Modern Contraception Utilization among Adolescent Girls in Ntcheu District, Malawi
Damson, Ellen Chifundo
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The World Health Organization (WHO, 2018) defines adolescents as individuals in the 10-19 years age group. Every year estimated 21million girls aged 15-19 years, and 2.5 million girls under 15 years become pregnant and approximately 3.9 million girls aged 15-19 years undergo unsafe abortion every year. Despite the high sexual activity by the Malawian adolescents which is rated at 51 percent, there is low utilization of modern contraception. Failure to utilize the modern contraception has resulted in adolescent girls getting unplanned pregnancies which have detrimental effects both to their health as well as their social life. Therefore, the aim of this study is to assess the modern contraception utilization among adolescent girls at Tsangano Turnoff community in Ntcheu District, Malawi. The objectives of the study were to determine the prevalence of modern contraception, to assess the level of knowledge among adolescent girls’, to determine socio-demographic, socio-cultural and health systems factors influencing the utilization of modern contraception among adolescent girls at Tsangano Turnoff community in Ntcheu District, Malawi. This study focused on all unmarried adolescent girls living in the study area at the period of study. The study used a cross sectional study employing both simple random sampling technique for quantitative data and purposive random sampling technique for qualitative. The research instruments were self-administered questionnaires and Focused Group Discussions (FGD). Quantitative data was analyzed using Statistical Package for Social Sciences (IBM SPSS®) version 22.0. Analysis proceeded in two steps. First, univariate descriptive statistics were used to describe sample characteristics and estimate contraceptive prevalence among the adolescents. Contingency table methods were used to test associations between independent (categorical) variable and utilization of contraception and the qualitative data from the FGDs was transcribed and analyzed by thematic content analysis techniques. Overall 180 adolescent girls aged 10-19 took part in the study (mean age 15.2 ±1.5 years). The findings showed that 41% of the respondents had sexual debut at the age of 15 years but modern contraception utilization is still low (36%) with the majority using condoms. On knowledge, it revealed that with higher knowledge are ≥1.5 times more likely to use contraceptives than their counterparts (OR=1.595: 95% CI 1.3394-1.825: P (χ2) ≤0.001).The study revealed that the odds of utilizing contraception among the adolescent girls is more ≥1.5 times higher in those of 15-19 years than those of the lesser age (10-14years) (OR = 1.561: 95% CI 1.386-1.758: P(χ2)≤ 0.001) similarly, those adolescent girls with higher education are ≥ 3.8 times higher than those with lower education levels (OR= 3.869:95% CI 2.381-4.972: P(χ2)< 0.05). On sociocultural, religion is significant in utilization of modern contraception as those from Zion and Catholics are less likely to utilize contraception than their counterparts from other denominations (OR=4.421:95% CI1.874-7.692: p(χ2)<0.05). However, health-care workers attitude, commodity availability and opening hours of the facility have no significant statistically as the odds of adolescent girls utilizing contraceptives because of these factors are less than 1 (OR =0.908, 95% CI 1.596-1.384: P (χ2)>0.05; OR = 0.944: 95% CI 0.167-5.325: P(χ2)>0.05 and OR= 0.344: 95% CI 0.104-1.173: P (χ2)>0.05) respectively. These results showed a big gap between knowledge and utilization among adolescent girls as it showed that 74% knew about modern contraceptive but only 36% utilized it. There is a need to develop age specific reproductive health messages to guide schools’ education curriculum as well as parents and guardians to specifically communicate to this group of people. Secondly, develop adolescent friendly health services as another vital aspect to improve adolescent health access to sexual and reproductive health services which will subsequently improve modern contraception utilization.