Dominican Republic - adolescent contraceptive use

Publication date: 2016

Adolescent contraceptive use DATA FROM LA ENCUESTA DEMOGRÁFICA Y DE SALUD DE REPÚBLICA DOMINICANA (ENDESARD), 2013 D O M I N I C A N R E P U B L I C What can be done to support Dominican adolescents to prevent unintended pregnancy? Plan for how, when and where different groups of sexually active adolescents (married and unmarried, boys and girls, rural and urban) use and do not use contraception. Learn the reasons why adolescents are not using contraception, and develop policies and programmes to better address their needs. Understand that adolescents may get contraception from a variety of sources and ensure that each of these sources can provide high quality services for adolescents. COMPILED IN 2016 | UPDATED NOVEMBER 2016 Adolescent population: who are they? In the Dominican Republic, there are over 2 million adolescents aged 10–19 years – 19.0% of the country’s total population.i The majority of adolescents live in urban areas, 78.6% of adolescent girls and 77.0% of adolescent boys.i By age 19, the mean number of years of schooling attended by adolescent girls is 11.0, while for adolescent boys it is 9.8.ii Among adolescents who become mothers before age 20, the average age at which Dominican adolescent girls have their first baby is 17.0 years.ii Sexual activity and marital status Analysis of data from the ENDESARDii shows that nearly 440 000 Dominicans aged 15–19 are currently sexually active – they are either unmarried and have had sex in the last three months or they are in a union (i.e. married or living together). On average, among adolescents who had sex before age 20, adolescent girls first have sexual intercourse at age 16.1 years and adolescent boys at 15.2 years. Among unmarried adolescents, 32.2% of adolescent girls report ever having sex and 24.5% are currently sexually active; among adolescent boys, 57.7% report ever having sex, while 41.0% are currently sexually active. Among all Dominican adolescents, 20.5% of adolescent girls and 3.8% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 16.2 years for adolescent girls and 17.4 for adolescent boys. Contraceptive use and non-use among adolescent girls FIGURE 1. Use and non-use of contraception: unmarried sexually active adolescent girls, aged 15–19 years (%) Not using Withdrawal Periodic abstinence Male condom Pill Injectable contraceptives IUD FIGURE 2. Use and non-use of contraception: adolescent girls in union, aged 15–19 years (%) LISTED FROM LEAST EFFECTIVE TO MOST EFFECTIVE LISTED FROM LEAST EFFECTIVE TO MOST EFFECTIVE Unmarried, sexually active ccording to ENDESARDii analyses, 71.5% of unmarried, sexually active adolescent girls report not wanting a child in the next two years, and 58.1% of them are currently using a method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • infrequent sex (37.6%) • not married (19.6%) • not having sex (15.7%) Among all unmarried, sexually active adolescent girls aged 15–19, 43.8% are not using a method of contraception. Male condoms and pills are the most common modern methods used (25.9% and 16.2% of these adolescent girls, respectively), and injectable contraceptive are used by 7.3%. IUDs, which are considered to be one of the most effective methods, are used by 0.9%. Withdrawal or periodic abstinence, traditional methods, are used by 4.3% (see Figure 1). In union According to ENDESARDii analyses, 67.1% of adolescent girls in a union report not wanting a child in the next two years, and 62.9% of them are currently using a method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • menses has not returned after giving birth (22.9%) • infrequent sex (17.1%) • fear of side-effects or health concerns (11.4%) Among all adolescent girls in a union aged 15–19, 45.5% are not using a method of contraception. Pills and injectable contraceptives are the most common modern methods used (30.7% and 13.4% of these adolescent girls, respectively). IUDs and implants, which are among the most effective methods, are used by 1.0% and 0.7% respectively. Female sterilization, a permanent method, is used by 0.2%. Traditional methods (withdrawal or periodic abstinence) are used by 2.7% of these adolescent girls (see Figure 2). i Urban and rural population by age and sex, 1980–2015 [online database]. New York (USA): United Nations Department of Economic and Social Affairs, Population Division; 2014 (https://esa. un.org/unpd/popdev/urpas/urpas2014.aspx, accessed 4 November 2016). ii Centro de Estudios Sociales y Demográficos (CESDEM) [Dominican Republic], ICF International. Encuesta Demográfica y de Salud de República Dominicana 2013 [Datasets]. DRIR61.DTA and DRMR61.DTA. Calverton (MD): ICF International; 2014 (http://dhsprogram.com/data/dataset/Dominican-Republic_Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). Not using Withdrawal Periodic abstinence Male condom Pill Injectable contraceptives Lactational amenorrhea (LAM) Implants IUD Female sterilization 13.4 0.21.6 0.71.0 2.13.5 30.7 45.5 43.8 3.40.9 25.9 16.2 7.3 0.9 LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Source: analysis of ENDESARD 2013ii Source: analysis of ENDESARD 2013ii Unmarried, sexually active adolescents who are using a modern method most often get it from a pharmacy (46.1%) or a government facility (28.1%). Adolescents in a union who are using a modern method most often get it from a government facility (51.2%) or a pharmacy (35.6%). 0.6 Adolescent contraceptive use D O M I N I C A N R E P U B L I C Use and non-use of contraception adolescent girls, aged 15-19 million adolescents ages 10-19 2 16.1 years for adolescent girls 15.2 years for adolescent boys Among adolescents who had sex before age 20, the average age at first sex is Among adolescents who become parents before age 20, the average age at first birth is What can be done to support Dominican adolescents to prevent unintended pregnancy? Main reasons for not using contraception Report not wanting a child in the next two years Sexually active, unmarried In union 71.5% sexually active, unmarried adolescent girls 67.1% adolescent girls in union 46.1% from a pharmacy 51.2% from a government facility 28.1% from a government facility 35.6% from a pharmacy Understand that adolescents may get modern contraception from a variety of sources. Learn the reasons why adolescents are not using contraception. Plan for how, when, and where different groups of adolescents use or don’t use contraception. ANALYSIS OF LA ENCUESTA DEMOGRÁFICA Y DE SALUD DE REPÚBLICA DOMINICANA, 2013 COMPILED IN 2016 | UPDATED NOVEMBER 2016 Centro de Estudios Sociales y Demográficos (CESDEM) [Dominican Republic], ICF International. Encuesta Demográfica y de Salud de República Dominicana 2013 [Datasets]. DRIR61.DTA and DRMR61.DTA. Calverton (MD): ICF International; 2014 (http:// dhsprogram.com/data/dataset/Dominican-Republic_Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). 17.0 for adolescent girls LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Sexually active, unmarried In union 37.6% infrequent sex 22.9% menses has not returned after giving birth 19.6% not married 17.1% infrequent sex 15.7% not having sex 11.4% fear of side- effects or health concerns Method Sexually active, unmarried In union Not using 43.8% 45.5% Withdrawal 3.4% 2.1% Periodic abstinence 0.9% 0.6% Male condom 25.9% 3.5% Pill 16.2% 30.7% Injectable contraceptives 7.3% 13.4% Lactational amenorrhea (LAM) -- 1.6% Implants -- 0.7% IUD 0.9% 1.0% Female sterilization -- 0.2% REASONS FOR NON-USE: Not married Not having sex Infrequent sex Menses has not returned after birth Breastfeeding Fatalistic (up to god) She is opposed Husband/partner is opposed Religious prohibition Knows no method Knows no source Fear of side effects/health concerns Inconvenient to use Others opposed Lack of access/too far SOURCE OF METHOD: Government facility Private facility Pharmacy Shop Friends or parents Other Community Health Worker Icon Directory METHODS: Not using Withdrawal Periodic abstinence Rhythm/calendar Female condom Male condom Standard days/cycle beads Pill Injectable contraceptives Lactational amenorrhea (LAM) Implants IUD Male sterilization Female sterilization © WHO 2016. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence WHO/RHR/16.56

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