Age of Sexual Debut and Modern Contraceptive Use Among Women of Reproductive Age in South Africa

Despite the increasing use of modern contraceptives worldwide, its use remains low in sub-Saharan Africa, and this has been attributed to demographic and socio-economic factors. The association between early sexual debut and the propensity to use modern contraceptives remains unexplored in South Africa. Thus, this study examines the association between the age of sexual debut and modern contraceptive use among women of reproductive age in South Africa. We used secondary dataset from the most recent South Africa Demographic and Health Survey conducted in 2016. For the purpose of the study, only sexually active women of reproductive age (15–49) with complete responses on all the variables of interest (N = 7505) were included. We used a multivariable binary logistic regression analysis to examine the association between age at sexual debut and modern contraceptive use. The regression analysis results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) at a 95% confidence interval (CI). Statistical significance was set at p < 0.05. The prevalence of modern contraceptive use among women of reproductive age who had a sexual debut at age 16 and above was 54.67%. Women who initiated sex at age 16 and above [aOR = 1.29; 95%CI = 1.03–1.60] were more likely to use modern contraceptives compared to those who initiated sex before age 16. Among the selected co-variates, women who were residing in the Free State Province [aOR = 0.68; 95%CI = 0.50–0.91] and Limpopo Province [aOR = 0.66; 95%CI = 0.49–0.90] were less likely to use modern contraceptives compared to those who resided in Western Cape Province. Women with 4 or more children [aOR = 2.80; 95% CI = 2.01–3.74], those with no desire for more children [aOR = 1.34; 95%CI = 1.15–1.56], those who were exposed to media [aOR = 1.38; 95% CI = 1.14–1.68], and those with secondary or above educational level [aOR = 1.68; 95%CI = 1.12–2.51] were more likely to use modern contraceptives compared to their counterparts with no child, those who wanted more children, those not exposed to mass media, and those with no education, respectively. To enhance the use of modern contraceptives among women of reproductive age in South Africa, behavioural communication change interventions such as in-school campaigns that will discourage early sexual debut should be promoted since in-school campaigns can reach wider coverage within a short period Early exposure to mass media should be encouraged among women in South Africa.