Kawuma Rachel, Lunkuse Jane Frances, Ssembajjwe Wilber, Kayesu Ivy, Price Matt A, Brickley Debbie B, Abaasa Andrew, Mayanja Yunia
Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.
Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, United States.
Front Reprod Health. 2023 Aug 15;5:1198672. doi: 10.3389/frph.2023.1198672. eCollection 2023.
Adolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14-24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost.
We conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically.
All 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20-24 years) (aOR = 0.32, 95% CI 0.16-0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception.
Non-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives.
参与危险行为的青春期女孩和年轻女性易出现多种健康问题，但性与生殖健康服务的利用率仍然较低。在一个免费提供避孕药具的环境中，我们评估了感染艾滋病毒风险较高的青春期女孩和年轻女性（14 - 24岁）未使用避孕药具的相关因素及使用障碍。
我们开展了一项混合方法研究，利用基线横断面调查数据和定性深入访谈。调查参与者妊娠检测呈阴性，并表示愿意使用避孕措施。未使用避孕药具被定义为在任何研究访视（基线及整个研究期间）都未采取避孕措施。采用逻辑回归模型评估未使用避孕药具的相关因素。我们有目的地挑选参与者进行访谈，以讨论她们对避孕药具的了解和使用经历，并提出改善使用情况的建议。对定性数据进行了主题分析。
所有285名参与者都纳入了分析。在这285名参与者中，127人未使用避孕药具，在这127人中，44人（34.6%）在整个研究期间未采取任何避孕方法，而其余83名采取了某种避孕方法的参与者中，有43人只选择了男用避孕套。与年轻女性（小于20岁）相比，年龄较大的女性（20 - 24岁）未使用避孕药具的可能性较小（调整后的比值比 = 0.32，95%置信区间0.16 - 0.89）。定性数据显示，对未来生育的担忧、对相关副作用的恐惧以及亲密关系的影响导致了未使用避孕药具。
尽管在一项研究中推广并提供了避孕药具，但未使用避孕药具的情况仍然普遍，主要原因是青少年在做出避孕决定时缺乏自主权。识别并解决她们的担忧，在推广避孕套的同时持续提供避孕使用咨询，可能会提高避孕药具的使用率和利用率。
