Global Health Priority: Teaching Teens About Contraception

 

Teen sexual health isn’t just a wellness issue in the UK; it’s a global public health priority. A lack of access to and use of contraception can put the wellbeing adolescent girls at risk worldwide, translating into high numbers of unintended pregnancies, and into high maternal mortality in countries with poor maternal health care systems.

 

According to adolescent health and development co-ordinator Venkatraman Chandra-Mouli, and Karlien Braet of the World Health Organisation (WHO), ‘Globally, progress is being made in reducing the unmet need for contraception, but it is slow with more progress in some countries than in others. Bangladesh and Malawi are cited as success stories. In Bangladesh, the use of contraception among married women aged 10 to 49 rose from 49% in 1996/97 to 61% in 2011. However, among married adolescents aged 15 to 19 years, contraception use rose by a lesser margin – from around 33% in 1996/97 to 47% in 2011. In Malawi, the use of contraception in married women aged 15 to 49 years rose from 13% in 1992 to 46% in 2010, whereas among married adolescents aged 15 to 19 years, it rose from 7% in 1992 to around 29% in 2010.’

 

But what is preventing adolescents in getting and using contraception? Chandra-Mouli and Braet explain, ‘Erratic availability, cost, laws and policies prevent unmarried adolescents in low and middle income countries from accessing contraceptives. Even when there are no legal restrictions, health workers often refuse to provide unmarried adolescents with contraceptives because they do not approve of premarital sex. And when they do provide contraceptives, they often limit these to condoms, wrongly believing that long-acting hormonal methods and intra-uterine devices are inappropriate for all young women and those who have not had children.’

 

Chandra-Mouli and Braet note, ‘Even when adolescents are able to obtain contraceptive methods, social pressure may prevent their use. First, in many places young women are under pressure to bear children soon after marriage. Contraception is considered – if it is considered at all – after the first child is born. Second, the stigma surrounding contraception prevents their use by adolescents who are not in stable relationships. A young woman who proposes condom use, for example, runs the risk of being considered “loose”. Third, adolescents in many places have misconceptions about health effects of contraceptives, including their future ability to bear children. As a result, they tend to prefer traditional remedies or to use ineffective methods such as withdrawal. Fourth, many adolescents have poor understanding of how contraceptive methods work and use them incorrectly. Finally, sporadic and infrequent sex leads to an inconsistent use of contraceptives.’

 

So what efforts are being made to overcome these barriers? ‘An outstanding example of overcoming the barriers that adolescents face accessing contraception is Pathfinder International’s Prachar project,’ Chandra-Mouli and Braet point out. ‘Intended to promote change in reproductive behaviour of adolescents project in Bihar, India, events were held for newly married couples to celebrate their marriage and emphasise the benefits of delaying having children and provided couples with a small supply of oral contraceptive pills and condoms. Further, male and female counsellors spoke to young married men and women individually in their homes on reproductive health.’

 

Chandra-Mouli and Braet add, ‘The project also targeted unmarried adolescents aged 15 to 19 with workshops on sexual and reproductive health. The programme successfully delayed marriage of both male and female participants. It led to significant increases in contraceptive demand and contraceptive use among married women under 25 and delayed childbearing. The challenge is to build on the lessons learned from projects such as Prachar to build large scale and sustained nationwide programmes. Core elements of that project are now being applied at scale in India’s Bihar state, but that is unusual. Many other projects aimed at providing contraceptive information and services to adolescents in India and elsewhere continue to be small-scale and time-limited.’

 

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