This study aimed to assess contraceptive use autonomy, decision-making, and dependence levels among young women in Nigeria. The cross-sectional survey included 5436 female adolescents and youth aged 15-24 across 4 Nigerian states. Results showed that while most women make contraceptive decisions jointly with their partners, a considerable number rely on others to convince or make decisions for them. There was a strong association between who makes contraceptive decisions and autonomy levels. The study concludes that integrating contraceptive negotiation and assertiveness into family planning programs could help empower more women to make their own informed choices. Implementers should meaningfully engage young people to design effective youth-focused interventions.

1. Contraceptive use autonomy, decision and
dependence level among young women in Nigeria; a
cross sectional survey.
Oluwayemisi Ishola, Olusegun Akinola, Dorcas Akila, Akinsewa Akiode &
Victor Igharo
Johns Hopkins Centre for Communication Programs: The Challenge
Initiative
December 2020

2. Presentation Outline
• Background/Objectives
• Methods
• Results
• Conclusion
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3. Background
• Evidences have shown that in countries
with a youth bulge like Nigeria, targeting
young people in the quest to increasing
contraceptive is a wise strategy.
• Young people, especially women have
continuously struggled with reproductive
health rights and needs, this has negatively
impacted the country’s FP outcomes.
• The Challenge Initiative is a program
positioned to scale up evidence-based FP
and Adolescent and Youth Sexual and
Reproductive Health (AYSRH) programs in
Nigeria.
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4. Background
Why AYSRH survey?
• Paucity of data specific to adolescents and youth in Nigeria
Routine- previously non-existent
Surveys- inadequate outcomes tailored to AYs
IPs data-Insufficient for generalization/representation
• Evidence revealed the need for tailor-made interventions for the
different AY age-groups: 15-19 reproductive health needs differ from
20-24
• Data is required for accurate audience segmentation
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5. Study objectives
•To generate data that will guide
design and implementation of the
Adolescent and Youth sexual and
reproductive health interventions in
the States.
•To track changes in norms, ideation
and contraceptive behaviour among
young persons aged 15-24 years.
•To track other AYSRH program related
indicators at the household level
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6. Study overview
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Eligibility criteria:
• 15-24 years old
• Married and unmarried
• Regular residence of study locations
Final sample size: 7011(1575M & 5436F)
• Sample was drawn from 3 Senatorial
Zones with eventual selection of
6 LGAs each in the 4 states.
Study dates: Oct. – December 2019

7. Methods
• A cross sectional survey conducted in in Ogun, Edo, Niger and
Plateau. Survey sample was drawn from 3 Senatorial districts in each
of the 4 states. The analytic sample is 5436 female adolescents and
youths aged 15-24 years.
• Variables of interest analyzed in the study were autonomy (ability to
successfully carry out certain FP actions confidently/independently)
and contraceptive use decision variables.
• Eight variables were used as constructs for contraceptive autonomy
after summing up to generate median score
• Data collected was analyzed using STATA version 14.0. Descriptive
statistics and test of association was used.
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8. Results
Age
56.6% 43.4%
15-19 20-24
Education Parity
ReligionGender
8.9% 91.1%
Men Women
10.3
54.1
35.2
0.1
Catholic
Protestant
Muslim
Traditional
59.7
29.6
10.7
No child
1-2 children
3+14.2
74.3
11.5
Primary Secondary Higher
Demographic characteristics of all respondents
74.4
24.9
0.7
Never married Married Others
Marital Status

9. 8
Results
27.6
5.6
5.9
5
11.7
10.7
12.9
16.3
4.4
0 1 2 3 4 5 6 7 8
46
59.7
30.2
39.7
54
40.3
69.8
60.3
Ogun Niger Plateau Edo
% of Young women with low efficacy score (below median score 0-3)
% of Young women with high efficacy score (4 and above)
Autonomy score across the 4 surveyed
States
Autonomy outcome by State

10. Contraceptive use decision & dependence level among
Current Users
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Person(s) who makes the contraceptive use decision Edo (W%) Niger
W%)
Ogun
(W%)
Plateau
(W%)
Self 12.9 30.2 21.2 27.7
Partner 18.8 24.9 11.4 9
Joint 64.6 42.3 65.6 63.3
Others 3.7 2.6 1.8 0
Level of dependence to obtain a method
Entirely dependent 21.1 21.9 21.1 14.5
Somewhat dependent 17.4 12.3 25.4 29.1
Not dependent 55.7 59.8 49.3 53.5
No response 5.8 6 4.2 2.9

11. Association between “who takes contraceptive decisions” and
contraceptive autonomy.
10
44
55
34.2
64.9
56
45
65.8
35
Jointly
Mainly husband/partner
Mainly you
Other people
Contraceptive use decision making and autonomy
Low autonomy High autonomy
There is a strong
association
between decision
making on
contraceptive use
and autonomy
(0.000 p-value).

12. Conclusion
• A considerable number of women rely other people like peers, partners and
religious leaders to either convince them or make contraceptive related decisions
on their behalf. It is therefore essential to integrate contraceptive negotiation and
assertiveness into FP/AYSRH programming.
• There is a strong association between contraceptive decision and autonomy. This
implies that young people need to be aware that FP/SRH is a fundamental right of
everyone and that they can make informed choices on use of contraception if
they so desire.
• Lastly, implementers need to meaningfully engage young people in order to be
able to successfully implement targeted and impactful programs for young
people
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13. 12
Discussion