Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa

Abstract

Background Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa. Materials and methods We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15–24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs). Results At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs. Conclusion Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation’s health and well being for all as enshrined in Sustainable Development Goals 3 and 5.

Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017–2018 data

“…Regarding parity, women with three or more children were more likely to use both permanent and LARC methods. According to previous studies,4 62 63 using permanent and LARCs increases as children grow 64. One explanation could be that multiparous women frequently get FP information and counselling on contraceptive usage throughout their pregnancy counselling or that women who have previously achieved their desired fertility may take permanent contraceptives or LARCs until menopause 4 64.…”

"I was just concerned about getting pregnant”: Attitudes toward pregnancy and contraceptive use among adolescent girls and young women in Thika, Kenya

“…Many factors influence AGYW’s choices around pregnancy and contraceptive use, including individual opinions, social norms and living circumstances, misconceptions about contraceptives, and stigma among communities and healthcare providers [ 3 , 4 , 9 ]. Research has also shown that use of long-acting reversible contraceptives (LARCs) is particularly low among AGYW, while use of emergency contraception (EC) pills has been emerging as a more popular and accessible option among this group [ 14 – 16 ].…”