Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial

Abstract

Background The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch. Objective To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda. Methods A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care. Results Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition. Conclusion Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents’ fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.

“They will say you want to make their home die”: A mixed methods study to assess modern family planning use in partnered South Sudanese refugee and host populations in Northern Uganda

“…There is a plethora of studies published to date which focus on the sexual and reproductive health of refugee populations in Uganda [11][12][13][14][15][16][17][18][19] and Ugandan populations [20][21][22][23][24][25][26][27][28]. However, to our knowledge, there are no published studies focused on the sexual and reproductive health of both refugee and host populations, which is important to study given that both these populations are often living in close proximity to each other and have access to the same services, though experience different health outcomes [29].…”

Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda

“…We developed a structured questionnaire by reviewing the existing literature with instruments on the knowledge and practice of SRHR among adolescents and teenagers in LMICs. We complied with questions from the Demographic and Health Survey in Uganda20 and other studies conducted mainly in sub-Saharan countries 41–43 46–48. Questions included basic sociodemographic characteristics, SRHR knowledge and perceptions, sexual behaviour, and vendor usage (online supplemental material S2).…”