Determinants of Contraceptives Use Among the Female Undergraduates of Niger Delta University

Understanding the determinants of contraceptive use is important for designing effective reproductive health interventions among young adults. This study examined socio-demographic and psychosocial predictors of contraceptive use among university students. A cross-sectional analytical study was conducted among undergraduate students of Niger Delta University. Data were analyzed using descriptive statistics and multivariable logistic regression to identify predictors of ever and current contraceptive use. The prevalence of ever contraceptive use was 74.1%, while current use was 53.8%. Significant determinants of contraceptive use included age, religion, marital status, residence, faculty, and level of study (p < 0.05). Psychosocial barriers such as fear of side effects and partner disapproval were independently associated with lower odds of current use. Early sexual debut was also significantly associated with contraceptive uptake. Both structural and psychosocial factors influence contraceptive use among university students. Interventions addressing accessibility, confidentiality, and misconceptions about side effects are essential to improve sustained contraceptive use among young adults.

In Nigeria, youths account for 32% of the approximately 140-150 million people in the country, with more than half of the adolescents within the age range of 15-19 years been sexually active1 and the median age of sexual debut being 21 years for males and 17 years for females [2,1,3]. Contraception is a recognized integral part of primary health care [4]. and has been in existence since ancient times. However, the utilization of effective and safe methods of contraception only became available in the twentieth century5 with the commonly used methods been the physical and behavioural methods [6,7].

Study Area

This study was carried out amongst the female undergraduates of Niger Delta University, Wilberforce Island located in Bayelsa State [8,9]. The institution has two campuses, the Yenagoa campus, which contains the Law Faculty and the main campus in Amassoma (Wilberforce Island). The institution has nine faculties and forty-three departments. The faculties are: Faculty of Science, Faculty of Arts, Faculty of Social Sciences, Faculty of Agricultural Technology, Faculty of Engineering, Faculty of Medicine, Faculty of Pharmacy, Faculty of Nursing, and Faculty of Law.

Study Population

The study population consisted of female undergraduates of the institution both married and unmarried. This consisted of sexually active females between the ages of 15-35 years.

Study design

A descriptive cross-sectional study design was used. 

Sample size determination

The sample size was determined using the Fisher formula [1] with a contraceptive prevalence of 30% [10-12] among female undergraduates. Accordingly, the calculated sample size was 323. Adjusting for 10% attrition (for non-response and missing data): N = 323 + 48 =371 participants. However, a total of 500 respondents were enrolled for the study.

Sampling technique

A multi-stage, sampling method was used in enrolling participants for the study. 

Step 1:The students were first grouped according to their faculties to ensure adequate coverage and generalizability of the results to the entire University.

Step 2:Informed consent was then obtained from the participants and a systematic random sampling technique was then used to choose the number of participants from each of the faculties to participate in the study.

Step 3:From the sampling frame, every fourth person starting from the beginning was chosen to participate in the study and the self-administered questionnaire distributed to them.

Study instrument

Data were obtained using a structured, self-administered questionnaire adapted from NDHS 2013 and NARHS 2012 validated survey tools. The instrument was pretested among twenty female students of Bayelsa State College of Health Technology, and necessary revisions were made to enhance clarity and contextual relevance. The components of the questionnaire included: Socio-demographic characteristics, Sexual history (including age at sexual debut), Ever and current contraceptive use, Partner involvement in contraceptive decision-making, Reasons for non-use and Psychosocial barriers (e.g., fear of side effects, partner disapproval).

Data analysis

Data analysis was performed using IBM SPSS Version 21.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics summarized socio-demographic characteristics and contraceptive use variables. Bivariate associations between independent variables (socio-demographic, behavioral, and psychosocial factors) and contraceptive use (ever use and current use) were examined using the Chi-square test. Variables significant at the bivariate level were included in multivariable logistic regression models to identify independent predictors of contraceptive utilization. Adjusted odds ratios (AORs) with 95% confidence intervals were reported. Statistical significance was set at p < 0.05.

Socio-Demographic Characteristics

Table 1: Demographic profile of the respondents

Mean age = 24.1 ± 9.1 years; Others include Benin, Kalabari, Ikwere, Ogoni, Anioma, Igalla, Efik, and Adoni.

Table 2: Socio-demographic characteristics of the respondents and the prevalence of contraceptive use

*Significant

A high proportion of those aged 15 – 20 years 109 (82%) had used contraception at some point in their sexual lives compared to 5 (50.0%) of the respondents aged 31 – 35 years. There was an increased tendency to have used contraception among the younger respondents. This association was statistically significant (p = 0.023).

Of the respondents that were Christians, 319 (76.9%) of them had used contraception compared to 36 (63.2%) of their Muslim counterparts. This association was statistically significant (p = 0.003).

Among the married respondents, 114 (84.4%) reported to have used contraception compared to 239 (73.1%) of their single counterparts. This association was also statistically significant (p < 0.001), with increasing contraceptive use noted among the respondents that where married.

Most, 105 (94.6%) of the respondents residing in rural areas had used contraception compared to 194 (79.8%) of their urban counterparts. This association was also statistically significant (p < 0.001).

All the respondents at the medical college had used contraception, 50 (90.9%) of those in the faculty of law and 59 (75.6%) of those in pharmaceutical sciences had used contraception. This association was statistically significant (p < 0.001). 

All the respondents in 500 level had used contraception compared to 70 (70.0%) of those in 100 level. There was an increase tendency to have used contraception with increase in level. This was statistically significant (p < 0.001). There was no statistically significant relationship between the respondents’ knowledge of contraception and ever using it (p = 0.611).

Table 3: Logistic regression for predictors of respondents’ ever use of contraception

*Reference value; **Significant

Reference category, R2 (coefficient of determination) = 16.0% to 23.5%. Respondents aged less than 20 years were 2.275 times more likely to have used contraception compared to their older counterparts. This was statistically significant (p = 0.003). Christian respondents were less likely to have used contraceptives compared to respondents of other religions [OR = 0.127; 95% CI (0.016 – 0.976)]. This was statistically significant (p = 0.047). Respondents residing in rural areas were 8.066 times more likely to have used contraception compared to their urban counterparts. This was statistically significant (p < 0.001).

Table 4: Socio-demographic characteristics of the respondents and their current contraceptive use

*Significant

Fifty-seven (41.6%) of the respondents aged 15 – 19 years currently used contraception compared to 82 (39.4%) of their counterparts aged 25 years and above. There was no statistically significant relationship between the age of the respondents and their current use of contraception (p = 0.885).

There was no statistically significant relationship between the respondents’ religion and their current use of contraception (p = 0.102).

About half of the respondents who were single 155 (47.4%) reported to a current use of contraception compared to 35 (25.9%) of their married counterparts. This association was also statistically significant (p < 0.001).

More than half, 64 (57.7%) of the respondents residing in rural areas were currently using contraception compared to 103 (42.4%) of their urban counterparts. This association was also statistically significant (p < 0.001).

Majority 35 (63.6%) of the respondents in the faculty of law were currently using contraception while 43 (58.1%) of those in medical college were also currently using it. This association was statistically significant (p < 0.001).

All the respondents in 500 level were currently using contraception compared to 47 (47.0%) of those in 100 level. There was an increase tendency to use contraception with increase in level. This was statistically significant (p < 0.001).

 There was a statistically significant relationship between the respondents’ knowledge of contraception and their current use of it (p < 0>

Table 5: Logistic regression for predictors of respondents’ current use of contraception

*Reference value; **Significant 

Reference category, R2 (coefficient of determination) = 9.6% to 13.0%. Single respondents were 3.700 times more likely to be using contraception compared to their married and divorced counterparts. This was statistically significant (p = 0.004). Respondents residing in rural areas were 3.843 times more likely to be using contraception compared to their urban counterparts. This was statistically significant (p < 0>

Table 6: Respondents’ age at coitarche and use of contraception 

Most, 421 (85.2%) of the respondents were sexually active. Of this proportion, 139 (33.0%) had their first sexual intercourse at 10 – 15 years and 198 (47.0%) had it at 16 – 20 years. One hundred and thirty-nine (33.0%) used contraception and of this proportion, 90 (64.7%) reported condom as the type of contraception used. One hundred and seventy (40.4%) reported having sex a week prior to the survey while 112 (26.6%) reported having sex two weeks prior. Three hundred and seventeen (75.3%) respondents used contraception at their last sexual intercourse.

Fear of side effects (42%) and spouse disapproval (20.7%) were the leading reasons for contraceptive non-use among sexually active respondents. Other factors included religious beliefs, ignorance, cultural norms and poor access to services. These findings are consistent with previous studies reporting fear of adverse effects, inadequate knowledge, embarrassment in purchase and misconceptions about infertility [13-18].

There was a significant association between contraceptive use and marital status, age, residence, religion and educational level, similar to other studies.19,14,20,21,16 Married and older respondents were more likely to use contraception, likely due to the emphasis of services on married couples and child spacing.

Religion also played a significant role, consistent with reports identifying it as a key determinant of contraceptive behavior [22-24].

The study found a high prevalence of ever contraceptive use (74.1%) but only fair current utilization (53.8%) among students of Niger Delta University, indicating suboptimal sustained uptake.

Age, religion, marital status, residence, faculty, and level of study were significant socio-demographic determinants of contraceptive use. Importantly, psychosocial factors including fear of side effects and partner/spouse disapproval, emerged as critical barriers to consistent use.

The university authority should review and strengthen existing adolescent and youth sexual and reproductive health intervention programs to address unmet contraceptive needs, particularly among female undergraduates.

Youth-friendly reproductive health units should be integrated into the University Health Centre to improve accessibility of contraceptive services for the students.

Interventions should specifically address identified barriers such as fear of side effects and partner disapproval through counseling services and peer-support initiatives.

Government sexual and reproductive health policies should be reoriented to prioritize unmarried youths and adolescents so as to enable them make the right choice with regards to their sexual and reproductive health.