Predictors of contraceptive use at first sexual intercourse among adolescent girls in Ratlou local municipality, South Africa.

Adolescent girls are vulnerable to unintended pregnancies, unsafe abortions, and sexually transmitted infections when contraception is not used at sexual debut. Understanding the factors influencing contraceptive use at first sex is important for informing adolescent sexual and reproductive health and rights interventions, especially in rural settings where there is limited evidence. The study adopted a cross-sectional design. The sample of 290 adolescent girls was drawn from nine selected villages in the Ratlou local municipality of South Africa. Bivariate analysis, with a chi-square test, and binary logistic regression were conducted. Overall, 41.0% of adolescent girls reported contraceptive use at first sex. The regression model revealed that secondary education [AOR=0.40], a working household head [AOR=0.47], having first sex at 14-16 [AOR=0.16] and at 17-19 [AOR=0.39], ever use of dual methods of contraception [AOR=0.21], and living in Kraaipan village [AOR=0.18] were associated with lower odds of contraceptive use at first sex. Strengthening school-based sexual and reproductive health and rights education, improving parent-adolescent communication, and ensuring equitable access to youth-friendly services are important for improving contraceptive use at first sexual intercourse among adolescents in Ratlou local municipality.