Samkeliso G Shongwe, Mduduzi Colani Shongwe, Christopher O Aimakhu, Anas M Malami, Ronald Kooko
Most participants were aged 20-24 years (61.7%). The pooled magnitude of modern contraceptive use among sexually active AGYW was 46.3% (95% CI: 45.2-47.5%). At individual level, AGYW with higher education (aOR = 3.73, 95% CI: 2.89-4.81), employed (aOR = 1.20, 95% CI: 1.13-1.29), married (aOR = 1.29, 95% CI: 1.19-1.40), lacked desire for more children (aOR = 1.23, 95% CI: 1.06-1.43), and those with a recent health facility visit (aOR = 1.32, 95% CI: 1.22-1.42) had higher odds of modern contraceptive use. At the community level, AGYW from communities with higher education levels (aOR = 1.21, 95% CI: 1.10-1.34) also had increased odds of modern contraceptive use.
BACKGROUND: Unintended pregnancies remain a major public health concern in Sub-Saharan Africa (SSA), especially among adolescent girls and young women (AGYW). In Southern Africa, where HIV prevalence is among the highest globally, modern contraceptive use is critical for both pregnancy prevention and HIV risk reduction. Therefore, this study sought to determine the magnitude and multilevel determinants of modern contraceptive use among sexually active AGYW in six Southern African countries with high HIV prevalence.
METHODS: This study used cross-sectional data from the Demographic and Health Surveys (DHSs) of six Southern African countries, including a weighted sample of 18,265 sexually active AGYW aged 15-24 years. We fitted multilevel logistic regression models to examine the individual and community-level determinants of modern contraceptive use, with statistical significance at p <0.05.
RESULTS: Most participants were aged 20-24 years (61.7%). The pooled magnitude of modern contraceptive use among sexually active AGYW was 46.3% (95% CI: 45.2-47.5%). At individual level, AGYW with higher education (aOR = 3.73, 95% CI: 2.89-4.81), employed (aOR = 1.20, 95% CI: 1.13-1.29), married (aOR = 1.29, 95% CI: 1.19-1.40), lacked desire for more children (aOR = 1.23, 95% CI: 1.06-1.43), and those with a recent health facility visit (aOR = 1.32, 95% CI: 1.22-1.42) had higher odds of modern contraceptive use. At the community level, AGYW from communities with higher education levels (aOR = 1.21, 95% CI: 1.10-1.34) also had increased odds of modern contraceptive use.
CONCLUSION AND RECOMMENDATIONS: Less than half of AGYW in the six high HIV prevalence Southern African countries reported modern contraceptive use. Several multilevel determinants influenced uptake. Therefore, governments in the six countries need to address disparities through targeted policies and interventions, such as enhancing education, engaging in mass media outreach programmes, and improving healthcare access, which could increase modern contraceptive use, reduce unintended pregnancies, and contribute to HIV prevention efforts.