Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: a national cross-sectional survey

Abstract

Background Modern contraceptive use among adolescents is low despite the adverse effects of adolescent pregnancies. Understanding correlates of modern contraceptive use in different settings is key to the design of effective context-specific interventions. We aimed to determine factors associated with modern contraceptives use among adolescents in rural and urban settings of Zambia. Methods We analyzed secondary data from 2018 Zambia demographic and health survey (ZDHS) focusing on adolescent girls aged 15–19 years. We used multivariable logistic regression in SPSS version 25 to examine rural-urban variations in factors associated with modern contraceptive utilization. Results Overall, 12.0% (360/3000, 95% CI: 10.9–13.2) of adolescents in Zambia were using modern contraceptives. Use of modern contraceptives was higher in rural areas at 13.7% (230/1677, 95% CI: 12.1–15.3) compared to 9.8% (130/1323, 95% CI: 8.3–11.6) in urban areas. In the rural areas, having a child (aOR = 13.99; 95% CI 8.60–22.77), being married (aOR = 2.13; 95% CI 1.42–3.18), being older at 19 years (aOR = 3.90; 95% CI 1.52–10.03), having been visited by a field health worker (aOR = 1.62; 95% CI 1.01–2.64), having been exposed to family planning messages on mass media (aOR = 2.87; 95% CI 1.01–8.18) and belonging to the richest wealth quintile (aOR = 2.27; 95% CI 1.43–3.62) were associated with higher odds of contraceptive utilization. Furthermore, adolescents in the Northern (aOR = 0.29; 95% CI 0.11–0.80) and Luapula (aOR = 0.35; 95% CI 0.15–0.81) provinces were associated with less odds of utilizing contraceptives compared to those in Western province. In the urban areas, older age at 19 years (aOR = 4.80; 95% CI 1.55–14.84) and having a child (aOR = 18.52; 95% CI 9.50–36.14) were the only factors significantly associated with modern contraceptive utilization. Conclusion Age and having a child were associated with modern contraceptive use in both rural and urban areas. In rural areas (province, marital status, being visited by field health workers, family planning messages exposure and wealth index) were the only associated factors. This indicates that interventions aiming to increase contraceptive utilization should be context specific.

Spatial variations and multi-level determinants of modern contraceptive utilization among young women (15–24 years) in Ethiopia: spatial and multi-level analysis of mini-EDHS 2019

“…The possible justification for this is that married women had high likelihood to be pregnant and as a result, they usually prefer to use contraceptives to space births [ 36 ]. On the other hand, our study noted a higher prevalence of modern contraceptive use among young women compared to few studies in Zambia [ 37 ], Guinea [ 38 ], Western Nepal [ 19 ], Uganda [ 39 ]. The higher prevalence of modern contraceptive use in our study could be due to the survey year where our study is most recent and may be related availability of expanded services recently and could also be the countries difference in the investments of family planning initiatives by the non-governmental and governmental organizations.…”

Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study

“…Contraceptive use among adolescents was very low (17.4%), similar to Mali (17.1%) [ 28 ], but higher than Uganda (9.4%) [ 6 ], Benin (8.5%) [ 29 ], Nigeria (14.8%) [ 30 ], Nepal (11.9%) [ 31 ] and Zambia (12%) [ 32 ], according to previous studies. Nonetheless, the Government of Rwanda has put considerable efforts in family planing and reducing unwanted pregnancies as part of its 2030 Family Planing country commitment agenda.…”

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

“…Teenagers who live in rural areas and are from poorest households had an increase in teenage pregnancy over the four surveys analysed for this study. This finding could be explained by inadequate access to SRH information and low contraception use among young teenager from rural areas and those from poor communities [ 9 , 10 , 23 , 33 ]. The increase in the trends of teenage pregnancy was also observed among those illiterate and married/formerly married teenage women.…”

“…Poverty equally plays a crucial role in motivating both teenage marriages and teenage pregnancy. In their qualitative study looking at parallel discourses on teenage pregnancy in rural Zambia, [ 7 , 10 ] found poverty to be a prominent factor in teenage marriages, both from the parents and young women’s perspective. Parents want to marry off their young girls for cash from bride-wealth while young girls are motivated to leave their parents’ homes because of the failure by parents to meet basic needs such as school fees and other daily necessities.…”