McCurdy Rebekah J, Jiang Xuezhi, Schnatz Peter F
a Department of Obstetrics and Gynecology , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , U.S.A.
b Department of Obstetrics and Gynecology , Reading Hospital , West Reading , PA , U.S.A.
Eur J Contracept Reprod Health Care. 2018 Oct;23(5):357-364. doi: 10.1080/13625187.2018.1519535. Epub 2018 Nov 22.
To explore (1) long-acting reversible contraception (LARC) use and (2) future contraceptive preferences in Sub-Saharan African adolescents as undesired pregnancies in Sub-Saharan African adolescents are associated with significant maternal/neonatal morbidity.
Nationally-representative Demographic and Health Surveys (USAID) obtained informed consent and interviewed 45,054 adolescents, including 19,561 (43.4% of total) sexually active adolescents (aged 15-19) from 18 least developed Sub-Saharan African nations regarding contraception (years 2005-2011, response rate 89.8-99.1% for all women interviewed). Frequencies and percentages of contraceptive use, prior pregnancies, and unwanted births were reported. Categorical variables were analyzed through χ and unadjusted and binary logistic regression, adjusted for confounders, evaluated LARC use.
A majority of sexually active adolescents were not using contraception (n = 16,165 non-users; 82.6% of all sexually active adolescents). Many (n = 8465, 43.3% of sexually active adolescents) interviewed already had at least one child, with 31.5% (n = 2646) of those with previous children reporting the pregnancy was not wanted at the time it occurred. Sexually active adolescents using contraception (n = 3384) used LARCs (injectable contraception, implants, or intrauterine devices; 29.8%, n = 1007) barrier contraceptives (31.9%), oral contraceptives (10.9%), and other methods (27.4%). Adolescents using LARCs were more likely to be urban [OR 1.76 (95% CI 1.39-2.22)], to have been visited by a family planning worker in the last 12 months [OR1.62 (95% CI 1.24-2.11)], and to have visited a health facility in the past 12 months [OR1.84 (95% CI 1.53-2.21)]. Injectable contraception was the most preferred (39.9%, n = 3036) future method by sexually-active non-contracepting adolescents who were asked about future methods (n = 7605) compared to other methods. An unfortunate percentage of adolescents surveyed cannot read (35.7%, n = 16,084).
A majority of sexually-active adolescents in Sub-Saharan Africa are not using contraception and are desirous of doing so. Offering LARCs during post-abortive or postpartum care with particular focus on rural adolescents may reduce undesired pregnancy and subsequent morbidity/mortality. Educational materials should limit printed information as many teens are unable to read.
鉴于撒哈拉以南非洲青少年意外怀孕与严重的孕产妇/新生儿发病率相关，探讨（1）长效可逆避孕方法（LARC）的使用情况，以及（2）撒哈拉以南非洲青少年未来的避孕偏好。
具有全国代表性的人口与健康调查（美国国际开发署）获得了知情同意，并对45,054名青少年进行了访谈，其中包括来自18个最不发达的撒哈拉以南非洲国家的19,561名（占总数的43.4%）性活跃青少年（年龄在15 - 19岁），询问了他们的避孕情况（2005 - 2011年，所有受访女性的回复率为89.8 - 99.1%）。报告了避孕方法的使用频率和百分比、既往怀孕情况和意外生育情况。通过χ检验以及未调整和二元逻辑回归分析分类变量，并对混杂因素进行调整，以评估LARC的使用情况。
大多数性活跃青少年未采取避孕措施（n = 16,165名未使用者；占所有性活跃青少年的82.6%）。许多接受访谈的青少年（n = 8465，占性活跃青少年的43.3%）已经至少有一个孩子，其中有过孩子的青少年中有31.5%（n = 2646）表示怀孕时并不想要。采取避孕措施的性活跃青少年（n = 3384）使用长效可逆避孕方法（注射用避孕药、植入剂或宫内节育器；29.8%，n = 1007）、屏障避孕法（31.9%）、口服避孕药（10.9%）以及其他方法（27.4%）。使用长效可逆避孕方法的青少年更有可能居住在城市[比值比（OR）1.76（95%置信区间[CI] 1.39 - 2.22）]，在过去12个月内有计划生育工作者上门访视[OR 1.62（95% CI 1.24 - 2.11）]，并且在过去12个月内去过医疗机构[OR 1.84（95% CI 1.53 - 2.21）]。在被问及未来避孕方法的未采取避孕措施的性活跃青少年（n = 7605）中，注射用避孕药是最受欢迎的未来避孕方法（39.9%，n = 3036）。接受调查的青少年中有相当比例（35.7%，n = 16,084）不识字。
撒哈拉以南非洲的大多数性活跃青少年未采取避孕措施，但有采取避孕措施的意愿。在人工流产后或产后护理期间提供长效可逆避孕方法，尤其关注农村青少年，可能会减少意外怀孕及随后的发病率/死亡率。由于许多青少年不识字，教育材料应减少印刷信息。
