Factors associated with modern contraceptive utilization among postpartum adolescent girls and young women in rural Mara,Tanzania: facility-based cross-sectional study

Abstract

Background:

Modern contraceptives are effective in preventing unintended pregnancies, which may consequently reduce the risk of unsafe abortions. However, their use among adolescent girls and young women (AGYW) in Tanzania remains low. Despite various national strategies, the fertility rate in the Mara region remains high at 6.1.

Objectives:

The first objective of this study was to determine the prevalence of modern contraceptive use among postpartum AGYW in rural Mara, Tanzania. The second objective was to identify factors influencing modern contraceptive use among postpartum AGYW.

Design:

An analytical cross-sectional study was conducted to assess modern contraceptive use among postpartum AGYW in rural Mara, Tanzania.

Methods:

A random multistage sampling technique was used to select 614 AGYW aged 15–24 years from rural Mara. Data were collected from January 5 to February 27, 2024, using a structured Swahili questionnaire. Analysis was performed using SPSS version 27.0, employing descriptive statistics, bivariate analysis to examine associations between categorical variables, and multivariate logistic regression to identify predictors of contraceptive use (p < 0.05).

Results:

Modern contraceptive use was reported by 21.7% (95% CI: 18.5%–25.0%) of postpartum AGYW. Women who had primary education were 4.83 times more likely to use contraceptives than those with no or incomplete primary education (AOR = 4.83, 95% CI: 2.61–8.91, p = 0.001). Women in the middle and highest wealth categories had significantly higher odds of contraceptive use (AOR = 1.83; 95% CI: 1.72–4.72; p = 0.04), representing an 83% increase compared to those in the lowest wealth category. In contrast, participants with two to three children were 60% less likely to use contraceptives compared to those with one child (AOR = 0.40; 95% CI: 0.22–0.72; p = 0.002).

Conclusion:

Modern contraceptive use among AGYW remains low. Education level, wealth status, and number of children significantly influence uptake, highlighting the need for targeted interventions to improve access and informed choice.

Plain language summary

Many adolescent girls and young women in Tanzania become pregnant soon after giving birth, partly because they are not using modern contraceptives. These contraceptives can help prevent unplanned pregnancies and reduce the chances of unsafe abortions. In the Mara region, where many young women live in rural areas, families are still very large, with an average of six children per woman. This study looked at how many young mothers use modern contraceptives after giving birth and what factors influence their decisions. We surveyed 614 girls and young women aged 15â€“24 years from rural communities in Mara between January and February 2024. We found that only about 1 in 5 (21.7%) young mothers were using a modern contraceptive method. Young women who had completed primary school were much more likely to use contraception than those with little or no education. Women from families with higher economic status were also more likely to use contraceptives than those from poorer households. On the other hand, those who already had two or more children were less likely to use any contraceptive method. Overall, the study shows that contraceptive use is still low among young mothers in rural Mara. Improving education, reducing economic barriers, and supporting young mothers to make informed choices could help increase the use of family planning services and improve their health and well-being.

Keywords

adolescent girls and young women family planning modern contraceptives rural Tanzania socioeconomic factors

Introduction

Adolescent girls and young women (AGYW) aged 15–24 constitute 16% of the global population, totaling 1.2 billion individuals.¹ In low- and middle-income countries, over 220 million women face barriers to accessing essential contraception,² and in sub-Saharan Africa (SSA), an estimated 25% of women, approximately 47 million, have unmet contraceptive needs, with AGYW representing a significant proportion.^2–4 These gaps contribute to around 14 million unintended or mistimed pregnancies annually in SSA,⁵ disproportionately affecting AGYW.⁶ Neglecting the sexual and reproductive health (SRH) of AGYW adversely impacts their health, well-being, and transition to adulthood.^7,8 Understanding the factors influencing contraceptive use among AGYW is therefore critical for designing targeted interventions and improving reproductive health outcomes in this high-risk population.

Tanzania has committed to reproductive rights through international agreements, such as the 2003 Maputo Protocol and the 2016 Outcome Document of the 7th African Conference on Sexual Health and Rights.^9,10 The government has integrated Family Planning services into maternal and child healthcare since 1974, recognizing them as key to reducing maternal and child mortality.¹¹ Family Planning is provided at no cost, with various contraceptive methods available, except for surgical options.¹¹

Modern contraceptive use among AGYW in Tanzania is low, particularly in rural areas, where only 16% of sexually active women use contraceptives, and 20% use none.¹² In the Mara region, prevalence among women of reproductive age is 27.1%,¹³ with only 26% of married women using modern contraceptives, below the national average of 31%.^14,15 The region also faces high adolescent childbirth rates, low women’s decision-making power (47% vs 55% nationally),¹⁵ elevated gender-based violence (64% vs 33% nationally), and a fertility rate of 6.1% compared to the national 4.8%.¹⁵ These factors contribute to unintended pregnancies, maternal morbidity, and unsafe abortions. Therefore, the objective of this study was to determine the prevalence of modern contraceptive use among postpartum AGYW and to identify the sociodemographic, economic, and reproductive factors associated with its use. This study aligns with Sustainable Development Goals (SDG) 3, specifically targets 3.1 (reducing maternal mortality) and 3.7 (ensuring universal access to SRH services). The study hypothesized that higher education, greater wealth, attendance at antenatal care (ANC) and postnatal care (PNC), and lower parity would lead to increased contraceptive uptake. The findings inform healthcare workers and other stakeholders in designing targeted interventions to improve postpartum contraceptive access and address barriers to uptake.

Methods and materials

Study design

The study employed an analytical cross-sectional design, chosen for its cost- and time efficiency. This design also allowed for the analysis of associations between multiple variables at a single point in time.

Study settings

The study was conducted in health facilities within Butiama and Musoma District Councils (DCs), two of the nine administrative councils in Mara region, northern Tanzania. Butiama DC has 51 health facilities (1 district hospital, 4 health centers, 46 dispensaries), 43 of which offer reproductive and child health (RCH) services. Musoma DC has 31 facilities (1 district hospital, 2 health centers, 28 dispensaries), with 29 providing RCH services.

Study population

This study targeted AGYW aged 15–24 living in rural districts of the Mara region, specifically Butiama and Musoma District Councils. It targeted those who had given birth within the 24 months preceding the investigation.

Sample size determination

Fischer’s formula $N = \frac{Z^{2} \times P Q}{D^{2}}$ ,¹⁶ was used to calculate the sample size based on TDHS-2022,¹⁵ which reported a 26% prevalence of modern contraceptive use in the Mara region. The calculation employed a 95% confidence level (Z = 1.96), a 5% margin of error (D = 0.05), and an estimated proportion (P = 0.26), yielding an initial sample size of 296. To account for potential non-response, a 10% adjustment was applied. Additionally, a design effect of 2 was incorporated to reflect the multistage cluster sampling method. $(\begin{array}{l} N (adjusted) = \\ N \times (\frac{1}{1 - non response rate}) \times D . Eff \end{array}),$ Thus, the final sample size was set at 658 participants to ensure adequate statistical power and representativeness.

Sampling technique

The Mara region was purposively selected due to its high prevalence of modern contraceptive use among postpartum AGYW. Within this region, Musoma and Butiama District Councils were purposively chosen based on their population size, availability of health facilities, and representativeness of the regional demographics. Health facilities with high birth rates providing RCH services were purposively selected, including one district hospital and two health centers in Musoma, and one district hospital and four health centers in Butiama. A total of 614 participants were systematically recruited, with 163 from each district hospital, 81 from each Musoma health center, and 41 from each Butiama health center, ensuring balanced representation across facilities. Data collection took place from January 5 to February 27, 2024.

Inclusion criteria

The study included AGYW aged 15–24 who had experienced at least one childbirth within the 24 months preceding the survey and were willing to provide informed consent. Participants were current residents of Musoma and Butiama districts and accessing postpartum services at selected facilities, regardless of where they delivered. Delivery dates were verified using ANC cards or facility records when available; otherwise, self-reported dates were cross-checked with significant events to ensure eligibility within the 24-month postpartum period.

Exclusion criteria

Postpartum AGYW who were severely ill or had severe mental illness impairing informed consent were excluded to ensure participant safety and data reliability.

Dependent variables

Modern contraceptive utilization was defined as the current use of any modern contraceptive method among AGYW. It was measured as a binary variable, coded as 1 = currently using a modern contraceptive method and 0 = not currently using any modern contraceptive method.

Independent variables

Independent variables include age, marital status, education, income, occupation, healthcare access, and household assets (classified into economic status tiers). Maternal health service uptake, antenatal/postnatal care visits, family planning counseling, childbirth location, contraceptive use, and fertility intentions. Responses were coded numerically for analysis.

1. Age group was categorized as: 15–18 years (adolescents) and 19–24 years (young women).

2. Marital status was categorized as: (1) Single, (2) Married/Cohabiting, and (3) Divorced/Separated/Widowed.

3. Education level was categorized as: (1) None/Primary Incomplete, (2) Primary Education, and (3) Secondary School and Above.

4. Distance to the nearest healthcare facility was classified as >5 km or ⩽5 km.

5. ANC visits were categorized as: <4 for fewer than four visits, and ⩾4 for four or more, based on WHO guidelines.

6. Household monthly income in Tanzanian Shillings (TZS) was categorized as: (1) <100,000, (2) 100,000–500,000, and (3) >500,000 (1 USD ≈ 2650 TZS).

7. The participant’s main economic activity was categorized as: (1) Peasant/Homemaker, (2) Self-employed/Entrepreneur, and (3) Formally Employed.

8. The wealth index was based on household ownership of selected items (radio, TV, mobile phone, computer, refrigerator, bicycle, animal-drawn cart, motorcycle/scooter, and car).¹⁵ Participants were scored from 0 to 4:

0 = Lowest: Owns none or only a radio

1 = Second: Owns radio, phone, bicycle

2 = Middle: Owns radio, TV, phone, bicycle, refrigerator, motorcycle

4 = Highest: Owns all, including a car

9. Parity was categorized based on the number of births a woman has had: one birth, two to three births, and four or more births.

Study tool, research assistant training, and data collection process

The study questionnaire included three sections: sociodemographic characteristics, reproductive and maternal health service uptake, and factors influencing contraceptive use. Four female research assistants, each holding a nursing and midwifery diploma, were trained on study objectives, ethics, informed consent, confidentiality, and data collection procedures. The questionnaire was pre-tested with 10 participants from Butiama and Musoma districts to assess clarity, flow, and cultural relevance, leading to minor refinements for improved comprehension and usability. Originally developed in English, the tool was translated into Swahili to ensure clarity and cultural relevance. It underwent expert review by five specialists in public health, maternal and child health, and linguistics, achieving a Content Validity Index of 0.90 for individual items and 0.92 overall. Reliability testing showed a Cronbach’s alpha of 0.83. The questionnaire used in this study was adapted from previously validated instruments and incorporated into KoboToolbox to facilitate electronic data collection. Data collection was conducted from January 5 to February 27, 2024. The questionnaire is provided as a Supplemental File 1.

Statistical analysis

Data were entered and cleaned using Excel, with missing information checked before analysis in IBM Corporation (Armonk, NY, USA) SPSS version 27.0. Descriptive statistics were used to analyze sociodemographic characteristics. Categorical variables were summarized using frequencies and percentages, while continuous variables were presented as means and standard deviations. Results were displayed using tables. The chi-square test was used to determine the associations between the independent variables and the binary outcome, modern contraceptive use (yes/no). Univariate logistic regression identified candidate variables for the adjusted binary logistic regression model, which determined factors independently associated with contraceptive use. A p-value <0.05 indicated statistical significance. To account for the multistage sampling design, a design effect of 2 was applied during sample size estimation, and clustering was addressed by adjusting standard errors to reduce bias from intra-cluster correlation.

Reporting compliance

This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.¹⁷ The completed STROBE checklist has been provided as a Supplemental File 2.

Results

Sociodemographic characteristics

Table 1 presents the sociodemographic and economic characteristics of the 614 AGYW who participated out of 658 approached, resulting in a 93.3% response rate. The mean age was 19.51 years (SD ± 2.43), with 390 (63.5%) aged 19–24. Most were married or cohabiting 437 (71.1%) and had completed primary education 357, 58.1%). A total of 361 (58.8%) reported a monthly household income below 100,000 TZS (~37.74 USD), and 500 (81.4%) were peasants or homemakers. Additionally, 434 (70.7%) lived more than 5 km from a health facility, 361 (58.8%) were in the lowest wealth quintile, and 278 (45.3%) had two to three children.

Table 1.

Sociodemographic and economic characteristics of study participants (n = 614).

Variables	Frequency (N)	Percent
Age group (years)
15–18	224	36.5
19–24	390	63.5
Marital status
Single	98	16.0
Married/cohabiting	437	71.1
Divorced/separated/widow	79	12.9
Education of participants
None/primary incomplete	81	13.2
Primary education	357	58.1
Secondary school and above	176	28.7
Household monthly income in TZS
<100,000	500	81.4
100,000–500,000	85	13.8
>500,000	29	4.70
Participant’s main economic activity
Peasant/homemaker	339	55.2
Self-employed/entrepreneur	60	9.80
Employed in the formal sector	215	35.0
Education of the partner
None/primary incomplete	90	14.7
Primary education	370	60.2
Secondary school and above	154	25.1
Distance to the nearest health facility (km)
⩽5	180	29.3
>5	434	70.7
Wealth index
Lowest	361	58.8
Second	145	23.6
Middle	73	11.9
Highest	35	5.70
Parity
1	213	34.7
2–3	278	45.3
⩾4	123	20.0

Reproductive health and family planning

Table 2 summarizes the reproductive health and family planning characteristics of the participants. Over half attended fewer than four ANC visits (56.8%), and most delivered at a healthcare facility (71.2%). A large proportion reported receiving family planning education during postnatal care (72.5%). The prevalence of modern contraceptive use among postpartum AGYW was 21.7% (95% CI: 18.3%–24.6%). Additionally, most participants had resumed sexual activity after childbirth (64.8%). Among contraceptive users, the most commonly used methods were oral contraceptive pills (36.1%), condoms (25.6%), and implants (24.1%).

Table 2.

Reproductive health and family planning characteristics of AGYW (n = 614).

Variable	Frequency (N)	Percent
Number of ANC visits
<4	349	56.8
⩾4	265	43.2
Place of delivery for the recent pregnancy
Institution delivery	437	71.2
Home delivery	177	28.8
Provided with FP education during ANC
Yes	193	31.4
No	421	68.6
Time from delivery of the last baby to now (months)
1–6	111	18.1
7–12	182	29.6
>12–24	321	52.3
Number of PNC attended
1	181	29.5
2–3	245	39.9
⩾4	188	30.6
Provided with FP education during PNC
Yes	445	72.5
No	169	27.5
Use of modern contraceptives
Yes	133	21.7
No	481	78.3
Resumption of menstrual cycle
Yes	517	84.2
No	97	15.8
Initiated sexual activities after the recent birth
Yes	398	64.8
No	216	35.2
Contraceptive in use
Condoms	34	5.6
Oral contraceptive pills	48	7.8
Injectable contraceptives	11	1.8
Implants	32	5.2
Intrauterine device	8	1.3
None	481	78.3

AGYW, adolescent girls and young women; ANC, antenatal care; FP, family planning; PNC, postnatal care.

Predictors of modern contraceptive utilization

Table 3 shows that postpartum AGYW who had primary education were 4.83 times more likely to use contraceptives than those with no or incomplete primary education (AOR = 4.83, 95% CI: 2.61–8.91, p = 0.001). Women in the middle and highest wealth categories had significantly higher odds of contraceptive use (AOR = 1.83; 95% CI: 1.72–4.72; p = 0.04), representing an 83% increase compared to those in the lowest wealth category. In contrast, participants with two to three children were 60% less likely to use modern contraceptives compared to those with one child (AOR = 0.40; 95% CI: 0.22–0.72; p = 0.002).

Table 3.

Predictors of modern contraceptive use among adolescent girls and young women (n = 614).

Variables	Contraceptive use	p-Value	COR—95% CI		p-Value	AOR—95% CI		p-Value
Variables	Yes, n (%)	p-Value	Lower	Upper	p-Value	Lower	Upper	p-Value
Age group (years)
15–18	38 (28.6)	0.03	Reference
19–24	95 (71.4)		0.63 [0.41–0.96]		0.06	0.71 [0.44–1.15]		0.16
Education of participants
None/primary incomplete	40 (30.1)	0.001	Reference
Primary education	63 (47.4)		4.75 [2.64–8.54]		0.01	4.83 [2.61–8.91]		0.001*
Secondary school and above	30 (22.6)		1.04 [0.65–1.68]		0.21	0.97 [0.59–1.16]		0.91
Household monthly income in TZS
<100,000	112 (84.2)	0.001	Reference
⩾100,000	93 (19.3)		1.00 [0.58–1.74]		0.05	1.05 [0.77–2.02]		0.09
Parity
1	44 (33.1)	0.01	Reference
2–3	73 (54.9)		0.42 [0.23–0.76]		0.01	0.40 [0.23–0.72]		0.002*
4 and above	16 (12.0)		0.73 [0.48–1.12]		0.02	0.71 [0.46–1.09]		0.12
Number of ANC visits
<4	67 (50.4)	0.04	Reference
⩾4	66 (49.6)		0.75 [0.72–0.49]		0.01	0.69 [0.47–1.03]		0.07
Wealth index
Lowest	82 (61.7)	0.02	Reference
Second	26 (19.5)		0.59 [0.19–1.81]		0.21	0.55 [0.18–1.70]		0.29
Middle/highest	25 (18.8)		1.71 [1.87–4.45]		0.001	1.83 [1.72–4.72]		0.04*

ANC, antenatal care; AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio.

indicates that the variable is statistically significant at p < 0.05.

Discussion

This analytical cross-sectional study examined modern contraceptive use and its influencing factors among postpartum AGYW in rural Mara. The study found that women with primary education and those in higher wealth categories were significantly more likely to use contraceptives compared to their counterparts. Additionally, participants with two to three children were less likely to use contraceptives than those with one child.

This study identified a low prevalence of modern contraceptive use among AGYW at 21.7%, indicating a substantial unmet need for effective contraception in rural Mara, Tanzania. The low uptake is consistent with barriers reported in similar rural and resource-limited settings, including limited access to services, inadequate contraceptive knowledge, sociocultural stigma, and poor availability of youth-friendly reproductive health services.^11,18,19 The observed prevalence is comparable to pooled estimates from SSA (24.7%)²⁰ and DHS data from East Africa (24.9%).²¹ However, it is markedly lower than contraceptive use reported in urban Tanzanian settings, where prevalence exceeds 50%.²² This disparity underscores the influence of geographic and socioeconomic context on contraceptive access and utilization, and highlights persistent rural–urban inequities. By providing context-specific evidence from a rural population, this study adds novel insights that complement urban-focused research and inform targeted interventions to reduce contraceptive disparities in Tanzania.

The high proportion of women resuming sexual activity postpartum (62.7%) is particularly significant for rural Mara, where cultural expectations, partner influence, and limited postnatal guidance often shape early return to intimacy.²³ Similar evidence from Nigeria highlights how societal pressure can encourage early postpartum intercourse, sometimes against women’s preferences.²⁴ In rural Mara, these pressures, combined with inadequate access to sexual health information and postpartum family planning, increase the risk of unintended pregnancies and short birth intervals. Strengthening postnatal care by integrating sexual health counseling, addressing issues such as vaginal dryness, pain, and appropriate timing for resuming intercourse, is essential.^14,15 Expanding postpartum family planning education is also crucial, as counseling improves contraceptive uptake and supports healthier spacing.²⁵ Health programs should engage men to reduce cultural pressures, deploy community health workers for home-based counseling, and ensure consistent availability of postpartum contraceptive methods at local facilities.

This study shows that primary education among postpartum AGYW in rural Mara is associated with higher modern contraceptive use, indicating that even basic education empowers young women to make informed reproductive health decisions and increases their awareness and confidence in using contraceptives. However, its impact is moderated by local socio-cultural norms, partner influence, and access to health services.^13,26 Similar associations have been reported in Nigeria and Tanzania,^24,27 whereas evidence from rural South Asia suggests that cultural and social pressures can limit contraceptive use despite educational attainment.^28,29 These findings indicate that education alone is insufficient and should be complemented by supportive community structures and accessible family planning services. In rural Mara, enhancing contraceptive uptake requires coordinated efforts: the District Health Management Team (DHMT) to oversee programs, healthcare workers to provide postnatal counseling, community health workers and non-government organizations (NGOs) to conduct outreach, and local leaders and male partners to engage in community sensitization and address cultural barriers.

Participants from middle- and high-wealth households were more likely to use modern contraceptives compared to those from lower socioeconomic groups, suggesting that wealth influences access to information, autonomy in decision-making, and the ability to navigate healthcare services effectively. Although family planning services are free in Tanzania,¹⁹ higher-wealth AGYW may benefit from better education, greater exposure to reproductive health information, and stronger social support networks, enabling them to make informed choices and overcome non-financial barriers such as travel, cultural norms, partner restrictions, and stigma.^19,26 These findings align with evidence from SSA showing that financial resources, healthcare access, and education facilitate contraceptive uptake.^12,13 Conversely, women in lower wealth quintiles face barriers, including limited access to facilities, cultural stigma, and lower educational attainment,²³ indicating that socioeconomic disparities influence contraceptive use primarily through access, knowledge, empowerment, and social support rather than cost.^18,30 In the Mara region, strategies to address these barriers include the DHMT enhancing outreach to remote communities, healthcare workers providing tailored postnatal counseling, and community health workers and NGOs conducting awareness campaigns to reduce stigma, dispel misconceptions, and strengthen informed contraceptive choices among postpartum AGYW.

Having two to three children was associated with lower use of modern contraceptives compared to having only one child, likely reflecting women’s fertility desires to complete their desired family size before adopting contraception.³¹ Similar patterns have been observed in Ethiopia and Pakistan,^29,32 although some studies report higher use among larger families due to financial or caregiving pressures.³³ In the Mara region, cultural norms around family size, partner influence, sociocultural stigma, and fear of side effects further limit contraceptive uptake among postpartum AGYW.^13,15 These findings underscore the importance of fertility intentions and local sociocultural beliefs in shaping contraceptive behavior. Context-specific strategies to address these barriers include community education on birth spacing, tailored counseling by healthcare workers, engagement of local leaders and traditional birth attendants, mobile outreach programs, and consistent contraceptive supply, alongside community feedback and local health data to guide interventions.

This study hypothesized that higher education, greater household wealth, ANC/PNC attendance, and lower parity would increase modern contraceptive uptake among postpartum AGYW. The findings partially support this. Higher education and greater wealth were strong predictors of modern contraceptive use, highlighting the influence of socioeconomic status on postpartum reproductive choices. Lower parity was also associated with higher uptake, suggesting that women with fewer children are more likely to delay subsequent pregnancies. In contrast, ANC and PNC visits were not significantly associated with contraceptive use, indicating that contact with maternal health services may not effectively translate into family planning uptake. This points to potential gaps in counseling, provider communication, or integration of postpartum family planning within routine care.

Limitations

This study acknowledges that its cross-sectional design precludes causal inference, and while adjusted odds ratios were calculated to examine associations, causal relationships cannot be established. The questionnaire was carefully designed to minimize recall bias and other challenges, such as inaccurate reporting, low response rates, and sensitive questions, and stratified analysis was used to control for potential confounders. Ethical considerations were upheld through clear consent procedures and transparent communication with participants. This study was conducted among postpartum AGYW in rural Mara, Tanzania, and primarily reflects this context; findings may inform similar rural settings but should be generalized to urban areas or other regions with caution. Future longitudinal or intervention studies are recommended to better establish causal relationships between sociodemographic, economic, and reproductive factors and modern contraceptive use among postpartum AGYW.

Policy implications

There is a need for targeted interventions to improve modern contraceptive uptake among AGYW in rural Mara. Health authorities should engage male partners and community leaders to address cultural barriers and partner restrictions. Healthcare workers at health facilities and during postnatal care should integrate comprehensive contraceptive counseling for postpartum AGYW. Expanding access through mobile clinics and community health workers can reach remote areas, while health educators and local NGOs can raise awareness about contraception and dispel misconceptions regarding side effects. The DHMT should oversee implementation, monitor progress, and coordinate stakeholders to ensure interventions are contextually appropriate and sustainable.

Conclusion

Modern contraceptive use among postpartum AGYW in rural Mara remains low, reflecting persistent socioeconomic and structural challenges that influence reproductive health decisions. Addressing these disparities is essential to empower young women, promote equitable access to family planning services, and foster informed reproductive choices. Efforts that consider the local context and barriers faced by AGYW are critical for improving maternal and child health outcomes in this population.

Supplemental Material

sj-doc-2-reh-10.1177_26334941261426086 – Supplemental material for Factors associated with modern contraceptive utilization among postpartum adolescent girls and young women in rural Mara, Tanzania: facility-based cross-sectional study

Supplemental material, sj-doc-2-reh-10.1177_26334941261426086 for Factors associated with modern contraceptive utilization among postpartum adolescent girls and young women in rural Mara, Tanzania: facility-based cross-sectional study by Magnus Michael Sichalwe, Grace Tavengana, Manas Ranjan Behera, Fiaz ul Haq, Johnpaul Otuomasiri Egbobe, Shafee Ullah, Regnald Raymond Kimaro and Abdul Basit in Therapeutic Advances in Reproductive Health

Supplemental Material

sj-pdf-1-reh-10.1177_26334941261426086 – Supplemental material for Factors associated with modern contraceptive utilization among postpartum adolescent girls and young women in rural Mara, Tanzania: facility-based cross-sectional study

Supplemental material, sj-pdf-1-reh-10.1177_26334941261426086 for Factors associated with modern contraceptive utilization among postpartum adolescent girls and young women in rural Mara, Tanzania: facility-based cross-sectional study by Magnus Michael Sichalwe, Grace Tavengana, Manas Ranjan Behera, Fiaz ul Haq, Johnpaul Otuomasiri Egbobe, Shafee Ullah, Regnald Raymond Kimaro and Abdul Basit in Therapeutic Advances in Reproductive Health

Footnotes

Acknowledgements

We thank the AGYW participants and facility in-charges for their invaluable support, which greatly contributed to the success of this research.

Declarations

ORCID iDs

Magnus Michael Sichalwe

Manas Ranjan Behera

Supplemental material

Supplemental Material for this article is available online.

Artificial intelligence use

Grammarly artificial intelligence (AI) was used only for grammar and language polishing. No generative AI tools were used to create or modify content.

References

International Youth Day 2019 | Division for Inclusive Social Development (DISD). https://social.desa.un.org/issues/youth/events/international-youth-day-2019 (2019, accessed 5 December 2024).

Singh

Darroch

JE.

Adding it up: costs and benefits of contraceptive services, estimates for 2012. https://www.guttmacher.Org/report/adding-it-costs-and-benefits-contraceptive-services-estimates-2012 (2012, accessed 10 February 2024).

Darroch

Sedgh

Contraceptive technologies: responding to women’s needs. https://www.guttmacher.org/report/contraceptive-technologies-responding-womens-needs (2011, accessed 10 February 2024).

Durowade

Omokanye

Elegbede

, et al. Barriers to contraceptive uptake among women of reproductive age in a semi-urban community of Ekiti State, Southwest Nigeria. Ethiop J Health Sci 2017; 27(2): 121–128.

Hubacher

Mavranezouli

McGinn

Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it. Contraception 2008; 78(1): 73–78.

Ahissou

NCA

Benova

Delvaux

, et al. Modern contraceptive use among adolescent girls and young women in Benin: a mixed-methods study. BMJ Open 2022; 12(1): e054188.

Morris

Rushwan

Adolescent sexual and reproductive health: the global challenges. Int J Gynaecol Obstet 2015; 131(Suppl. 1): S40–S42.

Patton

Sawyer

Santelli

, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387(10036): 2423–2478.

The Maputo Protocol: protecting African women’s rights. Equality now. https://equalitynow.org/promoting_african_womens_rights/ (2015, accessed 10 February 2024).

10.

7th Africa Conference on Sexual Health and Rights (ACSHR) Outcome Document. UNFPA WCARO. https://wcaro.unfpa.org/en/publications/7th-africa-conference-sexual-health-and-rights-acshr-outcome-document (2016, accessed 10 February 2024).

11.

Contraception for adolescents and youth. https://www.unfpa.org/resources/contraception-adolescents-and-youth (2022, accessed 5 December 2024).

12.

Safari

Urassa

Mtenga

, et al. Contraceptive use and discontinuation among women in rural North-West Tanzania. Contracept Reprod Med 2019; 4(1): 18.

13.

Massenga

Noronha

Awadhi

, et al. Family planning uptake in Kagera and Mara Regions in Tanzania: a cross-sectional community survey. Int J Environ Res Public Health 2021; 18(4): 1651.

14.

Tanzania: National Plan for RMNCAH+N 2021/22-25/26 (One Plan III) | Global Financing Facility. https://www.globalfinancingfacility.org/tanzania-national-plan-rmncahn-202122-2526-one-plan-iii (2021, accessed 5 April 2023).

15.

NBS | Tanzania Demographic and Health Survey (TDHS). https://www.nbs.go.tz/statistics/topic/health-statistics (2023, accessed 20 November 2025).

16.

Charan

Biswas

How to calculate sample size for different study designs in medical research?

Indian J Psychol Med 2013; 35(2): 121–126.

17.

Cuschieri

The STROBE guidelines. Saudi J Anaesth 2019; 13(Suppl. 1): S31–S34.

18.

Dangat

Njau

Knowledge, attitude and practices on family planning services among adolescents in secondary schools in Hai District, northern Tanzania. Tanzan J Health Res 2013; 15(1): 19–25.

19.

Busse

Onyango

Tumlinson

Informal payments for modern family planning methods at public facilities in Tanzania: room for improvement. Hum Resour Health 2022; 20(1): 13.

20.

Ahinkorah

BO.

Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys. Contracept Reprod Med 2020; 5: 32.

21.

Hailu

Heluf

Ayana

, et al. Contraceptive use and determinants among sexually active unmarried adolescents and young women (aged 15–24 years) in East Africa: insights from Demographic and Health Survey data. Int Health 2024; 17(4): 452–460.

22.

Nkenguye

Ismail

Urassa

, et al. Factors associated with modern contraceptive use among out of school adolescent girls in Majengo and Njoro Wards of Moshi Municipality, Tanzania. East Afr Health Res J 2023; 7(1): 32–39.

23.

Begum

Ellis

Sarker

, et al. A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh. BMC Pregnancy Childbirth 2018; 18(1): 368.

24.

Adanikin

Awoleke

Adeyiolu

, et al. Resumption of intercourse after childbirth in southwest Nigeria. Eur J Contracept Reprod Health Care. https://www.tandfonline.com/doi/full/10.3109/13625187.2014.971742 (2015, accessed 10 December 2024).

25.

Hogben

Ford

Becasen

Sexual health promotion interventions: results of a systematic review. Sex Transm Infect 2013; 89: A8–A8.

26.

Kessy

Eliufoo

Godfrey

, et al. Predictors of modern contraceptive use among adolescent girls and young women in Tanzania: insights from a nationwide survey. Discov Public Health 2025; 22(1): 225.

27.

Rwabilimbo

Elewonibi

Yussuf

, et al. Initiation of postpartum modern contraceptive methods: evidence from Tanzania demographic and health survey. PLoS One 2021; 16(3): e0249017.

28.

Khan

Hossain

Hoq

Determinants of contraception use among female adolescents in Bangladesh. Asian Soc Sci 2012; 8: 181–181.

29.

Jamali

Simon

DJ.

Modern contraception in Pakistan: a cross-sectional study. Popul Econ 2024; 8(1): 77–96.

30.

Sidibé

Kolié

Grovogui

, et al. Knowledge, attitudes, and practices of health providers regarding access to and use of contraceptive methods among adolescents and youth in urban Guinea. Front Public Health 2022; 10: 953806.

31.

Kigongo

Tumwesigye

Anyolitho

, et al. Access to family planning services and associated factors among young people in Lira city northern Uganda. BMC Public Health 2024; 24(1): 1146.

32.

Bizuneh

Masresha

, et al. Individual and community level factors for modern contraceptives utilization among reproductive aged women in Amhara region, Mixed effect multi-level modeling, data from Mini-EDHS, 2019. Contracept Reprod Med 2023; 8(1): 56.

33.

Abdo

Demelash

Seid

, et al. First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors. BMC Pregnancy Childbirth 2023; 23(1): 742.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.10 MB

0.33 MB