Barriers to contraceptive use among adolescents in two semi-rural Nicaraguan communities

Objective To identify barriers to contraceptive use among adolescents in two neighboring semi-rural communities in Nicaragua. Methods We recruited and surveyed a convenience sample of 287 adolescents, ages 15-19 years old, in July and August, 2013 about barriers to contraceptive use. We compared adolescents by gender, sexually active status (sexual intercourse in the previous year) and frequency of contraceptive use. Results More than 40% (43.5%) of the adolescents surveyed reported that they had ever had sexual intercourse. The likelihood of ever having had sexual intercourse differed based on gender, relationship status, sexual activity of peers, and the presence of a father in the home. Contraceptive use was low and female adolescents were more likely than their male counterparts to report never or rarely using contraceptives (46.5% vs. 21.4%, p < 0.007). Contraceptive use for females was positively associated with discussing contraception with a healthcare professional (HCP) [adjusted odds ratio (AOR) 13.32; 95% confidence interval (CI) 1.35-139.98] and a family member (AOR 4.64; 95% CI 1.09-19.72). Reasons for non-use also varied significantly by gender. Low rates of contraceptive use in these two semi-rural Nicaraguan communities appear to be primarily related to gender norms, social stigma, and poor communication about family planning. Conclusions Interventions that focus on promoting gender equality and encouraging adolescent communication with HCPs, schools, families, and partners are imperative to combating adolescent pregnancy in Nicaragua and countries worldwide.