Patterns and Trends in Adolescents' Contraceptive Use and Discontinuation in Developing Countries and Comparisons with Adult Women

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CONTEXT: The reproductive choices made by young women and men have an enormous impact on their health, schooling, employment prospects and overall transition to adulthood. As the largest cohort of young people in history enter their childbearing years, their reproductive behavior will determine the growth and size of the world's population for decades to come.

METHODS: Demographic and Health Survey data from more than 40 countries were used to examine the proportions of 15-19-year-old women who are currently married or are unmarried but sexually active; their rates of contraceptive adoption, current use, discontinuation, method switching and contraceptive failure; trends in these indicators; and comparisons with older women.

RESULTS: In many countries, the proportion of adolescent women using contraceptives increased substantially over the last two decades; prevalence among adolescents increased faster than among older women. Greater proportions of adolescents than of older women discontinued using a contraceptive method within a year or experienced contraceptive failure.

CONCLUSIONS: Adolescent contraceptive use is growing, and compared with adult use, is characterized by shorter periods of consistent use with more contraceptive failure and more stopping for other reasons. Use through the reproductive years is likely to grow, fueled further by growth in the numbers of young people. An expanded demand for contraceptive supplies, services and information can be expected to challenge the preparedness, capacity and resources of existing family planning programs and providers.

International Perspectives on Sexual and Reproductive Health, 2009,35(2):63-71


The reproductive choices made by young women and men have an enormous impact on their health, schooling and employment prospects, as well as their overall transition to adulthood. (1), (2) In particular, school and work opportunities significantly influence young women's and men's marriage timing, quality of parenthood and ability to contribute to their families and society. (1), (3), (4) Young women's reproductive choices are especially important, as early child bearing can impair their health and limit their prospects for productive participation in society.

The literature suggests that, in general, sexually active unmarried adolescents are not seeking to become pregnant, and married adolescents wish not to become pregnant at a young age or, if they have already had a child, wish to delay a second pregnancy. (5) In nine national surveys conducted in South and Southeast Asian countries between 1996 and 1999, contraceptive prevalence among married female adolescents ranged from 6% in Nepal and Pakistan to 43-44% in Thailand and Indonesia. (6)

According to a study of nearly 34,000 15-year-old male and female students in 23 European countries and Canada, 14-38% were sexually experienced; (7) 82% of sexually active students reported using condoms or pills at last intercourse. Another study of 18 Demographic and Health Surveys conducted in Africa between 1993-2001 found that two out of five unmarried females aged 15-24 were sexually active; (8) unlike the results from Europe and Canada, however, the median proportion reporting any contraceptive use by 2001 was just 37%.

Although levels of sexual activity and contraceptive use are both substantial among adolescents in the developing world, the upward shift in the former tends to be faster than in the latter. (9), (10) According to a study of 27 Sub-Saharan countries, there was no pervasive shift toward early (before age 18) sexual initiation between 1994 and 2004, although the prevalence of premarital sex before age 18 increased significantly in 19 countries. (11) Condom use for pregnancy prevention rose significantly during the period, from 5% to 19%. Similar trends in condom use are found in the reproductive and contraceptive histories of single women aged 15-24 in eight Latin American countries, (9) where use of condoms increased faster than reliance on any other method used by this group. …


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