Contraception Decision-making Autonomy among Adolescent Girls and Young Women in Uganda: Implications for Self Care-oriented Family Planning

Abstract Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access to and utilization of self care-oriented family planning (FP) methods. We assessed current contraceptive use, contraception decision-making processes and interest in self care-oriented contraception among adolescent girls and young women (AGYW) in Uganda. Methods: This secondary analysis used cross-sectional data from 2109 sexually-active AGYW aged 10-24 years obtained from a national survey conducted in September 2020. AGYW were asked if they had ever used or were currently using any FP method. Current contraceptive users were asked about who made the decision to use contraception in general and the specific FP methods that they were currently using in particular (i.e. respondent, partner, respondent and partner, or provider); those who made the decision to use contraception on their own were considered to have had contraception decision-making autonomy. We used a modified multivariable Poisson regression model to assess the adjusted prevalence ratio (adj. PR) and 95% confidence interval (95%CI) associated with contraception decision-making autonomy. Interest in self care-oriented FP methods was assessed descriptively. Results: More than halfof AGYW (54.8%, n=1155) were current contraceptive users. Of these, 64.5% (n=745) made the decision to use contraception jointly with partner; 26.8% (n=310) made the decision on their own, while 8.7% (n=100) had the decision made by the partner. Fifty-nine per cent (n=684) made the final decision on the specific FP method to use jointly with partner; 27.8% (n=321) made the decision on their own while 12.9% (n=150) had the decision made by the respondent and partner or by the provider or partner. Having contraception discussion with partner prior to contraceptive use (adj. PR = 0.39; 95%CI: 0.32, 0.48) and being currently married (adj. PR=0.74; 95%CI: 0.56, 0.98) were negatively associated with contraceptive decision-making autonomy. Fifty-eight per cent of AGYW (n=1213) reported interest in obtaining information on how to access and/or use self care-oriented FP methods. Conclusion: Slightly more than a quarter of current contraceptive users had contraception decision-making autonomy. Given the high interest in self care-oriented FP methods, AGYW should be empowered to make contraceptive decisions on their own.