Background Globally, contraceptive use among young people aged 15-24 years is low with a prevalence lower than 21% yet contraceptive use reduces the likelihood of high-risk and unintended pregnancies. In Uganda, nearly a quarter (24%) of girls aged 15-19 years have either been pregnant or given birth, mainly attributed to non-use of contraceptives which is so low at 10% in Karamoja. In response the study aimed to assess determinants of contraceptive use and intention to use in Karamoja region Methods This was a quantitative study with a sample size of 448 youth (women and men 15-24 years). Of these,409 were sexually active (had sex within the last 12 months) and included in our analysis. Modified Poisson model that incorporated sampling weights was used to establish the factors associated with contraceptive use, and intention to use. Results About 41.6% (49.3% males and 32.6% females) had ever used a contraceptive. only 11.0% (16.3% women and 6.4% men) were currently using a contraceptive and about 72.4% (84% males and 59% females) intended to use contraception. Youths with secondary education had higher prevalence rate for ever use of contraceptives by 32% and 25% for females and males respectively than those with no education. Females who had a paid job were 4.5 times (APR=4.51, 95%CI: 3.80-5.36) and males were 1.6 times (APR=1.6, 95% CI: 1.26-1.92) more likely to use contraceptives while the prevalence of intention to use was higher among those who had a job by 5.7 times (APR=5.75, 95%CI: 4.94-6.69) for females and 2.3 times (APR=2.25, 95%CI: 1.76-2.89) for males. Never married females were 3.1 times (APR=3.09, 95%CI: 2.39-3.99) more likely to use contraceptives than married females. Females who had children 1.6 times (APR=1.46, 95% CI: 1.18-1.81) and males 7.4 times (APR=7.4, 95% CI: 4.74-11.69) more like to have ever used a contraceptive. Conclusion The factors positively associated with use of contraceptives and intention to use were age (being older, 20-24 year), marital status, having biological children, attaining secondary education level, living with biological parents and having a job and all these varied by gender. The study recommends improving access to education and employment opportunities for youth, involving parents in young people’s SRH, and targeting male youth with interventions to improve contraceptive use.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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This study was conducted in accordance with the Helsinki Declaration. This was part of a PhD study that was approved by the Makerere University School of Public Health, Research Ethics Committee (MUSPH-REC), approval number (SPH-2022-294). The study was also approved by Uganda National Council of Science and Technology (UNSCT), a national approving body (Internal Review Board), The UNCST approval number for the study is HS2547ES.

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