title: The social context of adolescent women's use of modern contraceptives in Zimbabwe: a multilevel analysis.
abstract: BACKGROUND
  Efforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. Despite a substantial attempt to study factors influencing adolescent contraceptive use in Sub-Saharan Africa (SSA), few studies have explored the role of community level characteristics on adolescent modern contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics.
  
  
  METHODS
  Data from the 2010/11 Zimbabwe Demographic Health Survey (ZDHS), supplemented by additional data from the Measure DHS consultants were used. A total weighted sample of 457 non-pregnant adolescent women aged 15 to 19 years who had their last sex within 12 months preceding the 2010/11 ZDHS was analysed. Univariate, bivariate and multilevel binary logistic regression analysis were performed using generalized linear mixed models (GLMM).
  
  
  RESULTS
  The odds of contraceptive use were higher for adolescent women with one or more children ever born (Odds Ratio (OR), 13.6) and for those ever married (OR, 2.5). Having medium and high access to media also increased the odds of using contraceptives (OR, 1.8; 2.1 respectively). At community level, the odds of modern contraceptive use decreased with an increase in the mean number of children ever borne per woman (OR, 0.071), an increase in the mean number of school years per women (OR, 0.4) and an increase in the proportion of women with at least secondary education (OR, 0.5). It however increased with an increase in the proportion of women experiencing at least one problem accessing health care (OR, 2.0). Individual and community level variables considered successfully explained the variation of adolescent contraceptive use across provinces.
  
  
  CONCLUSIONS
  Both individual and community characteristics were important predictors of adolescent contraceptive use in Zimbabwe. Reproductive program interventions aimed at increasing adolescent contraceptive use should take into account both individual and community factors. There is need for further research that examines other community characteristics influences that include political and cultural factors.
authors.affiliation: Department of Population Studies, University of Botswana, Private Bag UB0022, Gaborone, Botswana. enock.ngome@gmail.com.
authors.forename: Enock
authors.initials: E
authors.lastname: Ngome
authors.forename: Clifford
authors.initials: C
authors.lastname: Odimegwu
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D003267:Contraception / Q000523:psychology / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D004522:Educational Status; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D055361:Multilevel Analysis; D011247:Pregnancy; D012111:Residence Characteristics; D057566:Self Report; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult; D015030:Zimbabwe
references.citation: Afr J Reprod Health. 2003 Aug;7(2):57-73
references.pmid: 14677301
references.citation: Health Policy Plan. 2002 Jun;17(2):167-77
references.pmid: 12000777
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD005215
references.pmid: 19821341
references.citation: J Adolesc Health. 2001 Jul;29(1):37-45
references.pmid: 11429304
references.citation: Am J Public Health. 1998 Feb;88(2):216-22
references.pmid: 9491010
references.citation: Contraception. 1998 Jul;58(1):29-34
references.pmid: 9743893
references.citation: J Adolesc Health. 2013 May;52(5):517-22
references.pmid: 23608717
references.citation: Health Place. 2012 Jul;18(4):766-73
references.pmid: 22579117
references.citation: Perspect Sex Reprod Health. 2004 Sep-Oct;36(5):192-7
references.pmid: 15519961
references.citation: J Pediatr Adolesc Gynecol. 2011 Apr;24(2):79-84
references.pmid: 21126893
references.citation: Am J Public Health. 2003 Nov;93(11):1820-9
references.pmid: 14600048
references.citation: Stud Fam Plann. 1995 Nov-Dec;26(6):307-24
references.pmid: 8826071
references.citation: Int J Gynaecol Obstet. 2009 Oct;107(1):35-8
references.pmid: 19481751
references.citation: Stud Fam Plann. 2002 Jun;33(2):127-40
references.pmid: 12132634
references.citation: PLoS Med. 2007 Feb;4(2):e31
references.pmid: 17284155
references.citation: Am J Public Health. 2001 Nov;91(11):1783-9
references.pmid: 11684601
references.citation: Am J Obstet Gynecol. 2005 Feb;192(2):342-9
references.pmid: 15695970
references.citation: Int Fam Plan Perspect. 2006 Jun;32(2):71-8
references.pmid: 16837387
references.citation: J Fam Plann Reprod Health Care. 2009 Oct;35(4):221-6
references.pmid: 19849915
references.citation: Int Fam Plan Perspect. 2003 Jun;29(2):76-83
references.pmid: 12783771
references.citation: Lancet. 2009 Sep 12;374(9693):881-92
references.pmid: 19748397
references.citation: Reprod Health. 2005 Oct 21;2:8
references.pmid: 16242030
references.citation: Stud Fam Plann. 1995 Mar-Apr;26(2):57-75
references.pmid: 7618196
references.citation: Soc Sci Med. 1997 Dec;45(12):1789-804
references.pmid: 9447629
references.citation: Int J Gynaecol Obstet. 2008 Apr;101(1):88-92
references.pmid: 18082747
references.citation: Afr J Reprod Health. 2006 Aug;10(2):90-104
references.pmid: 17217121
references.citation: Demography. 1997 Aug;34(3):385-98
references.pmid: 9275247
references.citation: Int Perspect Sex Reprod Health. 2009 Jun;35(2):63-71
references.pmid: 19620090
references.citation: Int Fam Plan Perspect. 2008 Jun;34(2):62-70
references.pmid: 18644757
references.citation: Health Place. 2001 Sep;7(3):197-208
references.pmid: 11439255
references.citation: Contraception. 2003 Aug;68(2):125-34
references.pmid: 12954525
references.citation: Lancet. 2007 Apr 7;369(9568):1220-31
references.pmid: 17416266
references.citation: Health Place. 2012 Mar;18(2):408-14
references.pmid: 22240081
references.citation: Annu Rev Public Health. 2000;21:171-92
references.pmid: 10884951
references.citation: Stud Fam Plann. 2002 Dec;33(4):309-20
references.pmid: 12561780
references.citation: Reprod Health Matters. 2006 Nov;14(28):17-22
references.pmid: 17101418
references.citation: Perspect Sex Reprod Health. 2006 Jun;38(2):90-6
references.pmid: 16772190
references.citation: Popul Stud (Camb). 2003;57(1):21-40
references.pmid: 12745807