Factors associated with modern contraceptive use among sexually active youths attending secondary schools in Mbale City, Uganda

Sexual and reproductive health of youths constitutes a significant public health challenge because of the high risk for morbidity and mortality. There is low uptake of modern contraceptives among the sexually active youths despite availability. We investigated the factors associated with the uptake of modern contraceptives among youths attending secondary schools in Mbale City. This was a cross-sectional study that enrolled 2,690 students from six purposively selected high-volume secondary schools in Mbale City. Data were collected using a validated semi-structured questionnaire and analyzed using descriptive statistics and multivariable logistic regression to identify factors associated with modern contraceptive use. The factors associated with modern contraceptive were stratified by sex. Statistical significance was set at 5% confidence level. Out of 2690 participants, 38.0% were sexually active. The proportion of sexually active participants who had ever used modern contraceptives was 60.9%. Factors associated with modern contraceptive use among male participants were not knowing the fertility days of the female (AOR = 0.49; 95% CI: 0.32-0.77; p = 0.002) and not receiving health education from a health worker (AOR = 0.44; 95% CI: 0.30-0.64; p < 0.001). Among females, factors associated with modern contraceptive use were knowledge of fertility days (AOR = 0.39; 95% CI: 0.18-0.85; p = 0.018), history of abortion (AOR = 0.10; 95% CI: 0.02-0.62; p = 0.014), and receiving health education from a health worker (AOR = 0.36; 95% CI: 0.22-0.59; p < 0.001). Modern contraceptive use was low compared to the national average, with knowledge of fertility days and health education significantly influencing uptake. Among males, lack of fertility knowledge and absence of health education were associated with low use of modern contraceptives. Among females, knowledge of fertility, history of abortion, and health education were key factors. Strengthening school-based sexuality education and increasing health worker-led reproductive health counselling can improve modern contraceptive knowledge and uptake, with gender-specific interventions needed to address barriers to access and use.