Abstract / Summary
Modern contraceptive prevalence in Kisoro District, a mountainous cross-border district in south-western Uganda, stands at approximately 28%, below the national average of 38%. This study examined the prevalence of, and factors associated with, modern contraceptive uptake among women aged 15–49 years in Kisoro District. A community-based cross-sectional mixed-methods study was conducted among 690 women selected through two-stage cluster sampling across 30 clusters spanning all 15 sub-counties and Kisoro Municipality. Quantitative data were collected using structured interviewer-administered questionnaires and analysed in SPSS version 26 using descriptive statistics and bivariate and multivariable logistic regression, with associations reported as adjusted odds ratios (AORs) and statistical significance set at p < 0.05. Qualitative data were collected through five focus group discussions ( n = 50) and four key informant interviews, analysed thematically and triangulated with the quantitative findings. Modern contraceptive prevalence was 27.3% ( n = 188). Women aged 34–41 years (AOR = 2.08, 95% CI: 1.24–3.50, p = 0.006) and 42–49 years (AOR = 2.02, 95% CI: 1.07–3.80, p = 0.030) had significantly higher odds of uptake than women aged 18–25 years. Muslim women had significantly lower odds than Anglican women (AOR = 0.14, 95% CI: 0.04–0.51, p = 0.003). Women with primary or no formal education had lower odds than those with certificate-level education (AOR = 0.61, 95% CI: 0.40–0.93, p = 0.021), and women in occupations other than peasant farming, entrepreneurship, or professional work had lower odds than entrepreneurs (AOR = 0.12, 95% CI: 0.06–0.24, p = 0.001). Higher health literacy (AOR = 1.38, 95% CI: 1.02–1.86, p = 0.039) and better information access (AOR = 1.44, 95% CI: 1.04–1.99, p = 0.028) were each associated with higher odds of uptake. Distance to health facilities and household economic status were not significant predictors. Qualitative findings identified fear of side effects, male opposition, and cultural norms as barriers, and community radio and peer support as facilitators. Modern contraceptive uptake in Kisoro District remains substantially below the national average and is shaped more by knowledge, religious affiliation, education, and occupation than by distance or wealth. Faith-sensitive, information-focused, and occupationally targeted interventions are needed to close this gap.