Republic of the Gambia - adolescent contraceptive use

Publication date: 2016

Adolescent contraceptive use DATA FROM THE GAMBIA DEMOGRAPHIC AND HEALTH SURVEY (GDHS), 2013 R E P U B L I C O F T H E G A M B I A What can be done to support Gambian 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 the Gambia, there are 458 000 adolescents aged 10–19 years – 23.3% of the country’s total population.i The majority of adolescents live in urban areas, 61.2% of adolescent girls and 59.1% of adolescent boys.i By age 19, the mean number of years of schooling attended by both adolescent girls and boys is 7.1.ii Among adolescents who become parents before age 20, the average age at which Gambian adolescent girls have their first baby is 17.1 years, while the average age at which adolescent boys first become fathers is 18.7.ii Sexual activity and marital status Analysis of data from the GDHSii shows that over 37 500 Gambians 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 16.4 years and adolescent boys at 16.7 years. Among unmarried adolescents, 4.7% of adolescent girls report ever having sex and 1.2% are currently sexually active; among adolescent boys, 22.8% report ever having sex, while 10.3% are currently sexually active. Among all Gambian adolescents, 23.8% of adolescent girls and 0.3% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 16.3 years for adolescent girls and 18.1 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 Male condom Pill Injectable contraceptives 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 GDHSii analyses, only 7.0% of unmarried, sexually active adolescent girls report not wanting a child in the next two years. Among all unmarried, sexually active adolescent girls aged 15–19, 67.6% are not using a method of contraception. Male condoms are the most common modern methods used (25.2% of these adolescent girls), followed by pills (6.0%) and injectable contraceptives (1.3%) (see Figure 1). In union According to GDHSii analyses, 25.8% of adolescent girls in a union report not wanting a child in the next two years, yet only 6.5% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • breastfeeding (46.5%) • she is opposed (24.1%) • menses has not returned after giving birth (14.9%) Among all adolescent girls in a union aged 15–19, nearly all (96.7%) are not using a modern method of contraception. Of the 3.3% of adolescent girls that are using a method, 1.1% are using injectable contraceptives, and less than 1% are using male condoms, pills, or IUDs (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 The Gambia Bureau of Statistics (GBOS), ICF International. Gambia Demographic and Health Survey 2013 [Datasets]. GMIR60.DTA and GMMR60.DTA. Rockville (MD): ICF International; 2014 (http://dhsprogram.com/data/dataset/Gambia_Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). Not using Male condom Pill Injectable contraceptives IUD 1.1 0.2 0.1 0.8 96.7 67.6 25.2 6.0 1.3 LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Source: analysis of GDHS 2013ii Source: analysis of GDHS 2013ii Unmarried, sexually active adolescents who are using a modern method most often get it from a pharmacy (43.3%) or a shop (18.0%). Adolescents in a union who are using a modern method most often get it from a government facility (37.1%) or a pharmacy (32.2%). Adolescent contraceptive use R E P U B L I C O F T H E G A M B I A Use and non-use of contraception adolescent girls, aged 15-19 million adolescents ages 10-19 0.5 16.4 years for adolescent girls 16.7 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 Gambian 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 7.0% sexually active, unmarried adolescent girls 25.8% adolescent girls in union 43.3% from a pharmacy 37.1% from a government facility 18.0% from a shop 32.2% 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 THE GAMBIA DEMOGRAPHIC AND HEALTH SURVEY, 2013 COMPILED IN 2016 | UPDATED NOVEMBER 2016 The Gambia Bureau of Statistics (GBOS) and ICF International. Gambia Demographic and Health Survey 2013 [Datasets]. GMIR60.DTA and GMMR60.DTA. Rockville (MD): ICF International; 2014 (http://dhsprogram.com/data/ dataset/Gambia_Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). 17.1 18.7 for adolescent girls for adolescent boys LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Method Sexually active, unmarried In union Not using 67.6% 96.7% Male condom 25.2% 0.8% Pill 6.0% 0.1% Injectable contraceptives 1.3% 1.1% IUD -- 0.2% Sexually active, unmarried In union -- 46.5% breastfeeding -- 24.1% she is opposed -- 14.9% menses has not returned after giving birth 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/16.26

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