Contraceptive use in adolescents in Sub-Saharan Africa: evidence from Demographic and Health Surveys.

OBJECTIVE: Failure to use contraceptives contributes to an unacceptably high rate of undesired pregnancy in Sub-Saharan adolescents with associated maternal and neonatal mortality/morbidity. Evidence-based research is needed to understand contraceptive usage in Sub-Saharan adolescents and to enable appropriate allocation of donor resources. DESIGN: Nationally-representative USAID (U.S. Agency for International Development) Demographic and Health Surveys from 18 least developed Sub-Saharan African nations. POPULATION: 212,819 Sub-Saharan African women (45,054 were 15-19 years old). METHODS: The percentages of adolescents using contraception, as well as their preferred contraceptive methods and desired family size, were reported. MAIN OUTCOME MEASURES: Contraceptive Use, Neonatal Mortality, Undesired Pregnancy, Pregnancy Terminations. RESULTS: Most adolescents (92.4%) surveyed reported no contraceptive use, although 21.6% reported recent sexual activity. A current pregnancy was reported in 6.6% (n = 2,951) of adolescents with 29.9% of these pregnancies being unwanted. Many surveyed adolescents (18.8%) had at least one prior birth. A death of the previous child was reported in 6.6% (n = 560) with half of these deaths (n = 276) occurring within the first month of life. Many adolescents planned to delay childbearing for at least two years (37.1%) or were unsure about future timing (33.3%), and 2.2% reported a history of at least one pregnancy termination. Most adolescents (73.1%) felt it would be a problem if they became pregnant. Adolescents indicated injectable medications and contraceptive pills were the preferred future contraceptives at 39.9% and 31.4% respectively. CONCLUSIONS: Sub-Saharan African adolescents report a mismatch between desire for contraception and use; preferred methods are oral and injectable contraceptives