Contraceptive use among women has long been a critical topic in public health, psychology, and sociology, with much of the global discourse focused on medical, economic, and socio-cultural dimensions. Despite extensive research into these external factors, less attention has been paid to the psychological influences on women’s reproductive behaviours, particularly attachment theory. This theory suggests that early life experiences with caregivers’ shape individuals' internal working models of relationships, which in turn affect emotional regulation, interpersonal functioning, and health behaviours throughout life [1-3]. Understanding how attachment styles influence contraceptive intent may provide novel insights into the motivations and barriers behind contraceptive behaviour in young women.

Reproductive decision-making does not occur in isolation but is shaped by a dynamic interplay of individual, relational, and environmental influences. While economic barriers, inadequate sex education, and cultural taboos have all been shown to affect contraceptive uptake, psychological factors, especially those embedded in relationship dynamics, are increasingly recognized as pivotal [4, 5]. For university students, these decisions may be even more complex. Emerging adulthood is a life stage characterized by identity exploration, fluctuating romantic involvement, and evolving autonomy [1], making it a particularly relevant context for exploring the role of attachment in sexual and reproductive health.

At the University of Limpopo (UL), contraceptive use among female students occurs within a matrix of socio-cultural, economic, and psychological influences. Despite increased access to sexual health education and services, unintended pregnancies persist, with many students reporting inconsistent or incorrect use of contraception [6]. This discrepancy between knowledge and behaviour suggests that informational campaigns alone may be insufficient. Traditional public health frameworks have primarily addressed logistical and systemic barriers, such as cost, availability, and access, but there is growing recognition that deeper psychological processes may underpin behavioural inconsistencies [7].

Attachment styles namely: secure, anxious, avoidant, and fearful-avoidant, are defined by distinct emotional and relational patterns that originate in early caregiving experiences [2, 3, 8]. These internal working models persist into adulthood and influence the way individuals perceive intimacy, communication, and vulnerability, factors which are central to sexual relationships and contraceptive negotiation. Securely attached individuals tend to be more confident in their relationships and are thus more likely to communicate openly and plan contraceptive use effectively. In contrast, anxiously attached individuals may fear abandonment and seek closeness through unprotected sex or avoid discussions around contraception that may threaten the relationship. Avoidantly attached individuals may avoid emotional intimacy and discussions of sexual responsibility, while those with fearful-avoidant styles may experience inner conflict, resulting in ambivalence or inconsistency in contraceptive behaviour [4, 5, 9].

Empirical studies suggest that securely attached individuals display higher contraceptive intent and more consistent use [4, 10]. Conversely, those with insecure attachments, particularly anxious and avoidant, are more prone to inconsistent or non-use. These patterns appear to reflect the influence of attachment styles on key relational processes such as trust, fear of rejection, and emotional regulation. For example, anxiously attached women may avoid raising contraceptive concerns for fear of being perceived as distrustful or pushing their partners away, whereas avoidantly attached individuals might dismiss the importance of emotional or sexual planning altogether. These relational scripts have direct consequences for contraceptive behaviour but remain understudied in developing countries, especially in Sub-Saharan Africa.

Within the South African context, factors such as partner control, socioeconomic dependency, and social stigma can further complicate contraceptive negotiation, particularly for female students who are in transitional phases of their relational and financial independence. For instance, studies show that some female students engage in transactional sexual relationships due to economic constraints, limiting their autonomy in negotiating safe sex [6, 11]. In such cases, attachment insecurity may not only shape individual behaviour but also exacerbate vulnerability within unequal power dynamics. Psychological resilience, communication patterns, and emotional regulation, core aspects of attachment, can mediate or compound these challenges.

This study is thus grounded in the premise that attachment styles may provide a valuable psychological lens through which to understand contraceptive intent [2, 4]. By focusing on female students at the University of Limpopo, the research aims to broaden our understanding of the psychosocial dimensions of reproductive health. In doing so, it seeks to inform more nuanced and contextually sensitive interventions that go beyond awareness and access, targeting the affective and relational aspects that influence young women’s choices and behaviours [7, 9].

Furthermore, the study responds to a notable gap in current literature. Much of the existing research on attachment and contraceptive behaviour has been conducted in high-income countries, often using clinical or experimental samples [5]. Few studies have explored how attachment theory applies in resource-constrained or culturally diverse settings such as rural South Africa. Even fewer have focused on female university students, a population simultaneously navigating independence, academic pressures, and evolving romantic identities [10-13]. As such, this research provides a unique contribution by contextualising global psychological theory within the lived realities of South African students.

Recognizing the multifaceted nature of contraceptive choices, the study adopts a holistic perspective that integrates individual psychological factors with broader structural variables such as socioeconomic status, healthcare access, and cultural expectations [12, 13]. For example, a securely attached individual might still face systemic barriers, such as clinic stockouts or provider bias, that prevent contraceptive use. Conversely, a woman with insecure attachment may have full access to contraception but struggle to use it consistently due to fear, mistrust, or conflict avoidance in her relationship [5]. By bridging these internal and external dimensions, the study seeks to offer a more comprehensive framework for understanding and addressing contraceptive behaviour.

In line with this, attachment-based interventions may be worth exploring. While most sexual health programmes focus on knowledge dissemination or service provision, few consider the psychological readiness or interpersonal skills necessary for effective contraceptive use. If attachment styles influence relationship communication, autonomy, and trust, then interventions that build secure relational patterns could indirectly enhance contraceptive decision-making. These findings could hold important implications for campus health services, counselling initiatives, and future reproductive health strategies aimed at young adults.

In summary, the conceptual and empirical foundations for the study are outlined as the complex influences on contraceptive behaviour and highlight a specific psychological factor that is, attachment style, that warrants deeper investigation. By focusing on a South African university context, the research offers a timely and relevant contribution to both attachment and public health literature. Ultimately, the research provides a more holistic understanding of reproductive decision-making and contributes to improved support systems for young women navigating these choices.

The findings of the research investigating the relationship between attachment styles and contraceptive intent among female students at UL are presented. Both descriptive and inferential statistics are provided. Descriptive results summarize demographic data and distributions of attachment styles and contraceptive intent. Inferential results from a multinomial logistic regression analysis assess the predictive value of attachment styles on levels of contraceptive intent. It must be noted that although a convenience sample was used, multinomial logistic regression was applied to explore theoretical associations between attachment styles and contraceptive intent. This is acceptable in behavioural research where the aim is not broad generalizability but hypothesis testing within the sample [23]. The data met assumptions for regression, including categorical variables and an adequate sample size. While generalizability is limited, the analysis offers valuable insights into internal trends. The structured outcome categories and careful data cleaning further support the validity of using inferential statistics in this context.

Table 1 summarizes the demographic characteristics of the sample that was recruited. Most participants were in their second or third year of study, with a fairly even distribution between those in relationships and those who were single.

Table 2 shows the distribution of attachment styles and levels of contraceptive intent. Secure attachment was the most common, and moderate intent was the most frequently reported category.

In Table 3, the results of the multinomial logistic regression are provided. While the overall model was not significant, anxious and avoidant attachment styles showed significant associations with contraceptive intent.

Furthermore, although the overall regression model was non-significant (χ² (6) = 8.992, p = 0.774), individual predictors revealed contrasting effects: anxious attachment increased the odds of high contraceptive intent nearly two-fold (OR = 2.49, 95% CI [1.03–6.01]), whereas avoidant attachment decreased likelihood (OR = 0.47, 95% CI [0.23–0.92]). Secure attachment showed no meaningful association.

Pseudo R-squared values indicated weak model fit: Cox and Snell R² = 0.023, Nagelkerke R² = 0.116, McFadden R² = 0.106. These suggest that while psychological variables play a role, other contextual factors likely contribute more significantly to contraceptive decisions in this population.

This study explored the relationship between attachment styles and contraceptive intent among female university students at UL. Grounded in attachment theory, the study hypothesized specific associations between secure, anxious, and avoidant attachment styles and varying levels of contraceptive intent. The findings partially supported these hypotheses, offering insight into the psychological factors that may influence reproductive decision-making among young women in a South African context.

While the overall multinomial logistic regression model was not statistically significant, individual attachment styles showed meaningful associations with contraceptive intent. Anxious attachment was positively associated with high contraceptive intent, whereas avoidant attachment was negatively associated with high intent. These findings align with and extend prior research demonstrating that attachment insecurity influences sexual and reproductive behaviours [4, 5]. The positive association between anxious attachment and high contraceptive intent may initially appear counterintuitive, as anxious individuals are often characterized by heightened emotional dependency and fear of abandonment. However, this group may also exhibit heightened concern about the relational consequences of unintended pregnancy and thus be more motivated to use contraception as a way of preserving relational security [7]. Previous research has shown that anxiously attached individuals may engage in pre-emptive behaviours to avoid perceived relational disruptions [3], which may include contraceptive use as a protective strategy.

In contrast, the negative association between avoidant attachment and contraceptive intent is consistent with theoretical expectations and previous empirical studies [4, 10]. Avoidantly attached individuals often de-emphasize intimacy and may view reproductive planning discussions as intrusive or emotionally uncomfortable. Consequently, they may avoid proactive sexual health behaviours, including consistent contraceptive use. This finding supports previous literature that links avoidant attachment with lower levels of communication and planning in sexual relationships [8]. Interestingly, secure attachment was not a significant predictor of contraceptive intent in this sample, diverging from prior studies that have found positive associations between secure attachment and responsible sexual behaviours [3, 19]. One possible explanation is that in this university sample, other contextual or structural factors, such as partner influence, access to services, or socio-cultural attitudes, may play a more dominant role in shaping behaviour than attachment style alone. This finding reinforces the importance of adopting an integrated model that accounts for both psychological and contextual variables in understanding contraceptive behaviour [12, 13].

Additionally, the low pseudo-R-squared values observed in the regression analysis indicate that while attachment styles contribute to the variance in contraceptive intent, they do not account for most of it. This underscores the complexity of reproductive decision-making, which may also be shaped by educational, relational, cultural, and economic factors not fully captured in the current model [6, 11]. Future research should consider incorporating such variables into predictive models to achieve a more comprehensive understanding. The findings also have practical implications for public health interventions. Sexual and reproductive health programmes in university settings could be enhanced by incorporating psychological dimensions such as attachment style into their design. Interventions tailored to specific attachment-related needs may improve communication, decision-making, and ultimately contraceptive adherence among students [4].

In summary, these nuanced findings partially support attachment theory within reproductive decision-making. The heightened contraceptive intent among anxiously attached participants may reflect heightened relationship vigilance and desire for control, whereas avoidant attachment corresponds with relational disengagement and lower intent. Weak model fit underscores that psychological variables explain only a modest portion of variance, emphasizing the necessity of incorporating partner dynamics, service accessibility [24], and cultural norms into future predictive frameworks. Psychologically-informed reproductive-health counselling that fosters secure attachment patterns may enhance contraceptive consistency among students. These findings support previous literature and provide a foundation for future research to build more complex models that integrate both psychological and structural factors in reproductive health behaviours.

This study used a convenience sample drawn from a single university, which limits the generalizability of the findings to broader populations. Self-reported data may be subject to social desirability or recall bias. Another limitation is that the cross-sectional design restricts causal interpretations, and other potential influences on contraceptive intent, such as peer norms or relationship dynamics, were not measured. Additionally, while the regression model tested theoretical relationships, its low explanatory power indicates that other variables not included in the analysis may have a greater influence. The findings are not broadly generalizable beyond the sampled schools and population, given the purposive sampling and rural focus; however, they offer meaningful insights into similar contexts.

This research examined the relationship between attachment styles and contraceptive intent among female students at the University of Limpopo. While the overall regression model was not statistically significant, individual attachment styles, particularly anxious and avoidant, indicated meaningful associations with contraceptive intent. These findings suggest that psychological factors may play an important role in shaping reproductive behaviour, complementing the structural and socio-cultural factors often studied. The results provide partial support for attachment theory in the context of sexual and reproductive decision-making. Although secure attachment did not predict intent, the nuanced differences among insecure styles offer valuable insights. This highlights the need for tailored interventions that consider emotional and relational dynamics. University health programmes could benefit from integrating psychosocial education alongside contraceptive access. The study contributes to the growing recognition of mental health in public health frameworks. Future research should explore how attachment interacts with partner dynamics, cultural beliefs, and contraceptive access.