Socioeconomic and geographic inequalities in modern contraceptive use among adolescent girls aged 15–19 years in Nigeria: a cross-sectional analysis of the 2024 Nigeria Demographic and Health Survey

Abstract

Abstract Objectives We estimated the weighted prevalence of modern contraceptive use among adolescent girls aged 15–19 years in Nigeria, quantified socioeconomic and geographic inequality using the Erreygers corrected concentration index (CI) and identified correlates by marital status. Design Cross-sectional secondary analysis using the 2024 Nigeria Demographic and Health Survey. Setting Nigeria. Participants 7995 adolescent girls aged 15–19 years. Primary and secondary outcome measures The primary outcome was current modern contraceptive use. The secondary outcome was the Erreygers corrected CI of socioeconomic inequality. Results Weighted modern contraceptive prevalence was 2.73% (95% CI 2.29 to 3.18). Among married adolescent and cohabiting adolescent girls (n=1302), education demonstrated a significant dose-response association with modern contraceptive use. Addressing small subgroup sample sizes with Firth’s bias correction yielded consistent findings with narrower confidence intervals (eg, higher education: corrected adjusted OR (AOR) 34.33, 95% CI 4.15 to 283.88, vs original AOR 36.42, 95% CI 2.47 to 537.18). Compared with girls with no formal education, the adjusted odds of modern contraceptive use increased progressively among those with primary (AOR 2.58, 95% CI 1.02 to 6.56), secondary (AOR 3.48, 95% CI 1.21 to 9.95) and higher education levels. Among never-married adolescents, geographic region and age were significant independent predictors of modern contraceptive use. Adolescents in the Northwest and Northeast had 79% lower odds of contraceptive use compared with their North Central peers (AOR 0.21, 95% CI 0.08 to 0.51). Additionally, each additional year of age increased the odds of contraceptive use by 75% (AOR 1.75, 95% CI 1.54 to 1.99). Both the standard and Erreygers concentration indices confirmed a significant pro-rich disparity, indicating that the limited use of modern contraceptives is disproportionately concentrated among wealthier adolescents. Conclusions Modern contraceptive use among Nigerian adolescent girls remains very low and inequitably distributed. Targeted interventions are urgently needed to improve reproductive health equity.