Republic of Sierra Leone - adolescent contraceptive use

Publication date: 2016

Adolescent contraceptive use DATA FROM THE SIERRA LEONE DEMOGRAPHIC AND HEALTH SURVEY (SLDHS), 2013 R E PU B LI C O F S I E R R A LE O N E What can be done to support Sierra Leonean 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 Republic of Sierra Leone, there are nearly 1.5 million adolescents aged 10–19 years – 23.1% of the country’s total population.i About half of adolescents live in rural areas, 54.5% of adolescent girls and 55.9% of adolescent boys.i By age 19, the mean number of years of schooling attended by adolescent girls is 6.7, while for adolescent boys it is 8.5.ii Among adolescents who become parents before age 20, the average age at which Sierra Leonean adolescent girls have their first baby is 16.5 years, while the average age at which adolescent boys first become fathers is 17.7.ii Sexual activity and marital status Analysis of data from the SLDHSii shows that over 333 000 Sierra Leoneans 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 15.8 years and adolescent boys at 16.4 years. Among unmarried adolescents, 56.2% of adolescent girls report ever having sex and 44.9% are currently sexually active; among adolescent boys, 43.9% report ever having sex, while 33.8% are currently sexually active. Among all Sierra Leonean adolescents, 18.8% of adolescent girls and 0.9% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 16.0 years for adolescent girls and 17.5 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 Implants 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 SLDHSii analyses, 82.2% of unmarried, sexually active adolescent girls report not wanting a child in the next two years, and 54.1% 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 (24.1%) • fear of side-effects or health concerns (19.6%) • not married (14.2%) Among all unmarried, sexually active adolescent girls aged 15–19, 48.6% are not using a method of contraception. Injectable contraceptives are the most common modern method used (22.1% of these adolescent girls) and 13.3% are using implants, which are considered to be one of the most effective methods. Only a small proportion, 1.2%, are using a traditional method (withdrawal or periodic abstinence) (see Figure 1). In union According to SLDHSii analyses, 37.9% of adolescent girls in a union report not wanting a child in the next two years, yet only 10.9% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • breastfeeding (62.8%) • not having sex (33.9%) • she is opposed (6.7%) Among all adolescent girls in a union aged 15–19, 92.2% are not using a method of contraception. Injectable contraceptives are the most common modern method used (3.3% of these adolescent girls), while 1.0% are using IUDs or implants, which are the most effective modern methods (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 Statistics Sierra Leone (SSL) , ICF International. Sierra Leone Demographic and Health Survey 2013 [Datasets]. SLIR61.DTA and SLMR61.DTA. Rockville (MD): ICF International; 2014 (http://dhsprogram.com/data/dataset/Sierra-Leone_Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). Not using Male condom Pill Injectable contraceptives Lactational amenorrhea (LAM) Implants IUD 0.21.93.3 0.8 1.0 0.4 92.2 48.6 0.6 0.62.0 22.1 10.5 0.9 13.3 LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Source: analysis of SLDHS 2013ii Source: analysis of SLDHS 2013ii Unmarried, sexually active adolescents who are using a modern method most often get it from a government facility (68.1%) or a pharmacy (15.4%). Adolescents in a union who are using a modern method most often get it from a government facility (67.4%) or a private facility (20.0%). Adolescent contraceptive use R E P U B L I C O F S I E R R A L E O N E Use and non-use of contraception adolescent girls, aged 15-19 million adolescents ages 10-19 1.5 15.8 years for adolescent girls 16.4 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 Sierra Leonean 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 82.2% sexually active, unmarried adolescent girls 37.9% adolescent girls in union 68.1% from a government facility 67.4% from a government facility 15.4% from a pharmacy 20.0% from a private facility 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 THE SIERRA LEONE DEMOGRAPHIC AND HEALTH SURVEY, 2013 COMPILED IN 2016 | UPDATED NOVEMBER 2016 Statistics Sierra Leone (SSL) , ICF International. Sierra Leone Demographic and Health Survey 2013 [Datasets]. SLIR61. DTA and SLMR61.DTA. Rockville (MD): ICF International; 2014 (http://dhsprogram.com/data/dataset/Sierra-Leone_ Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). 16.5 17.7 for adolescent girls for adolescent boys LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Sexually active, unmarried In union 24.1% infrequent sex 62.8% breastfeeding 19.6% fear of side-effects or health concerns 33.9% not having sex 14.2% not married 6.7% she is opposed Method Sexually active, unmarried In union Not using 48.6% 92.2% Withdrawal 0.6% -- Periodic abstinence 0.6% -- Male condom 2.0% 0.4% Pill 10.5% 1.0% Injectable contraceptives 22.1% 3.3% Lactational amenorrhea (LAM) -- 1.9% Implants 13.3% 0.8% IUD 0.9% 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/16.42

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