Peer-reviewed article

What factors drive unmet need for modern contraception among sexually active adolescent girls and young women in Zambia: a multilevel analysis.

Phiri M, Namayawa S, Odimegwu C · 23 Apr 2026

Abstract

BACKGROUND: Unintended pregnancies are still a public health concern, particularly among adolescent girls and young women (AGYW) in sub-Saharan Africa and Zambia in particular. This study explored the drivers of unmet need for modern contraception among sexually active parous AGYW in Zambia. METHODS: The study was cross-sectional using national data from the 2018 Zambia Demographic and Health Survey (ZDHS), focusing on fecund, sexually active adolescent girls and young women aged 15–24 years. Unmet need for contraception refers to women of reproductive age who are sexually active and fertile, who wish to postpone their next birth or stop childbearing altogether, but are not using any method of contraception. A sample of 2,466 parous AGYW was included in the analysis. The outcome variable for this study is unmet need for contraception. A multilevel binary logistic regression models were fitted to examine the influence of individual and community level factors on unmet need for contraception. RESULTS: The prevalence of unmet need for contraception for spacing births among parous AGYW in Zambia in 2018 was 17.7% (95% CI, 16.0, 19.7). There were increased chances of experiencing unmet need for contraception among adolescents aged 15 to 19 [aOR = 1.64, 95% CI = 1.24–2.18], unmarried [aOR = 1.35, 95% CI = 1.03–1.79], and those from communities with a high desire for large family size [aOR = 1.43, 95% CI = 1.06–1.93]. In contrast, those from communities with high access to home visits from community health workers [aOR = 0.70, 95% CI = 0.50–0.99] and those who owned mobile phones had lower odds of experiencing unmet need for contraception [aOR = 0.67, 95% CI = 0.49–0.91]. CONCLUSION: The proportion of AGYW with unmet need for contraception in Zambia remains high. Both individual and community-level factors influenced unmet need for contraception among AGYW in Zambia. Integrating community level factors when designing sexual and reproductive health interventions for young people would be key to enhance access and utilisation of contraceptive methods.