Postpartum Long-Acting Reversible Contraceptive Use and Its Drivers Among Primipara Adolescent Mothers in Rubirizi District, Southwestern Uganda

BackgroundGlobally, 21 million adolescent pregnancies occur annually, half unintended and contributing to 20% of maternal deaths. While new adolescent pregnancies are concerning, repeat and rapid repeat pregnancies present higher risks of adverse obstetric outcomes, best prevented with Postpartum Long-Acting Reversible Contraceptives (PPLARCs) initiated within six weeks postpartum. In Rubirizi District, primipara adolescents are reported to shun PPLARCs, though without evidence. This study assessed PPLARC use and its drivers among primipara adolescent mothers in Rubirizi District, Southwestern Uganda.MethodsA cross-sectional study was conducted among 226 adolescent mothers. The district was stratified by sub-counties and Town Councils, from which parishes and villages were randomly selected. Households were systematically sampled, and data collected through structured interviews. Observations and record reviews were used to verify PPLARC uptake. Data were analyzed using descriptive statistics and a log-binomial model in SPSS 26.ResultsPPLARC use prevalence was 31%. Reduced use was associated with reporting implant duration as two years (aPR = 0.121, p = 0.000), not being forced into unprotected sex postpartum (aPR = 0.596, p = 0.010), low perceived risk of obstetric complications (aPR = 0.400, p = 0.044), youngest child <3 months (aPR = 0.373, p = 0.000), and negative provider attitudes (aPR = 0.618, p = 0.008). Increased use was linked to knowledge of IUD duration (aPR = 2.383, p = 0.002), postnatal care attendance (aPR = 18.000, p = 0.000), spousal discussion (aPR = 2.654, p = 0.001), husband support (aPR = 1.802, p = 0.019), counseling (aPR = 3.200, p = 0.023), and health education (aPR = 2.436, p = 0.024).ConclusionOnly 3 in 10 adolescent mothers used PPLARCs, exposing most to repeat pregnancy risks. Interventions should target spousal involvement, counseling, risk education, and adolescent-friendly services to enhance uptake.