1.1 Background of the study

Adolescent pregnancy and low contraceptive uptake remain pressing public-health challenges across sub-Saharan Africa and in Nigeria in particular. Sexually active adolescent girls face elevated risks of unintended pregnancy, unsafe abortion, school dropout and increased maternal–neonatal complications; low contraceptive use is a major proximal driver of these outcomes (Michael et al., 2024). Region-wide analyses show that contraceptive use among sexually active adolescents is generally low — often below 30% — and that education, marital status, media exposure and household wealth consistently predict whether an adolescent uses contraception (Michael et al., 2024).

Nigeria carries a large adolescent population and substantial regional variation in adolescent sexual and reproductive health indicators. Scoping reviews and syntheses of Nigerian studies highlight a complex web of determinants for adolescent pregnancy and poor contraceptive uptake: individual factors (knowledge, perceived side-effects, age at sexual debut), interpersonal dynamics (partner and family attitudes, gender power imbalances), and community or structural influences (poverty, cultural and religious norms, school dropout, and limited adolescent-friendly services) (Alukagberie et al., 2023; Ayamolowo et al., 2024). These multi-level drivers create heterogeneous local risk patterns so that national averages mask pockets of very low uptake and high unmet need. Local evidence from South-East Nigeria reinforces that well-designed, targeted health education and facility-level interventions can increase awareness and improve uptake of contraceptives — at least among adult women — suggesting that context-appropriate interventions in the region can work if they address the right local barriers (Tyotswam et al., 2024). However, adolescents differ from adult women in access routes, autonomy, and stigma they face; therefore, evidence specifically focused on adolescent girls in Nnewi North LGA is necessary to design effective, age-appropriate interventions.

1.2 Statement of the problem

Despite national family-planning efforts and programmes, many adolescent girls in Nigeria continue to have an unmet need for contraception and remain at high risk of unintended pregnancy. National and subnational reviews show wide disparities in adolescent contraceptive use and link low uptake to low schooling, poverty, early marriage, weak SRH (sexual and reproductive health) communication and limited access to adolescent-friendly services (Alukagberie et al., 2023; Ayamolowo et al., 2024). In Anambra State and neighbouring areas, programmatic reports and facility audits suggest contraceptive services are present but under-utilised by adolescents; local trials in Nnewi among adult women show that targeted education can increase uptake, but generalizability to adolescents is unknown (Tyotswam et al., 2024). For programme managers in Nnewi North LGA this creates three concrete problems. First, there is insufficient locally-granular data on how adolescent knowledge, attitudes, partner and family influences, service-level barriers (clinic hours, provider attitudes, confidentiality), and socio-economic constraints interact to shape contraceptive decisions among 15–19-year-olds. Second, without that data interventions risk being misdirected — for example, expanding clinic hours when stigma and provider bias are the limiting factors, or running school sessions that fail to reach out-of-school adolescents. Third, small clusters of unmet need among adolescents can quickly translate into higher rates of teenage pregnancy and unsafe abortion with long-term consequences for girls’ education and livelihoods. Therefore, a focused investigation of determinants of contraceptive uptake among adolescent girls in Nnewi North LGA is necessary to guide locally-tailored, cost-effective interventions.

1.3 Aim and objectives of the study

Aim: To identify individual, interpersonal and service-level determinants of contraceptive uptake among adolescent girls (15–19 years) in Nnewi North LGA, Anambra State.

Specific objectives:

1. Estimate the proportion of sexually active adolescent girls (15–19 years) in Nnewi North LGA reporting current contraceptive use.
2. Describe adolescents’ knowledge, attitudes and primary information sources about contraceptives.
3. Identify interpersonal factors associated with contraceptive uptake (partner support, parent/guardian communication, peer norms).
4. Assess service-level barriers and facilitators (facility opening times, staff attitudes, confidentiality, cost, commodity availability) that correlate with uptake.
5. Model socio-demographic predictors of contraceptive use (age, education, schooling status, marital status, household wealth).

1.4 Research questions

1. What proportion of adolescent girls (15–19 years) in Nnewi North LGA report current contraceptive use?
2. How do knowledge, perceived risks/side-effects, and primary information channels (school, radio, social media, peers) relate to contraceptive uptake among these adolescents?
3. Which interpersonal dynamics (partner approval, parental communication, peer norms) are associated with higher or lower contraceptive use?
4. Which facility-level factors (accessibility, opening hours, perceived provider friendliness, confidentiality and stockouts) influence adolescents’ decisions to seek contraception?
5. Which socio-demographic factors (education level, schooling status, wealth quintile, marital status) are significant predictors of contraceptive uptake?

1.5 Scope of the study

This will be a cross-sectional mixed-methods investigation conducted in Nnewi North LGA, Anambra State. The quantitative component will be a household survey of adolescent girls aged 15–19 who have lived in the LGA for at least six months; the primary outcome will be self-reported current use of any contraceptive method (modern or traditional). The sampling frame will cover both urban and peri-urban communities within the LGA to ensure representation of in-school and out-of-school adolescents. A facility assessment of a purposive sample of primary and secondary health facilities serving the LGA will document service hours, stock status, adolescent-friendliness criteria, and staff training. The qualitative component will include focus-group discussions and in-depth interviews with adolescents (users and non-users), partners, parents/guardians and health providers to understand contextual drivers and barriers. Findings will be analysed to produce actionable recommendations for adolescent-friendly programming in Nnewi North LGA.

References (APA 7)

Alukagberie, M. E., Elmusharaf, K., Ibrahim, N., et al. (2023). Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review. Reproductive Health, 20, Article 95. https://doi.org/10.1186/s12978-023-01629-5

Accessed from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-023-01629-5

Ayamolowo, L. B., Ayamolowo, S. J., Adelakun, D. O., & Adesoji, B. A. (2024). Factors influencing unintended pregnancy and abortion among unmarried young people in Nigeria: a scoping review. BMC Public Health, 24, Article 1494. https://doi.org/10.1186/s12889-024-19005-8

Accessed from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19005-8

Michael, T. O., Ojo, T. F., Ijabadeniyi, O. A., Oni, J. O., & Agboola, A. A. (2024). Prevalence and factors associated with contraceptive use among sexually active adolescent girls in 25 sub-Saharan African countries. PLOS ONE, 19(2), e0297411. https://doi.org/10.1371/journal.pone.0297411

Accessed from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297411

Tyotswam, Y. S., Iseme, R. A., & Makunyi, E. G. (2024). A randomized controlled study of the effects of targeted health education on uptake of contraceptives among women of reproductive age in Nnewi City, South-East Nigeria. SAGE Open Medicine. https://doi.org/10.1177/20503121241237877

Accessed from: https://journals.sagepub.com/doi/10.1177/20503121241237877