Modern contraception utilization and associated factors among adolescent girls and young women (AGYW) who participated in the Namibia DREAMS program

Abstract

OBJECTIVE : A significant gap exists in modern contraception utilization among adolescent girls and young women (AGYW) in Namibia, contributing to a high incidence of teenage pregnancies. This study assessed the utilization of modern contraceptive methods and related factors. STUDY DESIGN : We conducted a retrospective analysis of programmatic data from AGYW aged 15–24 who received clinical services through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program, implemented by Project HOPE Namibia, between 2018 and 2024. Data were analyzed using IBM SPSS version 29, employing Chi-squared tests and bivariate and multivariate logistic regression. RESULTS : Among the 28,945 participants in this analysis, 8420 (29.1%) used a modern contraceptive method. The most used method was the injectable (n = 5,205; 61.8%). Participants who had a higher likelihood of using a modern contraceptive method included those aged 15–19 years (AOR = 1.13, 95% CI (1.06–1.19)), with children (AOR = 2.20, 95% CI (2.04–2.37)), who were breastfeeding (AOR = 2.18, 95% CI (1.30–3.66)), and those who perceived themselves at risk of HIV (AOR = 1.15, 95% CI (1.08–1.22)). Participants less likely to utilize a modern contraceptive method included those who had recent or recurrent sexually transmitted infections (COR = 0.56, 95% CI (0.41–0.77)) and those who attended safe space HIV interventions (AOR = 0.85, 95% CI (0.78–0.93)). CONCLUSION : AGYW aged 20–24 years, those who do not consider themselves at risk of HIV, and those who participate in safe space interventions should be prioritized for initiatives aimed at improving contraception use. IMPLICATION : Several interventions, such as ensuring commodity security of preferred methods, enhancing education on SRH, and providing services on school premises to reduce health system and structural barriers, are required to ensure that AGYW in Namibia utilise modern contraceptive methods to reduce unwanted pregnancies and the risk of contracting HIV.