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A multilevel analysis of barriers to utilization of modern contraceptive methods among adolescent girls and young women in Zambia based on demographic and health survey data
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A multilevel analysis of barriers to utilization of modern contraceptive methods among adolescent girls and young women in Zambia based on demographic and health survey data
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A multilevel analysis of barriers to utilization of modern contraceptive methods among adolescent girls and young women in Zambia based on demographic and health survey data
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Journal Article
A multilevel analysis of barriers to utilization of modern contraceptive methods among adolescent girls and young women in Zambia based on demographic and health survey data
2025
Overview
Background
Modern contraception is one of the most significant public health interventions of the 20th century. This is because it improves maternal and child health. Despite the benefits, modern contraceptive use among adolescent girls and young women in Zambia remains low. Earlier studies in Zambia have ignored the influence of social context in understanding modern contraceptive use among adolescent girls and young women. Thus, this study was conducted to examine the individual and community level determinants of modern contraceptive use among adolescent girls and young women in Zambia.
Methods
Data from the nationally representative Zambia Demographic and Health Survey of 2018 were used in this study. A weighted sample of 3448 sexually active and non-fecund adolescent girls and young women (AGYW) aged 15–24 years was used in the analysis. The outcome variable for this study is modern contraceptive use. Modern contraceptive use was defined to include the following contraceptive methods captured in the demographic and health survey, female and male sterilization, oral contraceptive pills, intrauterine devices (IUDs), injectables, implants, male and female condoms and emergency contraception. Stata software version 14.2 Standard Edition was used to perform statistical analysis, considering complex survey design. Descriptive analysis and a multilevel binary logistic regression model was used to assess the determinants of modern contraceptive use among adolescent girls and young women. All analyses were weighted to account for under and over sampling in demographic and health survey.
Results
The prevalence of modern contraceptive use among adolescent girls and young women was (38.1% 95% CI: 35.9, 40.4). AGYW aged 20–24 were more likely to use modern contraceptive methods [aOR = 1.34, 95% CI = 1.12–1.59], as were AGYW who were married [aOR = 4.42, 95% CI = 3.70–5.20], with secondary education [aOR = 2.28, 95% CI = 1.43–3.63], those from Lusaka province [aOR = 1.46, 95% CI = 1.01–2.09] or North-Western province [aOR = 1.92, 95% CI = 1.31–2.82], and AGYW from communities with moderate wealth [aOR = 1.36, 95% CI = 1.01–1.85]. The intraclass correlation revealed that 8.9% of the overall variations remained unexplained after controlling for both individual and community-level influences.
Conclusion
The barriers to modern contraceptive use among adolescent girl and young women were younger age, not being married, no education or lower education, region, lower community wealth status, and high community employment status, contributing to lower uptake of modern contraceptives. Therefore, the prevalence of modern contraceptive use among adolescent girls and young women in Zambia remains low compared to the national target of 58%. This is despite many national and sub-regional family planning interventions aimed at accelerating uptake. The low prevalence of modern contraceptive use among adolescent girls and young women may imply an increased risk of unintended or mistimed pregnancies in this population group. This is because limited uptake of modern contraceptive use methods directly contributes to unmet need and reduce reproductive autonomy among young women. There is a need for tailored interventions addressing both individual and community-level barriers to enhance the utilization of modern contraceptive methods among adolescents and young women. Further research is required to identify effective strategies that can increase consistent and sustained use of modern contraceptives among this population.
