Community perceptions and factors associated with contraceptive use among adolescent females in Mazabuka district, Zambia

Abstract

Over the last few decades, there has been little evidence of young people accessing information necessary for Sexual Reproductive Health decision-making. Adolescent sexual and reproductive health (SRH) has increasingly been on national health agendas of many countries, including Zambia. One of the major causes of these agendas is the concern against early childbearing. Access to youth-friendly health services such as contraceptives is vital for ensuring the well-being of adolescents. This study would help determine the role of contraception in preventing early childbearing among young people aged 16-19 years who were sexually active. The study was a cross-sectional sample survey covering 369 urban secondary school adolescent female pupils (Grades 10-12) aged 16-19 years and some members of the urban community in Mazabuka. It employed a mixed-method approach in which both quantitative and qualitative techniques were used. These approaches were treated independently at data collection and analysis. A semi-structured questionnaire was used to determine the level of modern contraceptive use among adolescent female pupils as an outcome variable. Focus group discussions (FGDs) with purposively selected parents and interviews with purposively selected key informants (school guidance teachers and SRH personnel) provided data on community perceptions on adolescent contraceptive use. The results show that the prevalence of modern contraceptive use among adolescent females stood at 17% (65/369) whereas the prevalence of adolescents who regularly indulged in sexual activity was (26.8%). Frequency of sex (OR 4.41, 95% CI 2.9, 6.6, p-value <0.001), visits to a health facility (OR 2.63, 95% CI 1.2, 5.9, p-value 0.019) and values and belief systems (OR .18, 95%CI .1, .37, p-value <0.001) are the major factors that had significant association with contraceptive use. Secretiveness and fear of social stigma were cited as reasons for adolescents not accessing modern contraceptive services. Findings also showed existence of myths and beliefs held by both the adolescents and the community, relating to lack of information on some effects of modern contraceptive use and access to relevant SRH services. Adolescents largely did not visit health facilities for alternative services. Various community values relating to cultural and religious backgrounds exerted an influence on decision-making among adolescents regarding the use of modern contraceptives. Socio-cultural values played an important role in relation to adolescent response to contraceptive use. Adolescent access to SRH services and the decision whether or not to use them is primarily influenced by other people from the socio-cultural environment of Mazabuka. This study demonstrated the need for comprehensive SRH services accessible to adolescents in Mazabuka district. It also suggested the need for sensitisation of communities for change of mindsets for adolescents to be better equipped with contraceptive information and knowledge in order to enhance decision-making that promotes sexual reproductive health of adolescents. Keywords Adolescent, Modern contraceptive use, Community perceptions, Mazabuka, Zambia