Contraceptive use in adolescents in Sub-Saharan Africa: evidence from Demographic and Health Surveys.

OBJECTIVE

Failure to use contraceptives contributes to an unacceptably high rate of undesired pregnancy in Sub-Saharan adolescents with associated maternal and neonatal mortality/morbidity. Evidence-based research is needed to understand contraceptive usage in Sub-Saharan adolescents and to enable appropriate allocation of donor resources.

DESIGN

Nationally-representative USAID (U.S. Agency for International Development) Demographic and Health Surveys from 18 least developed Sub-Saharan African nations.

POPULATION

212,819 Sub-Saharan African women (45,054 were 15-19 years old).

METHODS

The percentages of adolescents using contraception, as well as their preferred contraceptive methods and desired family size, were reported.

MAIN OUTCOME MEASURES

Contraceptive Use, Neonatal Mortality, Undesired Pregnancy, Pregnancy Terminations.

RESULTS

Most adolescents (92.4%) surveyed reported no contraceptive use, although 21.6% reported recent sexual activity. A current pregnancy was reported in 6.6% (n = 2,951) of adolescents with 29.9% of these pregnancies being unwanted. Many surveyed adolescents (18.8%) had at least one prior birth. A death of the previous child was reported in 6.6% (n = 560) with half of these deaths (n = 276) occurring within the first month of life. Many adolescents planned to delay childbearing for at least two years (37.1%) or were unsure about future timing (33.3%), and 2.2% reported a history of at least one pregnancy termination. Most adolescents (73.1%) felt it would be a problem if they became pregnant. Adolescents indicated injectable medications and contraceptive pills were the preferred future contraceptives at 39.9% and 31.4% respectively.

CONCLUSIONS

Sub-Saharan African adolescents report a mismatch between desire for contraception and use; preferred methods are oral and injectable contraceptives.