Who Meets the Contraceptive Needs of Young Women in SubSaharan Africa?

Posted by Maria Codina on January 15, 2018 at 11:09 am



It is critical to address unwanted pregnancy among young women in sub-Saharan Africa, a region with one of the highest adolescent pregnancy rates and the lowest rates of family planning (FP) use [1]. Amidst increasing calls to prioritize adolescents’ contraceptive needs, understanding current patterns of adolescent FP service use is vital to achieving universal access to sexual and reproductive health services [2–4].

High-quality FP care is crucial to preventing unwanted pregnancy, particularly among young people. In a study of 40 countries with Demographic and Health Surveys (DHS), adolescent contraceptive practice was characterized by inconsistent use, with more method failure and discontinuation compared with older women; the authors suggest young women face more obstacles to use or abandon a method if experiencing side effects [5]. Health concerns and side effects are frequently cited as reasons for not using a method [4,6], and youth often have misconceptions about how contraception works [3,7]. Appropriate counseling, particularly when initiating contraceptive use or switching methods, is important to addressing knowledge gaps around pregnancy prevention and consistent contraceptive use [8,9] and is one of the six elements in the Bruce framework for quality FP care [10].

However, young people encounter significant barriers to accessing quality health care [11–13], including provider bias, age restrictions or stigmatization when seeking FP services, and concerns about confidentiality [7,14–16]. World Health Organization 2012 guidelines emphasized the improvement of young people’s health services [11], and efforts to make services “youth friendly” have appeared in several small-scale initiatives, primarily led by nongovernmental organizations (NGOs) and, to some extent, government-run health facilities [11,17]. Some evidence suggests that these efforts have increased health service utilization, including FP use [3,17,18].

Yet the evidence base for where adolescents seek FP care in low- and middle-income countries is limited. Much of the evidence on young people’s FP use and provider preferences in subSaharan Africa comes from small-scale, often qualitative, studies not nationally representative [14,15,19], focused on a limited number of countries [16,20,21] or studies that do not consider quality of FP counseling across provider types [22]. The private sector is an important source of FP care in the region for women of all ages [23], suggesting that public-sector efforts expanding youth-friendly services may miss a significant proportion of young people accessing private providers. Young people frequently utilize different FP methods compared with older users. As method and source can be linked, there is a need to consider how youth FP care seeking compares with older women.

Within global efforts to improve FP access and quality of care, particularly for youth, it is essential to understand where young people obtain contraception to inform points of intervention and cross-country learning. This paper aims to compare how FP sources and the content of FP care received differs between adolescent (aged 15–19), young (aged 20–24), and older women (aged 25+) using nationally representative surveys from multiple sub-Saharan African countries.

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