Current use of modern contraceptives and associated factors among women in Lesotho: evidence from the recent Lesotho demographic and health survey 2023–2024

BACKGROUND: One of the most important methods for reducing fertility and improving maternal health is the use of modern contraceptives. However, modern contraceptives were not widely used in developing countries, including Lesotho. Thus, this study aimed to determine the magnitude of modern contraceptive utilization and associated factors among women in Lesotho. METHODS: The 2023-2024 Lesotho Demographic and Health Survey data were used for analysis. The study comprised 6,413 women of reproductive age from 400 enumeration areas in 10 districts. A multilevel mixed-effect binary logistic regression model was built to identify individual and community-level factors associated with modern contraceptive utilization. Significant risk factors were determined by odds ratio with 95% CI along with p-value < 0.05. RESULTS: Around half (53%) of women used modern contraceptive methods. Increased odds of modern contraceptive use were observed among women aged 25-34 years (AOR = 2.1, 95% CI: 1.8-2.4) and 35-49 years (AOR = 1.9, 95% CI: 1.6-2.1), those with primary (AOR = 2.6, 95% CI: 1.5-4.7), secondary (AOR = 2.9, 95% CI: 1.6-5.2), and higher education (AOR = 3.0, 95% CI: 1.6-5.5), recently sexually active women (AOR = 2.1, 95% CI: 1.9-2.4), those with one (AOR = 1.88, 95% CI: 1.66-2.1) or ≥ 2 under-five children (AOR = 2.3, 95% CI: 1.9-2.9), and women from communities with high knowledge (AOR = 1.3, 95% CI: 1.13-1.6). In contrast, decreased odds were found among unmarried women (AOR = 0.61, 95% CI: 0.54-0.70), those from rich households (AOR = 0.76, 95% CI: 0.63-0.92), and women in households with ≥6 members (AOR = 0.87, 95% CI: 0.77-0.99). Lower odds were also observed among women residing in Leribe, Berea, Maseru, Mafeteng, Qacha's Nek, Mokhotlong, and Thaba-Tseka compared to Butha-Buthe. CONCLUSION: Around half of women use modern contraceptive methods. Utilization is influenced by socio-demographic factors such as age, education, sexual activity, number of under-five children, household size, marital status, and wealth. In several districts, modern contraceptive use is lower. Raising community awareness remains key to improving uptake.