FACTORS ASSOCIATED WITH CONTRACEPTIVE USE AMONG SEXUALLY ACTIVE ADOLESCENTS IN NORTHERN UGANDA.
ABSTRACT
The general objective of the study was to understand the factors associated with contraceptive use among adolescents in Northern Uganda. Specifically, the study examined the demographic factors associated with contraceptive use among adolescents in Northern Uganda, assessed the socio-economic factors associated with contraceptives among adolescents in Acholi sub-region, Northern Uganda and also understand the association between enabling factors and contraceptive use among adolescents in Northern Uganda. The study utilized secondary data based on UDHS (2016) with a sample size 18056 participants from northern Uganda.
On the first objective, the results revealed a very weak significant association between religion and contraceptive use p=0.217 while variables education level and marital status are highly associated with contraceptive use p=0.000. From the study, younger adolescents had different attitudes towards contraceptive use compared to older adolescents, influenced by maturity and experience. Higher levels of education was associated with increased knowledge about contraceptive options and access to services. Adolescents who were married may have different motivations and access to contraceptives compared to those who are unmarried. Cultural and religious beliefs strongly influenced attitudes towards contraception, affecting both acceptance and usage.
On the second objective, results in further revealed a very weak significant association between variables type of drinking water (p=0.8888), type of toilet facility (p=0.370), access to electricity (p=0.770), and contraceptive use p=0.217, ownership of the car (p=0.871), ownership of a bank account (p=0.270) and contraceptive use while variables employment status, and access to television are high associated with contraceptive use (p=0.000). Economic factors influenced access to contraceptive methods. Adolescents from lower socioeconomic backgrounds faced barriers such as cost and availability.
On the third objective, the results further revealed that access to a radio as a source of health information shown a weak association with contraceptive use (p=0.019) while variables accessibility to the health facility and availability of health officers at the health centre were associated with contraceptive use (p=0.000). Proximity to the health facility was highly associated with contraceptive use. Urban vs. rural residence can impact access to healthcare services, including contraceptive options, with rural areas often having fewer resources. Parental attitudes and communication about sexual health also affected adolescents’ likelihood of using contraceptives. Friends and peers can significantly impact decisions about contraceptive use through shared experiences and attitudes. Awareness of different contraceptive methods and their availability can influence usage rates.
Among the recommendations, it is better to increase the availability of youth-friendly health services that provide confidential and affordable contraceptive options. Ensure that these services are accessible in both urban and rural areas.
CHAPTER ONE: INTRODUCTION
1.0 Introduction
This chapter consists of introduction, background of the study, problem statement, study objectives, research objectives, conceptual framework, and justification of study.
1.1 Background of the study
Contraceptive use among adolescents is a significant public health issue globally, with trends and access varying widely across different regions and cultures. The prevalence of contraceptive use among adolescents varies significantly. In high-income countries, usage rates tend to be higher, with comprehensive sexual education and access to healthcare services contributing factors. In contrast, many low- and middle-income countries report lower usage rates, often due to cultural, economic, and informational barriers (Halton, 2018).
According to the World Health Organization (WHO, 2019) and United Nations (UN, 2019) data, around 30% of sexually active adolescents in developing countries use contraceptives. In contrast, this figure can be over 60% in high-income countries. Globally, approximately 23 million adolescents aged 15-19 in developing regions become pregnant each year, with many pregnancies being unintended. Improved contraceptive use could significantly reduce these rates. Among adolescents who do use contraception, condoms are the most common method, often due to their dual protection against STIs. However, many adolescents also use hormonal methods, such as the pill or injectables, especially in regions where these are more accessible (WHO, 2018). In countries with comprehensive sexual education programs, contraceptive use rates among adolescents tend to be higher. For instance, in some Nordic countries, nearly 90% of adolescents report receiving formal sexual health education (Halton, 2018).
In Africa, Trends in contraceptive use among adolescents reveal a complex landscape influenced by various social, economic, and cultural factors. Over the past decade, there has been a growing awareness of the importance of sexual and reproductive health among adolescents (UN, Women, 2020). Initiatives aimed at increasing knowledge about contraception have gained momentum, particularly in urban areas. While contraceptive use among adolescents remains relatively low, some countries have seen gradual increases. For example, in countries like Kenya and South Africa, contraceptive use among young people has risen, though it still often hovers around 20-30% (WHO, 2020). According to Njororge, (2020), condoms remain the most commonly used contraceptive method among adolescents in Africa, primarily due to their availability and effectiveness in preventing STIs. However, the use of hormonal methods, such as pills and injectables, is also increasing, especially among older adolescents.
There are significant regional differences in contraceptive use. East Africa generally shows higher rates compared to West and Central Africa, where cultural norms and lack of access continue to pose challenges (Njoroge, 2020). Despite some progress, many adolescents face barriers to accessing contraceptives. These include stigma, lack of education, and limited availability of youth-friendly health services. In many rural areas, healthcare facilities may be far away or lack the necessary resources (Kimenyi, 2020). Overall, while challenges remain, there are signs of progress in contraceptive use among adolescents in Africa, driven by increased awareness and targeted interventions.
In Uganda, trends in contraceptive use reflect significant changes over the past few decades, influenced by various social, cultural, and policy factors, (UBOS, 2020, Kassaga, 2020). As of recent data, contraceptive prevalence among married women in Uganda is around 30-40%. However, this number is generally lower among adolescents, with only about 20% of sexually active adolescents using contraception (UN, Women, 2023). There has been a gradual increase in the use of modern contraceptive methods, particularly in urban areas. Methods such as condoms, injectables, and oral contraceptive pills are becoming more popular, especially among younger women.
Sexually active adolescents in Uganda face a variety of challenges and opportunities that significantly impact their sexual and reproductive health (UN, Women, 2023). Estimates suggest that a substantial number of adolescents (ages 15-19) in Uganda are sexually active, with some studies indicating that around 30-40% of young women in this age group have had sexual intercourse. Among sexually active adolescents, contraceptive use remains relatively low. While there has been some increase in awareness and availability of contraceptives, many young people still face barriers such as stigma, lack of access to youth-friendly services, and insufficient sexual health education(UN, Women, 2023). Uganda has one of the highest rates of adolescent pregnancy in East Africa. Many pregnancies among adolescents are unintended, often due to inconsistent contraceptive use or lack of access to contraceptive methods.).
In northern Uganda, the rate of contraceptive use among women of reproductive age is yet no known putting policy makers at risk of making wrong policy decisions. The area is characterised by a growing number of women of reproductive age, lack of knowledge about contraceptive hence high birth-rates. According to Kaddaga, (2020), there exist a significant disparity in access to sexual and reproductive health services in northern Uganda alone accounting for over seven percent of the overall national figures on teenage pregnancies. Taking this data, it was thus necessary to investigate the factors associated with contraceptive use which was the basis for this study utilizing secondary data from UBOS, (UDHS, 2016).
1.2 Problem statement
In Uganda, the prevalence of modern contraceptive use among females is at 9.4% yet more that 62.3% are sexually active (Sserwanja et al., 2021). According to Reproductive Health Uganda (2022), barely 30% of married Ugandan women employed contemporary techniques of family planning in 2016.
In northern Uganda, the rates of contraceptive use among adolescents remain alarmingly low, contributing to high rates of unintended pregnancies and sexually transmitted infections (STIs) (UDHS, 2016).
Despite various health initiatives aimed at improving reproductive health, many adolescents still face significant barriers to accessing and utilizing contraceptive methods. This situation is exacerbated by a complex interplay of factors, including cultural norms, inadequate sexual health education, and limited access to youth-friendly health services. It was thus necessary to understand the factors associated with contraceptive use among adolescents in Northern Uganda.
1.3 Purpose of study
To understand the factors associated with contraceptive use among adolescents in Northern Uganda.
1.4 Specific Objectives
The study was guided by the following objectives;
- To examine the demographic factors associated with contraceptive use among adolescents in Northern Uganda.
- To assess the socio-economic factors associated with contraceptives among adolescents in Acholi sub-region, Northern Uganda.
- To understand the association between enabling factors and contraceptive use among adolescents in Northern Uganda.
1.5 Study Hypotheses
- Socio-demographic factors are significantly associated with contraceptive use among adolescents in Northern Uganda.
- Socio-economic factors are significantly associated with contraceptives among adolescents in Northern Uganda.
- There is a significant association between enabling factors and contraceptive use among adolescents in Northern Uganda.
1.6 Scope of the study
The study was carried out in Acholi-sub Region in Northern Uganda exploring the factors associated with contraceptive use among adolescents.
UDHS data 2016 was utilized for this study.
1.6 Significance of the study
The Uganda National Health Policy focus has been on strengthening health systems in line with increasing contraceptive use among sexual active adolescent through health education and increasing accessibility to various contraceptive methods. Thus, this study will help in conducting the study will aid in understanding the factors associated with non – use of contraceptives thereby set grounds for formulating policies/laws aimed at fostering the use of contraceptives. The study results will act as a guide for implementation of programs promoting contraceptive use in areas it has not been done. The study will be used as a guide by future researchers as they carry out research on other countries. In addition, further studies will develop their literature on this based on the information that will be generated in the study.
1.8 Justification of the study
Many teenagers conceive annually as a result of failure to use contraceptives which is associated with maternal and neonatal complications. The use of contraceptives can be improved if the demographic and socio – economic factors associated with uptake are well known. Related variables like accessibility and acceptability to contraceptives can be addressed in consideration to the demographic profile of the sexually active adolescents. Therefore, conducting this study in Northern Uganda will act as a yardstick for formulation of evidenced based programs aimed at improving contraceptive uptake among sexually active adolescents in the region.
