Long-acting reversible contraception in adolescents in Sub-Saharan Africa: evidence from demographic and health surveys

Abstract

Objective: 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.

Methods: 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 χ² and unadjusted and binary logistic regression, adjusted for confounders, evaluated LARC use.

Results: 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).

Conclusion: 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.

摘要

目的：为探讨(1)长效可逆性避孕措施(LARC)的使用和(2)撒哈拉以南非洲青少年未来的避孕方式的倾向, 因为撒哈拉以南非洲青少年的意外怀孕与产妇/新生儿发病率显著相关。

方法：经过调查者的知情同意, 用具有全国代表性的人口和健康调查（USAID）问卷, 对45,054名青少年进行了调查, 其中包括来自18个撒哈拉以南非洲最不发达国家的19,561名（占总数的43.4%）性活跃青少年（15-19岁）的避孕措施（2005-2011年, 所有受访女性的答复率为89.8-9.1%）。报告了使用避孕措施的频率和百分比、既往妊娠情况和非意愿分娩情况。分类变量通过χ²和未调整的二元逻辑回归进行分析, 根据混杂因素进行调整, 评估可逆避孕措施的使用。

结果：大多数性活跃的青少年没有使用避孕措施（n = 16,165不使用避孕措施的青少年, 占所有性活跃青少年的82.6%）。许多青少年（n= 8465, 43.3%性活跃的青少年）接受调查时至少已经有一个孩子, 这些有孩子的青少年中, 有31.5%（n = 2646）的人认为当时并不希望妊娠。有避孕措施的性活跃的青少年中（n = 3384）使用的避孕措施包括：使用LARCs（注射避孕措施、植入物或宫内节育器, 29.8%, n = 1007）, 屏障避孕措施（31.9%）、口服避孕（10.9%）, 以及其他方法避孕（27.4%）。更有可能使用LARCs的青少年为：城市人[OR 1.76 (95% CI 1.39-2.22)], 在过去12个月曾被计划生育工作者访问过[OR 1.62 (95% CI 1.24-2.11)], 以及在过去12个月曾访问过卫生机构[OR 1.84 (95% CI 1.53–2.21)]者。当问道未采取避孕措施的性活跃青少年（n = 7605未来选择的避孕方法时, 与其他避孕方法比较, 注射避孕措施是她们的首选方法（39.9%, n = 3036）。不幸的是, 接受调查的青少年中有相当一部分人不识字（35.7%,n = 16084）。

结论：在撒哈拉以南非洲, 大多数性活跃的青少年没有使用避孕措施, 同时他们希望使用避孕措施。在流产后或产后护理期间提供LARCs, 特别是以农村青少年为重点, 可减少意外发生的妊娠和随后的发病率/死亡率。教育材料应该限制印刷信息, 因为许多青少年不能阅读。

Keywords:

• LARC
• contraception
• adolescents
• Sub-Saharan Africa

Disclosure statement

The authors have no conflict of interest to declare.