Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys.

backgroundThe use of modern contraceptives among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remains an issue that needs urgent attention. This present study assesses the individual and contextual factors associated with modern contraceptive use among AGYW in SSA.

methodsData for this study was obtained from the latest Demographic and Health Surveys (DHS) conducted between January 2010 and December 2018 across 29 countries in SSA. Data were analysed with Stata version 14.2 by employing both Pearson's chi-square test of independence and a multilevel binary logistic regression. The selection of variables for the multilevel models was based on their statistical significance at the chi-square test at a p < 0.05. Model fitness for the multilevel models was checked using the log likelihood ratios and Akaike's Information Criterion (AIC) and the results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI).

resultsIt was found that 24.7% of AGYW in SSA use modern contraceptives. In terms of the individual level factors, the study showed that AGYW aged 15-19 [aOR = 0.86, CI = 0.83-0.90], those who were married [aOR = 0.83, CI = 0.79-0.87], Muslims [aOR = 0.59, CI = 0.57-0.62], working [aOR = 0.92, CI = 0.89-0.95], those who had no child [aOR = 0.44, CI = 0.42-0.47], those who had no exposure to newspaper/magazine [aOR = 0.44, CI = 0.63-0.71] and radio [aOR = 0.82, CI = 0.78-0.86] had lower odds of using modern contraceptives. Conversely, the use of modern contraceptives was high among AGYW whose age at first sex was 15-19 years [aOR = 1.20, CI = 1.12-1.28]. With the contextual factors, the odds of using modern contraceptives was low among AGYW who lived in rural areas [aOR = 0.89, CI = 0.85-0.93] and in communities with low literacy level [aOR = 0.73, CI = 0.70-0.77] and low socio-economic status [aOR = 0.69, CI = 0.65-0.73].

conclusionSeveral individual and contextual factors are associated with modern contraceptive use among AGYW in SSA. Therefore, Governments in the various countries considered in this study should intensify mass education on the use of modern contraceptives. This education should be more centered on AGYW who are in socio-economically disadvantaged communities, those who are not married, Muslims, those with high parity and high fertility preferences and those who are working.