ORIGINAL RESEARCH article
Front. Reprod. Health
Sec. Adolescent Reproductive Health and Well-being
Volume 7 - 2025 | doi: 10.3389/frph.2025.1667613
Contraceptive use Among Adolescent Girls and Young Women ages 15-24 in Seven high HIV prevalence Countries
Provisionally accepted
Abigail R Greenleaf1,2*
Karam Sachathep1,2
Tara F Abularrage1Giles A Reid1Felix Ndagije3Tepa Nkumbula4
Harriet Nuwagaba-Biribonwoha5Elaine Abrams6,7Nenna Philip1- 1ICAP at Columbia University, New York, United States
- 2Columbia University Heilbrunn Department of Population and Family Health, New York, United States
- 3ICAP at Columbia, Maseru, Lesotho
- 4ICAP at Columbia, Lusaka, Zambia
- 5ICAP at Columbia, Mbabane, Eswatini
- 6Columbia University ICAP, New York, United States
- 7Columbia University Department of Epidemiology, New York, United States
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ABSTRACT (231/250 words) Background: Adolescent Girls and Young Women (AGYW; ages 15-24) continue to use contraceptives at lower rates than older women in sub-Saharan Africa. We describe contraceptive use among AGYW in seven Southern African countries (Botswana, Eswatini, Lesotho, Malawi, Mozambique, Zambia and Zimbabwe). Methods: Cross-sectional, nationally representative household-based data from seven Population-based HIV Impact Assessment surveys (conducted between November 2019 and February 2022) were analyzed using survey weights to create descriptive results and pooled odds of modern contraceptive use. Results: Among the 11,094 AGYW, contraceptive use (male or female sterilization, IUD, implants, injectables, pills, condoms) ranged from 45.0% in Mozambique to 75.1% in Botswana. Condoms were the most frequently reported method in four of seven countries (Botswana 61% of those using modern methods use condoms, Eswatini 66%, Lesotho 49% and Mozambique 33%). Dual method (use of any modern contraceptive method plus a condom) ranged from <1% in Malawi to 15% in Botswana. When conducting a pooled multivariable logistic regression, higher odds of modern contraceptive use was associated with higher education (Odds Ratio (OR) 1.7, 95% Confidence Interval (CI) 1.5 – 2.0), being in the highest wealth quintile (OR 1.5, 95% CI 1.2-2.0), and having children (one birth: OR 2.0 95% CI 1.7 – 2.4), two or more: (2.5, 95% CI 2.0 – 3.0), but was lower among AGYW living with HIV (OR 0.7 95% CI 0.6 – 0.9). Conclusions: Contraceptive prevalence rates varied by country but across countries, AGYW in Southern Africa commonly use short-acting methods, and specifically condoms: a user-dependent method prone to inconsistent use. Promoting duel use of short-acting and condoms or PrEP may best meet AGYW's needs.
Keywords: Contraception, HIV, adolescent girls and young women, sub-Saharan Africa, Survey
Received: 16 Jul 2025; Accepted: 16 Oct 2025.
Copyright: © 2025 Greenleaf, Sachathep, Abularrage, Reid, Ndagije, Nkumbula, Nuwagaba-Biribonwoha, Abrams and Philip. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Abigail R Greenleaf, abgreenleaf@gmail.com
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