Background Three-quarters of pregnancy terminations in Africa are carried out in unsafe conditions. Unsafe abortion is the leading cause of maternal mortality among 15–24 year-old women in Sub-Saharan Africa. Greater understanding of the wider determinants of pregnancy termination in 15–24 year-olds could inform the design and development of interventions to mitigate the harm. Previous research has described the trends in and factors associated with termination of pregnancy for women of reproductive age in Nigeria. However, the wider determinants of pregnancy termination have not been ascertained, and data for all women have been aggregated which may obscure differences by age groups. Therefore, we examined the trends in and individual and contextual-level predictors of pregnancy termination among 15–24 year-old women in Nigeria. Methods We analysed data from the 2003, 2008, 2013 and 2018 Nigerian Demographic and Health Surveys (NDHS) comprising 45,793 women aged 15–24 years. Trends in pregnancy termination across the four survey datasets were examined using bivariate analysis. Individual and contextual predictors of pregnancy termination were analysed using a three-level binary logistic regression analysis and are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Trends in pregnancy termination declined from 5.8% in 2003 to 4.2% in 2013 then reversed to 4.9% in 2018. The declining trend was greater for 15–24 year-old women with higher socioeconomic status. Around 17% of the total variation in pregnancy termination was attributable to community factors, and 7% to state-level factors. Of all contextual variables considered, only contraceptive prevalence (proxy for reproductive health service access by young women) at community level was significant. Living in communities with higher contraceptive prevalence increased odds of termination compared with communities with lower contraceptive prevalence (aOR = 4.2; 95% CI 2.7–6.6). At the individual-level, sexual activity before age 15 increased odds of termination (aOR = 2.3; 95% CI 1.9–2.8) compared with women who initiated sexual activity at age 18 years or older, and married women had increased odds compared with never married women (aOR = 3.0; 95% CI 2.5–3.7). Conclusion Our findings highlight the importance of disaggregating data for women across the reproductive lifecourse, and indicates where tailored interventions could be targeted to address factors associated with pregnancy termination among young women in Nigeria.
Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent’s uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the ‘International Prospective Register for Systematic Reviews’ (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent’s uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA.
Antenatal care is an important determinant of pregnancy and childbirth outcomes. Although the youth disproportionately experience adverse maternal complications and poor pregnancy outcomes, including maternal mortality, timely and frequent use of antenatal care services among unmarried youth in Uganda remains low. This study examines the factors that are important predictors of the use of antenatal health care services among unmarried and married youth. Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey to examine the predictors of ANC use. This analysis was among a sample of 764 unmarried, compared to 5176 married youth aged 15–24 years. Overall, married youth were more likely to have more frequent antenatal care visits (56% versus 53%) and start antenatal care early (27% versus 23%) than unmarried youth. Factors significantly associated with use of antenatal care in the first trimester were education and occupation among unmarried youth, and place of residence and access to the radio among married youth. Key predictors of ANC frequency among unmarried youth were parity, education level, pregnancy desire, age group, sex of head of household and region of residence. Among married youth, significant predictors of ANC frequency were parity, pregnancy desire, occupation, access to the radio and region of residence. These findings will help inform health-care programmers and policy makers in initiating appropriate policies and programs for ensuring optimal ANC use for all that could guarantee universal maternal health-care coverage to enable Uganda to achieve the SDG3.
Mobile health (mHealth) programs offer opportunities to improve the sexual and reproductive health (SRH) of adolescents by providing information. This paper reports the findings of a study carried out in Homabay County, Kenya, to assess stakeholders’ perspectives on access to and use of mobile phones by adolescents for SRH education. We aimed to establish whether mobile phones could facilitate access to SRH information by adolescents and the barriers to be addressed. This was a qualitative exploratory study involving adolescents, parents, teachers, health care workers, and community health volunteers. Data were collected through focus group discussions (FGDs) and key informant interviews (KIIs), and were analyzed through thematic and content analysis. Respondents lauded mHealth as an effective and efficient approach to adolescent SRH education with a potential to promote the learning of useful SRH information to influence their behavior formation. Respondents pointed out bottlenecks such as the limited ownership of and inequitable access to phones among adolescents, logistical barriers such as lack of electricity, internet connectivity, and the impact of phones on school performance, which must be addressed. The usefulness of mHealth in adolescent SRH education can be enhanced through inclusive program formulation and co-creation, implemented through safe spaces where adolescents would access information in groups, and supported by trained counselors.
This paper reports findings of a pilot survey of adolescent sexual and reproductive health (ASRH) knowledge and behaviour in Homabay County of western Kenya. The study was based on a cross-sectional survey of 523 male and female adolescents aged 10–19 years from 32 Community Health Units (CHUs). Bivariate analysis of gender differences and associations between ASRH knowledge and behaviour was followed with two-level logistic regression analysis of predictors of ASRH behaviour (sexual activity, unprotected sex, HIV testing), taking individual adolescents as level-1 and CHUs as level-2. The findings reveal important gender differences in ASRH knowledge and behaviour. While male adolescents reported higher sexual activity (ever had sex, unprotected last sex), female adolescents reported higher HIV testing. Despite having lower HIV/AIDS knowledge, female adolescents were more likely to translate their SRH knowledge into appropriate behaviour. Education emerged as an important predictor of ASRH behaviour. Out-of-school adolescents had significantly higher odds of having ever had sex (aOR=3.3) or unprotected last sex (aOR=3.2) than their in-school counterparts of the same age, gender and ASRH knowledge, while those with at least secondary education had lower odds of unprotected sex (aOR=0.52) and higher odds of HIV testing (aOR=5.49) than their counterparts of the same age, gender and SRH knowledge who had primary education or lower. However, being out of school was associated with higher HIV testing (aOR=2.3); and there was no evidence of significant differences between younger (aged 10–14) and older (aged 15–19) adolescents in SRH knowledge and behaviour. Besides individual-level predictors, there were significant community variations in ASRH knowledge and behaviour, with relatively more-deprived CHUs being associated with poorer indicators. The overall findings have important policy/programme implications. There is a need for a comprehensive approach that engages schools, health providers, peers, parents/adults and the wider community in developing age-appropriate ASRH interventions for both in-school and out-of-school adolescents in western Kenya.
Adolescents’ access and use of reproductive and maternal health (RMH) services is a critical part of the global strategy for achieving the Sustainable Development Goals (SDGs). However, previous studies have shown that a complex range of factors, including restrictive policies and punitive laws, limit adolescents from accessing a full range of RMH services in Sub-Saharan Africa (SSA). Our study explores the experiences of unmarried adolescents’ access and use of RMH services in Nigeria and Uganda to understand the extent to which the diverse policy environment in both countries enables or hinders adolescents’ access to and use of RMH services. Our qualitative research design involved eight focus group discussions (FGDs) in Nigeria and in Uganda, 14 in-depth interviews, and eight FGDs among adolescents. The data were analysed thematically and organised according to the WHO’s five broad dimensions for assessing youth-friendly health services. Our findings show that RMH services were inequitably delivered in both countries. Adolescents were restricted from accessing services based on age and marital status. Being unmarried and having no partner, especially in Uganda, was a cause for discrimination during antenatal appointments. We also observed that the expectations of adolescents were not adequately met. Service providers tended to be impolite, judgemental, and unwilling to provide services, especially contraceptives, to younger and unmarried adolescents. Our findings suggest that the existence of a youth-friendly health policy does not translate into effective youth-friendly service provision. This underscores the need for further studies to understand the complexities surrounding this by using a realist evaluation method to examine how adolescent and youth-friendly health services can be designed to improve uptake of reproductive and maternal health services among adolescents in Sub-Saharan Africa.
Background Three-quarters of pregnancy terminations in Africa are carried out in unsafe conditions. Unsafe abortion is the leading cause of maternal mortality among young women in Sub-Saharan Africa. Greater understanding of the wider determinants of pregnancy termination in this age group could inform the design and development of interventions to mitigate the harm. Previous research has described the trends in and factors associated with termination of pregnancy for women of reproductive age in Nigeria. However, the wider determinants of pregnancy termination have not been ascertained, and data for all women have been aggregated which may obscure differences by age groups. Therefore, we examined the trends in and individual and contextual-level predictors of pregnancy termination among young women aged 15–24 years in Nigeria. Methods We analysed data from the 2003, 2008, 2013 and 2018 Nigerian Demographic and Health Surveys (NDHS) comprising 45,793 women aged 15–24 years. Trends in pregnancy termination across the four survey datasets were examined using bivariate analysis. Individual and contextual predictors of pregnancy termination were analysed using a three-level binary logistic regression analysis. Results Trends in pregnancy termination declined from 5.8% in 2003 to 4.2% in 2013 then reversed to 4.9% in 2018. The declining trend was greater for women with higher socioeconomic status. Around 17% of the total variation in pregnancy termination was attributable to community factors, and 7% to state-level factors. Of all contextual variables considered, only contraceptive prevalence (proxy for RH service access by young women) at community level was significant. Living in communities with higher contraceptive prevalence increased odds of termination compared with communities with lower contraceptive prevalence (aOR = 4.2; 95% CI 2.7–6.6). At the individual-level, sexual activity before age 15 increased odds of termination (aOR = 2.3; 95% CI 1.9–2.8) compared with women who initiated sexual activity at age 18 years or older, and married women had increased odds compared with never married women (aOR = 3.0; 95% CI 2.5–3.7). Conclusion Our findings highlight the importance of disaggregating data for women across the reproductive lifecourse, and indicates where tailored interventions could be targeted to address factors associated with pregnancy termination among young women in Nigeria.
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