Plurinational State of Bolivia - adolescent contraceptive use

Publication date: 2016

Adolescent contraceptive use DATA FROM LA ENCUESTA NACIONAL DE DEMOGRAFÍA Y SALUD DE BOLIVIA (ENDSAB), 2008 P L U R I N AT I O N A L S TAT E O F B O L I V I A What can be done to support Bolivian 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 Plurinational State of Bolivia, there are 2.4 million adolescents aged 10–19 years – 21.4% of the country’s total population.i The majority of adolescents live in urban areas, 68.3% of adolescent girls and 66.5% of adolescent boys.i By age 19, the mean number of years of schooling attended by adolescent girls is 10.3, while for adolescent boys it is 10.9.ii Among adolescents who become parents before age 20, the average age at which Bolivian adolescent girls have their first baby is 17.2 years, while the average age at which adolescent boys first become fathers is 17.8.ii Sexual activity and marital status Analysis of data from the ENDSABii shows that over 283 000 Bolivians 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 16.7 years and adolescent boys at 16.1 years. Among unmarried adolescents, 19.2% of adolescent girls report ever having sex and 8.7% are currently sexually active; among adolescent boys, 35.3% report ever having sex, while 23.7% are currently sexually active. Among all Bolivian adolescents, 13.4% of adolescent girls and 3.7% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 16.8 years for adolescent girls and 17.3 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 Standard days or cycle beads 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 According to ENDSABii analyses, 84.8% unmarried, sexually active adolescent girls report not wanting a child in the next two years, yet only 48.8% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • not married (51.5%) • infrequent sex (54.7%) • not having sex (22.6%) Among all unmarried, sexually active adolescent girls aged 15–19, 51.9% are not using a method of contraception. Male condoms and injectable contraceptives are the most common modern methods used (19.6% and 6.2% of these adolescent girls, respectively). IUDs, which are considered to be one of the most effective methods, are used by 0.5%. Traditional methods (withdrawal or periodic abstinence) are used by 15.4% (see Figure 1). In union According to ENDSABii analyses, 74.5% of adolescent girls in a union report not wanting a child in the next two years, yet only 46.4% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • menses has not returned after giving birth (31.8%) • not having sex (21.0%) • infrequent sex (18.5%) Among all adolescent girls in a union aged 15–19, 59.1% are not using a method of contraception. Injectable contraceptives are the most common modern method used (14.4% of these adolescent girls), while 3.4% are using IUDs. Traditional methods (withdrawal or periodic abstinence) are used by 14.4% 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 Ministerio de Salud y Deportes [Bolivia], Instituto Nacional de Estadístca ,ICF International. Encuesta Nacional de Demografía y Salud (ENDSA) de Bolivia 2008 [Datasets]. BOIR51.DTA and BOMR51.DTA. Calverton (MD): ICF International; 2009 (http://dhsprogram.com/data/dataset/Bolivia_Standard-DHS_2008.cfm?flag=0, accessed 4 November 2016). Not using Withdrawal Periodic abstinence Male condom Pill Injectable contraceptives Lactational amenorrhea (LAM) IUD 4.2 3.1 14.4 3.41.4 2.1 12.3 59.1 51.9 2.2 13.2 19.6 5.6 6.2 0.5 0.3 LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Source: analysis of ENDSAB 2008ii Source: analysis of ENDSAB 2008ii Unmarried, sexually active adolescents who are using a modern method most often get it from a pharmacy (60.9%) or a government facility (24.7%). Adolescents in a union who are using a modern method most often get it from a government facility (52.0%) or a pharmacy (36.1%). Adolescent contraceptive use P L U R I N A T I O N A L S T A T E O F B O L I V I A Use and non-use of contraception adolescent girls, aged 15-19 million adolescents ages 10-19 2.4 16.7 years for adolescent girls 16.1 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 Bolivian 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 84.8% sexually active, unmarried adolescent girls 74.5% adolescent girls in union 60.9% from a pharmacy 52.0% from a government facility 24.7% from a government facility 36.1% 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 NACIONAL DE DEMOGRAFÍA Y SALUD DE BOLIVIA, 2008 COMPILED IN 2016 | UPDATED NOVEMBER 2016 Ministerio de Salud y Deportes [Bolivia], Instituto Nacional de Estadístca, ICF International. Encuesta Nacional de Demografía y Salud (ENDSA) de Bolivia 2008 [Datasets]. BOIR51.DTA and BOMR51.DTA. Calverton (MD): ICF International; 2009 (http:// dhsprogram.com/data/dataset/Bolivia_Standard-DHS_2008.cfm?flag=0, accessed 4 November 2016). 17.2 17.8 for adolescent girls for adolescent boys LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Sexually active, unmarried In union 51.5% not married 31.8% menses has not returned after giving birth 54.7% infrequent sex 21.0% not having sex 22.6% not having sex 18.5% infrequent sex Method Sexually active, unmarried In union Not using 51.9% 59.1% Withdrawal 2.2% 2.1% Periodic abstinence 13.2% 12.3% Male condom 19.6% 4.2% Standard days or cycle beads 0.3% -- Pill 5.6% 3.1% Injectable contraceptives 6.2% 14.4% Lactational amenorrhea (LAM) -- 1.4% IUD 0.5% 3.4% 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/16.54

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