Study Notes on Contraception Determinants in Sierra Leone Youths

Background: Early sexual initiation in Sierra Leone; the study analyzes determinants of condom and contraceptive use among a representative youth sample (10 to 24 years).
Methods: Secondary analysis of a 2016 data study conducted to monitor UNFPA interventions aimed at improving sexual and reproductive health (SRH) in youth during the Ebola outbreak.
Results: Total of 1409 youth interviewed; 194 boys and 268 girls analyzed, with 40.5% not using condoms or contraception at last intercourse. Highlighted determinants include literacy, negotiation capacity, distance to health facilities (for girls) and schools (for boys), and hand washing. Main barriers identified were partner opposition to contraceptive use and lack of access.
Conclusion: Need for targeted outreach to sexually active young people not using contraception.

Significance: Effective family planning interventions decrease maternal and child mortality and prevent STI transmission, yet usage remains low among young people in sub-Saharan Africa.
Findings: Explored contraceptive and condom usage determinants among 10 to 24 year-olds in Sierra Leone; over 40% used neither during last sexual encounter.
Common Determinants for Both Genders: Literacy, distance (to health facilities/school), negotiation skills, and hand washing. Boys additionally linked to the number of sexual partners and knowledge of contraceptive methods.

Adolescent Pregnancy: High incidence (28% of all pregnancies) in Sierra Leone, with 40% of maternal deaths occurring among adolescents.
Safety of Sexual Practices: Dual protection is safest, while neither method poses risks.
Previous Reports: 2013 Sierra Leone Demographic and Health Survey (SLDHS) indicated minimal condom (1%) and modern contraceptive use (23%) among women aged 15 to 24.
Factors Affecting Utilization: Include inadequate sexual knowledge and negotiation skills.
Survey Setup: In collaboration with UNFPA and partner organizations to assess interventions post-Ebola outbreak.

Sample Selection: Survey conducted in three provinces, excluding the Western Area due to higher contraceptive use.
Sampling Methodology: Stratified three-stage cluster sampling in 149 chiefdoms, totaling 48 clusters from households.
Questionnaire Design: Included socio-demographic characteristics, sexual activity, negotiation capacity, exposure to SRH interventions, and health service usage.
Ethical Considerations: Approval obtained; parents consented for participants under 15.

Sex with Neither Condom nor Contraception: Defined for analyzing last sexual encounter without contraceptive use.
Negotiation Capacity: Measured via questions on refusal of sex and requesting condom use for boys and girls separately.
Literacy Measurement: Based on educational attainment and reading ability.
Determinants Explored: 19 determinants including socio-demographics, UNFPA interventions, sexual lifestyle, and healthy lifestyle behaviors.

Outcome Measurement: Examined prevalence of contraceptive/non-use and conducted bivariate and multivariable analyses.
Statistical Methods: Used Pearson’s Chi2 test, Odds Ratios, adjusted for various variables; significance set at 0.05.

Survey Response Rate: 1409 youths, 41.6% reported ever having sexual intercourse. Among sexually active youths, 40.5% did not use condoms or contraception. No significant difference between boys (42.3%) and girls (39.2%).
Bivariate Results: Identified multiple associated factors:
- For boys: province, distance to school, literacy, negotiation capacity, number of partners, and recent hand washing.
- For girls: age, distance to health facilities, education, literacy, negotiation capacity.
Multivariable Model: Four determinants common (literacy, negotiation, hand washing, and distance), with specific additional determinants for boys.

Top Reasons for Non-Use:
- Boys:
- Partner opposition (46.8%)
- Lack of availability (39.2%)
- Don’t know where to obtain (31.7%)
- Girls:
- Partner opposition (70.2%)
- Faithful to partner (37.5%)
- Lack of access and methods (24% each)

Contraceptive Prevalence: Rates higher for boys (55%) vs girls (43%); dual protection more common in boys (22% versus girls at 7%).
Significant Behavioral Determinants: Hand washing and negotiation highlighted for both genders. Distance effects differ—health facilities for girls and schools for boys.
Condom Misconceptions: Open-ended responses indicated significant misunderstandings about contraception's safety and usage.

Strengths: Electronic data collection improves quality; comparable metrics with similar surveys.
Limitations: Sample size underpowered for younger ages, and data affected by post-Ebola context reduces external validity.

Comprehensive sexual health programs must address education, negotiation skills, coercion, and partner dynamics. More tailored interventions necessary for diverse youth segments in Sierra Leone to better access contraception and health services.

CAG: Community Wellness Advocacy Groups
CI: Confidence Interval
DFID: Department for International Development (UK AID)
DHS: Demographic and Health Survey
EVD: Ebola Virus Disease
FP: Family Planning
GSHS: Global School-based Student Health Survey
HIV/AIDS: Human Immunodeficiency Virus - Acquired Immune Deficiency Syndrome
LMIC: Low and Middle Income Countries
OR: Odds Ratios
SLDHS: Sierra Leone Demographic and Health Survey
SRH: Sexual and Reproductive Health
STI: Sexually Transmitted Infection
UNFPA: United Nations Population Fund
VPE: Volunteer Peer Educators

Appreciation for participants, coordinators, and health agencies involved in the study.