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.

1.9 Conceptual framework

The conceptual frame work above presents the variables that were involved in the study i.e. dependent variable and independent variables. The dependent variable of the study was contraceptive use among sexually active adolescents. The independent variables was demographic factors, socio – economic factors and enabling factors.

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter consists of the literature review of previous published studies on factors associated with contraceptive use among sexually active adolescents which has been obtained from journals and text books.

2.1 Contraceptive use

Despite efforts towards making access and use of contraceptive services a basic reproductive right for all women, many countries still face high rates of unintended and unwanted pregnancies (Greek, 2019). In sub-Saharan Africa alone, about 14 million unintended (unwanted or mistimed) pregnancies occur every year; and adolescent girls and young women 15–24 years old are the most vulnerable group (WHO, 2019). The reasons behind this situation include the high prevalence (about 70%) of sexually active young women with low utilization of effective contraceptive methods (less than 10%) (WHO, 2019).

Additionally, unmarried sexually active adolescents are likely to have a high unmet need for contraception, which increases their risk of unintended pregnancies (Mishell, 2018). In low/middle-income countries, nearly half (49%) of pregnancies are unintended among adolescent girls of 15–19 years old. (Greek, 2019). Adolescence is viewed as the starting point in the continuum of care for reproductive, maternal, neonatal and child health; and is a phase when poor access and utilisation of contraception are likely to result in poor health outcomes across the continuum of care. Early and unintended pregnancies result in increased risks of maternal mortality and morbidity, premature births, low birth weight, unsafe abortions and social consequences such as stigmatisation, school drop-out and poverty (Chengen, 2019).

In Benin, although the use of modern contraceptives has been slowly increasing since 2006, it is still relatively low. The modern contraceptive prevalence among all women reached 12% in 2018 compared with 6% in 2006 (Africa, centre for Health Statistics, 2020). At the same time, almost half (48%) of all adolescent girls age 15–19 are sexually active, and one in five girls has already had a child or is pregnant. According to WHO,(2019), only 5.4% of women ages 15–24 were using modern contraceptive methods in 2017. Recent data showed a total fertility rate of 5.7 among all women of reproductive ages 15–49 years old, and the modern contraceptive prevalence rate was estimated at 12%. Of all pregnancies in the country, 19% were unintended, and in 2017, both the maternal mortality ratio and infant mortality rate remained high at 397 per 100 000 live births, and 30 per 1000 live births, respectively, (UNICEF, 2022, WHO, 2021).

Existing studies on the use of modern contraceptive methods in Benin largely reported on women of reproductive age as a whole, rather than focusing on specific age groups. MacQuarrie (2022) suggested that young women should be studied separately, as they do not have the same needs for or access to contraception as adult women.

2.2 Demographic characteristics of adolescents and contraceptive use

Population-based studies are important, as they are often used as a source of data on determinants of health and as a source of information on people’s health status (Ezzati, et al, 2019). As such, these surveys should adequately reflect the target population for the relevant indicators. A problem with population-based studies is that participation is voluntary, thus people can choose not to participate. Non-participation can reduce the precision of estimates, and more seriously may introduce selection bias if both the exposure and the outcome under investigation affect the probability of participation, and may reduce the generalizability of the results (Jousilahti, 2019).

The presence of selection bias cannot usually be inferred from the study data alone; participation studies are therefore necessary to identify any underrepresented subgroups (Lash & Rothman, 2021). Knowledge of the characteristics of non-participants may help to improve recruitment procedures and representativeness, leading to more accurate assumptions and conclusions in population-based studies, i.e., estimations of prevalence and incidence, and associations between exposures and outcomes.

Sociodemographic characteristics refer to a combination of social and demographic factors, including socioeconomic status (SES), which is often measured by an individual’s educational attainment, occupation, and income Mackenbach, 2019). Individuals with low SES have been reported to have poorer health status and to be less likely to participate in health surveys compared with individuals with high SES (Greek, 2021). Men, people who are unmarried, and those with low education or low income are also less likely to participate, according to previous studies (Greek, 2019). The association between participation and age or belonging to an ethnic minority (Palaba, 2019) is inconsistent in the literature.

2.3 Socio-economic factors associated with contraceptive use among adolescents

It has also been hypothesized that there is a positive correlation between contraceptive use and level of education (Feyisetan 2000). Other things being equal the higher the level of education the higher contraceptive use is expected to be. Although both the wives’ and husbands’ education is important there appears to be a consensus that the former is more important than the latter.

The observed place of residence variation, in the practice of contraception, may be attributed to differences in the availability of social services. Such as, education information about method and access to family planning and health care services which are among the important ones.

Religious affiliation also affects contraceptive use (Gyimah et al. 2008). Religions differ in their stand on fertility regulation and among the major world religions, Catholicism and Islam are widely regarded as pronatalist in their ideology. However, the relationship between religion and contraceptive use is much more complex than expected. In one study conducted in India, it was discovered that even though the average number of children born to a Muslim or Christian couple is higher than that born to a Hindu couple, the acceptance of sterilization to limit family size was greater among Muslims and Christians than Hindus (Ullah and Chakraborty 2019). A study of contraceptive use in Bangladesh found that Muslim women here were less likely to use contraception than Hindu women (Ullah and Chakraborty 2022). The strength of one’s religiosity or degree of one’s adherence to the norms of a given religion may exert an influence on ones’ mode of life including reproductive behaviour. Furthermore, studies in developing countries reveal that social, cultural and religious unacceptability of contraception frequently emerged as an obstacle to use contraception (Oni and McCarthy, 2022).

The work status of women has also been linked to knowledge and use of contraceptives. Women who work outside the home have higher rate of use than women who do not work outside home (housewives) (Robey et al.2022). Working women, particularly, those who earn cash incomes are assumed to have greater control over household decisions and increased awareness of the world outside home. Consequently, they have more control over reproductive decisions (Hialemariam et al. 2021). Some studies also add that paid work also provides alternative satisfactions for women, which may complete with bearing and rearing children and may promote contraceptive use.

CHAPTER THREE: METHODOLOGY

3.1 Introduction

This chapter explains the various methods and procedures through which my research was carried out. It presents the study design, target population, area of study, data type and sources of data, data collection method, variable selection, data management, data analysis, ethical considerations and limitations of the study

3.2 Study design

The study was a cross-section study design approach. The study design was used because it studied the snap short of the characteristics of adolescents within a short period of time at a single moment/encounter. The design enabled the research determine the relationship between the factors and contraceptive use.

3.3 Area of the study

The study was conducted in Northern Uganda.

3.4 Population and the sample of the study

The study involved sexually active adolescents. The sample size consisted of 18506 and this was data collected from all over the country. However, only 3627 participants were engaged in northern Uganda taking Lango (1236), west Nile (1281) and Acholi (1110). This was the sample size that was engaged in this current study.

3.5 Target population

The target population comprised of female adolescents between the age of 15-19 years of age in northern Uganda. Region.

3.6 Data type and source

The study involved secondary data. The UDHS 2016 was used as the major source of data. The 2016 Uganda Demographic and Health Survey (UDHS) was implemented by the Uganda Bureau of Statistics (UBOS). Data collection took place from 20 June to 16 December 2016. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Other agencies and organisations that facilitated the successful implementation of the survey through technical or financial support were the Government of Uganda, the United Nations Children’s Fund (UNICEF), and the United Nations Population Fund (UNFPA). Only Data collected in Northern Uganda was utilized

3.7 Study variables

Dependent variable: Contraceptive use (Yes and No).

Independent variables: These was demographic factors i.e age, marital status, education level, religion and marital status, as socio – economic factors such as wealth index and employment status.

Enabling factors included access to the health facility, availability of health personnel and the price of the contraceptives.

3.8 Data analysis.

Data analysis was conducted using statistical package for social sciences (SPSS) version 20 at univariate, bivariate and multivariate levels.

At the univariate level: It involved analysing one variable at a time. Frequency distributions were run to show the number of observations in each category and find out the variable characteristics.

3 At the bivariate level of analysis, The chi-square using a cross was used because the data is categorical in order to find out if there is an association between the two categorical variables.

Chi square test statistics was also used to test for significance and independence between the dependent and each of the independent variables, variables at 5%. A high significance value below 5% indicated a relationship between two variables.

At multi-variate level; A binary logistic regression because my dependent variable is categorized into only two categories (using contraceptives and not using contraceptives). This was used to determine the degree of relationship significance within the dependent variable and independent variables.

The model is illustrated as follows;

The model permits the computation of a regression coefficient bi for each independent variable Xi. Where;

Variable (Contraceptive use)

= probability of using contraceptive use being influenced by demographic and socio – economic factors.

= is the probability of not using contraceptives.

= independent variable

= constant (y-intersect)

= regression coefficient of the variable.

The interpretation of the results was based on probabilities (B), significance and the p- value. For OR which is the positive = the likelihood of contraceptive utilization for that particular variable relative to the reference category is high. OR which is negative= the likelihood of contraceptive is lower for that particular variable relative to reference category. p<0.05, the result is statistically significant, otherwise not.

3.9 Limitations

The limitation of the study is basically on the account of secondary data adopted in the study. The study is limited in providing an understanding of the rate of contraceptive use. Women’s perception on whether the contraceptive use was planned or wanted could change over time.

3.10 Ethical considerations

Data from UDHS was requested from Uganda bureau of statistics. The data set was sent via email and used for analysis.

The researcher respected confidentiality and privacy of individuals represented in the data. Even anonymized data can sometimes be re-identified, so researchers should be cautious about how they use and present the data.

CHAPTER FOUR: PRESENTATION OF RESULTS AND DISCUSSION

4.0 Introduction

This chapter presents results and discussion of findings in line with the objectives of the study which included; 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 Northern Uganda and to understand the association between enabling factors and contraceptive use among adolescents in Northern Uganda.

4.1 Univariate analysis

Univariate analysis is a statistical method that focuses on analyzing one variable at a time to summarize, describe, and understand its properties. Univariate analysis is a straightforward but powerful tool for summarizing data and gaining initial insights, forming the basis for more advanced statistical methods and data-driven decision-making.

4.1.1 Demographics characteristics of study respondents

Table 4.1: Showing demographics characteristics of study respondents

N=3627

Educational level	Percentage
No education	11.2
Primary	58.9
Secondary	22.8
Higher	7.2
Marital status	Percentage
Married	92.5
Single	7.5
Religion	Percentage
Anglican	9.1
Protestant	32.1
Catholic	50.1
Moslem	4.2
Born again	4.4
SDA	2.3

Source: Secondary data (UDHS, 2016)

A total of 3627 participants were engaged in the study in northern Uganda and out of these, slight majority 58.9% had primary education while 11.2 had no formal education. This means that majority of the participants in the study had attained atleast primary education.

Out of the 3627participants, majority 92.5% were married while 7.5% were single. This means that majority of the study participants were single. Out of the 3627participants, greater majority 50.1% were Catholics while least 2.3% were SDAs.

This means that from the study, majority of the participants were married, having attained primary education and the biggest number were Catholics.

4.1.2 Socio-economic factors of the respondents

Table 4.2 showing Socio-economic factors of the respondents

N=3627

Type of drinking water	Percentage
piped into dwelling	2.4
piped to yard/plot	5.4
piped to neighbor	5.0
public tap/standpipe	7.7
tube well or borehole	39.9
protected well	5.8
unprotected well	7.3
protected spring	9.2
unprotected spring	3.1
river/dam/lake/ponds/stream/canal/irrigation channel	8.7
rainwater	1.0
tanker truck	.1
bicycle with jerrycans	.4
bottled water	.2
sachet water	.1
other	.2
not a de jure resident	3.5
Type of toilet facility
flush to piped sewer system	1.0
flush to septic tank	2.3
flush to pit latrine	.6
flush to somewhere else	.1
flush, don’t know where	.1
ventilated improved pit latrine (vip)	6.2
pit latrine with slab	24.2
pit latrine without slab/open pit	53.9
no facility/bush/field	7.3
composting toilet/ecosan	.2
bucket toilet	.0
hanging toilet/latrine	.3
other	.3
not a dejure resident	3.5
Whether household has electricity
No	69.0
Yes	27.5
Not a dejure resident	3.5
Whether household has: television
No	79.7
Yes	16.8
not a dejure resident	3.5
household has: bicycle
No	60.7
Yes	35.7
not a dejure resident	3.5
Whether household has: car/truck
No	91.9
Yes	4.6
not a dejure resident	3.5
Whether household has a bank account or related financial institution
No	87.6
Yes	12.4
Employment status
Self Employed	32.3
Public servant	10.3
Employed in private sector	22.4
Unemployed	35.0

Source: Secondary data (UDHS, 2016)

Out of the 3627 participants, majority 39.9% utilized tube/borehole water as the major source of drinking water. Least 2.4% had pipped water. This means that majority of the participants in northern Uganda use bore hole/tube water. In this way, they might not have the capacity to buy contraceptives.

While assessing the type of toile as one of the components of wealth quantile, slight majority 53.9% had pit latrine without a slab/open pit followed by 24.2% who had pit latrine with a slab. This indicates high chances of high poverty levels and therefore they could not afford to buy contraceptives.

On whether the household had electricity as a component under wealth quantile, maloti of the participants 69% had no aces to electricity.

On the issue of television, majority 79.7% had no access to television and thus they could not watch media broadcasts on contraceptive use.

On whether the household had access to a bicycle, 60.7% did not have access to bicycle with least 35.7% having it. This means that the participants could face challenges in going to the health facility.

When asked whether the household had a truck/car, majority of the participants 91.9% did not have either a car or track which indicates challenges in accessing the health facility to access contraceptives.

When asked whether the participants had a bank account or not, majority of the participants 87.6% did not have a bank account. This means that the participants could face challenges in purchasing contraceptives.

For the case of employment as a socio-economic factor, majority of the participants, 35% were unemployed, 32.3% were self-employed, and 22.4% were employed in the private sector while 10.3% were public servants. This means that the majority of the participants were unemployed and thus had no source of income which limited them to access contraceptives.

4.1.3 Enabling factors of the respondents

Table 4.3 Showing enabling factors of the respondents

N=3627

Variable	Percentage
Whether household has a radio (Health information)
no	40.5
yes	55.9
not a dejure resident	3.5
Whether the household can access the health facility	Percentage
no	63.7
yes	36.3
Availability of health officers at the centre at first visit	Percentage
no	84.8
yes	15.2

Source; Secondary data (UDHS, 2016)

When asked whether the participants had aces to the radio, majority of the participants had access to the radio (55.9%) and thus they could access health ifnroamtion related to contraceptive use.

The table further shows that 63.7% of the participants could easily access the health facility and a bigger majority of 84.8% revealed that the health officers were available at the health facility on their first visit. This implied that accessibility to information, access to the health centre and availability of the health officers at the health facility on the first visits were responsible for contraceptive use intake.

4.1.4 Level of contraceptive use among respondents

Table 4.4 Level of contraceptive use among respondents

N=3627

Variable	Percentage
Knowledge of any method	Percentage
knows no method	1.1
knows only folkloric method	.0
knows only traditional method	.0
knows modern method	98.9
Ever used anything or tried to delay or avoid getting pregnant	Percentage
no	44.3
yes, used outside calendar	7.6
yes, used in calendar	48.1
Contraceptive use and intention	Percentage
using modern method	26.6
using traditional method	2.7
non-user – intends to use later	42.6
does not intend to use	28.1
Method currently used	Percentage
Daily/ monthly pill	16.6
IUD	5.2
Contraceptive injection	2.6
Contraceptive implant	1.6
Condoms	73.9

Source; Secondary data (UDHS, 2016)

From table 4.4 above it can be seen that majority of the participants 98.9% had information on the modern contraceptives. Only 1.1% did not know. This implies high level of knowledge on the contraceptives.

The table goes on and shows that slight majority of 48.1% had ever used some method the contraceptive method within their menstruation calendar and 26.6% were using some of the modern contraceptives with 42.6% intending to use them later or in future. This implied positive attitudes among the adolescents on contraceptive use. When asked any of the methods they had ever used to control pregnancy or delay birth, majority 73.9% indicated that they had ever used a condom, 5.25 indicated that they had ever used IUD, 2.6% had ever used contraceptive injection while 1.6% indicated using contraceptive implants while 16.6% had ever used emergency pills.

4.2 Bivariate analysis

4.2.1 Association between demographic factors and contraceptive use

Table 4.5: Association between demographic factors and contraceptive use

N=3627

Educational level	Percentage	p-value
No education	11.2	0.000
Primary	58.9
Secondary	22.8
Higher	7.2
Marital status	Percentage	0.000
Married	92.5
Single	7.5
Religion	Percentage	0.217
Anglican	9.1
Protestant	32.1
Catholic	50.1
Moslem	4.2
Born again	4.4
SDA	2.3

Source; Secondary data (UDHS, 2016)

Results in table 4.5 above did show 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.

This implies that education level and marital status are highly associated with contraceptive use. According to Greker (2019), higher education levels typically lead to better understanding of reproductive health and contraceptive methods. Educated individuals are more likely to be aware of various options and their effectiveness. Those with higher education levels often have better access to healthcare resources, including family planning services, which can facilitate the use of contraceptives.

Smeeding (2019) contends that education can empower individuals, particularly women, to make informed choices about their reproductive health. This can lead to increased contraceptive use as they may feel more capable of making decisions about their bodies.

Generally, married couples tend to use contraception to plan their families and prevent unintended pregnancies. The dynamics of communication within a marriage can affect contraceptive choices. Single people may also use contraception, often motivated by the desire to prevent unintended pregnancies and to manage their sexual health (Greek, 2019).

4.2.2 Association between socio-economic factors and contraceptive use

Table 4.6: Association between socio-economic factors and contraceptive use

N=3627

Variable	Percentage	p-value
Type of drinking water	Percentage	p-value
piped into dwelling	2.4	0.888
piped to yard/plot	5.4
piped to neighbor	5.0
public tap/standpipe	7.7
tube well or borehole	39.9
protected well	5.8
unprotected well	7.3
protected spring	9.2
unprotected spring	3.1
river/dam/lake/ponds/stream/canal/irrigation channel	8.7
rainwater	1.0
tanker truck	.1
bicycle with jerrycans	.4
bottled water	.2
sachet water	.1
other	.2
not a de jure resident	3.5
Type of toilet facility		0.370
flush to piped sewer system	1.0
flush to septic tank	2.3
flush to pit latrine	.6
flush to somewhere else	.1
flush, don’t know where	.1
ventilated improved pit latrine (vip)	6.2
pit latrine with slab	24.2
pit latrine without slab/open pit	53.9
no facility/bush/field	7.3
composting toilet/ecosan	.2
bucket toilet	.0
hanging toilet/latrine	.3
other	.3
not a dejure resident	3.5
Whether household has electricity		0.770
No	69.0
Yes	27.5
Not a dejure resident	3.5
Whether household has: television		0.000
No	79.7
Yes	16.8
not a dejure resident	3.5
household has: bicycle		0.821
No	60.7
Yes	35.7
not a dejure resident	3.5
Whether household has: car/truck		0.871
No	91.9
Yes	4.6
not a dejure resident	3.5
Whether household has a bank account or related financial institution		0.270
No	87.6
Yes	12.4
Employment status		0.000
Self Employed	32.3
Public servant	10.3
Employed in private sector	22.4
Unemployed	35.0

Source: Secondary data (UDHS, 2016)

Results in table 4.6 above did show 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).

The association between TV ownership and contraceptive use among women can reflect broader social, economic, and cultural factors; Television can serve as a source of information about reproductive health, family planning, and contraceptive methods. Programs that discuss these topics may increase awareness and promote contraceptive use (Jenning, 2019).

TV content often influences cultural norms and attitudes towards family planning. Exposure to programs that normalize contraceptive use can encourage women to adopt these methods (Greggory, 2019).

Ownership of a TV may correlate with higher socioeconomic status, which can also influence access to healthcare resources, including contraceptives. Women in wealthier households may have better access to family planning services (Jonie, 2019).

4.2.3 Association between enabling factors and contraceptive use

Table 4.7: Association between enabling factors and contraceptive use

Variable	Percentage	P-value
Whether household has a radio (Health information)		0.019
no	40.5
yes	55.9
not a dejure resident	3.5
Whether the household can access the health facility	Percentage	0.000
no	63.7
yes	36.3
Availability of health officers at the centre at first visit	Percentage	0.000
no	84.8
yes	15.2

Source; Secondary data (UDHS, 2016).

Results in table 4.7 above, it can be seen 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).

According to Greek (2019), when health facilities offer a range of contraceptive options and family planning services, women are more likely to use contraception. Access to various methods allows individuals to choose what best fits their needs. Facilities that provide quality care, including counseling and education about contraceptive options, can positively impact contraceptive use. Good relationships with healthcare providers can encourage women to seek advice and services.

Women living near health facilities are more likely to access contraceptive services. Long distances to clinics can be a significant barrier, especially in rural areas where transportation may be limited.

4.3 Multivariate analysis

Table 4.8: Analysis of variables between contraceptive use and intervention on demographic factors

ANOVA^a
Model		Sum of Squares	df	Mean Square	F	Sig.
1	Regression	702.008	5	140.402	113.216	.000^b
	Residual	20374.024	16429	1.240
	Total	21076.032	16434
a. Dependent Variable: contraceptive use
b. Predictors: (Constant), demographic factors, socio-economic factors and enabling factors

The output table provided is from an ANOVA (Analysis of Variance) test in a regression model, where the dependent variable is “contraceptive use.” The independent variables (predictors) are demographic factors, socio-economic factors and enabling factors. This value represents the sum of squares due to the regression, which indicates the portion of the total variability in contraceptive use and intention explained by the predictor variables. This is the sum of squares for the residual or error, representing the unexplained variability in contraceptive use and intention. This is the total sum of squares, representing the overall variability in the dependent variable. It’s the sum of the Regression and Residual sums of squares. The degrees of freedom for the regression is 5, corresponding to the five predictor variables. The degrees of freedom for the residual indicates the sample size minus the number of predictors minus one (total sample size – predictors – 1). The total degrees of freedom is equal to the total sample size minus 1.

This is calculated by dividing the regression sum of squares by its degrees of freedom (702.008 / 5). Calculated as the residual sum of squares divided by its degrees of freedom (20374.024 / 16429). The F-statistic tests the overall significance of the model, comparing the explained variance to the unexplained variance. The F-value here (113.216) is relatively high, which suggests that the model explains a significant amount of variance in contraceptive use and intention relative to the error. The p-value is less than 0.001, indicating strong evidence that the model as a whole is statistically significant. Therefore, we reject the null hypothesis that none of the predictors explain the variability in contraceptive use and intention. This means that at least one of the predictor variables contributes significantly to explaining the variability in the dependent variable. The ANOVA table indicates that the model significantly explains variability in contraceptive use and intention, with the predictors collectively contributing to the model’s explanatory power. The high F-statistic and the extremely low p-value suggest that these variables, such as sex of the household head, religion, age, and education, have a meaningful impact on the outcome variable. Further analysis could delve into the individual contributions of each predictor to understand their specific effects.

4.4 Discussion of Summary of Findings

4.4.1 Demographic factors associated with contraceptive use among adolescents in Northern Uganda.

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.

In sub-Saharan Africa alone, about 14 million unintended (unwanted or mistimed) pregnancies occur every year; and adolescent girls and young women 15–24 years old are the most vulnerable group (WHO, 2019). The reasons behind this situation include the high prevalence (about 70%) of sexually active young women with low utilization of effective contraceptive methods (less than 10%) (WHO, 2019).

Additionally, unmarried sexually active adolescents are likely to have a high unmet need for contraception, which increases their risk of unintended pregnancies (Mishell, 2018). In low/middle-income countries, nearly half (49%) of pregnancies are unintended among adolescent girls of 15–19 years old. (Greek, 2019). Adolescence is viewed as the starting point in the continuum of care for reproductive, maternal, neonatal and child health; and is a phase when poor access and utilisation of contraception are likely to result in poor health outcomes across the continuum of care. Early and unintended pregnancies result in increased risks of maternal mortality and morbidity, premature births, low birth weight, unsafe abortions and social consequences such as stigmatisation, school drop-out and poverty (Chengen, 2019).

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.

4.4.2 Socio-economic factors associated with contraceptives among adolescents in Northern Uganda

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.

In the study by, (Feyisetan 2000), it has also been hypothesized that there is a positive correlation between contraceptive use and level of education. Other things being equal the higher the level of education the higher contraceptive use is expected to be. Although both the wives’ and husbands’ education is important there appears to be a consensus that the former is more important than the latter.

Use of family planning is higher in urban than rural areas. Urban-rural difference in the adoption of contraception is the highest in SSA, where the rate is more than twice as high as among urban than among rural in all surveyed countries (Curtis and Katherine, 2021). The observed place of residence variation, in the practice of contraception, may be attributed to differences in the availability of social services. Such as, education information about method and access to family planning and health care services which are among the important ones.

4.4.3 The association between enabling factors and contraceptive use among adolescents in Northern Uganda.

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.

In a similar study by Jeffern (2019), it was revealed that 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. Despite efforts towards making access and use of contraceptive services a basic reproductive right for all women, many countries still face high rates of unintended and unwanted pregnancies (Greek, 2019). In sub-Saharan Africa alone, about 14 million unintended (unwanted or mistimed) pregnancies occur every year; and adolescent girls and young women 15–24 years old are the most vulnerable group (WHO, 2019). The reasons behind this situation include the high prevalence (about 70%) of sexually active young women with low utilization of effective contraceptive methods (less than 10%) (WHO, 2019).

Additionally, unmarried sexually active adolescents are likely to have a high unmet need for contraception, which increases their risk of unintended pregnancies (Mishell, 2018). In low/middle-income countries, nearly half (49%) of pregnancies are unintended among adolescent girls of 15–19 years old. (Greek, 2019). Adolescence is viewed as the starting point in the continuum of care for reproductive, maternal, neonatal and child health; and is a phase when poor access and utilisation of contraception are likely to result in poor health outcomes across the continuum of care. Early and unintended pregnancies result in increased risks of maternal mortality and morbidity, premature births, low birth weight, unsafe abortions and social consequences such as stigmatisation, school drop-out and poverty (Chengen, 2019).

CHAPTER FIVE: SUMMARY, RECOMMENDATIONS AND CONCLUSION

5.0 Introduction

This chapter presents a summary of the findings, conclusions, and recommendations based on the study objectives which included; to examine the socio-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 and to understand the association between enabling factors and contraceptive use among adolescents in Northern Uganda.

5.1 Summary of Findings

Exploring the association between demographic factors and contraceptive use among adolescents in Northern Uganda involved examining how various characteristics influence the likelihood of using contraceptives.

Association between demographic factors and contraceptive use

Association between socio-economic factors and contraceptive use

Association between enabling factors and contraceptive use

5.2 Conclusions

Education level and marital status are significant predictors of contraceptive use. Older adolescents and those with higher educational attainment tend to use contraceptives more frequently.

Adolescents from higher socioeconomic backgrounds have better access to contraceptive methods, highlighting the need for targeted interventions in lower-income communities.

Limited access to healthcare services, particularly in rural areas, significantly impacts contraceptive use. Efforts to improve the availability of contraceptive options are essential for increasing usage among adolescents.

5.3 Recommendations

Based on the findings regarding the association between socio-demographic and socio-economic factors and contraceptive use among adolescents in Northern Uganda, the following recommendations are proposed:

Enhance Education and Awareness: Implement comprehensive sex education programs in schools and communities that address reproductive health, contraceptive options, and responsible sexual behavior. Tailor these programs to the specific needs and cultural contexts of adolescents.

Improve Access to Contraceptive Services: 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.

Community Engagement and Advocacy: Engage community leaders and stakeholders in advocacy efforts to shift cultural attitudes toward contraception. Promote open discussions about reproductive health in community forums to reduce stigma and increase acceptance.

Strengthen Economic Support Programs: Develop and implement socio-economic programs aimed at improving the financial stability of families. Programs that provide vocational training or financial literacy can empower adolescents to make informed choices about their reproductive health.

Parental and Guardian Involvement: Encourage initiatives that promote communication between adolescents and their parents or guardians about sexual health. Workshops or information sessions can equip parents with the knowledge to discuss these topics with their children effectively.

By addressing these recommendations, stakeholders can create a supportive framework that enhances contraceptive use among adolescents in Northern Uganda, ultimately contributing to improved reproductive health outcomes and empowerment for young people in the region.

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