Patterns and trends of contraceptive use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria: Evidence from cross-sectional studies

  • Global Health Action, Volume 8, No. 1, Year 2015

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Study Justification:
– The study aims to assess the patterns and trends of modern contraception use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria.
– It explores the predictors of modern contraception use and discusses the implications of the findings for family planning policy and programs.
– The study highlights the importance of addressing child marriage and adopting effective strategies to reach married adolescents in order to improve empowerment and human capital of adolescent girls.
– It also emphasizes the need for further studies and documentation to understand the reduction of the equity gap in contraception coverage in Ethiopia.
Study Highlights:
– Two different groups of sexually active adolescents were identified: married or in a union with low modern contraception use and lower socio-economic status, and unmarried adolescents with nearly 50% using modern contraception.
– Younger adolescents have lower modern contraceptive prevalence.
– Significant inequality issues exist in modern contraception use by education, residence, and wealth quintile.
– Ethiopia showed significant and systematic reduction of inequalities in contraception use, particularly among childbearing adolescents with no education or living in rural areas.
– Marriage and child immunization were identified as the strongest factors affecting modern contraception use among childbearing adolescents.
– The study suggests a missed opportunity for integrating maternal and newborn care with family planning.
Recommendations:
– Address child marriage and adopt effective policies and strategies to reach married adolescents.
– Further study and documentation are needed to understand the reduction of the equity gap in contraception coverage in Ethiopia.
– Integrate maternal and newborn care with family planning to maximize impact.
Key Role Players:
– Government health departments and ministries responsible for adolescent health, family planning, and maternal and newborn care.
– Non-governmental organizations (NGOs) working on adolescent health, family planning, and women’s empowerment.
– Health workers and providers involved in delivering sexual and reproductive health services to adolescents.
– Community leaders and organizations advocating for adolescent health and rights.
Cost Items for Planning Recommendations:
– Training and capacity building for health workers on adolescent-friendly sexual and reproductive health services.
– Development and implementation of policies and strategies to address child marriage and reach married adolescents.
– Awareness campaigns and educational programs targeting adolescents, parents, and communities.
– Strengthening of health systems to ensure integration of maternal and newborn care with family planning services.
– Monitoring and evaluation activities to assess the impact of interventions and track progress in reducing inequalities in contraception coverage.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on data from nationally representative surveys and includes descriptive and multivariate analysis. However, to improve the evidence, the abstract could provide more details on the methodology used, such as the sample size and sampling method. Additionally, it would be helpful to include information on the statistical significance of the findings and any limitations of the study.

Background: The benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women’s empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations’ human capital. Objectives: The objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes. Design: Data are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15-to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables. Results: There are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation. Conclusions: Addressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration.2015.

We used data from publicly available national surveys (DHS) of Burkina Faso, Ethiopia, and Nigeria where information on adolescents’ sexual activity and contraception use were available. Burkina Faso is a landlocked country in West Africa with a low average contraception use and ranks 181 on the 2014 Human Development Index. Nigeria is also in West Africa, the most populous country in Africa with over 180 million inhabitants, a very low average contraceptive prevalence, and ranking 152 on the 2014 Human Development Index. Ethiopia is located in the Horn of Africa, with an estimated population of 80 million inhabitants, a federal government system similar to that in Nigeria, a recent increase in modern contraception use, and a ranking of 173 on the 2014 Human Development Index. Two surveys were included from Burkina Faso (2003 and 2010), three from Ethiopia (2000, 2005, and 2011), and three from Nigeria (2003, 2008, and 2013). The analyses focused on the use of modern methods of contraception among sexually active adolescents. Descriptive statistics on demographic factors (age and marriage), socio-economic factors (education, location, and wealth quintile), and birth risks (parity and birth spacing) were presented. Age was disaggregated into two groups (15–17 years and 18–19 years) to assess any differences for younger adolescents. Geographic differential effects were assessed at both urban and rural levels and also by states and regions. Short spacing was defined for women with at least two births as within a period of less than 24 months; parity was categorised as either zero, one, two, or more than two; and education was divided into no education, primary school completion, secondary level, or higher than secondary. Wealth quintiles were computed using household asset ownership and principal component analysis as described by Filmer and Pritchett (7). We explored the determinants of modern contraception use among adolescents using the latest DHS in a multivariate analysis, with special interest in the effect of contact with the health system. The indicators we used as proxies for contact with the system included the number of antenatal care (ANC) visits, institutional delivery (yes or no), a postnatal care visit for the mother in the 2 months following delivery (yes or no), child immunisation (three doses of DTP3 used as a proxy and categorised as yes or no), visit to the household by a family planning health worker (yes or no), visit to a health facility by the mother in the past 12 months (yes or no), and whether or not information and counselling on family planning was received during a visit to a health facility. For this analysis, a logistic regression was used, adjusting for the potential confounding effect of socio-economic characteristics (education, residence, wealth quintiles). All the analyses were performed with Stata 13.0 statistical software (8), taking into account the design characteristics of the surveys. Ethical clearances were secured by the organisations that carried out the original surveys.

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Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or text messaging services to provide sexual and reproductive health information, including contraception options, to adolescents. These platforms can also be used to send reminders for antenatal care visits and postnatal care.

2. Community Health Workers: Train and deploy community health workers to provide education and counseling on family planning and maternal health to adolescents in their communities. These workers can also facilitate access to contraceptives and link adolescents to healthcare facilities for antenatal and postnatal care.

3. Youth-Friendly Health Services: Establish youth-friendly health clinics or designated spaces within existing healthcare facilities that cater specifically to the needs of adolescents. These clinics should provide confidential and non-judgmental services, including contraception counseling, provision of contraceptives, and comprehensive sexual and reproductive health services.

4. School-Based Health Education: Integrate comprehensive sexual and reproductive health education into school curricula, ensuring that adolescents receive accurate information about contraception, pregnancy prevention, and the importance of antenatal and postnatal care.

5. Task-Shifting: Train and empower non-medical healthcare providers, such as nurses and midwives, to provide contraceptive services and antenatal and postnatal care. This can help alleviate the shortage of healthcare professionals and increase access to maternal health services.

6. Public-Private Partnerships: Foster collaborations between the public and private sectors to improve access to maternal health services. This can involve leveraging private sector resources and expertise to expand the reach of healthcare facilities, improve infrastructure, and enhance service delivery.

7. Policy and Advocacy: Advocate for policy changes that prioritize adolescent sexual and reproductive health and ensure that comprehensive maternal health services are accessible and affordable for all. This can include removing legal barriers to contraception access for adolescents and allocating sufficient funding for maternal health programs.

These innovations have the potential to address the barriers identified in the research and improve access to maternal health for adolescents in Burkina Faso, Ethiopia, and Nigeria.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to address child marriage and adopt effective policies and strategies to reach married adolescents. This is crucial for improving the empowerment and human capital of adolescent girls. Additionally, there is a need to integrate maternal and newborn care with family planning services to ensure a comprehensive approach to reproductive health. The reduction of the equity gap in coverage in Ethiopia also warrants further studies and documentation to understand the factors contributing to this progress.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Strengthening Adolescent-Friendly Health Services: Implementing comprehensive sexual and reproductive health services specifically tailored to meet the needs of adolescents. This includes providing information, counseling, and access to contraceptives in a non-judgmental and confidential manner.

2. Increasing Community Awareness and Engagement: Conducting community-based awareness campaigns to educate parents, community leaders, and adolescents themselves about the importance of maternal health and the available services. This can help reduce stigma and increase support for adolescent access to maternal health services.

3. Improving Health System Integration: Integrating maternal health services with other existing health services, such as immunization programs and antenatal care, to ensure a holistic approach to adolescent health. This can improve access and continuity of care for adolescents.

4. Addressing Socio-economic Barriers: Implementing strategies to address socio-economic barriers that prevent adolescents from accessing maternal health services, such as poverty, lack of education, and limited transportation. This can include providing financial support, scholarships, and transportation assistance.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data Collection: Collect data on the current status of access to maternal health services among adolescents in the target population. This can be done through surveys, interviews, or analysis of existing data sources such as the Demographic and Health Surveys (DHS).

2. Modeling: Develop a mathematical model that simulates the impact of the recommendations on access to maternal health services. This model should take into account factors such as population size, socio-economic characteristics, and existing health system infrastructure.

3. Parameter Estimation: Estimate the parameters of the model based on available data and expert knowledge. This may involve conducting statistical analysis or using data from previous studies.

4. Scenario Analysis: Simulate different scenarios by varying the parameters of the model to assess the potential impact of each recommendation on access to maternal health services. This can help identify the most effective strategies and prioritize interventions.

5. Evaluation: Evaluate the results of the simulation to determine the potential impact of the recommendations on improving access to maternal health services. This can include analyzing changes in key indicators such as contraceptive prevalence, antenatal care coverage, and institutional delivery rates.

6. Policy Recommendations: Based on the simulation results, provide evidence-based policy recommendations to stakeholders and decision-makers. These recommendations should prioritize interventions that have the greatest potential for improving access to maternal health services among adolescents.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data.

Statistics:
Citations: 38
Authors: 8
Identifiers:
DOI: 10.3402/gha.v8.29737
Research Areas:
Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Burkina Faso, Ethiopia, Multi-Countries, Nigeria
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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