Determinants of condom use among young women in South Africa

Abstract

Background: The consistent and correct use of both female and male condoms during sexual activity has been the key component and have been proven to be 80% to 90% effective to preventing HIV, sexually transmitted infections (STIs) and unwanted pregnancies. Though young women are the most vulnerable population to HIV, evidence on young South African women reveals that condom use is under-utilized in this population. Young women are the most probable to acquire HIV and are still having unintended pregnancy due to contraceptive failure when using other methods. Previous studies on contraceptive use are mostly based on general use of contraceptives, and not condom use. Therefore, this study was designed to identify factors that determine the use of condoms among young women aged 15 - 24 years in South Africa. The operational definition of condom use refers to the use of a condom with the most recent partner. Methods: The study followed a quantitative cross-sectional design focusing on sexually active young women aged 15 - 24 years in South Africa (n =1757). Which involved using secondary data from the 2016 South Africa Demographic and Health Survey (SADHS, 2016). The following analyses were conducted using the Statistical Package of Social Science (SPSS) version 27 namely, univariate analysis (frequency distribution), Pearson Chi square to examine the association between each of the independent variables and dependent variable and binary logistic regression to investigate the influence of individual- and community- level factors on condom use among young women. Results: The results reveal that of 1757 young women, 55.6% reported using condom during last sexual intercourse with the most recent partner. Based on the Pearson Chi square statistics, the age group, population group, marital status, level of education, parity, sex of household head, multiple sexual partners in the past 12 months, household wealth, place of residence and province were statistically associated (P<0.05) with condom use during last sexual intercourse with most recent partner. Condom use during last sexual intercourse with the most recent partner among young women was less prevalent among women aged 20-24 years (53.1%), who belonged to other population group (44.9%), who have ever been in union (24.8%), with primary and lower education (28.9%), with two or more children (44.5%), with no multiple sexual partners (21.6%), who came from male headed households (48.2%), poor households (48.9%), from rural areas (50.0%), and the Western Cape (48.6%) as compared to other young women. Based on the binary logistic regression, the results show that the population group, marital status, level of education, parity, multiple sexual partners in the past 12 months, household wealth and place of residence were statistically associated (P<0.05) with condom use during last sexual intercourse with most recent partner. The odds of using condoms during sexual intercourse with the most recent partner were low and high among some women. Young women from other population group [Odds ratio's (OR): 0.493; 95% CI: 0.328 - 0.741; P=0.001], ever been in union [OR: 0.45; 95% CI: 0.254 - 0.816; P=0.008] , with one child [OR: 0.554; 95% CI: 0.440 - 0.697; P=0.000], two or more children [OR: 0.595; 95% CI: 0.425 - 0.834; P=0.003], from rural areas [OR: 0.687; 95% CI: 0.537 - 0.878; P=0.003] were less likely to use a condom during last sexual intercourse compared to other young women. Young women with secondary education [OR: 2.287; 95% CI: 1.451 - 3.603; P=0.000], higher education [OR: 1.843; 95% CI: 1.034 - 3.285; P=0.038], with one extra sexual partner [OR: 2.219; 95% CI: 1.171 - 4.205; P=0.015], two or more extra sexual partners [OR: 2.429; 95% CI: 1.158 - 5.094; P=0.019], from rich households [OR: 1.480; 95% CI: 1.106 - 1.982; P=0.008] were more likely to use a condom during last sexual intercourse compared to other young women. Conclusion: The study identified areas where condom use was less prevalent among young women. The study has also found several individual and community level factors to be significantly associated with the use of condom during sexual intercourse. There is a need for interventions aimed at elevating educational levels integrated with sexual health information, increasing access to family planning, antenatal and health care services, empowering women economically, that are central to increase condom use among young women. Such as empowering young women economically, promoting women's reproductive health, improving sexual and reproductive health care services in rural areas, access to free quality education and provide counselling with respect to sexual health in marriages.