Motorcycle Taxi Riders in Kampala Take the Lead in Contraceptive Talks, Study Finds

On the crowded streets of Kampala, the men who weave between traffic on motorcycle taxis known as Boda-Boda are more than a transport workforce. They are a mobile, high-risk population whose sexual networks stretch across the city and beyond, and whose reproductive health decisions ripple through Uganda’s broader public health landscape. A new cross-sectional study published in the International Journal of Public Health offers one of the most detailed quantitative portraits to date of how these riders engage, or fail to engage, in the conversations that determine whether contraception gets used at all. The central finding is striking: more than half of the riders surveyed said they had personally started a conversation about contraception with a sexual partner in the previous three months, and those men were dramatically more likely to agree on a method and to use it consistently.

The research team, led by Kevin Micheal Mugisa of National Yang Ming Chiao Tung University in Taiwan together with Joseph Rujumba of Makerere University in Uganda and Li-Yin Chien of National Yang Ming Chiao Tung University, surveyed 421 sexually active male Boda-Boda riders between August and September 2023. Participants were recruited from registered stages across Kampala’s five divisions, Central, Kawempe, Makindye, Nakawa and Rubaga, with sample sizes allocated proportionally to the roughly 25,226 registered riders listed by the Kampala Capital City Authority. Eligible men had worked as riders for at least six months, had a female sexual partner within the previous three months, and could be interviewed in English or Luganda. The response rate was exceptionally high at 98 percent, with 422 of 430 approached riders completing confidential structured interviews and one later excluded for inconsistent answers.

The question at the heart of the study was deliberately simple: in the last three months, did you start a conversation about contraceptive use with your sexual partner or partners? A total of 229 men, or 54.4 percent, answered yes. Most of these negotiations concerned hormonal methods, which accounted for 55 percent of the agreed-upon approaches. That figure places male initiation at the center of a process that public health programs have long treated as a predominantly female domain. In Uganda, where modern contraceptive uptake sits at just 39 percent despite widespread awareness, and where fertility rates remain far above the global average, understanding who opens these conversations carries substantial programmatic weight.

The statistical architecture of the study was rigorous. The researchers used multivariable logistic regression with backward elimination to isolate the factors independently associated with initiation, then applied multinomial logistic regression to test whether initiation predicted agreement on specific contraceptive methods and frequency of use. The final model included seven predictors and showed good fit, with a nonsignificant Hosmer-Lemeshow test and no evidence of multicollinearity among the retained variables. Age was dichotomized at 45 years because the relationship between age and initiation was non-monotonic, peaking among riders aged 25 to 34, of whom 63.5 percent initiated negotiations compared with 42 percent of those aged 45 and older.

After adjustment, men under 45 had 2.66 times the odds of initiating contraceptive negotiations compared with older riders, a pattern the authors attribute to active family formation and greater exposure to family planning messaging among younger adults. A history of sexually transmitted infection diagnosis nearly doubled the odds of initiation, with an adjusted odds ratio of 1.89, suggesting that personal experience with sexual health risk primes men to talk about prevention. Recent receipt of family planning information, reported by nearly 90 percent of the sample, raised the odds by 2.67 times. Perhaps most tellingly, men whose partners had experienced contraceptive side effects were 2.27 times more likely to initiate discussions, presumably to negotiate method switching or address concerns about bleeding, reduced libido, or other complaints documented in earlier studies from Rwanda, Zambia and South Africa.

Three negative associations defied easy explanation and may prove the most consequential findings for program design. Men earning at least one million Ugandan shillings per month, roughly 265 US dollars and well above the sample mean of about 815,000 shillings, had 45 percent lower odds of initiation than lower earners. The authors suggest that financial authority can reinforce a sense of male control over reproductive decisions, echoing evidence from India and Pakistan where restrictive male authority norms suppress women’s contraceptive use regardless of education or wealth. Men who reported selling or buying sex were also less likely to initiate, with an adjusted odds ratio of 0.58, consistent with research showing that transactional dynamics and power imbalances erode negotiation over protection.

The third negative association was the most counterintuitive: men who had discussed family planning with a healthcare worker had 80 percent lower odds of initiating negotiations with their partners, an adjusted odds ratio of just 0.20. Rather than indicating that clinical contact discourages communication, the authors argue this likely reflects reverse causation. Men may consult providers only after a partner has already raised the topic or encountered side effects, meaning the clinical conversation is a consequence of female initiation rather than a catalyst for male initiation. Alternatively, family planning services in Uganda may still feel so woman-centered that men engage passively when they do attend. Either interpretation points to the same remedy: providers need training in men-inclusive counseling that actively encourages joint decision-making rather than waiting for women to bring their partners into the clinic.

The downstream effects of initiation were unambiguous. Compared with men who never started the conversation, initiators had 12.8 times the odds of agreeing on a hormonal method, 3.9 times the odds of agreeing on a barrier method, 5.41 times the odds for natural methods and 16.25 times the odds for traditional methods. They were 8.48 times more likely to report always using contraception and 4.07 times more likely to report sometimes using it. These crude associations align with a broader evidence base: in Senegal, joint couple discussions were associated with a 56 percent increase in contraceptive use, and even one partner’s discussion raised use by 25 percent. A systematic review in Ethiopia found a pooled male involvement prevalence of 59.7 percent, though that construct bundles negotiation with approval, support and direct use, making the Kampala study’s narrower focus on initiation a distinct contribution.

The authors are careful about what the data cannot show. The cross-sectional design precludes causal inference, initiation was measured with a single self-reported item, and all behaviors were subject to recall error and social desirability bias. The convenience sample of registered riders may exclude the most transient and highest-risk men, and only seven participants were HIV-positive, too few to model HIV status independently. Notably, about 15 percent of initiators settled on less effective natural or traditional methods, a concern given the riders’ elevated STI risk and their complex sexual networks that include sex workers, students and multiple concurrent partners. The authors recommend emphasizing dual protection, combining condoms with a reliable female-controlled method, in any counseling aimed at this population.

What emerges is a clear programmatic blueprint. Family planning information reaches riders largely through media rather than clinics, and men who received it recently were far more likely to speak up at home. The authors call for risk-tailored social and behavioral change communication, male-friendly and couple-centered services, and outreach delivered directly at Boda-Boda stages, where riders already gather. In a country where population has grown from 9.5 million in 1969 to 45.9 million in 2024, and where regional disparities in maternal death and contraceptive non-use remain severe, teaching men to open the conversation may be one of the highest-leverage interventions available. The men on the motorcycles, the study suggests, are ready to talk; the health system needs to meet them where they park.

Subject of Research: Male initiation of contraceptive negotiation and its association with contraceptive use among Boda-Boda riders in Kampala, Uganda

Article Title: Male initiation in contraceptive negotiation among Boda-Boda riders in Kampala, Uganda

Article References: Mugisa, K. M., Rujumba, J., & Chien, L.-Y. (2026). Male initiation in contraceptive negotiation among Boda-Boda riders in Kampala, Uganda. International Journal of Public Health, 71, Article 1609598. https://doi.org/10.3389/ijph.2026.1609598

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1609598

Keywords: contraception, family planning, male involvement, Boda-Boda riders, Uganda, Kampala, reproductive health, cross-sectional study, partner communication, STI risk, contraceptive negotiation, public health