Factors Associated with the use of Long-Acting Reversible Contraceptives among adolescents at first level hospitals in Lusaka, Zambia

Abstract

Abstract Background Unintended adolescent pregnancies remain a public health challenge in Zambia, where LARC use is low despite their effectiveness. Barriers such as stigma, misconceptions, and limited access persist. Previous studies conducted in Lusaka district did not explore the challenges faced by adolescents in trying to access and use LARCs. Understanding these challenges is crucial for developing targeted interventions to promote safe and effective contraception practices. This study examined factors influencing adolescent knowledge, willingness, and uptake of LARCs in public health facilities in Lusaka. Methods A cross-sectional study was conducted between November 2024 and March 2025 among adolescent girls aged 15–19 years in five first-level hospitals in Lusaka, Zambia, using structured questionnaires to obtain quantitative data 1 . LARC use was measured as a binary outcome, with multiple regression identifying associated factors. Results There were 400 participants in total, of whom 48.0% (181/377) reported ever using a LARC. In the investigator-led adjusted key-predictor model, age was associated with higher odds of ever using LARC (AOR = 1.31, 95% CI: 1.01-1.69; p = 0.042). Adolescents who were not willing to delay pregnancy had higher odds of LARC use than those willing to delay pregnancy (AOR = 4.31, 95% CI: 1.05-17.73; p = 0.043). Knowledge of LARCs (AOR = 2.81, 95% CI: 1.27-6.19; p = 0.011), having children (AOR = 2.71, 95% CI: 1.32-5.54; p = 0.006), and residence in Chipata compared with Kanyama (AOR = 231.96, 95% CI: 28.51-1887.37; p < 0.001) were also significant predictors.. Conclusions The findings indicate that older age, knowledge of LARCs, reproductive experience, fertility intentions, and facility context were associated with ever use of LARCs. The large residence effect points to clinic-level service delivery differences, highlighting the need for targeted strategies to improve equitable access to LARCs, particularly among younger women and facilities with lower uptake, while future research should investigate service delivery factors and determinants of current LARC use.