Determinants of contraceptive use and intention to use among youth 15–24 years from a remote pastoral community in Northeastern, Uganda

Background: Contraceptive prevalence in the Karamoja region of Northeastern Uganda is 10%, compared to the national prevalence of 38%. Young people aged 15-24 years have limited access to contraceptive services in this region. This study assessed the determinants of contraceptive use and intention to use among youths aged 15-24 years. Methods: A cross-sectional study using quantitative methods was conducted. Data were collected from 409 randomly selected youth. A modified Poisson regression model was used to identify determinants of contraceptive use and intention to use. Results: In Karamoja, the prevalence of contraceptive use among sexually active youth was 11.0% (6.4% males, 16.3% females), while intention to use some form of contraceptives was 72.4% (84% males, 59% females). Factors associated with contraceptive use included paid employment (APR = 4.51, 95% CI: 3.80-5.36 for females; APR = 1.6, 95% CI: 1.26-1.92 for males), secondary education or higher (APR = 1.32, 95% CI: 1.15-1.52 for females; APR = 1.25, 95% CI: 0.50-0.77 for males), older age (20-24 years) (APR = 1.30, 95% CI: 1.20-1.41 for females; APR = 1.42, 95% CI: 1.37-1.63 for males), and living with biological parents. Factors associated with intention included paid employment (APR = 5.75, 95% CI: 4.94-6.69 for females; APR = 2.25, 95% CI: 1.76-2.89 for males), having biological children (APR = 3.15, 95% CI: 1.92-5.15 for males), and age. Intention among 20-24-year-old females was half that of 15-19-year-olds (APR = 0.50, 95% CI: 0.44-0.56), and 28% lower among 20-24-year-old males (APR = 0.72, 95% CI: 0.53-0.95). Muslims and married youth reported very low contraceptive use. Conclusion: Secondary education and above, paid employment, and living with parents were key determinants of contraceptive use and intention. We recommend improving access to education and employment opportunities, promoting parental involvement, and providing adolescent-friendly SRH services to translate intention into actual use. Registration: The study was registered by Makerere University School of Public Health, Research Ethics Committee, reg number (SPH-2022-294) and Uganda National Council of Science and Technology (UNSCT), reg number HS2547ES.