UPTAKE OF MODERN CONTRACEPTION AMONG YOUTHS (15-24) AT COMMUNITY LEVEL IN BUSIA DISTRICT, UGANDA BY: SUSAN BABIRYE KAYONGO MakSPH-CDC FELLOW FEBUARY 2013 UPTAKE OF MODERN CONTRACEPTION AMONG YOUTHS (15-24) AT COMMUNITY LEVEL IN BUSIA DISTRICT, UGANDA BY: SUSAN BABIRYE KAYONGO B.MASS COMM.; MPHL MakSPH-CDC FELLOW MakSPH-CDC FELLOWSHIP PROGRAM FEBUARY 2013 Table of Contents LIST OF TABLES AND FIGURES ........................................................................................... iii DECLARATION ....................................................................................................................... iv DEDICATION ........................................................................................................................... v ACKNOWLEDGEMENTS ....................................................................................................... vi ACRONYMS AND ABBREVIATIONS ..................................................................................viii OPERATIONAL DEFINITION OF CONCEPTS ...................................................................... ix ABSTRACT ............................................................................................................................... 1 1.0 INTRODUCTION AND BACKGROUND...................................................................... 2 1.1 Introduction ....................................................................................................................... 2 1.2 Background ....................................................................................................................... 3 1.3 Statement of the Problem................................................................................................... 6 1.4 Significance of the Study ....................................................................................................... 6 2.0 LITERATURE REVIEW ................................................................................................ 8 2.1Background Information on Youths’ Sexuality and Contraception ...................................... 8 2.1.1 Sexual Behaviors of Youths in Sub-Saharan Africa ..................................................... 8 2.1.2 Contraception among Youths in Uganda ..................................................................... 9 2.2 Factors Affecting Contraceptive Use among Young People ............................................. 11 2.2.1 Individual Factors ..................................................................................................... 11 2.2.2 Reproductive Health Service Factors ........................................................................ 13 2.3 Research Questions and Objectives.................................................................................. 17 2.3.1 Research Questions................................................................................................... 17 2.3.2 General Objective ..................................................................................................... 17 2.3.3. Specific Objectives .................................................................................................. 17 2.4 Conceptual Framework.................................................................................................... 18 3.0 METHODOLOGY ........................................................................................................ 19 3.1 Study Design ................................................................................................................... 19 3.2 Study Area and Population .............................................................................................. 19 3.2.1 Study Area ............................................................................................................... 19 3.2.3 Sample Size .............................................................................................................. 20 3.2.4 Sampling Procedure .................................................................................................. 20 3.2.5 Study Variables ........................................................................................................ 23 3.3 Data Collection Procedures ............................................................................................. 23 3.3.1 Tools ........................................................................................................................ 24 3.4 Data Management, Quality Control and Analysis ............................................................. 25 3.4.1 Data Management ..................................................................................................... 25 3.4.3 Data Analysis ........................................................................................................... 26 3.5 Ethical Considerations ..................................................................................................... 27 4.0 RESULTS ........................................................................................................................... 29 4.1 Introduction ..................................................................................................................... 29 4.2 Demographic Characteristics of Respondents .................................................................. 29 4.2.1 Socio-demographic Characteristics of Respondents ................................................... 29 4.2.2 Sexual and Reproductive Behaviors and Experiences of Respondents ....................... 30 4.3 Use and Preferences of Contraceptives among Respondents ............................................ 32 4.3.1 Contraceptive Prevalence .......................................................................................... 32 4.3.3 Modern Contraception Preferences of Respondents ................................................... 33 4.3.4 Contraceptive Use Behaviors and Practices among Respondents ............................... 34 4.3.5 Source of Contraceptives at Community Level .......................................................... 36 4.4 Factors that Influence Uptake of Modern Contraceptives among Respondents ................. 37 4.4.1 Logistic Regression Predicting the Likelihood of Modern Contraceptive Use ............ 37 4.4.2 Logistic Regression Predicting the Likelihood of Condom Use ................................. 38 4.4.3 Logistic Regression Predicting the Likelihood of Use of Depo-Provera ..................... 39 4.5. Young People’s Perceptions towards Receiving Contraceptives from the Different Service Providers at Community Level .............................................................................................. 40 4.5.1 Perceptions of Youths towards Contraceptive Uptake by Youths ............................... 41 4.5.2 Perceptions of Youths towards Availability and Variability of Contraceptive Services ......................................................................................................................................... 41 4.5.3 Perceptions of Youths towards the Information Given to Clients ............................... 43 4.5.4 Perceptions of Youths towards Provider’s Technical Competences ........................... 44 4.5.5 Perceptions of Youths towards Provider’s Interpersonal Relations ............................ 45 4.5.6 Perceptions of Youths towards the Availability of Mechanisms for Continuity of Contraceptive Use ............................................................................................................. 45 4.5.6 Perceptions of Youths towards Constellation of Services .......................................... 46 ii 4.6. Community level provider’s perspectives on provision of contraceptives to youths ............. 47 4.6.1 Non Attitudinal Factors............................................................................................. 47 4.6.2 Attitude Related Factors ........................................................................................... 51 5.0 DISCUSSION ..................................................................................................................... 57 5.1 Introduction ..................................................................................................................... 57 5.2 Discussion ....................................................................................................................... 57 6.0 CONCLUSIONS AND RECOMMENDATIONS................................................................ 61 6.1 Conclusion ...................................................................................................................... 61 6.2 Public Health Implications & Recommendations ............................................................. 61 REFERENCES ......................................................................................................................... 63 iii LIST OF TABLES AND FIGURES TABLE 1: Socio-demographic characteristics of respondents……………….………...30 TABLE 2: Sexual and reproductive behaviors and experiences of respondents by contraceptive uptake…………………………………………..…………………...……31 TABLE 3: Age, sex, marital and schooling status of respondents by modern Contraception……………………………….……………………………………………32 TABLE 4: Unadjusted and Adjusted Odds Ratios for the factors influencing modern contraception among respondents……………………………..………………………...37 TABLE 5: Unadjusted and Adjusted Odds Ratios for the factors influencing use of Condoms