Effectiveness of peer-led education interventions on contraceptive use, unmet need, and demand among adolescent girls in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial

Abstract

Background Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. Objective The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. Methods A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. Result After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. Conclusions School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.

Barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia: a formative qualitative study

“…Thus, we must address these misconceptions through drama, poetry, role play, individual or group counselling, key message preparation, and reading to students during morning flag hour or before or after drama portrayal and other sessions. 29 The current study discovered that numerous rumours are already embedded in the community’s mind and may act as a barrier to contraceptive use, consistent with research conducted in Kenya, Ghana and India. 9 33 36 …”

“…Furthermore, student reproductive health interventions need to receive adequate attention in the school curriculum and other school club activities; linking students with health facilities, and YFS can help students better understand contraceptive methods; significantly improve their knowledge, misconception and contraceptive use. 29 …”

Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework

“…Women lack a formal education may have inadequate health literacy and access to knowledge on contraceptive method mix, availability, efficacy, and adoption. Furthermore, they may be impacted more by societal norms that restrict open discussions about family planning, making it difficult for them to seek information or services [7,46]. Because of their lower socioeconomic status and restricted bargaining power within their families and communities, these women may have less agency in making reproductive health decisions.…”