1Population Council,Washington DC,USA.
2Population Council,Addis Ababa,Ethiopia.
J Biosoc Sci. 2019 Jul;51(4):505-519. doi: 10.1017/S0021932018000305. Epub 2018 Oct 23.
Nearly 33 million female youths have an unmet need for voluntary family planning (FP), meaning they are sexually active and do not want to become pregnant. In Ethiopia, age at marriage remains low: 40% and 14% of young women aged 20-24 were married by the ages of 18 and 15, respectively. Despite increases in FP use by married 15- to 24-year-olds from 5% in 2000 to 37% in 2016, unmet need remains high at 19%. Supply-and-demand factors have been shown to limit FP use, yet little is known about how stigma influences FP use among youth. This study validates an anticipated stigma (expectation of discrimination from others) index and explores its effect on unmet need. A cross-sectional survey was implemented with 15- to 24-year-old female youth in Ethiopia in 2016. The analytic sample included married respondents with a demand (met and unmet need) for FP (n=371). A five-item anticipated stigma index (Cronbach's α=0.66) was developed using principal component factor analysis. These items related to fear, worry and embarrassment when accessing FP. The findings showed that 30% agreed with at least one anticipated stigma question; 44% had an unmet need; 58% were married before age 18; and 100% could name an FP method and knew where to obtain FP. In multivariate regression models, youth who experienced anticipated stigma were significantly more likely to have an unmet need, and those who lived close to a youth-friendly service (YFS) site were significantly less likely to have an unmet need. Interventions should address anticipated stigma while focusing on social norms that restrict married youth from accessing FP; unmet need may be mitigated in the presence of a YFS; and the anticipated stigma index appears valid and reliable but should be tested in other countries and among different adolescent groups.
近 3300 万少女有未满足的计划生育需求（FP），这意味着她们处于性活跃期且不想怀孕。在埃塞俄比亚，结婚年龄仍然较低：分别有 40%和 14%的 20-24 岁年轻女性在 18 岁和 15 岁结婚。尽管已婚的 15-24 岁青少年中 FP 的使用率从 2000 年的 5%增加到 2016 年的 37%，但未满足的需求仍高达 19%。供应和需求因素已被证明会限制 FP 的使用，但人们对耻辱感如何影响青少年的 FP 使用知之甚少。这项研究验证了预期耻辱感（预期会受到他人的歧视）指数，并探讨了其对未满足需求的影响。2016 年在埃塞俄比亚对 15-24 岁的女性青年进行了一项横断面调查。分析样本包括有 FP 需求（满足和未满足）的已婚受访者（n=371）。使用主成分因子分析开发了一个由五项预期耻辱感问题组成的指数（Cronbach's α=0.66）。这些问题涉及到在获取 FP 时的恐惧、担忧和尴尬。研究结果表明，30%的人至少同意一个预期耻辱感问题；44%有未满足的需求；58%在 18 岁之前结婚；100%可以说出一种 FP 方法，并知道在哪里可以获得 FP。在多变量回归模型中，经历过预期耻辱感的青年更有可能有未满足的需求，而那些居住在青年友好服务（YFS）站点附近的青年更不可能有未满足的需求。干预措施应该解决预期耻辱感，同时关注限制已婚青年获得 FP 的社会规范；在有 YFS 的情况下，未满足的需求可能会减轻；预期耻辱感指数似乎有效且可靠，但应在其他国家和不同的青少年群体中进行测试。
