[EN]Adolescent reproductive health is part of internationally agreed development goals
but unmarried adolescents are often left out of the picture despite higher
contraceptive demand and prevalence in this group. Sánchez-Páez and Ortega
(2018) show the importance of increasing prevalence in explaining recent declines
in adolescent fertility and the potentially larger effect of meeting current unmet
need

Ortega Osona, José Antonio

Sánchez-Páez, David Antonio

English

Gestion del Repositorio Documental de la Universidad de Salamanca

Published on N-IUSSP.ORG September 3, 2018Adolescent contraceptive use and its effects on fertilityLa pratique contraceptive des adolescents et ses effets surla féconditéDavid A. Sánchez-Páez, José A. OrtegaAdolescent reproductive health is part of internationally agreed development goalsbut  unmarried  adolescents  are  often  left  out  of  the  picture  despite  highercontraceptive demand and prevalence in this group. Sánchez-Páez and Ortega(2018) show the importance of increasing prevalence in explaining recent declinesin  adolescent  fertility  and  the  potentially  larger  effect  of  meeting  current  unmetneeds.Do not leave unmarried adolescents behindGlobal monitoring of adolescent fertility and contraceptive use has centered onwomen who are married or in a union (UN 2015). Groups with special needs, suchas sexually active unmarried adolescent women, are often ignored. About sixteenmillion young women between 15 and 19 years of age give birth every year, andthree  million  undergo  unsafe  abortions,  making  pregnancy  and  childbirth  theleading cause of death for teenage girls (Advocates for Youth 2013). Approximately11% of  global  births occur to adolescent women, 95% of  them in developingcountries  (Vogel  et  al.  2015).  Contraceptive  use  is  therefore  key  to  avoidingunintended  births,  which  account  for  between  50% and  90% of  all  births  toadolescent women, depending on the country (Sedgh, Singh, and Hussain 2014).While unmarried adolescents have a higher “unmet need for contraceptives” thanmarried women of the same age, many of them do not use contraceptive methodsdue to lack of access (Chandra-Mouli et al. 2014; MacQuarrie 2014). This happenseven though the consequences of  unwanted conceptions are more severe forthem:  unsafe  abortion,  maternal  and  child  mortality,  school  dropout,  reducedearning potential, and lower educational achievement (Neelofur-Khan and WHO2007; Santhya and Jejeebhoy 2015). However, changing adolescent contraceptivebehavior is achievable (ICRW 2014).Adolescents often face many barriers to acquiring contraceptives and to usingthem correctly  and  consistently  (Chandra-Mouli  et  al.  2014).  Moreover,  manybrought to you by COREView metadata, citation and similar papers at core.ac.ukprovided by Gestion del Repositorio Documental de la Universidad de Salamancaadolescents have no access to sex education and are unaware of the risks ofsexual activity (Kirby 2011). Despite increasing adolescent contraceptive use, theirperiods of consistent use are shorter, and contraceptive failures are more frequentthan for older women (Blanc et al. 2009).Our  purpose  is  to  quantify  the  childbearing  consequences  of  adolescentcontraceptive use and non-use in developing countries. We use 120 Demographicand Health Surveys (DHS) for 34 Latin American (LAC) and sub-Saharan African(SSA) countries.The  effect  of  increasing  levels  of  contraceptiveprevalencePanel  (a)  of  figure  1  displays  the  percentages  using  contraceptives  (orcontraceptive prevalence) among sexually active adolescent women, unmarriedand married (or in union) at the latest DHS survey. Contraceptive prevalence ishigher for unmarried women, implying the importance of bringing contraceptivemethods to them so that they can decide when to begin childbearing and when toget married. Prevalence for unmarried adolescents is, on average, about 60% inLAC  (Latin  American  Countries)  and  39%  in  SSA  (Sub  Saharan  Africa).In most countries, contraceptive prevalence has increased over time, especially forunmarried  adolescents.  However,  there  are  a  few  countries,  like  Benin,  Coted’Ivoire,  Guinea,  Haitia,  or  Togo,  where  prevalence  has  declined  since  the  firstsurvey for unmarried women despite increasing or stable levels of demand. Inother countries such as Burkina Faso, Cameroon, Madagascar, or Malawi, demandhas  increased  but  prevalence  has  not,  resulting  in  higher  unmet  need  forcontraception. Investigating the reasons behind such trends and understandingwhat is behind such lack of access would provide important insights for policy-makers.In figure 2 the red line highlights the role of increasing contraceptive prevalence infertility  decline.  If  prevalence  had  remained  constant  at  the  levels  of  the  firstavailable  survey  (SimCP),  adolescent  fertility  (i.e,  the  age-specific  fertility  rateamong exposed women aged 15-19 years) would have been 6.8 percent higher inLAC and 4.1 percent higher in SSA. The average contribution is higher in LAC sinceprevalence has increased faster.The potential impact of meeting total demandPanel  (b)  of  figure  1  highlights  the  significant  differences  in  total  demand  forcontraceptives. While levels of total demand for married adolescents vary widely,they are high for unmarried adolescents almost everywhere, with an average ofabout 85% and 80% for LAC and SSA countries, respectively. The comparison withprevalence suggests that levels of unmet need for contraception are higher forsexually  active  unmarried adolescents:  about  24% and 41% in  LAC and SSA,respectively,In figure 2, the green line (SimTD) displays the fertility levels that would have beenreached  had  unmet  need  been  satisfied  for  unmarried  adolescents.  Notsurprisingly,  this would have had a sizable effect on adolescent fertility in almostevery country. Adolescent birth rates among exposed women would have beenabout 9 percent and 17 percent lower in LAC and SSA, respectively.Levels of unmet need and total demand are higher for unmarried adolescents sincemany married adolescents want to have children. Still, meeting the total demandfor married adolescents would lead to an additional reduction of 3.5 percent in LACand 2.9 percent in SSA.Policy implicationsFrom a sexual and reproductive health and rights (SRHR) perspective, our analysiscorroborates that a focused approach is needed so that adolescents, especiallythose  who  are  unmarried  and  sexually  active,  are  not  left  aside  in  globalmonitoring. The situation of lack of access is particularly intense for them: theyhave higher levels of unmet need and total demand for family planning comparedto  married  adolescents.  Lowering  the  incidence  of  adolescent  pregnancy  bysatisfying  current  demand levels  could  avoid  many  of  the  adverse  outcomesconnected  with  adolescent  pregnancy  and  childbearing,  and  the  subsequentreduction of well-being for the present and the next generation. Strengtheninghealth systems to meet the needs and priorities of unmarried adolescents shouldtherefore be a priority.While we have focused on the impact of increasing contraceptive prevalence, theliterature indicates the importance not only of use but also of effective use. Usingmore  efficient  methods  in  combination  with  condom  use  for  the  prevention  ofsexually transmitted diseases would have a stronger public health impact. In thisrespect,  sex education and the adoption of  more efficient methods could play animportant  additional  role.  Sex  education  tends  to  increase  the  use  ofcontraceptives,  provided,  of  course,  that  they  are  available.ReferencesAdvocates for Youth (2013). The Sexual and Reproductive Health of Young Peoplein Low and Middle Income Countries. Washington D.C.: Advocates for Youth.Blanc, A.K., Tsui, A.O., Croft, T.N., and Trevitt, J.L. (2009). Patterns and trends inadolescents’ contraceptive use and discontinuation in developing countries andcomparisons  with  adult  women.  International  Perspectives  on  Sexual  andReproductive  Health  35(2):63–71.Chandra-Mouli, V., McCarraher, D., Phillips, S., Williamson, N., and Hainsworth, G.(2014). Contraception for adolescents in low and middle countries: Needs, barriers,and access. Reproductive Health 11(1):1.ICRW  (2014).  Understanding  the  Adolescent  Family  Planning  Evidence  Base.Washington D.C.: International Center for Research on Women (ICRW).Kirby, D. (2011). Sex Education: Access and Impact on Sexual Behaviour of YoungPeople. New York: Expert Group Meeting on Adolescents, Youth, and Development;United Nations, Population Division, Department of Economic and Social Affairs.MacQuarrie, K.L.D. (2014). Unmet Need for Family Planning Among Young Women:Levels and Trends. Rockville: ICF International, DHS Comparative Reports No. 34.Neelofur-Khan,  D.  and WHO (2007).  Adolescent  Pregnancy:  Unmet  Needs andUndone Deeds: A Review of the Literature and Programmes. Geneva: World HealthOrganization.Santhya, K. and Jejeebhoy, S. (2015). Sexual and reproductive health and rights ofadolescent girls: Evidence from low- and middle-income countries. Global PublicHealth 10(2):189–221.Sánchez-Páez, D.A. and Ortega, J.A. (2018). Adolescent contraceptive use and itseffect  on  fertility.  Demographic  Research  38(45):1359–1388.doi:10.4054/DemRes.2018.38.45.Sedgh, G., Singh, S., and Hussain, R. (2014). Intended and unintended pregnanciesworldwide in 2012 and recent trends. Studies on Family Planning 45(3):301–314.doi:10.1111/j.1728-4465.2014.00393.x.UN (2015). Trends in Contraceptive Use Worldwide.  New York: United Nations,Department  of  Economic  and  Social  Affairs,  Population  Division,  sales  number:16.XIII.13.  hVogel, J., Pileggi-Castro, C., Chandra-Mouli, V., Nogueira, V., Souza, J., Chou, D., andSay, L. (2015). Millennium development goal 5 and adolescents: Looking back,moving forward. In: Archives of Disease in Childhood. s43–s47.

La pratique contraceptive des adolescents et ses effets sur la fécondité

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La pratique contraceptive des adolescents et ses effets sur la fécondité

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