This study was conducted in 2021 in schools (middle schools and high schools) in Guinea as part of a doctoral research project.

The research was conducted in public and private schools (middle and high schools) in six regions of Guinea (Conakry, Faranah, Kankan, Kindia, Labé and N’zérékoré) and included all students present in class at the time of the survey.

The study population consisted of adolescent girls and young women enrolled in secondary schools in Guinea. The World Health Organization defines adolescents as individuals aged 10–19 years, while young people are defined as those aged 15–24 years.¹⁸ Sampling in each region was carried out in three stages: firstly, schools were selected on a targeted basis; secondly, classes were chosen by grade level, with priority given to classes with the most students; thirdly, students were selected at random using a systematic approach.

Figure 1 illustrates the sample selection criteria for this study, which initially included students aged 13–24 years. The sample size was derived from the initial population of students aged 13–24 years (N = 11 139) through a successive exclusion process based on predefined criteria. Initially, boys were excluded, followed by married females and then unmarried females who had never had sexual intercourse. Ultimately, only sexually active unmarried females were retained, forming the final study sample. The final sample comprised 2552 unmarried sexually active students.

The outcome variable in this study was the lack of use of modern contraceptive methods (modern methods of contraception include intrauterine devices, implants or Norplants, injectable contraceptives, oral contraceptives, condoms and sterilisation) among sexually active, non-married, school-going adolescents and young women. Those who had never used a modern contraceptive method were coded ‘1’. Those who used at least one modern contraceptive method were coded ‘0’.

The study’s independent variables included age, educational level, school type, religion and region. Additionally, adolescents’ girls were questioned about their knowledge of contraceptive methods, having heard of contraception, wanting a child within the next 2 years, thinking that men should authorise the use of contraceptive methods, opinion on contraception, having a sexual partner at the moment of the interview, being willing to use a contraceptive method even if the partner opposes it, having contraceptive needs and ease of access to contraceptive methods. Age was recoded into two classes (13–19 years and 20–24 years). Education level was recorded into middle school (Grades 7–10) and high school (Grades 11–13) and school type into public and private. Knowledge was assessed using three indicators: knowledge of at least one contraceptive method, knowledge of a benefit of family planning and knowledge of a family planning service delivery location, each coded as ‘1’ for a positive response. A composite score ranging from 0 to 3 was then calculated by summing these items. Based on this score, participants were categorised into three levels of knowledge: none (0 points), moderate (1–2 points) and high (3 points). Students who had not used any contraceptive methods were asked about the reasons for non-use.

The data were imported into Stata software, version 16 (StataCorp LLC, College Station, TX, United States [US]) for analysis, and their completeness and coherence were carefully checked. Descriptive statistics were calculated, including means, standard deviations, frequencies and percentages. To assess potential multicollinearity among the explanatory variables, the variance inflation factor was applied. Associations between categorical variables were examined using Pearson’s chi-square test. Explanatory variables with a p-value < 0.25 in the bivariate logistic regression were selected and subsequently included in the multivariable analysis. Multivariable logistic regression was performed to explore the relationship between independent variables and the outcome. Each variable was adjusted for the presence of other variables in the model. Adjusted odds ratios (AOR) with 95% confidence intervals (CIs) were reported, and a p-value less than 0.05 was considered statistically significant.

Ethical clearance to conduct this study was obtained from the National Ethics Committee for Health Research (CNERS) (No. 045/CNERS/19). Ethical authorisation was not necessary, as the primary study was obtained after obtaining ethical authorisation from the National Ethics Committee of Guinea. The authors obtained permission to use this dataset.

The 13–19 years age group was the most represented (74.4%), around 77% studied in public schools, 83.6% had heard of contraception and 46.6% had a high knowledge of contraceptive methods. Only 16.6% thought that men should authorise the use of contraceptive methods, 23% disapproved of contraceptive methods, 86% had a sexual partner at the moment of the interview, 76.8% were prepared to use a contraceptive method even if their partner objected and almost 61% had easy access to contraceptive methods (Table 1).

The prevalence of non-use of modern contraceptive methods among participants was 48.2% (46.3–50.2). Middle school students (50.5%), private school students (59%), Muslims (56%), students who had no knowledge of contraceptive methods (90.5%), those who wanted a birth within the next 2 years (61%), those who thought that men should authorise the use of contraceptive methods (69.3%), those who disapproved of the use of contraceptive methods (62.5%), those who are not having a sexual partner (54.7%), students who were not prepared to use contraceptive methods if their partner objected (70.5%), those who had family planning needs (51.7%) and those who did not have easy access to contraceptive methods when needed (78.2%) showed higher non-use of modern contraceptive methods within their respective categories. No statistically significant variation was found among the different age categories (Table 2).

The main reasons given by students (n = 1231) for not using contraceptive methods were failure of previous contraception and partner’s opposition (3%), negative beliefs or rumours (4%), high cost and difficulty of access (5%), reduced sexual satisfaction (10%), lack of information (13%), fear of parents (25%), religious barrier (30%) and fear of side effects (59%). Other reasons cited were difficulty of access, negative perceptions or beliefs about contraception, opposition from a partner and failure of previous use.

Several factors were associated with non-use of modern contraceptive methods among school-attending adolescents and young women. Middle school students had higher odds of non-use (AOR: 1.67, 95% CI: 1.29–2.17) than high school students, and students in private schools had higher odds of non-use (AOR: 1.69, 95% CI: 1.29–2.21) than those in public schools. Religious affiliation was also a significant factor, with Muslim students (AOR: 4.23, 95% CI: 2.27–7.88) and Christian students (AOR: 3.01, 95% CI: 1.62–5.62) less likely to use modern contraceptives than students of other religious denominations (traditionalists and no religious denomination). Knowledge of contraceptive methods strongly influenced use. Students with no knowledge (AOR: 11.95, 95% CI: 7.08–20.1) or moderate knowledge (AOR: 4.57, 95% CI: 3.57–5.86) were much less likely to use modern contraceptives than those with high knowledge. Planning a birth within the next 2 years (AOR: 2.51, 95% CI: 1.98–3.17), unwillingness to use contraception if their partner objected (AOR: 2.05, 95% CI: 1.53–2.74) and having unmet family planning needs (AOR: 1.68, 95% CI: 1.31–2.15) were also associated with higher odds of non-use. Limited access to contraceptive methods markedly increased non-use (AOR: 3.87, 95% CI: 2.97–5.04) (Table 3).

In our study, several factors influenced the use of modern contraceptive methods among unmarried sexually active teenagers and young women, including level of education, type of school, level of knowledge, religion, wanting a baby within the next 2 years and not having easy access to contraceptive methods.

College girls had higher odds of non-use of the modern contraceptive methods compared to high school girls. Several findings have shown that a low level of education is associated with non-use of modern contraceptive methods.^6,24,25 This could be attributed to the fact that higher education enhances understanding of health-related determinants. Educated women have improved access to health information and greater autonomy to make decisions regarding their own health, including the adoption of contraceptive methods.

Students in private schools were more likely to refrain from using modern contraceptive methods, possibly because many perceive themselves as more independent than those attending public schools.

Low knowledge of contraceptive methods was associated with non-use in our study. Knowledge is a key predisposing factor that encourages positive health behaviours, including the uptake of contraceptive methods. Evidence from multiple studies indicates that insufficient knowledge is a major contributor to women’s non-use of contraceptives.^{9,25,26,27,28} Efforts should be made to increase knowledge and the adoption of contraceptive methods among adolescent girls and young women.

Sexually active Muslim and Christian women were less likely to use modern contraceptives than traditionalists and those with no religion. This result corroborates those of other studies.^29,30

Religious beliefs can hinder women’s adoption of modern contraceptive methods. In our study, 30% of participants who had never used a modern method reported religion as a barrier. Similarly, a study exploring contraceptive practices among Muslim women in the United States found that 35% of respondents believed that Islam prohibits the use of permanent contraceptive methods.³¹

Adolescent girls and young women planning a pregnancy in the next 2 years were less likely to adopt modern contraceptive methods. Similarly, research in the Kigoma region of Tanzania showed that women aged 15–49 years who wanted to postpone childbirth by at least 2 years were four times more likely to use contraceptives.³² A woman’s desire to become pregnant within a short space of time is an obstacle to using a contraceptive method.

In our study, teenage girls and young women who were unwilling to use contraceptive methods if their partner objected were more likely to be non-users. Several studies have shown that women whose partners had an unfavourable opinion of the use of modern contraceptive methods were less likely to use them.^6,8,14

In our study, adolescents and young women with family planning needs and those without easy access to contraceptive methods were more likely to be non-users. These results corroborate those of the literature.^14,29,32,33 Easy access to free or low-cost contraceptives is a key determinant of their utilisation.

Our study has some limitations. As a result of its cross-sectional nature, it cannot establish a causal link between non-utilisation of modern contraceptives among sexually active, unmarried adolescent girls and young women and the associated factors. As a result of the cultural sensitivity surrounding sexuality and the use of contraceptive methods, responses could be subject to social desirability bias. In addition, this study was unable to assess the influence of other factors such as parental control, multiple sexual partners and the consumption of psychoactive substances, including tobacco and other drugs. Despite this, the present study of a nationally representative sample provides evidence that could help policymakers implement interventions to increase the prevalence of the adoption of modern contraceptive methods among school students, offering a basis for subsequent studies.