ABSTRACT
Background and Aims
Bangladesh has made notable progress in increasing contraceptive use, but it has not yet fully achieved its Sustainable Development Goal (SDG) targets aiming to reduce the unmet need to 6% by 2030. This study explored geographical disparities, sources, and determinants of contraceptive use among married female adolescents using the Bangladesh Adolescent Health and Wellbeing Survey 2019–20.
Methods
A sample of 4802 married female adolescents aged 15–19 years was used, and their contraceptive use patterns, sources, and associated risks were assessed. Various statistical tools, including geographical disparities analysis using GIS tools, bar diagrams, proportion z‐tests, and a multinomial binary logistic regression model, were employed in the data analysis.
Results
Contraceptive use among adolescents was 65.1%, higher in urban (70.56%) areas. The married adolescents frequently use modern methods (88.86%), while 10.1% use traditional methods. The predominant method was pills (65.36%), followed by condoms (17.72%) and injections (13.26%). Contraceptive use was lowest in Sylhet, with non‐use linked to childbearing desire, husband's opposition, or absence. Regional disparities were evident, with Chittagong showing higher contraceptive use among rural adolescents (19.4%) and Dhaka among urban adolescents (26.9%). Multinomial logistic regression identified division, TV watching, mobile phone use, and residence as key factors influencing contraceptive use. Urban adolescent girls showed 37% (AOR: 1.37; 95% CI: 1.17–1.62; p = < 0.001) more likely to use contraceptive.
Conclusion
Contraceptive use among adolescents varies significantly in Bangladesh, with higher usage in urban areas. The pill is the most used method, but many adolescents avoid contraception due to wanting children or their husband's opposition. Addressing regional disparities and sociocultural factors is crucial to improving adolescent contraceptive use in Bangladesh and achieving the maternal and child health SDGs.
Keywords: Adolescent Health and Wellbeing Survey, Bangladesh, contraceptive use, geographical disparities, married female adolescents
Summary
Contraceptive use among married female adolescents in Bangladesh is 65.1%, with a higher prevalence in urban areas (70.56%).
Modern methods dominate, with pills (65.36%) being the most used, followed by condoms (17.72%) and injections (13.26%).
Significant regional disparities exist; Sylhet Division reports the lowest usage, while Chittagong and Dhaka show higher use in rural and urban areas, respectively.
Key reasons for non‐use include a desire for children, opposition from husbands, and husbands living abroad.
Division, television viewing, and mobile phone use are significant determinants of contraceptive use among adolescents.
1. Introduction
Adolescence is a transformative stage in human life marked by significant physical, emotional, and social development [1]. Globally, the contraceptive methods have risen significantly, and this advancement has reduced unwanted pregnancies by 40% and infant mortality [2]. There are 21 million unwanted pregnancies among adolescents in lower‐ and middle‐income countries (LMICs), with 55% of them resulting in termination in unsafe environments [3]. The primary cause of global death among adolescents is pregnancy and childbirth complications, and this issue is particularly prevalent in LMICs [4]. In Bangladesh, the prevalence of unplanned pregnancies is higher (33%) among those who never used contraceptives compared to those who used them (23%) [5]. The likelihood of childbirth, preterm birth, and abortion is higher in teenage pregnancies [6]. Along with this, about 50% of deaths among women of childbearing age are related to miscarriage, pregnancy, and childbirth in Bangladesh [7, 8]. Proper utilization of birth control methods can reduce unwanted pregnancies and decrease maternal deaths by 30% and infant deaths by 10% [9, 10].
In Bangladesh, the accessibility of pregnancy prevention methods for women remains limited, contributing to 48% of the six million annual pregnancies being unintended or unwanted [11]. These pregnancies often result in unsafe terminations, leading to various health complications. The adoption of effective birth control measures significantly reduces the incidence of unwanted pregnancies, teenage pregnancies, and risky abortions performed in unsafe environments, ultimately decreasing maternal and child mortality rates [12, 13]. Effective family planning is therefore crucial for reducing maternal mortality, which currently accounts for approximately 115 to 153 deaths per 100,000 live births [14]. Moreover, unintended pregnancies are associated with a higher risk of mortality, morbidity, and inadequate healthcare services [11].
Most of the people in Bangladesh live in rural areas where the adolescent‐based healthcare facilities are limited due to the low‐resource settings. The proper utilization of contraceptives is essential in Bangladesh to achieve the Sustainable Development Goals (SDGs) related to maternal and child health (Targets 3.1 and 3.2) and universal access to sexual and reproductive healthcare services (Target 3.7). Bangladesh has made significant progress in reducing the total fertility rate from over six births per woman in the mid‐1970s to 2.3 in 2014, alongside an increase in contraceptive prevalence from 10% to 54% [15]. The government of Bangladesh has set ambitious targets to further increase contraceptive use to 75% and reduce the number of children per woman to 2.1, aiming to improve health outcomes for mothers and children [16].
Contraceptive utilization is influenced by various sociodemographic factors, including age, education, husbands' education, number of living children, desire for more children, wealth index, geographic division, area of residence, women's autonomy, and knowledge of contraceptive methods [15, 17, 18, 19, 20]. Globally, approximately two‐thirds (64%) of women use fertility control measures, a figure closely mirrored in Bangladesh (62%) [21]. In comparison, other South Asian countries such as India (58%), Nepal (50%), Pakistan (35%), and Afghanistan (23%) report lower rates of contraceptive use [22, 23, 24, 25, 26, 27]. The widespread use of contraceptives in Bangladesh has contributed to a dramatic decrease in the fertility rate [28]. To sustain this progress, the government needs to identify and address social barriers to contraceptive use through data‐driven and practical approaches.
While numerous studies have examined female contraceptive use in Bangladesh, there is a lack of research specifically addressing the contraceptive use among married female adolescents, a group that faces unique challenges in accessing and utilizing family planning services. Recent data indicates that a significant proportion of female adolescents in Bangladesh are married, yet their contraceptive needs remain underexplored [29]. This study aims to fill that gap by examining the risk factors, prevalence, sources, and hesitancy surrounding contraceptive use among married adolescents across different divisions. Additionally, the study will explore variations in contraceptive use based on wealth index and education, identifying regions with the lowest uptake rates. By focusing on this demographic, the study will provide valuable insights that can inform the development of targeted policies to improve contraceptive adoption and address the specific barriers faced by married adolescents in Bangladesh.
2. Methods
Ethics Approval and Consent to Participate
This study followed the CONSORT guideline for reporting the study. As the study used a secondary dataset, the ethical approval and consent are not applicable.
2.1. Data Source
This study utilized data from the nationally representative Bangladesh Adolescent Health and Wellbeing Survey (BAHWS) 2019–2020, which was obtained from the website of USAID [30]. The BAHWS is a cross‐sectional survey conducted in Bangladesh as part of the Demographic and Health Survey Program. The survey was implemented by the National Institute of Population Research and Training (NIPORT) and was administered and monitored under the supervision of the Ministry of Health and Family Welfare.
2.2. Sampling Design
This study used nationally representative secondary data from the Bangladesh Adolescent Health and Wellbeing Survey (BAHWS) 2019–2020. The survey employed a two‐stage cluster sampling design to ensure national representation of adolescents aged 15–19 across rural, non‐slum urban, and slum areas in all eight administrative divisions. A household listing was conducted in each cluster, and eligible adolescents were identified and interviewed. The final sample included 4802 ever‐married females. The detailed methodology can be found in the Bangladesh Adolescent Health and Wellbeing Survey 2019–20: Final Report [31].
2.3. Place of Study
The study was conducted in Bangladesh using the nationally representative dataset of the Adolescent Health and Wellbeing Survey (BAHWS) 2019–20. While the legal age of marriage for females in Bangladesh is 18 years, the study included only married female adolescents aged 15–19 years.
2.4. Study Population and Sample Size
The study population consisted of married female adolescents aged 15–19 years. The survey covered 67,093 households, achieving a response rate of 98%. In the BAHWS 2019–20, the original sample size of ever‐married adolescents was 4942, and we extracted the adolescents (N = 4802) who were currently married, excluding those who were divorced, separated, or widowed. Out of 4802 samples, the number of adolescents who responded to the question on current contraceptive use was 4038. The dataset contained missing values, which were handled on a variable‐by‐variable basis, and the sample size for each variable was reported accordingly.
2.5. Dependent Variable
The outcome variable of this study was the current contraceptive use. According to the Bangladesh Adolescents Health and Wellbeing Survey (BAHWS) 2019–20, the current contraceptive use refers to any respondent (or their spouse) using a family planning method at the time of the survey [31]. During the survey of this study, currently married female adolescents were asked, ‘Did they currently use any method to avoid pregnancy?’. The responses are coded as “1” for use of the contraceptive, and the code for non‐use of the contraceptive is “0”.
2.6. Explanatory Variables
Previously published literature was considered for selecting individual, household, and community factors. Individual factors were education (illiterate, primary, secondary, post‐secondary), working status (yes, no), TV watching (yes, no), Mobile Phone Use (yes, no), age at child birth (13–15 years, and 16–19 years), age of menarche (09–13 years, and 14–19 years), Household factors were husband's age (16–28 years, 29–41 years, 42–50 years), number of children (One, More than one), and household wealth index (lowest, second, middle, richer, richest). Community‐level factors included place of residence (urban or rural) and administrative division (Barishal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi, Rangpur, and Sylhet).
The study reported the methods of contraception as modern, traditional, and both methods. The BAHWS 2019–20 classified contraceptives into modern methods (pill, condom, injectable, IUD, implant, sterilization) and traditional methods (periodic abstinence, withdrawal, folk methods), and both methods [31]. In addition, the study also reported the sources of contraceptives (multiple responses) and hesitancy (multiple responses) faced by the adolescents in Bangladesh.
2.7. Statistical Analysis
The present study examines contraceptive use among adolescents in Bangladesh through bivariate analyses conducted at both the aggregate level (total sample) and disaggregated levels (rural and urban populations). Descriptive statistics, specifically frequency distributions, were employed to summarize the respondents' sociodemographic and obstetric characteristics. Bivariate analyses were conducted using proportion tests to assess statistically significant differences in contraceptive use across various background characteristics. The outcome variable, contraceptive use, was binary (use vs. non‐use). To identify significant predictors of contraceptive use, a multinomial binary logistic regression model was applied, where the model goodness of fit was assessed by the Hosmer–Lemeshow test and the Area under the ROC curve (AUC). Geographic disparities in contraceptive prevalence were visualized in relation to education level and wealth index using spatial mapping based on the ‘Bangladesh’ shapefile, implemented through the R programming language. The sampling weight was considered before data analysis, and the statistical significance was evaluated at a 5% level (p < 0.05), with 95% confidence intervals. All statistical analyses were performed using SPSS (version 26) and R (version 4.3.1).
3. Results
3.1. Sociodemographic Characteristics of the Married Female Adolescents in Bangladesh
The study sample comprised 4,802 currently married female adolescents in Bangladesh, of whom 3742 (77.92%) resided in rural areas and 1060 (22.08%) in urban areas. The highest regional representation was from the Dhaka division (20.6%), while the Sylhet division accounted for the lowest proportion (4.3%). Overall, secondary education was the most attained educational level (73.2%), though slightly lower among urban respondents (67.92%). Employment status varied notably by residence: 23% of rural adolescents were employed, compared to only 5.25% in urban areas. In terms of the wealth index, 23.70% of the total sample fell into the middle quintile. Among rural adolescents, the second wealth quintile had the highest representation (23.70%), whereas among urban adolescents, the richest quintile was most prevalent (29.52%). Additionally, 52.4% of participants reported owning a mobile phone (Table 1).
Table 1.
Socio‐demographic characteristics of the married adolescent girls.
| Variable (n) | Overall, n (%) | Rural 3742, n (%) | Urban 1060, n (%) |
|---|---|---|---|
| Division (N = 4802) | |||
| Barisal | 279 (5.8) | 220 (5.90) | 59 (5.56) |
| Chittagong | 996 (20.7) | 728 (19.50) | 268 (25.28) |
| Dhaka | 988 (20.6) | 717 (19.20) | 271 (25.56) |
| Khulna | 556 (11.6) | 460 (12.30) | 96 (9.05) |
| Rajshahi | 738 (15.4) | 603 (16.10) | 135 (12.73) |
| Rangpur | 639 (13.3) | 536 (14.30) | 103 (9.71) |
| Sylhet | 207 (4.3) | 160 (4.30) | 47 (4.43) |
| Mymensingh | 399 (8.3) | 318 (8.50) | 81 (7.64) |
| Education (N = 4802) | |||
| No Education | 102 (2.1) | 66 (1.80) | 36 (3.39) |
| Primary | 904 (18.8) | 669 (17.90) | 235 (22.17) |
| Secondary | 3529 (73.5) | 2809 (75.10) | 720 (67.92) |
| Post‐Secondary | 267 (5.6) | 198 (5.30) | 69 (6.50) |
| Employment status (N = 4802) | |||
| Yes | 278 (5.8) | 64 (7.34) | 214 (5.25) |
| No | 4524 (94.2) | 807 (92.65) | 3857 (94.74) |
| TV watching (N = 4802) | |||
| Yes | 3463 (72.1) | 3546 (94.76) | 978 (92.26) |
| No | 1339 (27.9) | 196 (5.35) | 82 (7.73) |
| Wealth index (N = 4802) | |||
| Lowest | 922 (19.2) | 841 (22.50) | 81 (7.64) |
| Second | 1025 (21.3) | 885 (23.70) | 140 (13.20) |
| Middle | 1127 (23.5) | 859 (23) | 268 (25.28) |
| Richer | 1025 (21.3) | 712 (19) | 313 (29.52) |
| Highest | 702 (14.6) | 445 (11.90) | 257 (24.25) |
| Mobile Phone Use (N = 4802) | |||
| Yes | 2582 (52.4) | 453 (52) | 2129 (52.50) |
| No | 2344 (46.6) | 418 (48) | 1926 (47.50) |
3.2. Obstetric Characteristics of Married Adolescents
Among married adolescent females, 65.1% reported using some form of contraception, with notable geographic variation in usage, with 63.55% in rural areas, while it was 70.56% in urban areas. A substantial majority (approximately 88%) relied on modern contraceptive methods. Nearly 90% of adolescents, regardless of residence, reported having one child. The decision to use contraception was mutual between partners in many cases (about 82%), whereas decisions made solely by the adolescent female were comparatively low (8.1% overall; 8.2% in rural and 7.52% in urban areas). Additionally, 21% of adolescents gave birth to their first child between the ages of 12 and 15, with similar proportions observed in both rural (20.70%) and urban (21.88%) populations. Over 80% of adolescents experienced menarche between the ages of 9 and 13 (Table 2).
Table 2.
Obstetric characteristics of married female adolescents in Bangladesh.
| Variable | Total n (%) | Rural | Urban n (%) |
|---|---|---|---|
| Use of contraceptive method (N = 4038) | |||
| Yes | 2629 (65.1) | 1996 (63.55) | 633 (70.56) |
| No | 1409 (34.9) | 1145 (36.45) | 264 (29.43) |
| Current contraceptive method (N = 2607) | |||
| Modern | 2292 (88.86) | 1737 (88) | 555 (88.09) |
| Traditional | 250 (10.04) | 188 (9.50) | 62 (9.84) |
| Both | 62 (1.06) | 49 (2.5) | 13 (2.06) |
| Number of children (N = 2146) | |||
| One | 1992 (90.9) | 1523 (91.20) | 425 (89.29) |
| More than one | 200 (9.1) | 147 (8.80) | 51 (10.71) |
| Decision for using contraceptives (N = 3670) | |||
| Mainly my decision | 296 (8.1) | 231 (8.2) | 65 (7.52) |
| Mainly husband's decision | 319 (8.7) | 237 (8.4) | 82 (9.49) |
| Both | 3015 (82.2) | 2307 (82.2) | 708 (81.94) |
| Other | 40 (1.1) | 31 (1.1) | 9 (1.04) |
| Age at childbirth (N = 1792) | |||
| 13–15 years | 460 (21) | 353 (20.70) | 107 (21.88) |
| 16–19 years | 1732 (34.2) | 1350 (79.30) | 382 (78.11) |
| Age of menarche (N = 2455) | |||
| 9–13 years | 1993 (81.1) | 1561 (81.30) | 432 (80.60) |
| 14–19 years | 462 (18.9) | 359 (18.70) | 104 (19.40) |
3.3. Geographical Disparities in Contraceptive Use Among Currently Married Female Adolescents
In the lowest‐income category, the Rangpur division reported the highest prevalence of contraceptive use (28.9%). For the second‐lowest and middle‐income categories, the Rajshahi division led with rates of 19% and 20%, respectively. In contrast, the Dhaka division had the highest prevalence in the richer and highest‐income categories, at 27.5% and 44.4%, respectively. The Sylhet division consistently showed the lowest contraceptive use across all income categories: 4% in the lowest, 2.2% in the second‐lowest, 1.9% in the middle, 2.5% in the richer, and 2.2% in the highest. Overall, contraceptive use among currently married women in the middle‐income group was the highest across all divisions except Dhaka (Figure 1).
Figure 1.
Contraceptive use variation concerning the educational status of adolescents.
Among adolescents with no formal education, the highest prevalence of contraceptive use was observed in the Rajshahi division (16.3%), while the lowest (0%) was recorded in the Barishal division. Dhaka division showed the highest percentages for primary, secondary, and post‐secondary education levels, with rates of 20.3%, 20.7%, and 18.5%, respectively. In contrast, Sylhet division had the lowest prevalence in these categories, at 4%, 2.2%, and 6.8%. Contraceptive use was most prevalent among adolescents with secondary education in the Chittagong, Dhaka, Mymensingh, Rajshahi, and Rangpur divisions. However, in Barishal, Khulna, and Sylhet, the highest prevalence was found among those with higher education (Figure 2).
Figure 2.
Variation in contraceptive use among adolescents by family wealth index.
3.4. Types of Contraceptive Methods and Their Sources in Bangladesh
The majority (88.86%) of currently married female adolescents prefer modern contraceptive methods, compared to 10.04% who use traditional methods, and only 1.10% who use both (Figure 3A). Among those using contraceptives, the most used method was the pill (65.36%), followed by condoms (17.72%), injectables (13.26%), implants (3.09%), IUDs (0.13%), and emergency contraceptives (2.6%) (Figure 3B). The private medical sector was the predominant source for pills (68.6%), injectables (50.3%), and condoms (64.1%), while the public sector was the main source for implants (77.2%) (Figure 3C).
Figure 3.
(A) Contraceptive methods used by currently married female adolescents; (B) Types of modern methods; (C) Sources of contraceptives (multiple response); and (D) Hesitancy (multiple response) faced by the adolescents.
3.5. Hesitancy Faced By Adolescents in Bangladesh
This study explores the barriers to contraceptive use among adolescents. A majority (95.32%) cited a single reason for non‐use, while 4.26% reported two reasons, and 0.43% mentioned three. The most reported reason was the desire to have a child (n = 556), followed by the husband's absence due to staying abroad (n = 393), opposition from the husband (n = 73), concerns about interfering with normal physiological processes (n = 59), opposition from others (n = 20), and, least frequently, religious prohibitions (n = 3) (Figure 3D).
3.6. Contraceptive Use Variation Among Currently Married Female Adolescents
Contraceptive use was significantly higher across all divisions except Dhaka. Dhaka had the highest prevalence (20.7%), followed by Rajshahi (18.3%), Rangpur (14.8%), Chittagong (14.1%), Khulna (13.8%), Mymensingh (9.2%), Barishal (6.5%), and Sylhet (2.6%). The study revealed a significant difference in contraceptive use among currently married adolescents with no formal education; however, the prevalence was lowest (2.6%) in this group compared to those who had received some level of education.
In urban areas, this difference was particularly significant among those with primary education, with the highest contraceptive use (66.4%) observed in this group. Among currently married female adolescents, both overall and in rural areas, those who watched television had a significantly higher prevalence of contraceptive use compared to those who did not (74.3% and 71.3%, respectively).
The study also found a significant difference in contraceptive use across wealth index categories. The highest prevalence was observed among the middle‐income group (23.8%), followed by the second‐lowest (22.2%), the richer (21.1%), the lowest (19.1%), and the highest income group (13.8%).
In urban areas, contraceptive use was significantly higher (57.6%) among those who owned a mobile phone. In contrast, in rural areas, a higher percentage of contraceptive use (50.6%) was reported among those without a mobile phone (Table 3).
Table 3.
Contraceptive use variation among married female adolescents.
| Variable | Contraceptive use | *P‐Value | Rural contraceptive use | *P‐Value | Urban contraceptive use | *P‐Value | |||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Division | |||||||||
| Barisal | 172 (6.5) | 64 (4.5) | 0.01 | 127 (6.4) | 55 (4.8) | 0.072 | 45 (7.1) | 9 (3.4) | 0.010 |
| Chittagong | 370 (14.1) | 446 (31.7) | < 0.001 | 246 (12.3) | 343 (30.0) | < 0.001 | 124 (19.6) | 103 (39) | < 0.001 |
| Dhaka | 545 (20.7) | 293 (20.8) | 0.962 | 375 (18.8) | 234 (20.4) | 0.261 | 170 (26.9) | 59 (22.3) | 0.962 |
| Khulna | 364 (13.8) | 111 (7.9) | < 0.001 | 303 (15.2) | 95 (8.3) | < 0.001 | 61 (9.6) | 16 (6.1) | < 0.001 |
| Rajshahi | 481 (18.3) | 165 (11.7) | < 0.001 | 388 (19.4) | 143 (12.5) | < 0.001 | 93 (14.7) | 22 (8.3) | < 0.001 |
| Rangpur | 388 (14.8) | 139 (9.9) | < 0.001 | 317 (15.9) | 123 (10.7) | < 0.001 | 71 (11.2) | 16 (6.1) | < 0.001 |
| Sylhet | 67 (2.6) | 103 (7.3) | < 0.001 | 50 (2.5) | 80 (7.0) | < 0.001 | 17 (2.7) | 23 (8.7) | < 0.001 |
| Mymensingh | 242 (9.2) | 88 (6.2) | < 0.001 | 190 (9.5) | 72 (6.3) | 0.002 | 52 (8.2) | 16 (6.1) | < 0.001 |
| Education | |||||||||
| No education | 36 (2.6) | 43 (1.6) | 0.044 | 348 (17.4) | 198 (17.3) | 0.919 | 149 (23.5) | 49 (18.6) | 0.101 |
| Primary | 247 (17.5) | 497 (18.9) | 0.283 | 1523 (76.3) | 856 (74.8) | 0.332 | 420 (66.4) | 193 (73.1) | 0.047 |
| Secondary | 1049 (74.4) | 1943 (73.9) | 0.707 | 101 (5.1) | 66 (5.8) | 0.397 | 45 (7.1) | 11 (4.2) | 0.097 |
| Higher secondary and above | 77 (5.5) | 146 (5.6) | 0.907 | 24 (1.2) | 25 (2.2) | 0.033 | 19 (3.0) | 11 (4.2) | 0.376 |
| Employment status | |||||||||
| Yes | 176 (6.7) | 81 (5.7) | 0.241 | 115 (5.8) | 64 (5.6) | 0.841 | 61 (9.6) | 17 (6.4) | 0.121 |
| No | 2453 (93.3) | 1328 (94.3) | 0.241 | 1881 (94.2) | 1081 (94.4) | 0.841 | 572 (90.4) | 247 (93.6) | 0.121 |
| TV watching | |||||||||
| Yes | 1954 (74.3) | 975 (69.2) | < 0.001 | 1423 (71.3) | 764 (66.7) | 0.007 | 531 (83.9) | 211 (80) | 0.153 |
| No | 675 (25.7) | 434 (30.8) | < 0.001 | 573 (28.7) | 381 (33.3) | 0.007 | 102 (16.1) | 53 (20) | 0.153 |
| Wealth index | |||||||||
| Lowest | 502 (19.1) | 249 (17.7) | < 0.001 | 454 (22.7) | 233 (20.3) | 0.118 | 48 (7.6) | 16 (6.1) | 0.427 |
| Second lowest | 583 (22.2) | 287 (20.4) | < 0.001 | 498 (24.9) | 255 (22.3) | 0.090 | 85 (13.4) | 32 (12.2) | 0.61 |
| Middle | 625 (23.8) | 304 (21.6) | < 0.001 | 463(23.2) | 241 (21) | 0.165 | 162 (35.6) | 63 (24) | 0.607 |
| Richer | 556 (21.1) | 330 (23.4) | < 0.001 | 374 (18.7) | 244 (21.3) | 0.081 | 182 (18.8) | 86 (32.7) | 0.240 |
| Highest | 363 (13.8) | 238 (16.9) | < 0.001 | 207 (10.4) | 172 (15) | < 0.001 | 156 (24.6) | 66 (25.1) | 0.887 |
| Mobile phone use | |||||||||
| Yes | 1311 (49.9) | 835 (59.3) | 0.714 | 987 (49.4) | 683 (59.7) | < 0.001 | 324 (51.2) | 152 (57.6) | 0.08 |
| No | 1318 (50.1) | 574 (40.7) | 0.724 | 1009 (50.6) | 462 (40.3) | < 0.001 | 309 (48.8) | 112 (42.4) | 0.08 |
*Proportion test.
3.7. Risk Factors of Contraceptive Use Among Married Adolescents
Logistic regression analysis indicated regional variation in contraceptive use among married adolescent females in Bangladesh. Adolescent girls from the Chattagram (AOR = 0.28; 95% CI: 0.23–0.39; p < 0.001), Dhaka (AOR: 0.58; 95% CI: 0.30–0.1.10; p < 0.009), and Sylhet (AOR = 0.15; 95% CI: 0.06–0.35; p < 0.001) division showed a lower likelihood of contraceptive use compared to adolescents from Mymensingh division.
Media exposure also emerged as a significant determinant; adolescents who watched television were more likely to use contraceptives (AOR = 1.49; 95% CI: 1.07–2.05; p < 0.01). Adolescents who used mobile phones had significantly lower odds of contraceptive use compared to non‐users (AOR = 0.58; 95% CI: 0.42–0.79; p < 0.001). Adolescent girls who reside in urban areas were 37% (AOR: 1.37; 95% CI: 1.17–1.62; p < 0.001) more likely to use contraceptives than the rural residents (Table 4).
Table 4.
Risk factors of contraceptive use among currently married female adolescents.
| Characteristics | Overall AOR (95% CI) | P‐value |
|---|---|---|
| Division | ||
| Barisal | 0.86 (0.36–2.04) | 0.72 |
| Chittagong | 0.28 (0.23–0.39) | < 0.001 |
| Dhaka | 0.58 (0.30–1.10) | 0.009 |
| Khulna | 0.84 (0.39–1.77) | 0.64 |
| Rajshahi | 1.14 (0.56–2.31) | 0.71 |
| Rangpur | 1.14 (0.57–2.26) | 0.70 |
| Sylhet | 0.15 (0.06–0.35) | < 0.001 |
| Mymensingh | Reference group | |
| Education | ||
| Primary | 1.27 (0.43–3.78) | 0.66 |
| Secondary | 1.26 (0.43–3.70) | 0.67 |
| Post secondary | 1.4 (0.34–5.70) | 0.63 |
| No education | Reference group | |
| Work status | ||
| Yes | 1.14 (0.56–2.34) | 0.70 |
| No | Reference group | |
| TV watch | ||
| Yes | 1.49 (1.07–2.05) | 0.01 |
| No | Reference group | |
| Child number | ||
| One | 1.08 (0.65–1.78) | 0.76 |
| One or more | Reference group | |
| Husband age | ||
| 16–28 | 0.97 (0.06–15.2) | 0.98 |
| 29–41 | 0.76 (0.04–12.02) | 0.84 |
| 42–50 | Reference group | |
| Mobile phone | ||
| Yes | 0.58 (0.42–0.79) | < 0.001 |
| No | Reference group | |
| Menstruation age | ||
| 9–13 | 0.87 (0.57–1.32) | 0.52 |
| 14–19 | Reference group | |
| Child birth | ||
| 12–15 | 1.08 (0.72–1.61) | 0.69 |
| 16–19 | Reference group | |
| Residence | ||
| Urban | 1.37 (1.17–1.62) | < 0.001 |
| Rural | Reference group | |
4. Discussion
This study conducted a detailed investigation into the prevalence of contraceptive use across different geographic regions of Bangladesh. It initially highlighted geographical disparities and identified areas with high and low levels of contraceptive use among adolescents. The analysis also explored individual, household, and sociodemographic factors associated with variations in contraceptive use. In addition, the study examined the barriers adolescents face in accessing and using contraceptives. Currently, there is a limited number of studies that specifically consider contraceptive prevalence in relation to geographic diversity among currently married female adolescents.
Bangladesh has been passing through a transition of various communicable and noncommunicable diseases, along with its high population density [32, 33, 34, 35, 36, 37, 38, 39]. Birth control is an important way of reducing this density. However, the current contraceptive use prevalence in this study was 65.1%, which surpasses the rates reported in a systematic review study on married female adolescents in Bangladesh [40]. Among married adolescents, 88.1% were using modern contraceptive methods, while 5.2% were relying on traditional methods. Previous research has similarly indicated a preference for modern contraceptive methods over traditional ones [16, 20]. The findings underscore the need for sustainable policy to upgrade the prevalence of use.
This study identified significant regional variation in contraceptive use across different divisions of Bangladesh. Contraceptive prevalence was found to be low in the Barisal, Sylhet, and Mymensingh divisions, with the highest prevalence observed in the Dhaka division. Another study on geographical variation in contraceptive use in Bangladesh similarly reported lower prevalence in Sylhet and higher prevalence in Rangpur [19]. The contraceptive use is lower in these regions due to a combination of factors, including lower levels of female education, limited access to family planning services in remote areas, and fewer visits from health workers [41]. Additionally, strong sociocultural norms favor early childbearing and larger families, often driven by a desire for male children, while conservative attitudes around gender roles and religion further discourage contraceptive use [42]. These combined barriers contribute to Sylhet's persistently low uptake of contraception compared to other regions in Bangladesh. These findings underscore the need for area‐specific policies and programs to increase contraceptive use in regions with lower prevalence.
This study identified education and employment status as crucial factors influencing contraceptive use in Bangladesh. The analysis indicates that married adolescents with post‐secondary education show significantly higher contraceptive use, underscoring the role of education in empowering individuals to make informed health decisions. Education enhances understanding and empowers individuals to make informed decisions [43, 44]. Additionally, access to employment and educational opportunities is associated with higher contraceptive adoption rates [2, 45, 46]. Employed female adolescents tend to prioritize their careers over starting families and have greater financial means to afford contraceptives compared to their unemployed counterparts [47]. However, further research is needed to explore the area‐specific relationships between contraceptive use, education, and employment. Updated policies and programs aimed at raising awareness among adolescents about contraceptive use are also recommended.
This study revealed that television watching significantly impacts contraceptive use, with women who regularly watch TV tending to have fewer children and showing a greater inclination toward adopting contraceptives [48]. While mobile phone use was not significantly associated with contraceptive use in the overall Chi‐square analysis, it became significant in subgroup analyses by residence and in logistic regression. This suggests that mobile phone ownership may still play an important role, particularly by improving access to reproductive health information, supporting private decision‐making, and facilitating partner communication. In contexts like Bangladesh, mobile phones can help overcome social and logistical barriers, especially for adolescents and women, by offering confidential, easily accessible information and enhancing autonomy [49, 50, 51].
Educational TV programs serve as an effective means of disseminating information to individuals who are illiterate or have limited education [52]. Health education programs broadcast through television can be an important source of knowledge on the importance of contraceptive use, particularly for illiterate adolescents. The wealth index was identified as a crucial factor in contraceptive use. Adolescents from middle‐income households were more likely to use contraceptives compared to those from the lowest‐income households, due to higher purchasing power among middle‐income families [52, 53, 54]. Additionally, this study found that adolescents with husbands aged 16–28 and 29–41 were less likely to use contraception compared to those with husbands aged 42–50.
The private medical sector plays a crucial role in providing various types of contraceptives and ensuring family planning services. Among the different methods of family planning, pills are the most used method by adolescents. Previous studies indicate that pills are preferred by many women of reproductive age [20, 55]. Few female adolescents possess the autonomy to make decisions regarding contraceptive use. Most female adolescents who do not use contraceptives cite a single reason for their choice. The primary reasons include a desire for children, a husband staying abroad, opposition from the husband, and interference with normal physiological processes. Additionally, another study found that factors such as increasing age, a smaller number of living children, inadequate healthcare facilities, recent childbirth, and a desire for children or pregnancy are directly linked to lower contraceptive use [56].
This study has both strengths and limitations. It provides a detailed examination of geographical variations in contraceptive use at the divisional level and includes a comprehensive review of the literature to inform the selection of explanatory variables. The study also analyzed the socio‐economic disparities and gendered constraints of contraceptive use. The findings have practical implications for policy and program development. However, a notable limitation is that the study relies on cross‐sectional data, which does not allow for the identification of causal relationships. To better understand causality, future research should utilize time series data. Another important limitation is that this study did not include two important demographic variables, religion and ethnicity of the adolescents. Literature suggests that religion and ethnicity are the two important predictors of contraceptive use that were lacking in the manuscript.
To improve contraceptive use among married female adolescents in Bangladesh, targeted interventions are needed in regions like Sylhet, where cultural and socio‐economic barriers limit contraceptive use, and in rural areas with low uptake, such as in certain parts of Chittagong. Focused educational programs should be implemented for both adolescents and husbands to overcome misconceptions and resistance, with an emphasis on male involvement in family planning discussions [28]. Expanding access to modern contraceptive methods, particularly injectable contraceptives and condoms, should be prioritized in underserved regions through mobile clinics and increased availability in healthcare centers. Urban areas, where contraceptive use is higher, can serve as models for rural outreach programs. Leveraging mobile and TV platforms for information dissemination and virtual consultations, especially in rural areas, can bridge the gap in access and awareness. Additionally, establishing adolescent‐friendly health services that are confidential, non‐judgmental, and easily accessible will further promote contraceptive use and reduce regional disparities in uptake.
5. Conclusion
The study reports a significant prevalence of contraceptive use among married female adolescents, varying by region and socioeconomic status. There are significant geographical disparities in contraceptive use, with the lowest prevalence found in Sylhet, highlighting the impact of geographical factors on contraceptive practices. Urban areas, particularly the Dhaka division, show higher contraceptive use rates. Modern methods like pills and condoms are preferred, but barriers include husbands' opposition and desire for children. Adolescents' division, TV watching, and mobile phone use were found to the influential factors in contraceptive practices among this demographic. The study's findings highlight the need for targeted interventions that address geographic disparities and leverage educational and media‐based strategies to enhance contraceptive use among adolescents.
Author Contributions
Zaki Farhana: investigation, methodology, validation, visualization, software, formal analysis, project administration, resources, supervision, data curation, conceptualization, writing – original draft, writing – review and editing. Nafia Rumman: investigation, writing – original draft, writing – review and editing, visualization, validation, methodology, software, formal analysis, data curation. Rifat Ara: investigation, funding acquisition, writing – original draft, writing – review and editing, visualization, validation, project administration, data curation. Ashfi Laila Elora: investigation, funding acquisition, writing – original draft, visualization, validation, project administration, data curation. Mohammad Yousuf Ali: investigation, funding acquisition, writing – original draft, writing – review and editing, visualization, validation, data curation. Shamiul Hoque Chowdhury: investigation, writing – original draft, writing – review and editing, visualization, validation, methodology, software, data curation. Md. Azad Uddin: investigation, funding acquisition, writing – original draft, writing – review and editing, validation, data curation. Mohammad Meshbahur Rahman: conceptualization, investigation, funding acquisition, writing – original draft, writing – review and editing, visualization, validation, methodology, software, formal analysis, project administration, resources, supervision, data curation.
Funding
The authors have nothing to report.
Ethics Statement
As the study used a secondary dataset, the ethical approval and consent are not applicable.
Conflicts of Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Transparency Statement
The author, Mohammad Meshbahur Rahman, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Acknowledgments
We are thankful to the Department of Biostatistics, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, for providing technical support during the data analysis.
Data Availability Statement
The data that support the findings of this study are openly available in Data for Impact, USAID at https://www.data4impactproject.org/publications/bangladesh-adolescent-health-and-wellbeing-survey-2019-20-final-report/, reference number 31.
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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 that support the findings of this study are openly available in Data for Impact, USAID at https://www.data4impactproject.org/publications/bangladesh-adolescent-health-and-wellbeing-survey-2019-20-final-report/, reference number 31.