| Summary: | Abstract Background Modern contraceptive use among adolescents is low despite the adverse effects of adolescent pregnancies. Understanding correlates of modern contraceptive use in different settings is key to the design of effective context-specific interventions. We aimed to determine factors associated with modern contraceptives use among adolescents in rural and urban settings of Zambia. Methods We analyzed secondary data from 2018 Zambia demographic and health survey (ZDHS) focusing on adolescent girls aged 15–19 years. We used multivariable logistic regression in SPSS version 25 to examine rural-urban variations in factors associated with modern contraceptive utilization. Results Overall, 12.0% (360/3000, 95% CI: 10.9–13.2) of adolescents in Zambia were using modern contraceptives. Use of modern contraceptives was higher in rural areas at 13.7% (230/1677, 95% CI: 12.1–15.3) compared to 9.8% (130/1323, 95% CI: 8.3–11.6) in urban areas. In the rural areas, having a child (aOR = 13.99; 95% CI 8.60–22.77), being married (aOR = 2.13; 95% CI 1.42–3.18), being older at 19 years (aOR = 3.90; 95% CI 1.52–10.03), having been visited by a field health worker (aOR = 1.62; 95% CI 1.01–2.64), having been exposed to family planning messages on mass media (aOR = 2.87; 95% CI 1.01–8.18) and belonging to the richest wealth quintile (aOR = 2.27; 95% CI 1.43–3.62) were associated with higher odds of contraceptive utilization. Furthermore, adolescents in the Northern (aOR = 0.29; 95% CI 0.11–0.80) and Luapula (aOR = 0.35; 95% CI 0.15–0.81) provinces were associated with less odds of utilizing contraceptives compared to those in Western province. In the urban areas, older age at 19 years (aOR = 4.80; 95% CI 1.55–14.84) and having a child (aOR = 18.52; 95% CI 9.50–36.14) were the only factors significantly associated with modern contraceptive utilization. Conclusion Age and having a child were associated with modern contraceptive use in both rural and urban areas. In rural areas (province, marital status, being visited by field health workers, family planning messages exposure and wealth index) were the only associated factors. This indicates that interventions aiming to increase contraceptive utilization should be context specific.
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