Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial

PLoS One. 2021 Sep 2;16(9):e0256479. doi: 10.1371/journal.pone.0256479. eCollection 2021.

Abstract

Background: The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch.

Objective: To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda.

Methods: A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care.

Results: Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition.

Conclusion: Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents' fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Contraception / methods
  • Contraception Behavior / psychology*
  • Contraceptive Agents / therapeutic use*
  • Contraceptive Devices, Female / statistics & numerical data*
  • Fear / psychology
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Peer Group
  • Pregnancy
  • Pregnancy in Adolescence / psychology*
  • Pregnancy in Adolescence / statistics & numerical data
  • Pregnancy, Unplanned / psychology*
  • Refugees
  • Sex Counseling / methods*
  • Uganda

Substances

  • Contraceptive Agents

Grants and funding

This study was funded in part by the Swedish International Development Cooperation Agency (Sida) and Makerere University under Sida contribution No: 51180060. Ritah Bakesiima was the grant recipient. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.