Adolescence, a period when young people develop from childhood to adulthood, presents vast opportunities and increased risky behaviors. It’s time many young people become sexually active and get married with limited or no information and services on how to delay pregnancy. Globally an estimated 20 million pregnancies occur in adolescents every year [1]. There are disproportionately high rates of adolescent pregnancy in developing countries. In low resource settings, 2.5 million births occur in adolescents below the age of 16 years annually [2]. In Africa, 20% of all pregnancies occur in adolescents, with a big burden in the East African Region [3]. Within the developing countries, the burden of adolescent pregnancy is higher among the less privileged poor and the illiterate. Uganda is one of the countries with the highest rates of adolescent pregnancy, estimated at 25% [4]. Adolescent pregnancy has been attributed to various factors including sociocultural, environmental, and economic reasons [5].

Adolescent pregnancy has well-documented consequences for the mother and newborn. There is an increased risk of maternal and perinatal morbidity and mortality during adolescence [6]. Maternal deaths are more common in adolescents and young people with an even higher risk in those below 15 years. Babies born to adolescent mothers are at an increased risk of infant and childhood mortality and morbidity. On the other hand, it is associated with long-term socioeconomic consequences [7] [8]. Adolescent pregnancy is a recipe for poverty in these populations to school dropout and facing rejection from their families [5]. Reducing pregnancy rates in sexually active adolescents can be achieved by the use of modern contraceptives [9].

Low contraceptive prevalence has been reported among adolescents. In 2019, globally 10.2% of sexually active adolescent women 15 - 19 were using modern contraceptives with notably low prevalence and high unmet need in Sub-Saharan Africa [10]. Contraceptive prevalence rates in Uganda among married couples increased from 14% in 2011 to 35%, according to the 2016 Uganda Demographic Health Survey (UDHS 2016) yet that of sexually active married and unmarried adolescents was 25.1%. Uganda’s National policies on contraception use among adolescents allow sexually active adolescents to access contraceptives without the consent of the parent/guardian [11]. To understand what drives contraceptive use in this age group, data on the association between demographic characteristics and the use of modern contraceptives among adolescents is crucial. The objective of this study was to determine the prevalence and factors associated with the ever use of modern contraceptives among adolescents in Uganda.

The study aimed to determine the factors associated with the ever use of modern contraceptives among adolescents in Uganda. The data suggests that the older adolescents, those who are knowledgeable about contraceptives, puberty, and those married were more likely to ever use modern contraceptives. In addition, those who had attained primary education and those who had the freedom to the club were more likely to use modern contraceptives. Adolescents from the rural areas who had discussed sex with parents while those in urban settings those from poor households and knowledgeable about contraception and puberty were likely to use modern contraceptives.

The study shows that three in ten adolescents had ever used a modern contraceptive. The majority had used short-acting contraceptives like condoms pills and injectables. The results of this study are comparable to modern contraceptives ever used among adolescents 15 - 19 years in Ghana (35%) [18] and the Demographic Republic of Congo (28.9%) [19]. A lower prevalence (9.5%) of contraceptive ever use among adolescents in Uganda has been reported after a secondary analysis of 2016 UDHS data [20]. This study looked at the utilization of all adolescents irrespective of their previous sexual experience which explains the main differences. The unmet need for contraception among adolescents is much higher than among other women of reproductive age in general [21]. The low prevalence of ever use of modern contraceptives in this population highlights the underlying cause of adolescent pregnancy.

The study found adolescents who were knowledgeable about modern contraceptives were more likely to ever use them. It has been previously found that curriculum-based sex and HIV education programs when given to young people

***P < 0.001, **P < 0.05, *P < 0.1, CPR-Crude prevalence ratios, PR-Prevalence ratio, attending school at the beginning of the year was dropped from the multivariable model because of the missing data (13%).

promote contraceptive use [22]. A study in Uganda found very low knowledge of contraceptives and yet the main source of information was the media [23]. Media is not a reliable means of delivery of SRH information because it may not be accurate or be misrepresented [24]. Knowledge empowers adolescents to make effective choices on the prevention of pregnancy and sexually transmitted infections. Delivery of SRH information to adolescents should be taken as a priority to reduce adolescent pregnancy in Uganda.

The study found that adolescents with primary education were more likely to ever use modern contraceptives compared to those who attained secondary education. This effect was more evident in adolescents from the rural setting. This is contrary to a previous study from Ghana among sexually active unmarried adolescents which showed that attaining secondary education promoted the use of modern contraceptives [18]. Previous studies, in addition, have indicated that older women and those with high education are more likely to use modern contraceptives [25] [26]. The possible explanation in this setting is that high school dropouts in the rural areas due to poverty expose them to more sexual activity and therefore need to use contraceptives. The adolescents who have stayed longer in school are likely to differ sexual activity which explains why the adolescents who had secondary education had less sexual activity and low contraceptive ever use.

Married, older adolescents were more likely to ever use modern contraceptives. Older adolescents are more likely to be exposed to receive information on contraceptives from the health facility as reported previously in a study done in the Democratic Republic of Congo [19]. Married adolescents are likely to be exposed to regular sexual activity as compared to the unmarried and these are also socially acceptable to access modern contraceptives compared to their counterparts.

In this study, adolescents from rural areas were more likely to ever use modern contraceptives. The desire to prevent pregnancy could be influenced by the high rates of teenage pregnancy in rural areas. The finding is contrary to what has been previously shown that adolescents in rural areas are less likely to use contraceptives compared to their urban counterparts [26]. Adolescents in rural areas have been at higher risk of teenage pregnancy [3]. Low socioeconomic status has been independently linked to adolescent pregnancy [27] [28]. It’s likely that as an intervention to prevent pregnancy and consequences of adolescent pregnancy are evident in the rural and poor communities, which motivates them to use contraceptives.

The unlikely findings in this study were that contraceptives are ever used more likely in the urban poor adolescents. Previously it has been shown that the more educated and rich are more likely to use contraceptives [26]. The urban poor adolescents were found to be at a higher risk of adolescent pregnancy compared to the rural poor in Zambia [29]. The urban poor likely has greater temptations to raise economic status at any cost, including risky sexual behavior which predisposes them to pregnancy and therefore, the increased demand for contraception.

Those who had ever discussed sex with their parent and had the freedom to go dancing and clubbing were more likely to ever-used modern contraceptives. Discussing sex with parents has been shown previously to be protective of adolescent pregnancy in Africa [3]. Parental supportiveness is associated with the use of modern contraceptives among secondary students in Scotland [30]. Parents discussing sexual reproductive health issues with the adolescent gives accurate information and empowers them to make good decisions.

The main limitation of the study was that data on contraceptive ever use got from self-reports which could have brought bias. Data collected on the variables were self-reported which may have affected the data. Details of the contraceptives were captured in the questionnaire; however, data on being out of school at the beginning of the year had missing data and was not included in the analysis. Data was collected after the COVID 19 lock-down of schools in Uganda which may have affected the sexual exposure of the adolescents and possibly the use of contraception. In addition, the cross-sectional nature of the study data does not give a causal interpretation of the findings. However, the sample size was adequate and the data collection tools were validated. The data was collected from two districts in Uganda and is not representative of all adolescents in Uganda.

This study presents the results of an analysis of recent data on contraceptive ever use among adolescents in Uganda. This analysis allowed us to assess factors associated with contraceptive ever use among adolescents. Stratified analysis was conducted to determine whether the associated factors were affected by the residence of the adolescents, which revealed that older and married adolescents were more likely to ever use modern contraceptives. In the rural district, those who had discussed sex with their parents were more likely to use contraceptives. Vulnerable adolescents like the poor and less educated were more likely to use modern contraceptives. Empowering the girl child early with knowledge, especially with the parent as the primary source may be a good strategy for promoting contraceptive use among adolescents. The different stakeholders, including parents, health workers, and policymakers should consider using this evidence to guide decisions on the provision of SRH information regarding contraceptives in adolescents and preadolescents.

The results of the study are not generalizable to all adolescents in Uganda. It’s representative of adolescents in the selected rural and urban settings.

We would like to acknowledge all the adolescents and their parents/guardians who took part in this study. The research assistants who participated in the data collection. The district health and Village health teams at Kamuli and Wakiso districts introduced us to the community.

The study was approved by the Makerere University School of Public Health Research and Ethics Committee (HDREC 768) and the Uganda National Council of Science and Technology (SS 5236). All study participants provided informed consent and assent before participating in the study.

All data generated or analyzed during this study are included in this published article.

All the authors contributed to the conception and conduction of the study. FN drafted the first manuscript and all authors contributed and approved the final draft.

The authors declare no competing interests.

Fatuma, N., Theresa, P.-W., Joseph, R., Flavia, N., Lorraine, O., Paul, M., Sabrina, B.-K. and Nicolette, N.-B. (2022) Ever Use of Modern Contraceptive among Adolescents in Uganda: A Cross-Sectional Survey of Sociodemographic Factors. Health, 14, 696-723. https://doi.org/10.4236/health.2022.146051

SRH: Sexual Reproductive Health

STI: Sexually transmitted infections

VHT: Village Health teams

aPR: Adjusted Prevalence Ratio

CPR: Crude Prevalence Ratio

Sexual and Reproductive Health Information

Makerere University

001 QUESTIONNAIRE ID No. |___|___|___|___|___|___|

002 INTERVIEWER NAME: _____________________________

003 DISTRICT: _______________________

004 NAME OF VILLAGE: ________________________

005 NAME OF SUB COUNTY:_____________________

006 Rural = 1 Urban = 2 Other (specify) _________

007 DATE OF INTERVIEW: ___/____ / 2020

ASK: Please confirm that you are between 13 and 19 years

IF THE RESPONDENT DOES NOT FIT THE CRITERIA…Tell them you cannot interview them,thank them, and end the interview.

008 Interview Result: Result codes: Completed = 1; Partially Completed = 2; Refused = 3; Other = 4

009 DECIDE CATEGORY

Ever been or currently pregnant: 1

Never been pregnant: 2

010 INTERVIEW CHECKED BY SUPERVISOR:

SUPERVISOR SIGNATURE ______________CODE |___|___| Date ___/____ / 2020

First, I have some questions about yourself

Now, am going to ask you questions about your family and yourself?

INSTRUCTION: Now am going to ask you questions about social economics status of the household

THANK YOU VERY MUCH FOR YOUR COOPERATION