Measuring social norms endorsement and normative influence on contraceptive use among youth (15–24) in northeastern Uganda

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Background: Despite widespread availability of contraceptives, uptake remains lower than expected given the unmet need. This gap highlights the importance of examining how social norms influence contraceptive use. This study measured young people's endorsement of social and contraceptive use among young people aged 15-24 years in Uganda. Methods: A cross-sectional study was conducted among 448 youth aged 15-24, of whom 409 were sexually active. A Likert-scale social norms tool, developed by the same research team through literature review and qualitative research, was applied. Eight scales captured domains including provision of sexual education, family planning myths and misconceptions, reproductive health, couple communication, masculinity, sanctions, self-efficacy, and engagement norms. Descriptive statistics summarized participant characteristics and responses, with median scores dichotomized into high vs. low agreement. Associations between social norms and contraceptive use were examined using modified Poisson regression with robust variance estimation, while sensitivity analyses with continuous scores provided predicted probabilities for a nuanced interpretation. Results: Contraceptive use was strongly predicted by self-efficacy (APR = 3.80, 95% CI: 3.39-4.25) and endorsement of positive reproductive health norms (APR = 4.62, 95% CI: 4.16-5.13), with predicted probabilities rising to near universal levels among high scorers. Rejecting negative masculinity, myths, and restrictive views on sexual education produced moderate gains (APR range 1.12-1.30), while sanctions suppressed uptake (APR = 0.42, 95% CI: 0.16-1.09). Overall, empowerment and supportive norms most strongly promoted contraceptive use, whereas punitive attitudes reduced it. Conclusion: Contraceptive use among youth is most strongly influenced by self-efficacy and positive reproductive health norms, moderately shaped by reductions in restrictive attitudes, and suppressed by sanctions. Interventions that build confidence, promote supportive norms, and address stigma are likely to achieve the greatest gains in uptake.

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