Republic of Zambia - adolescent contraceptive use

Publication date: 2016

Adolescent population: who are they? In the Republic of Zambia, there are 3.7 million adolescents aged 10–19 years – 23.9% of the country’s total population.i Just over half of adolescents live in rural areas, 56.6% of adolescent girls and 58.9% of adolescent boys.i By age 19, the mean number of years of schooling attended by adolescent girls is 8.2, while for adolescent boys it is 8.5. Among adolescents who become parents before age 20, the average age at which Zambian adolescent girls have their first baby is 17.4 years, while the average age at which adolescent boys first become fathers is 18.1. Sexual activity and marital status Analysis of data from the ZDHSii shows that over 531 000 Zambians 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, adolescent girls first have sexual intercourse at age 16.4 years and adolescent boys at 16.2 years. Among unmarried adolescents, 38.7% of adolescent girls report ever having sex and 18.7% are currently sexually active; among adolescent boys, 47.1% report ever having sex, while 25.9% are currently sexually active. Among all Zambian adolescents, 16.9% of adolescent girls and 1.1% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 16.7 years for adolescent girls and 18.1 for adolescent boys. Adolescent contraceptive use DATA FROM THE ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY (ZDHS), 2013-14 R E P U B L I C O F Z A M B I A What can be done to support Zambian 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 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 Male condom Pill Injectable contraceptives Implants 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 ZDHSii analyses, 73.3% of unmarried, sexually active adolescent girls report not wanting a child in the next two years, yet only 20.6% 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 (61.7%) • infrequent sex (37.3%) • fear of side-effects or health concerns (8.6%) Among all unmarried, sexually active adolescent girls aged 15–19, 81.9% are not using a method of contraception. Injectable contraceptives and condoms are the most common modern methods used (6.5% and 6.3% of these adolescent girls, respectively), while implants, which are considered to be one of the most effective methods, are used by 2.5%. Only a small proportion (0.3%) are using a traditional method (withdrawal) (see Figure 1). In union According to ZDHSii analyses, 50.8% of adolescent girls in a union report not wanting a child in the next two years, yet only 43.3% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include: • breastfeeding (28.5%) • menses has not returned after giving birth (26.5%) • not having sex (14.9%) Among all adolescent girls in a union aged 15–19, 62.5% are not using a method of contraception. Injectable contraceptives are the most common modern method used (21.0% of these adolescent girls), followed by pills (6.4%) and male condoms (4.4%). Implants, one of the most effective methods, are used by 2.6%. Few (1.7%) are relying on a traditional method, withdrawal (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 Central Statistical Office [Zambia], Ministry of Health [Zambia], ICF International. Zambia Demographic and Health Survey 2013–14 [Datasets]. ZMIR61.DTA and ZMMR61.DTA. Calverton (MD): ICF International; 2014 (http://dhsprogram.com/data/dataset/Zambia_Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). Not using Withdrawal Female condom Male condom Pill Injectable contraceptives Lactational amenorrhea (LAM) Implants 1.7 1.2 0.3 6.4 4.4 21.0 2.6 62.5 81.9 0.3 6.3 2.4 6.5 2.5 LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use Source: analysis of ZDHS 2013-14ii Source: analysis of ZDHS 2013-14ii Unmarried, sexually active adolescents who are using a modern method most often get it from a government facility (69.1%) or a shop (19.5%). Adolescents in a union who are using a modern method most often get it from a government facility (90.6%) or a shop (6.1%). Adolescent contraceptive use R E P U B L I C O F Z A M B I A Use and non-use of contraception adolescent girls, aged 15-19 million adolescents ages 10-19 3.7 16.4 years for adolescent girls 16.2 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 Zambian 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 73.3% sexually active, unmarried adolescent girls 50.8% adolescent girls in union 69.1% from a government facility 90.6% from a government facility 19.5% from a shop 6.1% from a shop 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 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY, 2013-14 COMPILED IN 2016 | UPDATED NOVEMBER 2016 Central Statistical Office [Zambia], Ministry of Health [Zambia], ICF International. Zambia Demographic and Health Survey 2013–14 [Datasets]. ZMIR61.DTA and ZMMR61.DTA. Calverton (MD): ICF International; 2014 (http://dhsprogram.com/data/dataset/Zambia_ Standard-DHS_2013.cfm?flag=0, accessed 4 November 2016). 17.4 18.1 for adolescent girls for adolescent boys Sexually active, unmarried In union 61.7% not married 28.5% breastfeeding 37.3% infrequent sex 26.5% menses has not returned after giving birth 8.6% fear of side-effects or health concerns 14.9% not having sex Method Sexually active, unmarried In union Not using 81.9% 62.5% Withdrawal 0.3% 1.7% Female condom -- 0.3% Male condom 6.3% 4.4% Pill 2.4% 6.4% Injectable contraceptives 6.5% 21.0% Lactational amenorrhea (LAM) -- 1.2% Implants 2.5% 2.6% LEARN MORE AT who.int/reproductivehealth/adol-contraceptive-use 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/16.47

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