Introduction Teenage pregnancies and sexually transmitted diseases are major public health problems in Uganda. Early sexual debut is one of the main routes of these public health problems. This study aimed to identify factors that explain age at first sex inequality between men and women Ugandan youth. Methods This study used secondary data from a cross-sectional Uganda demographic health survey (2016). Participants were 10 189 sexually experienced youth. Using Stata 14, intermediary analysis was done to assess the statistical association between explanatory variables and age at first sex in a multiple logistic regression analysis. Oaxaca decomposition was used to decompose factors that explain inequalities in age at first sex between men and women youth. Results Intermediary results showed Islam, many household members, residing in the eastern region, and being divorced/widowed were predictors of early age at first sex. While secondary education, higher education, blue-collar jobs, and being 20 to 30 years old were protective factors against early age at first sex. Material, behavior/cultural, psychosocial, and demographic explanatory factors jointly explained a statistically significant portion of the observed gap in early age at first sex between women and men youth. More women were at a disadvantage at an early age at first sex compared to men youth. About 96.37% of this gap was explained by unequal distribution of material, behavior/cultural, psychosocial, and demographic factors between men and women youth. Relationship to household head (49%), education (16.87%), occupation (8,94%), number of household members (8.57%), using the internet (7.99%), and reading newspapers or magazines (4.39%) made a significant contribution to the explanation of early age at first sex inequality between men and women youth. Conclusions Results showed early age at first sex inequality between women and men youth that favored men. Programs designed to address early age at first sex and related health outcomes must combat inequities in education, employment opportunities, access to sexual reproductive information through internet, and newspapers or magazines between men and women youth. They should also foster household relationships and monitor girls.

Background Sierra Leone has one of the world's highest rates of maternal mortality. Preventing unintended pregnancies reduces the burden of maternal morbidity and mortality. Unfortunately, 25% of reproductive-age women do not have access to modern contraceptive services, and the proportion of demand met for modern contraception remains low at 46% in Sierra Leone. Rural Sierra Leonean women use modern contraception less frequently than urban women. This study aimed to quantify the rural-urban disparity in modern contraceptive use among Sierra Leonean women of reproductive age and to identify factors that explain it. Method Data from 2019 Sierra Leone demographic health survey was used. Participants were sexually active women aged 15 to 49 (n=13,975). Modern contraceptive use was the outcome variable. Explanatory variables were grouped into materialistic, behavioral/cultural, and psychosocial theoretical perspectives. Descriptive statistics, intermediary analysis, and blinder Oaxaca decomposition analysis were used to summarize and identify the factors that explain inequalities in modern contraceptive use between rural and urban women. Data were analyzed using Stata version 14.0. Results There was a rural-urban disparity in modern contraceptive use of 18 percentage points favoring urban women. The exposure variables explained 68% of this disparity. Education (76%), marital status (39%), hearing about family planning on the radio (16%), age of respondent (13%), problems with distance to a healthcare facility (12%), and problems getting permission to seek treatment (9%) made a significant contribution to the explanation of the modern contraceptive use disparity between urban and rural women. Conclusions There was a large rural-urban disparity in modern contraceptive use in Sierra Leone that favoured urban women. Material, behavior/cultural, psychosocial, and demographic explanatory factors jointly explained 68% of the disparity in modern contraceptive utilization between rural and urban women. To close the rural-urban disparity in modern contraceptive use, policy makers must address inequities in education, mass media (radio), and healthcare access. Rural women should be empowered to have the autonomy to access healthcare. Educating men about modern contraceptives and involving them in contraceptive programs can increase rural women's ability to get permission to seek care hence increasing modern contraceptive utilization and consequently bridging the rural-urban gap.

Background Sierra Leone has one of the world's highest rates of maternal mortality. Preventing unintended pregnancies reduces the burden of maternal mortality. Unfortunately, 25% of reproductive-age women do not have access to modern contraceptives, and the proportion of demand met for modern contraception remains low at 46% in Sierra Leone. Rural Sierra Leonean women use modern contraception less frequently than urban women. This study aimed to quantify the rural-urban disparity in modern contraceptive use among Sierra Leonean women of reproductive age and to identify factors that explain it. Method Data from the 2019 Sierra Leone demographic health survey was used. Participants were sexually active women aged 15 to 49 (n = 13,975). Modern contraceptive use was the outcome variable while the selected explanatory variables were grouped into materialistic, behavioral/cultural, and psychosocial theoretical perspectives. Descriptive statistics, intermediary analysis, and Oaxaca decomposition analysis were used to summarize and identify the factors that explain inequalities in modern contraceptive use between rural and urban women. Data were analyzed using Stata version 14.0. Results There was a rural-urban disparity in modern contraceptive use of 18 percentage points favoring urban women and the exposure variables explained 68% of this disparity. Education made the biggest (76%) contribution to the explanation of the modern contraceptive use disparity between urban and rural women. Other important contributors were marital status (39%), hearing about family planning on the radio (16%), age of respondent (13%), problems with distance to a healthcare facility (12%), and problems getting permission to seek treatment (9%). Conclusions There was a large rural-urban disparity in modern contraceptive use that favored urban dwellers. Material, behavior/cultural, psychosocial, and demographic explanatory factors jointly explained 68% of the difference in modern contraceptive utilization between rural and urban dwellers. To close the rural-urban disparity in modern contraceptive use, policymakers must address inequities in education, mass media (radio) access, and healthcare access. Rural women should be empowered so that they can have the autonomy to access healthcare. Involving men in modern contraceptive programs can increase rural women's ability to get permission to seek services hence increasing modern contraceptive utilization and consequently bridging the rural-urban gap.