College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.
Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.
Reprod Health. 2022 Nov 16;19(1):209. doi: 10.1186/s12978-022-01494-8.
Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa.
We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15-24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs).
At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs.
Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation's health and well being for all as enshrined in Sustainable Development Goals 3 and 5.
长效可逆避孕药（LARC）在减少意外怀孕方面发挥着重要作用，因此有必要了解在高生育率国家中，哪些因素会影响青少年女孩和年轻女性使用 LARC。本研究旨在调查撒哈拉以南非洲高生育率国家中，青少年女孩和年轻女性使用 LARC 的流行情况和预测因素。
我们对来自撒哈拉以南非洲十大高生育率国家 2010 年至 2020 年期间的最新人口与健康调查（DHS）中女性档案的数据进行了汇总，这些国家都属于 DHS 项目。总样本为 5854 名 15-24 岁的有性行为的青少年女孩和年轻女性，她们在调查时正在使用现代避孕药具。我们采用描述性和多水平逻辑回归模型进行分析。结果以百分比和调整后的优势比（AOR）及其相应的 95%置信区间（CI）表示。
在描述性水平上，十个国家的 LARC 使用率总体为 17.6%，其中安哥拉最低为 1.7%，马里最高为 55.8%。已婚的青少年女孩和年轻女性使用 LARC 的可能性低于从未结婚的女性[AOR=0.63，95%CI=0.45，0.88]。与希望生育更多孩子的女性相比，希望生育更少孩子的青少年女孩和年轻女性使用 LARC 的几率更高[AOR=1.56，95%CI=1.09，2.26]。生育一到三个孩子的青少年女孩和年轻女性[AOR=6.42，95%CI=4.27，9.67]和生育四个或更多孩子的青少年女孩和年轻女性[AOR=7.02，95%CI=3.88，12.67]使用 LARC 的可能性高于没有孩子的女性。在撒哈拉以南非洲，安哥拉、尼日尔和莫桑比克等国家使用 LARC 的概率较低，而马里的青少年女孩和年轻女性使用 LARC 的概率较高。
本研究结果表明，在撒哈拉以南非洲的高生育率国家中，青少年女孩和年轻女性使用 LARC 的比例较低。为了降低意外怀孕和人工流产的发生率，必须对撒哈拉以南非洲的青少年女孩和年轻女性进行 LARC 优势的教育。此外，撒哈拉以南非洲的政府、政策制定者和利益相关者应通过执行健康促进措施来提高认识，以增加青少年女孩和年轻女性对 LARC 的需求。实现这些目标不仅可以预防意外怀孕和人工流产，还有助于实现联合国可持续发展目标 3 和 5 中关于所有人健康和福祉的目标。
