Unmet Need and Barriers to Modern Contraceptive Use among Postpartum Adolescent Girls and Young Women in Rural Mara, Tanzania: Facility-based cross-sectional study

Background Modern contraceptives are proven to prevent unintended pregnancies and reduce unsafe abortions; however, their utilization among adolescent girls and young women (AGYW) in sub-Saharan Africa, including Tanzania, remains low. Despite ongoing interventions, the Mara Region continues to report a high fertility rate of 6.1. This study assessed the unmet need and barriers to modern contraceptive use among postpartum AGYW in rural Mara, Tanzania. Methodology A facility-based cross-sectional study was conducted among 614 AGYW aged 15–24 in rural Mara, Tanzania, selected through multistage random sampling. Data were collected in January–February 2024 using a structured Swahili questionnaire via Kobo Toolbox. SPSS v27 was used for analysis, including descriptive statistics, bivariate tests, and multivariate logistic regression, with significance set at p  ≤ 0.05. Results Among AGYW surveyed, 21.7% were using modern contraceptives, while 37.3% had an unmet need for family planning. Unmet need was significantly higher among adolescents aged 15–18 years compared to those aged 19–24 (AOR = 1.70, 95% CI: 1.15–2.51, p = 0.008), those whose partners had no or incomplete primary education compared to those with secondary education or above (AOR = 1.66, 95% CI: 1.95–2.92, p = 0.02), and participants in the lowest wealth quintile compared to those in higher quintiles (AOR = 1.70, 95% CI: 1.11–2.60, p = 0.01). Conclusion Unmet need for family planning remains high among AGYW, especially younger adolescents and those from disadvantaged backgrounds. Targeted efforts are essential to improve access to contraceptive services for these groups.