Evaluating contraceptive preferences and barriers in Sierra Leone: Analysis of 2020 Sierra Leone District Health Information System 2 (DHIS2) data

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Kanu, Peter Palmer, Alhaji Saeed Janneh, Fatu Yamah Mansaray, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7744168/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Access to and use of modern contraceptive methods are essential components of reproductive health and are critical for reducing maternal mortality, preventing unintended pregnancies, and promoting gender equality. This study aimed to evaluate contraceptive preferences, patterns, and barriers to family planning in Koinadugu District, Sierra Leone, in 2020. Methods This study utilized a retrospective, descriptive cross-sectional approach and extracted data from the District Health Information System 2 (DHIS2). The data collection process involved extracting variables related to contraceptive type, demographic information, and temporal patterns of service use. To ensure data accuracy, the research team worked in conjunction with the Koinadugu District Health Management Team, implementing validation procedures, such as eliminating duplicates, cross-checking information, and following standardized protocols. After the dataset was cleaned, the researchers conducted descriptive and temporal trend analyses via Microsoft Excel. Results This study identified 10,795 family planning users in 2020, 42% of whom were aged 25 and above, 31% of whom were between 20 and 24 years, and 27% of whom were in the 10–19 age group. The contraceptive methods showed a preference for male condoms (62%), with oral contraceptives (16%), injectables (10%), and implants (7%). Regional disparities were notable, as Diang chiefdom reported the highest uptake at 34%, in contrast to Thamiso (1.7%). Usage peaks in December, potentially owing to seasonal or cultural factors. Societal disapproval and stereotypes have emerged as significant barriers, particularly affecting women's access to family planning services. Conclusion An analysis of family planning services in Koinadugu District revealed disparities based on age and location, with male condoms as the primary contraceptive method. Although utilization experiences seasonal fluctuations, societal stigma and misconceptions pose substantial obstacles, particularly for females. Addressing these challenges could enhance equitable long-term contraceptive adoption across districts. Contraceptive preferences Koinadugu District Family planning DHIS2 (District Health Information System 2) Temporal patterns Figures Figure 1 Figure 2 Figure 3 Introduction Family planning constitutes a critical component of public health, enabling individuals and couples to make informed decisions regarding their reproductive health and family size [ 1 , 2 ]. This practice plays a significant role in reducing maternal and infant mortality, decreasing unintended pregnancies, and enhancing the overall quality of life of families and communities [ 3 ]. Globally, effective family planning initiatives have been associated with promoting gender equality, alleviating poverty, and contributing to the achievement of Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and 5 (Gender Equality) [ 4 ]. However, substantial challenges persist in regions characterized by high fertility rates and limited healthcare access, such as sub-Saharan Africa, including Sierra Leone [ 5 ]. In Sierra Leone, access to family planning services remains limited, with only 22.3% of the population utilizing modern contraceptive methods [ 6 ]. The country encounters numerous challenges in expanding contraceptive use, including cultural and religious factors, low male participation in reproductive health decisions, and difficulties in providing services to remote rural communities [ 7 ]. Research has demonstrated that educational attainment, marital status, and distance from healthcare facilities significantly influence contraceptive adoption [ 8 ]. However, existing studies have focused predominantly on urban populations or provided broad national perspectives, resulting in a lack of representation of rural and underserved regions in the current literature [ 9 ]. The Koinadugu district, Sierra Leone's largest and one of its least developed regions, presents a unique environment for examining family planning trends. The rural nature and heterogeneous cultural and religious composition of the district create specific challenges and opportunities for contraceptive adoption [ 10 ]. This research deficit hinders the development of tailored programs that address the district's specific sociocultural and infrastructural conditions. This investigation aims to address these knowledge gaps by examining the distribution of family planning services, temporal patterns of contraceptive usage, and preferences for various birth control methods in the Koinadugu District in 2020. By utilizing data from the District Health Information System 2 (DHIS2), this study seeks to provide actionable insights for policymakers and healthcare professionals to improve reproductive health outcomes in the district. This research specifically investigates how cultural and religious practices, healthcare facility accessibility, and contraceptive awareness influence family planning adoption, addressing the urgent need for data-driven strategies in this distinct context. Materials and methods Study Design and Type: This study employed a retrospective descriptive cross-sectional methodology, analyzing records from January to December 2020. It explores family planning trends in Koinadugu District, focusing on demographic, geographical, and temporal dimensions. As an observational study, it examines existing phenomena without intervention to identify patterns and draw conclusions, thus enhancing the understanding of the factors influencing family planning decisions. The research design aligned with the study's questions and objectives. The retrospective approach examines past data, uncovers patterns in family planning usage, and identifies factors affecting contraceptive choices. The cross-sectional component enabled simultaneous data analysis across various demographic groups and geographic areas within the district. This method aligns with the goal of gaining insights into family planning dynamics without external interference, offering vital information for decision-making and future reproductive health planning. Study Setting: Koinadugu District, the largest in Sierra Leone, with an area of 12,121 km 2 (4,680 sq. mi), shares borders with Bombali, Tonkolili, Kono, Falaba, and the Republic of Guinea. According to the 2015 national census, the district's population stands at 404,097, comprising several ethnic groups, such as Kuranko, Mandingo, Fula, Limba, and Yalunka. Islam is the predominant religion, influencing more than 90% of the population's religious and cultural practices. A small Christian minority exists, mainly among the Limba. The district's economic activities center on diamond extraction and agricultural production, with key crops including rice, mango, cacao, and coconut. Koinadugu's demographic makeup and strong Islamic presence significantly shape its cultural landscape. Study participants: This research examines the utilization of family planning services in Koinadugu District in 2020, encompassing individuals with various demographic characteristics, including age, gender, and socioeconomic background. The collected data included information on the contraceptive methods employed, offering insights into the population's preferences for family planning. The study's data collection criteria encompassed all individuals who sought family planning services within a specified timeframe without exclusion. This approach was designed to capture a complete picture of family planning adoption and to acknowledge the district's diverse population. This research employed a census methodology for data gathering and examined every applicable case within the population. This strategy ensured a comprehensive representation of family planning practices across demographic groups and geographical areas, thus enhancing the validity and reliability of the study. Sampling Procedure: This study used a comprehensive approach to examine family planning patterns in Koinadugu District, aiming to understand contraceptive adoption across various demographic and geographic factors. The investigation incorporated all available information from January to December 2020, ensuring that no subgroups were excluded and enabling a detailed analysis of family planning trends. The benefits of a census method include improved external validity, reduced selection bias, and precise representation of family planning preferences. The study's external validity can be generalized to the entire population using family planning services in Koinadugu District. Furthermore, the census approach minimizes selection bias, ensuring that the dataset represents the full spectrum of demographic and geographical characteristics within the district. By including every relevant case, this study provides a comprehensive examination of the factors that influence contraceptive choices. Data collection procedure: The data extraction process from the District Health Information System 2 (DHIS2) was systematic to retrieve accurate family planning data. The process begins with accessing DHIS2. The DHIS2 is a national health information platform used in Sierra Leone to collect and report routine health service data, including information on family planning services. A query was formulated to retrieve specific family planning indicators, considering contraceptive types, demographic details, and the temporal aspects of service utilization. DHIS2 served as the primary source of family planning data within the Koinadugu district, providing a repository of information on various health indicators. Measures to ensure accuracy and completeness included data validation, removal of duplicate entries, cross-referencing with supplementary sources, reviewing data entry protocols, and communication with the Koinadugu District Health Management Team. This collaborative approach contributed to the reliability of the family planning data obtained from the district-level health-information system. Data processing and analysis techniques: The data from DHIS2 were systematically organized and cleaned to ensure reliable analyses. This involved sorting and structuring information; identifying inconsistencies, missing values, or outliers; and creating a clean dataset for robust analyses of family planning trends in the Koinadugu District. Microsoft Excel 2010 was chosen for its versatility, accessibility, and widespread use in health research. Excel's capabilities in statistical calculations, visualizations, and data exploration were aligned with the study's requirements. To determine family planning usage percentages, we extracted information on birth control types and distributions among the demographic groups. The formula for calculating proportions divides the number of individuals via a particular method by the total number of individuals in the dataset. The results are presented in tables and charts. The tables provide a detailed breakdown of family planning uptake proportions, whereas the charts visually represent key trends, offering an intuitive understanding of the distribution and uptake of family planning methods. This approach aimed to cater to different data interpretation preferences and to ensure detailed and visually compelling results. Ethical approval: This study involved the analysis of secondary data obtained from the 2020 Sierra Leone District Health Information System 2 (DHIS2) database, which is freely available to the public on their website (https://sl.dhis2.org/). The dataset used is fully anonymized and contains no identifiable information on individual participants. The study did not require ethics approval. However, DHIS2 follows a strict ethical protocol from the respective ethics committee in Sierra Leone to ensure the protection of the privacy of research participants. Consent to Participate Informed consent was not required for this study, as the data were already collected for routine health monitoring purposes and provided in an anonymized format. No direct contact with human participants occurred, and no minors were interviewed or involved directly in the research process. Personal identifiers were removed during data extraction, and the research team was committed to handling and storing information securely. This approach ensured privacy and prevented tracing of the results to specific individuals. Results This study investigates the adoption of family planning methods in Koinadugu District, Sierra Leone, from January to December 2020. The data were processed and analyzed via Excel. This study explored factors influencing women's choices regarding family planning methods, including demographic data, awareness of contraceptive options, and motivations for selecting or rejecting specific methods. The results provide insights into the current family planning landscape and help identify areas for improving access to contraceptive services. The family planning usage dataset comprises 10,795 records. Approximately 6% of the users were aged 10--14 years, while those aged 15--19 years accounted for nearly 21%. Middle-aged women showed greater utilization, with women aged 20--24 representing approximately 31% of users and those aged 25 and above constituting approximately 42%. Figure 2 presents the family planning distribution for each month of 2020. The district's family planning uptake was initiated at N = 998 in January and decreased to N = 564 in February. A substantial increase was observed from March (N = 864) to April (N = 1987). However, the numbers declined from May to July, reaching 678. August experienced a slight decrease, but uptake patterns began to increase again in September (N = 378). The final quarter exhibited a notable upward trend, with October at N = 678, November at N = 1025, and December peaking at N = 2345. Figure 3 illustrates the family planning methods utilized in the Koinadugu District. Male condoms were the predominant method used (62%), followed by combined oral contraceptives (16%). Injectable DEPO accounts for 10% of the usage, whereas implants represent 7%. Progestin-only oral contraceptives constituted 3% of the methods used. Female condoms and emergency pills each comprised 1% of the total, with other methods accounting for the remainder. Table 1: Family planning uptake by chiefdom, Koinadugu District, 2020 (N= 10,795) Chiefdom Frequency Percentage Diang 3,670 34.0% Wara Wara Yagla 1,695 15.7% Sengbeh 1,187 11.0% Nieni 1,101 10.2% Wara-Wara Bafodia 1,069 9.9% Kasunko Kakellay 615 5.7% Kamukeh 507 4.7% Kallian 399 3.7% Gbonkorbor Kayaka 367 3.4% Thamiso 184 1.7% Total 1079.4 100.0% Table 1 illustrates family planning adoption across the Koinadugu district chiefdoms. The highest usage rates were observed for Diang (34%), Wara-Wara Yagala (15.7%), Sengbeh (11%), Nieni (10.2%), and Wara Bafodia (9.9%). Lower rates were reported for Thamiso (1.7%), Gbonkorbor Kayaka (3.4%), Kallian (3.7%), Kamukeh (4.7%), and Kasunko Kakellay (5.7%). Discussion This study provides crucial insights into family planning adoption in Koinadugu District, Sierra Leone, in 2020. These findings enhance our understanding of contraceptive use in resource-limited settings. Women in the prime reproductive years (20–24 and 25+ years) comprised the majority of users, accounting for 31% and 42%, respectively. This aligns with other studies in sub-Saharan Africa, which reported greater contraceptive use among women during peak reproductive years. A study revealed that women aged 20–34 years were most likely to use family planning because of their increased fertility awareness and desire for birth spacing, with lower uptake among adolescents (6% for those aged 10–14 years and 21% for those aged 15–19 years) [11]. These findings are similar to those of another study conducted in Nigeria [12], which identified barriers to family planning, such as limited access to youth-friendly services, social stigma, and inadequate sex education. According to the health belief model (HBM), younger women may perceive lower susceptibility to unintended pregnancy or greater barriers (e.g., stigma, side‐effect fears) and therefore delay adoption [13]. This highlights the need for targeted efforts to improve contraceptive access in younger groups. Geographic variations in family planning adoption across chiefdoms have revealed significant disparities in service availability and utilization. Diang (34%) had the highest uptake, whereas Thamiso (1.7%) and Gbonkorbor Kayaka (3.4%) had the lowest. An earlier study noted similar regional differences in Kenya, often owing to variations in healthcare infrastructure, provider accessibility, and cultural acceptance [14]. This indicates the need for tailored approaches to address specific obstacles in low-performance areas. These disparities likely reflect differential access to services. Some chiefdoms may host districts or mission clinics, community health worker programs or outreach visits, whereas others are mountainous or sparsely populated. In the socioecological framework, such environmental factors (health system distribution, transportation) interact with community factors such as literacy and norms. The markedly uneven uptake suggests that women in underserved areas face both structural and informational obstacles. National reports emphasize community health workers’ role in expanding family planning access. In line with that policy, Koinadugu’s low-uptake areas would benefit from intensified outreach: mobile clinics, community health worker (CHW) distributions of condoms and pills, and youth-focused campaigns. Tailoring interventions to the local context (e.g., engaging local leaders and men in low-access areas) can address interpersonal and community levels of influence [15]. The adoption of family planning over time showed notable fluctuations, with increases in April and December. These patterns may be due to specific initiatives or interventions, similar to those in Ghana and Tanzania, where use increased after intensive outreach [16]. The decreases in February and mid-year could be due to logistical challenges, supply shortages, or competing health priorities. These observations highlight the need for ongoing efforts and consistent family planning and supply availability throughout the year [17]. Contraceptive preferences were strongly inclined toward male condoms (62%), combined oral contraceptives (16%), and injectable DEPOs (10%). This preference for short-acting and barrier methods aligns with Sierra Leone's Demographic and Health Survey (DHS, 2019) and other low-income nations, where ease of use and cost-effectiveness drive choices. The minimal adoption of long-acting reversible contraceptives (LARCs), such as implants (7%), reflects broader regional trends, as noted by a previous study [18], which emphasized that limited awareness, misconceptions about side effects, and insufficient provider training hinder LARC adoption. Addressing these barriers through community education and enhancing provider skills can increase LARC uptake. These findings carry important program implications. At the individual level (HBM), efforts should target perceived barriers and benefits. Demand generation campaigns can emphasize the health and social benefits of birth spacing (leveraging religious leaders’ supportive messages) and counteract myths about side effects. Messaging should be age-tailored: for adolescents, avoid school drop-out; for older women, emphasize child health and economic stability, aligning with leaders’ testimonies. At the interpersonal/community level (social-ecological), engaging with partners and families is crucial. Programs might involve men’s groups or faith-based organizations to reinforce positive norms. The Sierra Leone Family Planning Costed Implementation Plan already authorizes community health workers to distribute condoms and pills and provide counseling; expanding CHW training and supervision would extend outreach into low-uptake areas. Coordinating CHWs with existing maternal/child health posts can integrate FP into ANC and immunization visits, making services more convenient. Limitations This study provides valuable insights into family planning dynamics in Koinadugu District, Sierra Leone, by analyzing data from the District Health Information System 2 (DHIS2) for 2020. However, several limitations must be acknowledged. The temporal scope, which focuses on 2020, offers only a snapshot without capturing longitudinal trends or accounting for events, such as the COVID-19 pandemic. Incorporating multiyear data in future research would help identify broader trends and long-term impacts on contraceptive use. The methodological approach relied on Microsoft Excel, which limited the depth of analysis. Employing more robust statistical tools can enhance analytical rigor and provide deeper insights. The secondary data from DHIS2 may be subject to biases and inaccuracies inherent in the original data collection process. Addressing these data quality concerns in future studies will require strategies to validate the secondary data against primary sources. However, the quantitative approach does not fully capture the nuanced cultural and contextual factors that influence family planning preferences and barriers. Future research should adopt a mixed-method approach for a more comprehensive understanding. The reliance on DHIS2 service utilization data limits the ability of the study to represent the views of individuals who do not seek family planning services. Including primary data collection methods would enable researchers to capture the perspectives of nonusers and underserved populations, thus providing a more balanced view of family planning dynamics. Conclusion Family planning usage in Koinadugu District reached 10,795 users in 2020, with women aged 25 and above accounting for 42% of users, followed by those aged 20--24 at 31%, while adolescents (10--19) made up only 27%. Significant regional differences were observed, as Diang led in adoption rates at 34%, contrasting sharply with Thamiso and Gbonkorbor Kayaka at 1.7% and 3.4%, respectively. Male condoms emerged as the preferred contraceptive method, chosen by 62% of the users, whereas long-acting options such as implants were underutilized at 7%. User numbers fluctuated throughout the year, peaking in December with 2,345 users. To achieve more equitable reproductive health outcomes, overcoming obstacles such as limited adolescent access, service deficiencies in underperforming regions, and insufficient awareness of long-acting contraceptive methods is essential. Recommendations Improving family planning uptake in Koinadugu District requires targeted interventions. First, adolescent-focused initiatives, including comprehensive sexuality education and youth-friendly services, should be prioritized to address low contraceptive use among young people. Geographic disparities must be approached by strengthening the healthcare infrastructure in underperforming chiefdoms, deploying mobile clinics, and collaborating with local leaders to address cultural barriers. To ensure consistent access, supply chain systems should be strengthened to prevent stockouts, and community-based distribution networks should be expanded for last-mile deliveries. Efforts to promote long-acting reversible contraceptives (LARCs) should include awareness campaigns, cost subsidies, and provider training to increase accessibility and affordability. Engaging men in family planning through targeted awareness programs can foster shared responsibility and promote male-friendliness. Additionally, the use of demographic and geographic data to design localized strategies will enhance the effectiveness of the program. Robust monitoring and evaluation systems should be established to track progress and adapt to the initiatives. Finally, increased government investment and supportive policies are essential to sustain progress. These efforts will ensure equitable access to family planning services, reduce disparities, and improve reproductive health outcomes in the district. Declarations Author Contributions LKK: Formal analysis, drafted the original manuscript, and contributed substantially to the interpretation of the results. PP: Conceived and designed the study, coordinated the research activities, and oversaw the overall project execution. ASJ: Discussion and conclusion; and managed the revisions on the basis of peer feedback. FYM, SSF, SMKL, DL & DAKT assisted with the literature review, provided critical input on methodology, and contributed to the final manuscript editing. EKFM, MMA, & FS: Writing-- reviewing and editing Funding This research did not receive any external funding. Competing Interests The authors declare that they have no competing interests. Data availability The data used for the study are available with the corresponding author and will be provided upon request. Code availability Not applicable Consent to participate Not applicable References Lusianawati EF: Family Planning Knowledge and Attitudes of Childbearing Couples Regarding Reproductive Health with Husband's Participation. Arkus 2023. 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International Journal for Equity in Health 2022, 21(1):142. Schröder M, Storch DM, Marszal P, Timme M: Anomalous supply shortages from dynamic pricing in on-demand mobility. Nat Commun 2020, 11(1):4831. Fassa A, Ruivo ACO, Wachs L, Tomasi E, Facchini LA: Availability of family planning supplies in the Brazilian Primary Health Care Units. European Journal of Public Health 2020, 30(Supplement_5). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 15 Jan, 2026 Editor assigned by journal 30 Sep, 2025 Submission checks completed at journal 30 Sep, 2025 First submitted to journal 29 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7744168","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":576022103,"identity":"c87161c6-199f-48a7-8712-80b058cea950","order_by":0,"name":"Lucas K. 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1","display":"","copyAsset":false,"role":"figure","size":20431,"visible":true,"origin":"","legend":"\u003cp\u003eFamily planning uptake by age group, Koinadugu District, 2020 (N= 10,795\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7744168/v1/7f41b2017e31494527cfe0cb.png"},{"id":100678758,"identity":"6c2670c9-d080-4ad0-bb07-4c5626be5d5d","added_by":"auto","created_at":"2026-01-20 11:41:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":105377,"visible":true,"origin":"","legend":"\u003cp\u003eFamily planning uptake by month, Koinadugu District, 2020\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7744168/v1/aabd5313d77c1cd6298ac42b.png"},{"id":100678545,"identity":"04dd39e0-b472-4e56-8bc6-abaa2f9b6838","added_by":"auto","created_at":"2026-01-20 11:37:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":119408,"visible":true,"origin":"","legend":"\u003cp\u003eFamily planning uptake by method, Koinadugu District, 2020\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7744168/v1/9e8226aa487e3970d5a4ef19.png"},{"id":100684686,"identity":"e0879ff7-79bf-4cbb-9bfc-17d5efc5f4d0","added_by":"auto","created_at":"2026-01-20 12:45:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":767637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7744168/v1/faed4621-9e1f-43ba-864d-0e02bb04bc9b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating contraceptive preferences and barriers in Sierra Leone: Analysis of 2020 Sierra Leone District Health Information System 2 (DHIS2) data","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFamily planning constitutes a critical component of public health, enabling individuals and couples to make informed decisions regarding their reproductive health and family size [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This practice plays a significant role in reducing maternal and infant mortality, decreasing unintended pregnancies, and enhancing the overall quality of life of families and communities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Globally, effective family planning initiatives have been associated with promoting gender equality, alleviating poverty, and contributing to the achievement of Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and 5 (Gender Equality) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, substantial challenges persist in regions characterized by high fertility rates and limited healthcare access, such as sub-Saharan Africa, including Sierra Leone [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Sierra Leone, access to family planning services remains limited, with only 22.3% of the population utilizing modern contraceptive methods [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The country encounters numerous challenges in expanding contraceptive use, including cultural and religious factors, low male participation in reproductive health decisions, and difficulties in providing services to remote rural communities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Research has demonstrated that educational attainment, marital status, and distance from healthcare facilities significantly influence contraceptive adoption [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, existing studies have focused predominantly on urban populations or provided broad national perspectives, resulting in a lack of representation of rural and underserved regions in the current literature [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Koinadugu district, Sierra Leone's largest and one of its least developed regions, presents a unique environment for examining family planning trends. The rural nature and heterogeneous cultural and religious composition of the district create specific challenges and opportunities for contraceptive adoption [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This research deficit hinders the development of tailored programs that address the district's specific sociocultural and infrastructural conditions.\u003c/p\u003e \u003cp\u003eThis investigation aims to address these knowledge gaps by examining the distribution of family planning services, temporal patterns of contraceptive usage, and preferences for various birth control methods in the Koinadugu District in 2020. By utilizing data from the District Health Information System 2 (DHIS2), this study seeks to provide actionable insights for policymakers and healthcare professionals to improve reproductive health outcomes in the district. This research specifically investigates how cultural and religious practices, healthcare facility accessibility, and contraceptive awareness influence family planning adoption, addressing the urgent need for data-driven strategies in this distinct context.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Design and Type:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a retrospective descriptive cross-sectional methodology, analyzing records from January to December 2020. It explores family planning trends in Koinadugu District, focusing on demographic, geographical, and temporal dimensions. As an observational study, it examines existing phenomena without intervention to identify patterns and draw conclusions, thus enhancing the understanding of the factors influencing family planning decisions. The research design aligned with the study\u0026apos;s questions and objectives. The retrospective approach examines past data, uncovers patterns in family planning usage, and identifies factors affecting contraceptive choices. The cross-sectional component enabled simultaneous data analysis across various demographic groups and geographic areas within the district. This method aligns with the goal of gaining insights into family planning dynamics without external interference, offering vital information for decision-making and future reproductive health planning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Setting:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKoinadugu District, the largest in Sierra Leone, with an area of 12,121 km\u003csup\u003e2\u003c/sup\u003e (4,680 sq. mi), shares borders with Bombali, Tonkolili, Kono, Falaba, and the Republic of Guinea. According to the 2015 national census, the district\u0026apos;s population stands at 404,097, comprising several ethnic groups, such as Kuranko, Mandingo, Fula, Limba, and Yalunka. Islam is the predominant religion, influencing more than 90% of the population\u0026apos;s religious and cultural practices. A small Christian minority exists, mainly among the Limba. The district\u0026apos;s economic activities center on diamond extraction and agricultural production, with key crops including rice, mango, cacao, and coconut. Koinadugu\u0026apos;s demographic makeup and strong Islamic presence significantly shape its cultural landscape.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy participants:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research examines the utilization of family planning services in Koinadugu District in 2020, encompassing individuals with various demographic characteristics, including age, gender, and socioeconomic background. The collected data included information on the contraceptive methods employed, offering insights into the population\u0026apos;s preferences for family planning. The study\u0026apos;s data collection criteria encompassed all individuals who sought family planning services within a specified timeframe without exclusion. This approach was designed to capture a complete picture of family planning adoption and to acknowledge the district\u0026apos;s diverse population. This research employed a census methodology for data gathering and examined every applicable case within the population. This strategy ensured a comprehensive representation of family planning practices across demographic groups and geographical areas, thus enhancing the validity and reliability of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSampling Procedure:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used a comprehensive approach to examine family planning patterns in Koinadugu District, aiming to understand contraceptive adoption across various demographic and geographic factors. The investigation incorporated all available information from January to December 2020, ensuring that no subgroups were excluded and enabling a detailed analysis of family planning trends. The benefits of a census method include improved external validity, reduced selection bias, and precise representation of family planning preferences. The study\u0026apos;s external validity can be generalized to the entire population using family planning services in Koinadugu District. Furthermore, the census approach minimizes selection bias, ensuring that the dataset represents the full spectrum of demographic and geographical characteristics within the district. By including every relevant case, this study provides a comprehensive examination of the factors that influence contraceptive choices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData collection procedure:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data extraction process from the District Health Information System 2 (DHIS2) was systematic to retrieve accurate family planning data. The process begins with accessing DHIS2. The DHIS2 is a national health information platform used in Sierra Leone to collect and report routine health service data, including information on family planning services. A query was formulated to retrieve specific family planning indicators, considering contraceptive types, demographic details, and the temporal aspects of service utilization. DHIS2 served as the primary source of family planning data within the Koinadugu district, providing a repository of information on various health indicators. Measures to ensure accuracy and completeness included data validation, removal of duplicate entries, cross-referencing with supplementary sources, reviewing data entry protocols, and communication with the Koinadugu District Health Management Team. This collaborative approach contributed to the reliability of the family planning data obtained from the district-level health-information system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData processing and analysis techniques:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data from DHIS2 were systematically organized and cleaned to ensure reliable analyses. This involved sorting and structuring information; identifying inconsistencies, missing values, or outliers; and creating a clean dataset for robust analyses of family planning trends in the Koinadugu District. Microsoft Excel 2010 was chosen for its versatility, accessibility, and widespread use in health research. Excel\u0026apos;s capabilities in statistical calculations, visualizations, and data exploration were aligned with the study\u0026apos;s requirements. To determine family planning usage percentages, we extracted information on birth control types and distributions among the demographic groups. The formula for calculating proportions divides the number of individuals via a particular method by the total number of individuals in the dataset. The results are presented in tables and charts. The tables provide a detailed breakdown of family planning uptake proportions, whereas the charts visually represent key trends, offering an intuitive understanding of the distribution and uptake of family planning methods. This approach aimed to cater to different data interpretation preferences and to ensure detailed and visually compelling results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved the analysis of secondary data obtained from the 2020 Sierra Leone District Health Information System 2 (DHIS2) database, which is freely available to the public on their website (https://sl.dhis2.org/). The dataset used is fully anonymized and contains no identifiable information on individual participants. The study did not require ethics approval. However, DHIS2 follows a strict ethical protocol from the respective ethics committee in Sierra Leone to ensure the protection of the privacy of research participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was not required for this study, as the data were already collected for routine health monitoring purposes and provided in an anonymized format. No direct contact with human participants occurred, and no minors were interviewed or involved directly in the research process. Personal identifiers were removed during data extraction, and the research team was committed to handling and storing information securely. This approach ensured privacy and prevented tracing of the results to specific individuals.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study investigates the adoption of family planning methods in Koinadugu District, Sierra Leone, from January to December 2020. The data were processed and analyzed via Excel. This study explored factors influencing women\u0026apos;s choices regarding family planning methods, including demographic data, awareness of contraceptive options, and motivations for selecting or rejecting specific methods. The results provide insights into the current family planning landscape and help identify areas for improving access to contraceptive services.\u003c/p\u003e\n\u003cp\u003eThe family planning usage dataset comprises 10,795 records. Approximately 6% of the users were aged 10--14 years, while those aged 15--19 years accounted for nearly 21%. Middle-aged women showed greater utilization, with women aged 20--24 representing approximately 31% of users and those aged 25 and above constituting approximately 42%.\u003c/p\u003e\n\u003cp\u003eFigure 2 presents the family planning distribution for each month of 2020. The district\u0026apos;s family planning uptake was initiated at N = 998 in January and decreased to N = 564 in February. A substantial increase was observed from March (N = 864) to April (N = 1987). However, the numbers declined from May to July, reaching 678. August experienced a slight decrease, but uptake patterns began to increase again in September (N = 378). The final quarter exhibited a notable upward trend, with October at N = 678, November at N = 1025, and December peaking at N = 2345.\u003c/p\u003e\n\u003cp\u003eFigure 3 illustrates the family planning methods utilized in the Koinadugu District. Male condoms were the predominant method used (62%), followed by combined oral contraceptives (16%). Injectable DEPO accounts for 10% of the usage, whereas implants represent 7%. Progestin-only oral contraceptives constituted 3% of the methods used. Female condoms and emergency pills each comprised 1% of the total, with other methods accounting for the remainder.\u003c/p\u003e\n\u003cp\u003eTable 1: Family planning uptake by chiefdom, Koinadugu District, 2020 (N= 10,795)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChiefdom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eDiang\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e3,670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e34.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eWara Wara Yagla\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1,695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e15.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eSengbeh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1,187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e11.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eNieni\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1,101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eWara-Wara Bafodia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1,069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eKasunko Kakellay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e5.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eKamukeh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e4.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eKallian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eGbonkorbor Kayaka\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eThamiso\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1079.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Table 1 illustrates family planning adoption across the Koinadugu district chiefdoms. The highest usage rates were observed for Diang (34%), Wara-Wara Yagala (15.7%), Sengbeh (11%), Nieni (10.2%), and Wara Bafodia (9.9%). Lower rates were reported for Thamiso (1.7%), Gbonkorbor Kayaka (3.4%), Kallian (3.7%), Kamukeh (4.7%), and Kasunko Kakellay (5.7%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides crucial insights into family planning adoption in Koinadugu District, Sierra Leone, in 2020. These findings enhance our understanding of contraceptive use in resource-limited settings. Women in the prime reproductive years (20\u0026ndash;24 and 25+ years) comprised the majority of users, accounting for 31% and 42%, respectively. This aligns with other studies in sub-Saharan Africa, which reported greater contraceptive use among women during peak reproductive years. A study revealed that women aged 20\u0026ndash;34 years were most likely to use family planning because of their increased fertility awareness and desire for birth spacing, with lower uptake among adolescents (6% for those aged 10\u0026ndash;14 years and 21% for those aged 15\u0026ndash;19 years) [11]. These findings are similar to those of another study conducted in Nigeria [12], which identified barriers to family planning, such as limited access to youth-friendly services, social stigma, and inadequate sex education. According to the health belief model (HBM), younger women may perceive lower susceptibility to unintended pregnancy or greater barriers (e.g., stigma, side‐effect fears) and therefore delay adoption [13].\u0026nbsp;This highlights the need for targeted efforts to improve contraceptive access in younger groups.\u003c/p\u003e\n\u003cp\u003eGeographic variations in family planning adoption across chiefdoms have revealed significant disparities in service availability and utilization. Diang (34%) had the highest uptake, whereas Thamiso (1.7%) and Gbonkorbor Kayaka (3.4%) had the lowest. An earlier study noted similar regional differences in Kenya, often owing to variations in healthcare infrastructure, provider accessibility, and cultural acceptance [14]. This indicates the need for tailored approaches to address specific obstacles in low-performance areas. These disparities likely reflect differential access to services. Some chiefdoms may host districts or mission clinics, community health worker programs or outreach visits, whereas others are mountainous or sparsely populated. In the socioecological framework, such environmental factors (health system distribution, transportation) interact with community factors such as literacy and norms. The markedly uneven uptake suggests that women in underserved areas face both structural and informational obstacles. National reports emphasize community health workers\u0026rsquo; role in expanding family planning access. In line with that policy, Koinadugu\u0026rsquo;s low-uptake areas would benefit from intensified outreach: mobile clinics, community health worker (CHW) distributions of condoms and pills, and youth-focused campaigns. Tailoring interventions to the local context (e.g., engaging local leaders and men in low-access areas) can address interpersonal and community levels of influence [15].\u003c/p\u003e\n\u003cp\u003eThe adoption of family planning over time showed notable fluctuations, with increases in April and December. These patterns may be due to specific initiatives or interventions, similar to those in Ghana and Tanzania, where use increased after intensive outreach [16]. The decreases in February and mid-year could be due to logistical challenges, supply shortages, or competing health priorities. These observations highlight the need for ongoing efforts and consistent family planning and supply availability throughout the year [17].\u003c/p\u003e\n\u003cp\u003eContraceptive preferences were strongly inclined toward male condoms (62%), combined oral contraceptives (16%), and injectable DEPOs (10%). This preference for short-acting and barrier methods aligns with Sierra Leone\u0026apos;s Demographic and Health Survey (DHS, 2019) and other low-income nations, where ease of use and cost-effectiveness drive choices. The minimal adoption of long-acting reversible contraceptives (LARCs), such as implants (7%), reflects broader regional trends, as noted by a previous study [18], which emphasized that limited awareness, misconceptions about side effects, and insufficient provider training hinder LARC adoption. Addressing these barriers through community education and enhancing provider skills can increase LARC uptake.\u003c/p\u003e\n\u003cp\u003eThese findings carry important program implications. At the individual level (HBM), efforts should target perceived barriers and benefits. Demand generation campaigns can emphasize the health and social benefits of birth spacing (leveraging religious leaders\u0026rsquo; supportive messages) and counteract myths about side effects. Messaging should be age-tailored: for adolescents, avoid school drop-out; for older women, emphasize child health and economic stability, aligning with leaders\u0026rsquo; testimonies. At the interpersonal/community level (social-ecological), engaging with partners and families is crucial. Programs might involve men\u0026rsquo;s groups or faith-based organizations to reinforce positive norms. The Sierra Leone Family Planning Costed Implementation Plan already authorizes community health workers to distribute condoms and pills and provide counseling; expanding CHW training and supervision would extend outreach into low-uptake areas. Coordinating CHWs with existing maternal/child health posts can integrate FP into ANC and immunization visits, making services more convenient.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study provides valuable insights into family planning dynamics in Koinadugu District, Sierra Leone, by analyzing data from the District Health Information System 2 (DHIS2) for 2020. However, several limitations must be acknowledged. The temporal scope, which focuses on 2020, offers only a snapshot without capturing longitudinal trends or accounting for events, such as the COVID-19 pandemic. Incorporating multiyear data in future research would help identify broader trends and long-term impacts on contraceptive use. The methodological approach relied on Microsoft Excel, which limited the depth of analysis. Employing more robust statistical tools can enhance analytical rigor and provide deeper insights.\u003c/p\u003e\n\u003cp\u003eThe secondary data from DHIS2 may be subject to biases and inaccuracies inherent in the original data collection process. Addressing these data quality concerns in future studies will require strategies to validate the secondary data against primary sources. However, the quantitative approach does not fully capture the nuanced cultural and contextual factors that influence family planning preferences and barriers. Future research should adopt a mixed-method approach for a more comprehensive understanding. The reliance on DHIS2 service utilization data limits the ability of the study to represent the views of individuals who do not seek family planning services. Including primary data collection methods would enable researchers to capture the perspectives of nonusers and underserved populations, thus providing a more balanced view of family planning dynamics.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFamily planning usage in Koinadugu District reached 10,795 users in 2020, with women aged 25 and above accounting for 42% of users, followed by those aged 20--24 at 31%, while adolescents (10--19) made up only 27%. Significant regional differences were observed, as Diang led in adoption rates at 34%, contrasting sharply with Thamiso and Gbonkorbor Kayaka at 1.7% and 3.4%, respectively. Male condoms emerged as the preferred contraceptive method, chosen by 62% of the users, whereas long-acting options such as implants were underutilized at 7%. User numbers fluctuated throughout the year, peaking in December with 2,345 users. To achieve more equitable reproductive health outcomes, overcoming obstacles such as limited adolescent access, service deficiencies in underperforming regions, and insufficient awareness of long-acting contraceptive methods is essential.\u003c/p\u003e\u003ch2\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eImproving family planning uptake in Koinadugu District requires targeted interventions. First, adolescent-focused initiatives, including comprehensive sexuality education and youth-friendly services, should be prioritized to address low contraceptive use among young people. Geographic disparities must be approached by strengthening the healthcare infrastructure in underperforming chiefdoms, deploying mobile clinics, and collaborating with local leaders to address cultural barriers.\u003c/p\u003e\n\u003cp\u003eTo ensure consistent access, supply chain systems should be strengthened to prevent stockouts, and community-based distribution networks should be expanded for last-mile deliveries. Efforts to promote long-acting reversible contraceptives (LARCs) should include awareness campaigns, cost subsidies, and provider training to increase accessibility and affordability.\u003c/p\u003e\n\u003cp\u003eEngaging men in family planning through targeted awareness programs can foster shared responsibility and promote male-friendliness. Additionally, the use of demographic and geographic data to design localized strategies will enhance the effectiveness of the program. Robust monitoring and evaluation systems should be established to track progress and adapt to the initiatives.\u003c/p\u003e\n\u003cp\u003eFinally, increased government investment and supportive policies are essential to sustain progress. These efforts will ensure equitable access to family planning services, reduce disparities, and improve reproductive health outcomes in the district.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eAuthor Contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLKK:\u003c/strong\u003e Formal analysis, drafted the original manuscript, and contributed substantially to the interpretation of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePP:\u003c/strong\u003e Conceived and designed the study, coordinated the research activities, and oversaw the overall project execution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eASJ:\u003c/strong\u003e Discussion and conclusion; and managed the revisions on the basis of peer feedback.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFYM, SSF, SMKL, DL \u0026amp; DAKT\u003c/strong\u003e assisted with the literature review, provided critical input on methodology, and contributed to the final manuscript editing.\u003c/p\u003e\n\u003cp\u003eEKFM, MMA, \u0026amp; FS: Writing-- reviewing and editing\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any external funding.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data used for the study are available with the corresponding author and will be provided upon request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCode availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLusianawati EF: Family Planning Knowledge and Attitudes of Childbearing Couples Regarding Reproductive Health with Husband\u0026apos;s Participation. \u003cem\u003eArkus \u003c/em\u003e2023.\u003c/li\u003e\n\u003cli\u003eArias Mlf Fau - Champion JD, Champion Jd Fau - Soto NES, Soto Nes Fau - Tovar M, Tovar M Fau - D\u0026aacute;vila SPE, D\u0026aacute;vila SPE: Barriers to Use of Family Planning Methods Among Heterosexual Mexican Couples. (1541-6577 (Print)).\u003c/li\u003e\n\u003cli\u003eSingh S, Darroch JE, Ashford LS, Vlassoff M: Adding It Up: The costs and Benefits of Investing in family Planning and maternal and new born health. In\u003cem\u003e.\u003c/em\u003e: Guttmacher Institute; 2009.\u003c/li\u003e\n\u003cli\u003eAli S, Hassan S, El- Nemer A: Assessment of family planning knowledge and practice among married couples. \u003cem\u003eMansoura Nursing Journal \u003c/em\u003e2020, 7(2):214-226.\u003c/li\u003e\n\u003cli\u003eHe Q, Meng Q, Flatley W, He Y: Examining the Effects of Agricultural Aid on Forests in Sub-Saharan Africa: A Causal Analysis Based on Remotely Sensed Data of Sierra Leone. In: \u003cem\u003eLand.\u003c/em\u003e vol. 11; 2022.\u003c/li\u003e\n\u003cli\u003eJames P, Yendewa G, Bah AJ, Osborne A, Kpagoi S, Margao E, Kangbai J, Wardle J: Women\u0026apos;s Empowerment and Homebirth in Sierra Leone. A Secondary Analysis of the 2019 Sierra Leone Demographic Health Survey; 2022.\u003c/li\u003e\n\u003cli\u003eJames PB, Yendewa GA, Bah AJ, Osborne A, Kpagoi SS, Margao EK, Kangbai J, Wardle J: Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey. \u003cem\u003eBMC Pregnancy and Childbirth \u003c/em\u003e2023, 23(1):810.\u003c/li\u003e\n\u003cli\u003eSserwanja Q, Nuwabaine L, Kamara K, Musaba MW: Determinants of quality contraceptive counseling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey. \u003cem\u003eBMC Women\u0026apos;s Health \u003c/em\u003e2023, 23(1):266.\u003c/li\u003e\n\u003cli\u003eSserwanja Q, Mufumba I, Kamara K, Musaba MW: Rural\u0026ndash;urban correlates of skilled birth attendance utilization in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey. \u003cem\u003eBMJ Open \u003c/em\u003e2022, 12.\u003c/li\u003e\n\u003cli\u003eAbdul Rahman S: Gender relations in the livestock production in Koinadugu district, Sierra Leone. \u003cem\u003eJournal of Applied and Advanced Research \u003c/em\u003e2023.\u003c/li\u003e\n\u003cli\u003eAlenezi GG, Haridi HK: Awareness and use of family planning methods among women in Northern Saudi Arabia. \u003cem\u003eMiddle East Fertility Society Journal \u003c/em\u003e2021, 26(1):8.\u003c/li\u003e\n\u003cli\u003eOyefara J: Women Age at First Birth and Knowledge of Family Planning Methods in Yoruba Society, Nigeria. \u003cem\u003eJournal of Sociological Research \u003c/em\u003e2012, 3.\u003c/li\u003e\n\u003cli\u003eHall KS: The Health Belief Model can guide modern contraceptive behavior research and practice. \u003cem\u003eJ Midwifery Womens Health \u003c/em\u003e2012, 57(1):74-81.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;alıkoğlu EO, Bilge Yerli E, Kavuncuoğlu D, Yılmaz S, Koşan Z, Aras A: Use of Family Planning Methods and Influencing Factors Among Women in Erzurum. \u003cem\u003eMed Sci Monit \u003c/em\u003e2018, 24:5027-5034.\u003c/li\u003e\n\u003cli\u003eYillah RM, Bull F, Sawaneh A, Reindorf B, Turay H, Wurie HR, Hodges MH, Osborne A: Religious leaders\u0026apos; nuanced views on birth spacing and contraceptives in Sierra Leone - qualitative insights. \u003cem\u003eContracept Reprod Med \u003c/em\u003e2024, 9(1):40.\u003c/li\u003e\n\u003cli\u003eSteyn PS, Cordero JP, Nai D, Shamba D, Fuseini K, Mrema S, Habib N, Nguyen MH, Kiarie J: Impact of community and provider-driven social accountability interventions on contraceptive uptake in Ghana and Tanzania. \u003cem\u003eInternational Journal for Equity in Health \u003c/em\u003e2022, 21(1):142.\u003c/li\u003e\n\u003cli\u003eSchr\u0026ouml;der M, Storch DM, Marszal P, Timme M: Anomalous supply shortages from dynamic pricing in on-demand mobility. \u003cem\u003eNat Commun \u003c/em\u003e2020, 11(1):4831.\u003c/li\u003e\n\u003cli\u003eFassa A, Ruivo ACO, Wachs L, Tomasi E, Facchini LA: Availability of family planning supplies in the Brazilian Primary Health Care Units. \u003cem\u003eEuropean Journal of Public Health \u003c/em\u003e2020, 30(Supplement_5).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Contraceptive preferences, Koinadugu District, Family planning, DHIS2 (District Health Information System 2), Temporal patterns","lastPublishedDoi":"10.21203/rs.3.rs-7744168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7744168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAccess to and use of modern contraceptive methods are essential components of reproductive health and are critical for reducing maternal mortality, preventing unintended pregnancies, and promoting gender equality. This study aimed to evaluate contraceptive preferences, patterns, and barriers to family planning in Koinadugu District, Sierra Leone, in 2020.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study utilized a retrospective, descriptive cross-sectional approach and extracted data from the District Health Information System 2 (DHIS2). The data collection process involved extracting variables related to contraceptive type, demographic information, and temporal patterns of service use. To ensure data accuracy, the research team worked in conjunction with the Koinadugu District Health Management Team, implementing validation procedures, such as eliminating duplicates, cross-checking information, and following standardized protocols. After the dataset was cleaned, the researchers conducted descriptive and temporal trend analyses via Microsoft Excel.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study identified 10,795 family planning users in 2020, 42% of whom were aged 25 and above, 31% of whom were between 20 and 24 years, and 27% of whom were in the 10\u0026ndash;19 age group. The contraceptive methods showed a preference for male condoms (62%), with oral contraceptives (16%), injectables (10%), and implants (7%). Regional disparities were notable, as Diang chiefdom reported the highest uptake at 34%, in contrast to Thamiso (1.7%). Usage peaks in December, potentially owing to seasonal or cultural factors. Societal disapproval and stereotypes have emerged as significant barriers, particularly affecting women's access to family planning services.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAn analysis of family planning services in Koinadugu District revealed disparities based on age and location, with male condoms as the primary contraceptive method. Although utilization experiences seasonal fluctuations, societal stigma and misconceptions pose substantial obstacles, particularly for females. Addressing these challenges could enhance equitable long-term contraceptive adoption across districts.\u003c/p\u003e","manuscriptTitle":"Evaluating contraceptive preferences and barriers in Sierra Leone: Analysis of 2020 Sierra Leone District Health Information System 2 (DHIS2) data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 10:02:25","doi":"10.21203/rs.3.rs-7744168/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-01-15T09:13:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-30T06:38:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-30T06:37:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2025-09-29T16:40:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"64d485a7-4671-4c7e-9056-0cc12b5c80ca","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-20T10:02:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 10:02:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7744168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7744168","identity":"rs-7744168","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}