variables with a p < 0.05 at bivariate analysis and with no (Vif < 10), and these include age, marital status, confidence in discussing modern contraceptives with peers, Access to modern contraceptives, discussion with partners, interaction with VHT and knowledge about contraceptive service point.
Ethics statement
This study was approved by the Mildmay Research Ethics Committee (MUREC-2024-366) and the Uganda National Council of Science and Technology (SS2610ES). Each participant signed a full informed consent form.
Results
Characteristics of study participants
Table 1 shows the background characteristics of study population. A total of 490 participants were interviewed. The mean age of respondents was 19.3 years (Standard Deviation (SD) = 6.7). The age distribution of the study sample was 10–14 years (12%), 15–19 years (53.9%) and 20–24 years (34.1%). 64.9% had recent sexual intercourse in the last 6 months. More than half (56.9%) had used modern contraceptives. Ten per cent of participants were living with a form of disability, 3.0% of participants had not received a formal education, 62% had primary education, and 34% had attained at least secondary education. Regarding marital status, 66.3% were single, 29.8% married or cohabiting and 3.9% were divorced or separated. The majority of participants (85.5%) had confidence in discussing modern contraceptives with their peers or older people. Regarding partner discussion, 78% of participants discuss with their partners about contraceptive use. More than half (57.6%) of the participants had visited a health facility in the last 12 months, 57.8% knew contraceptive service points, 55.5% perceived the health facilities had privacy, and health workers kept clients’ information confidential. The majority (87.3%) had interacted with community health workers/Village health teams, while 79.2% of participants knew about modern contraceptives.
Table 1.
Percentage distribution of characteristics of study participants
| Characteristic | Category | Frequency (n = 490) | Percent (%) |
|---|---|---|---|
| Use of modern contraceptives | Used | 279 | 56.9 |
| Never used | 211 | 43.1 | |
| Age of respondent (years) | 10–14 | 59 | 12.0 |
| 15–19 | 264 | 53.9 | |
| 20–24 | 167 | 34.1 | |
| Sexual intercourse in the last 6 months | Yes | 318 | 64.9 |
| No | 172 | 35.1 | |
| Education | No education | 16 | 3.3 |
| Primary Education | 304 | 62.0 | |
| Secondary and above | 170 | 34.7 | |
| Disability status | Has disability | 49 | 10.0 |
| No disability | 441 | 90.0 | |
| Marital status | Single | 325 | 66.3 |
| Married | 146 | 29.8 | |
| Separated | 19 | 3.9 | |
| Confidence discussing contraceptives with peers | Yes | 419 | 85.5 |
| No | 71 | 14.5 | |
| Knowledge about modern contraceptives | Yes | 388 | 79.2 |
| No | 102 | 20.8 | |
| Knowledge about modern contraceptives service point | Yes | 283 | 57.8 |
| no | 207 | 42.2 | |
| Access to modern contraceptives services | Yes | 377 | 76.9 |
| No | 113 | 23.1 | |
| Discussion about family planning with the partner | Yes | 382 | 78.0 |
| No | 108 | 22.0 | |
| Visit to the health facility | Yes | 282 | 57.6 |
| No | 206 | 42.0 | |
| Perceived privacy at health facility | Yes | 272 | 55.5 |
| No | 218 | 44.5 | |
| Fear of stigma | Yes | 468 | 95.5 |
| No | 22 | 4.5 | |
| Interaction with VHT | Yes | 428 | 87.3 |
| No | 62 | 12.7 |
Bivariate analysis of factors associated with nonuse of modern contraceptives
Results of the bivariate analysis shown in Table 2 indicate that the nonuse of modern contraceptives decreases with increasing age, and the relationship is significant (p = 0.001). Over 6 in 10 (62.7%) sexually active young people aged 10–14 years do not use modern contraceptives, while about 1 in 4 (26.9%) young people aged 20–24 years do not use non-use. Likewise, Marital status was significantly associated with nonuse of Modern contraceptives (p = 0.000). More young people who are married (74.7%) and separated youth (73.7%) do not use modern contraceptives compared to their single counterparts (48.0%). Regarding confidence in discussing contraceptives with peers, more (81.7%) young people who lacked confidence in discussing contraceptives with peers do not use contraceptives compared to those who felt confident (36.5%), and the relationship is significant (p = 0.005). More than half (66.7%) of the young people who lack knowledge about modern contraceptives do not use modern contraceptives compared to those who were knowledgeable (36.9%) (p = 0.000). In comparison, over 3 in 4 (77.4%) of those unaware of contraceptive service points do not use them compared to those with knowledge (46.0%) (p = 0.000). Inaccessibility to contraceptives was also significantly associated with nonuse (p = 0.000). More than three-quarters (78.8%) of young people without access to modern contraceptives do not use them compared to those with access (32.4%). Confidence discussing contraceptives with Peers (p = 0.005), discussion about Contraceptives with a Partner (p = 0.000), perceived privacy at Health Facilities (p = 0.000), fear of stigma (p = 0.000), non-interaction with Village Health Teams (VHTs) (p = 0.050) were significantly associated with nonuse of modern contraceptives.
Table 2.
Nonuse of modern contraceptives among AGYW by selected characteristics
| Characteristic | Non-use of SRH services | Frequency (n = 490) | P Value | |
|---|---|---|---|---|
| No (n = 279) % | Yes (n = 211) % | |||
| Age of respondent (years) | ||||
| 10–14 | 20 (37.3) | 39 (62.7) | 59 | 0.001 |
| 15–19 | 135 (51.1) | 129(48.9) | 264 | |
| 20–24 | 124 (73.1) | 43 (26.9) | 167 | |
| Sexual intercourse in the last 3 months | ||||
| Yes | 190 (59.8) | 128 (40.2) | 318 | 0.089 |
| No | 89 (51.7) | 83 (48.3) | 172 | |
| Education | ||||
| No education | 10 (63.5) | 6 (37.5) | 16 | 0.166 |
| Primary Education | 163 (53.6) | 141 (46.4) | 304 | |
| Secondary and above | 106 (62.4) | 64 (37.6) | 170 | |
| Disability status | ||||
| Has disability | 32 (63.3) | 17 (34.7) | 49 | 0.214 |
| No disability | 247 (56.0) | 194 (44.0) | 441 | |
| Marital status | ||||
| Single | 157 (48.0) | 168 (52.0) | 325 | 0.000 |
| Married | 108 (74.7) | 38 (25.3) | 146 | |
| Separated | 14 (73.7) | 5 (26.3) | 19 | |
| Confidence discussing modern contraceptives with peers | ||||
| Yes | 208 (63.5) | 153 (36.5) | 419 | 0.005 |
| No | 71 (18.3) | 58 (81.7) | 71 | |
| Access to modern contraceptives | ||||
| Yes | 255 (67.6) | 122 (32.4) | 377 | 0.000 |
| No | 24 (21.2) | 89 (78.8) | 113 | |
| Discussion about modern contraceptives with partner | ||||
| Yes | 257 (67.3) | 125 (32.7) | 382 | 0.000 |
| No | 22 (20.4) | 86 (79.6) | 108 | |
| Knowledge about modern contraceptives | ||||
| Yes | 245 (63.1) | 143 (36.9) | 388 | |
| No | 34 (33.3) | 68 (66.7) | 102 | 0.000 |
| Knowledge about modern contraceptive service point | ||||
| yes | 229 (54.0) | 197 (46.0) | 283 | 0.000 |
| No | 50 (77.4) | 14 (22.6) | 207 | |
| Perceived privacy at health facility | ||||
| Yes | 223 (82.0) | 49 (18) | 272 | 0.000 |
| No | 56 (25.7) | 162 (74.3) | 218 | |
| Fear of stigma | ||||
| Yes | 279 (59.6) | 189 (40.4) | 468 | 0.000 |
| No | 0 (0) | 22 (100) | 22 | |
| Interaction with VHT | ||||
| Yes | 231 (54.0) | 197 (46.0) | 428 | 0.050 |
| No | 48 (77.4) | 14 (22.6) | 62 | |
Factors associated with nonuse of modern contraceptives among sexually active AGYW
Table 3 shows the results of the multivariate modified Poisson regression model fit to find out the factors associated with the nonuse of modern contraceptives among sexually active AGYW in the Busoga region. The nonuse of modern contraceptives was associated with marital status. The risk of not using modern contraceptives is 60% higher among married young people compared to single (APR = 1.631 95% CI = 1.475–1.838). Confidence in discussing modern contraceptives with peers was also significantly related to the nonuse of modern contraceptives. The prevalence of non-use of contraceptives among young people without confidence discussing contraceptives with peers is 33% higher than among young people with confidence (APR = 1.331 95% CI = 1.056–1.667). The findings also indicate that young people with no access to modern contraceptives had 38% higher prevalence of not using modern contraceptives compared to those with access to modern contraceptives (APR = 1.386 95% CI = 1.021–1.845). In comparison, those who did not discuss with their partners about contraceptive use had 37% higher prevalence of not using it compared to their counterparts who discussed contraception with their partners (APR = 1.386 95% CI = 1.023–1.845).
Table 3.
Factors associated with non-use of SRH services among young people
| Variable | Contraceptive Non-Use | UPR (95% CI) | P value | APR (95% CI) | P Value | |
|---|---|---|---|---|---|---|
| No (n = 279) % | Yes (n = 211) % | |||||
| Age of respondent (years) | ||||||
| 10–14 | 20 (37.3) | 39 (62.7) | 1(ref) | 1(ref) | ||
| 15–19 | 135 (51.1) | 129(48.9) | 0.779 (0.617–0.983) | 0.035 | 1.094 (0.859–1.394) | 0.465 |
| 20–24 | 124 (73.1) | 43 (26.9) | 0.429 (0.312–0.590) | 0.000 | 0.797 (0.564–1.125) | 0.198 |
| Marital status | ||||||
| Single | 157 (48) | 168 (52) | 1(ref) | 1(ref) | ||
| Married | 108 (74.7) | 38 (25.3) | 0.487 (0.362–0.656) | 0.000 | 1.631 (1.475–1.838) | 0.001* |
| Separated | 14 (73.7) | 5 (26.3) | 0.506 (0.236–1.082) | 0.079 | 0.729 (0.348–1.529) | 0.359 |
| Confidence discussing about SRH | ||||||
| Yes | 208 (63.5) | 153 (36.5) | 1(ref) | 1(ref) | ||
| No | 71 (18.3) | 58 (81.7) | 2.237 (1.891–2.645) | 0.000 | 1.331 (1.056–1.667) | 0.015* |
| Access to modern contraceptives | ||||||
| Yes | 255 (67.6) | 122 (32.4) | 1(ref) | 1(ref) | ||
| No | 24 (21.2) | 89 (78.8) | 2.433 (2.043–2.898) | 0.000 | 1.386 (1.021–1.845) | 0.036* |
| Discussion with a partner about contraceptive use | ||||||
| Yes | 257 (67.3) | 125 (32.7) | 1(ref) | 1(ref) | ||
| No | 22 (20.4) | 86 (79.6) | 2.433 (2.047–2.892) | 0.000 | 1.373 (1.023–1.845) | 0.035* |
| Interaction with VHT | ||||||
| Yes | 231 (54.0) | 197 (46.0) | 1(ref) | 1(ref) | ||
| No | 48 (77.4) | 14 (22.6) | 0.490 (0.305–0.787) | 0.003 | 0.623 (0.401–0.967) | 0.035* |
UPR-Unadjusted Prevalence Ratio, APR-Adjusted Prevalence Ratio, CI-Confidence Interval, ref-reference category *significance at p < 0.05
Discussion
This study aimed to examine the factors associated with the nonuse of modern contraceptives among sexually active adolescent girls and young women in the Busoga subregion. Results show that marital status, confidence in discussing modern contraceptives with peers, access to modern contraceptives, discussion with partners about modern contraceptives, and interaction with community health workers/VHTs were significantly associated with nonuse of modern contraceptives.
The prevalence on non-use of modern contraceptives were 60% higher among married AGYW than singles. This could be due to societal expectations around fertility or spousal influence. This finding is similar to a study conducted in twelve countries of Angola, Chad, Congo, Congo DR, Guinea, Mozambique, Niger, Nigeria, and Senegal in Africa, Philippines and Timor-Leste in Asia and Guyana in Latin America & Caribbean which found that married young women were less likely to use contraceptives than their unmarried counterparts [17]. Similarly, a study by Kabagenyi, Habaasa (14) in Uganda reported that young married women had lower contraceptive use due to male dominance in decision-making and sociocultural norms emphasizing childbearing soon after marriage. Likewise, a study by Bakesiima and others (2020) found low utilization of modern contraceptives among married refugees compared to singles [18]. However, this finding contradicts other studies conducted and found that in some contexts, married women were more likely to use contraceptives than singles [7, 19]. The findings align with previous studies that show that marriage often reduces contraceptive uptake due to cultural and gender norms [20]. However, in some settings where family planning counseling is integrated into maternal health services, married women may have higher contraceptive use [21, 22].
Adolescent girls and young women who lacked confidence in discussing sexual reproductive health issues, including contraceptives, had 33% higher prevalence of not using contraceptives. This is due to the role of peer communication and openness in influencing contraceptive use among young people. This finding agrees with Chandra-Mouli, Parameshwar [23], who emphasized that adolescents who engage in open discussions with peers about sexual health are more likely to use contraceptives due to better awareness and normalization of contraceptive use. It also agrees with another study conducted in Uganda; Namanda, Atuyambe [24] found that young women who could discuss contraceptive issues with their friends were significantly more likely to access and use modern contraceptives. Conversely, Khanal, Khatri [25] found that social stigma around contraceptive discussions often limits young people’s willingness to seek family planning services, especially in rural areas.
Participants who lacked access to modern contraceptive services had a 38% higher prevalence of not using modern contraceptives. This finding suggests that service accessibility is a major determinant of contraceptive utilization. It is similar to Makwinja [26], who reported that limited access to SRH services in Sub-Saharan Africa was one of the biggest barriers to contraceptive uptake, particularly in rural and underserved areas. Silumbwe, Nkole [27] found that young people who live far from SRH service points or face cost and stigma barriers are significantly less likely to use contraception. In Uganda, studies by Ninsiima, Chiumia (24), and Asingwire, Muhangi [28] found that access to youth-friendly services increased contraceptive uptake. Additionally, in Kenya, it was found that the presence of trained health workers significantly improved utilization [29].
Young people who do not discuss contraceptives with their partners have a 37% higher prevalence of not using modern contraceptives compared to their counterparts. This finding emphasizes the role of partner communication in contraceptive decision-making. This is similar to one of Capurchande, Coene [30], who studied Mozambican adolescents and found that young women who had no open discussions with their partners about contraception were less likely to use modern methods. Another study in sub-Saharan Africa by Nkwonta and Messias [31]also reported that male partner involvement in SRH decisions increases contraceptive uptake among women in Sub-Saharan Africa. However, a study conducted in the Democratic Republic of Congo found that in some settings, men’s disapproval of contraception limited the effect of partner communication on contraceptive use [32].
Participants who did not interact with Village Health Teams (VHTs) had a higher prevalence of non-use of modern contraceptives. This finding suggests that community-based health education and outreach improve contraceptive utilization. The finding is similar to other studies that found that community health workers (CHWs) and VHTs significantly improved contraceptive access, particularly in rural areas [33, 34]. In West Africa, Village health teams played a major role in dispelling myths about contraception, leading to increased uptake [35]. Another study in Uganda found that while VHTs were highly effective in promoting adolescent contraceptive use, challenges such as stock-outs and cultural resistance remained [33].
Conclusion
This study examined the factors associated with the non-utilization of modern contraceptives among adolescent girls and young women in the selected districts of Busoga region. We found that being married, access to modern contraceptives, confidence in discussing contraception, partner communication, and interaction with Village Health Teams (VHTs) were significantly associated with the nonuse of modern contraceptives. Married AGYW were significantly less likely to use modern contraceptives than their unmarried counterparts. Additionally, AGYW who lack confidence in discussing SRH issues are more likely to avoid contraceptive use. Furthermore, lack of access to contraceptives was a major barrier to contraceptive uptake. The study recommends strengthening interventions that enhance AGYW confidence in discussing contraceptives through peer-led programs, strengthen community-based outreach by Village Health Teams, and target young married people with tailored family planning awareness emphasizing the role of contraception. The study utilized a cross-sectional design, and the findings could have some limitations, including reliance on self-reported data. The study also focused on specific districts, limiting generalizability to other settings. There is a need for a longitudinal study to track changes in contraceptive use over time and provide insights into causal relationships rather than associations.
Biographies
Godfrey Tumwizere
is a population scientist with research interests in Adolescent, Maternal and Child Health. He holds a master’s degree in population and reproductive health from Makerere University, Kampala. He undertook specialized training in global adolescent health from the London School of Hygiene and Tropical Medicine, UK. He is currently pursuing a doctoral degree (PhD) in public health at the School of Public Health, Makerere University, Kampala, in the Department of Community Health and Behavioural Sciences.
Nelson Bunani
is a public health specialist with research interests in Child, maternal, and Adolescent Health and cancer prevention. He holds a master’s degree in public health from Makerere University. He is currently pursuing a doctoral degree (PhD) in public health at the School of Public Health, Makerere University, Kampala, in the Department of Health Policy Planning and Management.
Nicholas Muhumuza
is a Public Health specialist with a Master of Public health from Makerere University. He has research experience in community health workers’ response to disease outbreaks. He is currently pursuing a doctoral degree (PhD) in public health at the School of Public Health, Makerere University, Kampala, in the Department of Disease Control and Environmental Health. His research interests are climate change and infectious disease.
Angel Uwera
is an Agricultural engineer with a Bachelor of Agricultural Engineering from Makerere University. She is a Water Sanitation and Hygiene (WASH) Engineer with research interests in Geographic Information Systems (GIS) and remote sensing.
Allen Kabagyenyi
is a population scientist and senior lecturer and head department of population studies, school of statistics and planning , Makerere University.
Author contributions
GT conceived and conceptualized the study, analyzed data, and participated in manuscript development. NB and NM participated in data analysis and Manuscript development. AU participated in cartography and manuscript development. AK provided technical oversight on conceptualization and methodology. All the authors read, edited, and approved the final manuscript.
Funding
The study was not funded.
Data availability
The data set used for this study is available on request from the Authors.
Declarations
Ethics approval and consent to participate
The study received approval from the Mildmay Research and Ethics Committee (MUREC-2024-366) and the Uganda National Council of Science and Technology (SS2610ES). Luuka and Buyende district Health Offices provided administrative clearance to collect data. All participants including emancipated minors signed informed consent during the survey.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data set used for this study is available on request from the Authors.