Contraception in adolescence: the influence of parity and marital status on contraceptive use in 73 low-and middle-income countries

Abstract

Background There is still a large gap in relation to effectively meet the contraceptive needs and family planning goals of adolescents. Our aim was to describe how having a partner and children impact on contraceptive behavior of sexually active female adolescents from low and middle-income countries (LMICs). Methods Analyses were based on the most recent Demographic and Health Surveys and Multiple Indicator Surveys carried out since 2005 in 73 LMICs with available data for sexually active women aged 15–19 years. Modern contraceptive prevalence and demand for family planning satisfied with modern methods of contraception (mDFPS) were estimated among three subgroups of adolescents considering their parity and marital status- not married, married without children, and married with children – at national and regional levels. Results Female adolescents who were married with no children presented the lowest median modern contraceptive prevalence in all world regions, ranging from 2.9% in West & Central Africa to 29.0% in Latin America & Caribbean. Regarding mDFPS, the lowest coverage for married adolescents without children was found in West & Central Africa (12.6%), whereas Latin America & Caribbean presented the highest (50.4%). In East Asia & Pacific, not married adolescents were the group with the lowest mDFPS (17.1%). In 12 countries, mDFPS was below 10% among married adolescents without children: Angola, Chad, Congo, Congo DR, Guinea, Mozambique, Niger, Nigeria, and Senegal in Africa, Philippines and Timor-Leste in Asia and Guyana in Latin America & Caribbean. Conclusions In most countries, modern contraceptive prevalence and mDFPS were particularly low among married female adolescents without children, which should be considered a priority group for intervention. The findings suggest that social norms regarding marriage and fertility expectations and other cultural barriers have a role at least as relevant as contraceptive availability. All these aspects need to be considered in the design of family planning strategies to effectively increase modern contraceptive use among adolescents everywhere, particularly in conservative contexts. Electronic supplementary material The online version of this article (10.1186/s12978-019-0686-9) contains supplementary material, which is available to authorized users.

Modern contraceptive use among female refugee adolescents in Northern Uganda: prevalence and associated factors

“…Participants who were married and those who were cohabiting were 89% and 57% less likely to use modern contraceptives respectively than their counterparts who were single. In contrast, previous studies among non-refugees adolescents have shown that adolescents who were married were more likely to use modern contraceptives compared to those who were single (25,26). This inconsistency could have been brought about by the difference in setting and study population of the studies compared to ours.…”

Age disparities in unmet need for contraception among all sexually active women in Colombia: an analysis of the 2015 Demographic Health Survey

“…This use of the algorithm is in contrast to the evidence from a study using DHS data from developing countries which identifies striking differences between married and never-married women with regards to unmet need of contraception, and highlights that the youngest (15 to 19 years old) and single have the highest-burden for unmet need (3). Also, a current study in contraceptive behavior among adolescents identifies marital status as a critical factor of contraceptive use (7). Moreover, previous studies estimated that sexually active unmarried women contribute nearly 20% to the overall unmet need in developing countries (5).…”

“…However, conceptually, the indicator should consider sexually active women as a denominator regardless of their marital status. Besides, the literature has found that the prevalence of unmet need for contraception varies according to marital status (3,(5)(6)(7). The unmet need can be calculated for sexually active unmarried women when information is available (1,2,6,8,9), such as the case of the Demographic and Health Surveys (DHS) in the Latin American region (9) and in contrast with the situation in national surveys of Asia and North Africa, where surveys do not ask unmarried women about their sexual behavior for cultural reasons (8).…”

“…On reproductive health outcomes, these differences mainly affect fertility rates in younger women (20). Age barriers related to the provision of reproductive health services leave behind the poorest, least formally educated, and most vulnerable women, which is disturbing due to the social and economic costs of phenomena such as teenage pregnancy (7,(21)(22)(23).…”

Levels and trends in family planning method use among urban adolescents and young women in Guinea: analysis of Demographic and Health Surveys from 1999 to 2018

“…et Al in 2016 (36). This could be justi ed with the rigid social norms context, the decision-making capacity and maturity of young women to engage in decision making about their own health care including to opt for modern FP methods since they are more enlightened about the availability of different types of FP method as well as their advantages, compared to younger adolescents who may be naïve (32,36,37).…”