Modern contraceptive use among female refugee adolescents in northern Uganda : prevalence, effect of peer counselling, adherence, and experiences

Background: Adolescent pregnancies have remained high globally, with the highest rates occurring in low- and middle-income countries and humanitarian settings. The high adolescent pregnancy rates have been attributed to low and inconsistent use of modern contraceptives, resulting from limited knowledge on contraception, fear of side effects, and social norms among others. The complications associated with adolescent pregnancy and childbirth are the leading cause of death among adolescents globally. There is limited knowledge on the causes of low and inconsistent use of contraception among female refugee adolescents. This study aimed to assess the use of modern contraceptives among female refugee adolescents in northern Uganda, prevalence, effect of peer counselling, adherence, and experiences. Methods: This was a mixed-methods study employing both quantitative and qualitative techniques, carried out in Palabek refugee settlement, northern Uganda. Study I, whose objective was to determine the prevalence and factors associated with modern contraceptive use, was a cross-sectional study conducted from May to July 2019. It involved 839 female refugee adolescents aged 15 to 19 years. Study II, to determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents, was a randomized, controlled, single-blind, superiority trial with two-parallel groups in a 1:1 allocation ratio. It was carried out from May to July 2019 and involved 588 female refugee adolescents aged 15 to 19 years. Study III had an objective to determine the rates and predictors of adherence to modern contraceptives among female refugee adolescents in northern Uganda. This was a prospective single cohort study, nested into the randomized controlled trial. It involved 272 female adolescents aged 15 to 19 years who were new starters of modern contraceptives. They were followed up for a period of six months from May 2019 to January 2020, with follow-ups done at one, three and six months. Study IV was conducted ...