Factors Associated with Modern Contraceptive Use among Women of Reproductive Age in Zambia: Analysis of the 2024 Demographic and Health Survey

Abstract Background Modern contraceptive use remains central to reducing unmet need, unintended pregnancy, short birth intervals, and maternal morbidity in Zambia and across sub–Saharan Africa. National strategies and Sustainable Development Goal target 3.7 call for universal access to sexual and reproductive health care services, including family planning. Coverage is uneven by age, partnership status, socioeconomic position, and province, and published married women estimates are not interchangeable with an all-women analytic sample of non-pregnant women. Objective To estimate survey weighted prevalence of modern contraceptive use among non-pregnant women aged 15–49 in the 2024 Zambia Demographic and Health Survey and to identify sociodemographic and media related factors associated with use. Methods We analysed the ZMIR81FL individual recode for women aged 15–49. Following standard DHS family planning analytic practice, currently pregnant women (v213 = 1; n = 951) were excluded from the denominator because pregnancy indicates no immediate need for contraception for pregnancy prevention and would otherwise dilute estimates of contraceptive use among women at risk. The analytic sample comprised 13,000 non-pregnant women. The outcome was current modern contraceptive use (v313). Survey weights, strata, and primary sampling units were applied throughout. Results Survey weighted modern contraceptive prevalence was 41.1% (95% CI 40.0–42.3). Use was lowest among adolescents aged 15–19 (16.1%) and never in union women (17.6%), and highest among married women (58.3%) and women aged 25–34 (approximately 55–56%). Injectables (21.3%) and implants (8.9%) dominated the method mix. In the final mixed model (ICC = 0.042), marriage retained the strongest association (AOR 5.29, 95% CI 4.68–5.98). Age 25–29 (AOR 2.54), grand multiparity (AOR 1.70), employment (AOR 1.36), secondary education (AOR 1.33), and Eastern Province (AOR 1.49) were positively associated with modern use; Northern, Muchinga, and Luapula provinces showed lower adjusted odds. Residence and family planning media messages (radio, television, newspaper) were not retained. Conclusions About two in five non pregnant Zambian women aged 15–49 used a modern method in 2024 after survey weighting. Partnership, life course stage, parity, employment, province, and selected socioeconomic factors structure use. Progress toward national and SDG 3.7 goals is incomplete, particularly for adolescents, never in union women, and northern belt provinces. Future expanded models should incorporate religion, fertility preference, service contact variables, and, among partnered women, decision making autonomy and partner education.