Patterns and trends of contraceptive use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria: evidence from cross-sectional studies

Background The benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women's empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations’ human capital. Objectives The objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes. Design Data are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15- to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables. Results There are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation. Conclusions Addressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration.

[1]  T. Robinson,et al.  Sustainable Development Goals , 2016 .

[2]  S. Humair,et al.  Prospects for Economic Growth in Nigeria: A Demographic Perspective , 2016 .

[3]  Y. Chuang,et al.  Factors associated with contraceptive use and intention to use contraceptives among married women in Ethiopia , 2016, Women & health.

[4]  A. Barros,et al.  Estimating family planning coverage from contraceptive prevalence using national household surveys , 2015, Global health action.

[5]  Yoonjoung Choi,et al.  Meeting demand for family planning within a generation: prospects and implications at country level , 2015, Global health action.

[6]  Marleen Temmerman,et al.  Towards a new Global Strategy for Women’s, Children’s and Adolescents’ Health , 2015, BMJ : British Medical Journal.

[7]  J. Bongaarts,et al.  Meeting demand for family planning within a generation: the post-2015 agenda , 2015, The Lancet.

[8]  D. Chou,et al.  Adolescent first births in East Africa: disaggregating characteristics, trends and determinants , 2015, Reproductive Health.

[9]  Rachel Thompson,et al.  Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study , 2015, BMC Public Health.

[10]  Jamie Perin,et al.  Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis , 2015, The Lancet.

[11]  S. Adedini,et al.  Ethnic differentials in under-five mortality in Nigeria , 2014, Ethnicity & health.

[12]  Ali Mehryar Karim,et al.  Effect of the health extension program and other accessibility factors on care-seeking behaviors for common childhood illnesses in rural Ethiopia. , 2014, Ethiopian medical journal.

[13]  W. Winfrey,et al.  Use of family planning in the postpartum period , 2014 .

[14]  C. AbouZahr,et al.  Monitoring Intervention Coverage in the Context of Universal Health Coverage , 2014, PLoS medicine.

[15]  Tim Evans,et al.  Monitoring Progress towards Universal Health Coverage at Country and Global Levels , 2014, PLoS medicine.

[16]  A. Fatusi,et al.  Women’s perceptions and reflections of male partners and couple dynamics in family planning adoption in selected urban slums in Nigeria: a qualitative exploration , 2014, BMC Public Health.

[17]  J. Casterline,et al.  Understanding unmet need: history, theory, and measurement. , 2014, Studies in family planning.

[18]  S. Adebowale,et al.  Determinants of Unmet Need for Modern Contraception and Reasons for Non-use among Married Women in Rural Areas of Burkina Faso , 2014 .

[19]  A. Akinyemi,et al.  Demographic dynamics and development in Nigeria , 2014 .

[20]  Z. Matthews,et al.  Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. , 2014, The Lancet. Global health.

[21]  S. Rutstein,et al.  The effects of fertility behavior on child survival and child nutritional status: Evidence from the Demographic and Health Surveys 2006 to 2012. , 2014 .

[22]  M. Temmerman,et al.  It's about time: WHO and partners release programming strategies for postpartum family planning , 2014, Global Health: Science and Practice.

[23]  V. Chandra-Mouli,et al.  Contraception for adolescents in low and middle income countries: needs, barriers, and access , 2014, Reproductive Health.

[24]  A. Raj,et al.  Effects of young maternal age and short interpregnancy interval on infant mortality in South Asia , 2014, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[25]  P. Sheehan,et al.  Advancing social and economic development by investing in women's and children's health: a new Global Investment Framework , 2013, The Lancet.

[26]  Ron Lesthaeghe,et al.  The Fertility Transition in Sub-Saharan Africa into the 21 st Century , 2014 .

[27]  Daniel R Hogan,et al.  Who Library Cataloguing-in-publication Data , 2022 .

[28]  A. Donner,et al.  Extension of the modified Poisson regression model to prospective studies with correlated binary data , 2013, Statistical methods in medical research.

[29]  D. Shapiro,et al.  Fertility Transition in Sub-Saharan Africa: Falling and Stalling , 2013 .

[30]  O. Odu,et al.  Barriers to use of modern contraceptives among women in an inner city area of Osogbo metropolis, Osun state, Nigeria , 2013, International journal of women's health.

[31]  K. Deribe,et al.  Geographical variation and factors influencing modern contraceptive use among married women in Ethiopia: evidence from a national population based survey , 2013, Reproductive Health.

[32]  J. Stover,et al.  Changes in the distribution of high-risk births associated with changes in contraceptive prevalence , 2013, BMC Public Health.

[33]  N. Walker,et al.  Overview of the Lives Saved Tool (LiST) , 2013, BMC Public Health.

[34]  N. Walker,et al.  Residual confounding explains the association between high parity and child mortality , 2013, BMC Public Health.

[35]  Robert E Black,et al.  The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis , 2013, BMC Public Health.

[36]  W. Fawzi,et al.  The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis , 2013, BMC Public Health.

[37]  Neff Walker,et al.  Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison , 2013, BMC Public Health.

[38]  C. Moyer,et al.  Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review , 2013, Reproductive Health.

[39]  S. Clark,et al.  Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status , 2013, International journal of epidemiology.

[40]  Luche Tadesse Ejeta,et al.  Effect of Ethiopia’s Health Extension Program on Maternal and Newborn Health Care Practices in 101 Rural Districts: A Dose-Response Study , 2013, PloS one.

[41]  Susheela Singh,et al.  Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys , 2013, The Lancet.

[42]  I. Goicolea,et al.  Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study , 2013, International Journal for Equity in Health.

[43]  D. Hotchkiss,et al.  Association between child marriage and reproductive health outcomes and service utilization: a multi-country study from South Asia. , 2013, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[44]  A. Barros,et al.  Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions , 2013, PLoS medicine.

[45]  A. Blanc,et al.  New Findings for Maternal Mortality Age Patterns: Aggregated Results for 38 Countries , 2013, PloS one.

[46]  A. van Soest,et al.  Contraceptive use, birth spacing, and child survival in Matlab, Bangladesh. , 2013, Studies in family planning.

[47]  G. Ramana,et al.  Ethiopia - The health extension program in Ethiopia , 2013 .

[48]  B. Mberu,et al.  BIRTH SPACING AND CHILD MORTALITY: AN ANALYSIS OF PROSPECTIVE DATA FROM THE NAIROBI URBAN HEALTH AND DEMOGRAPHIC SURVEILLANCE SYSTEM , 2012, Journal of Biosocial Science.

[49]  Z. Matthews,et al.  Childbearing in adolescents aged 12–15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries , 2012, Acta obstetricia et gynecologica Scandinavica.

[50]  D. Canning,et al.  The economic consequences of reproductive health and family planning , 2012, The Lancet.

[51]  Qingfeng Li,et al.  Maternal deaths averted by contraceptive use: an analysis of 172 countries , 2012, The Lancet.

[52]  A. Pankhurst,et al.  Child protection and harmful traditional practices: female early marriage and genital modification in Ethiopia , 2012 .

[53]  A. Conde-Agudelo,et al.  Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. , 2012, Studies in family planning.

[54]  A. S. Susuman.  Child Mortality Rate in Ethiopia , 2012, Iranian journal of public health.

[55]  Cesar G Victora,et al.  Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries , 2012, The Lancet.

[56]  J. Lazarus,et al.  Key barriers to the use of modern contraceptives among women in Albania: a qualitative study , 2012, Reproductive health matters.

[57]  T. Croft,et al.  Revising unmet need for family planning. , 2012 .

[58]  J. Bongaarts.  Can family planning programs reduce high desired family size in Sub-Saharan Africa? , 2011, International perspectives on sexual and reproductive health.

[59]  Diddy Antai,et al.  Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants , 2011, Population health metrics.

[60]  J. Cleland,et al.  Family planning in sub-Saharan Africa: progress or stagnation? , 2011, Bulletin of the World Health Organization.

[61]  L. Pritchett,et al.  Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India* , 2001, Demography.

[62]  J. Cramer.  Social factors and infant mortality: Identifying high-risk groups and proximate causes , 1987, Demography.

[63]  A. Adewuyi,et al.  Influence of independent and proximate variables on condom use in selected states in Nigeria. , 2010, African journal of reproductive health.

[64]  S. Sheps,et al.  The effect of maternal age on adverse birth outcomes: does parity matter? , 2010, Journal of Obstetrics and Gynaecology Canada.

[65]  V. Racalbuto,et al.  Countdown to 2015: comparing progress towards the achievement of the health Millennium Development Goals in Ethiopia and other sub-Saharan African countries. , 2010, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[66]  J. Stover,et al.  How Increased Contraceptive Use has Reduced Maternal Mortality , 2010, Maternal and Child Health Journal.

[67]  J. Ginneken,et al.  Determinants of infant and child mortality in Zimbabwe: Results of multivariate hazard analysis , 2009 .

[68]  C. Iyaniwura,et al.  Utilization of antenatal care and delivery services in Sagamu, south western Nigeria. , 2009, African journal of reproductive health.

[69]  I. Mavranezouli,et al.  Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it. , 2008, Contraception.

[70]  L. Hale,et al.  The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: How they vary by the type of pregnancy outcome that began the interval , 2008, Population studies.

[71]  Patrick Royston,et al.  Multivariable Model-Building: A Pragmatic Approach to Regression Analysis based on Fractional Polynomials for Modelling Continuous Variables , 2008 .

[72]  Y. Kinfu,et al.  Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries , 2008, The Lancet.

[73]  David A. Freedman,et al.  On regression adjustments to experimental data , 2008, Adv. Appl. Math..

[74]  J. Cecatti,et al.  The Associations between Inter-Pregnancy Interval and Maternal and Neonatal Outcomes in Brazil , 2008, Maternal and Child Health Journal.

[75]  L. Hale,et al.  Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh , 2007, BJOG : an international journal of obstetrics and gynaecology.

[76]  N. Madise,et al.  Contextual influences on modern contraceptive use in sub-Saharan Africa. , 2007, American journal of public health.

[77]  A. Ezeh,et al.  Family planning: the unfinished agenda , 2006, The Lancet.

[78]  Malcolm Potts,et al.  Barriers to fertility regulation: a review of the literature. , 2006, Studies in family planning.

[79]  Saima Hamid,et al.  Provider and health facility influences on contraceptive adoption in urban Pakistan. , 2006, International family planning perspectives.

[80]  A. Conde-Agudelo,et al.  Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. , 2006, JAMA.

[81]  V. Verma,et al.  Taylor linearization sampling errors and design effects for poverty measures and other complex statistics , 2011 .

[82]  S. Rutstein,et al.  Effects of preceding birth intervals on neonatal, infant and under‐five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys , 2005, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[83]  A. Conde-Agudelo,et al.  Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. , 2005, American journal of obstetrics and gynecology.

[84]  Sander Greenland,et al.  Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. , 2004, American journal of epidemiology.

[85]  D. Hogan,et al.  Social identity and community effects on contraceptive use and intentions in southern Ethiopia. , 2004, Studies in family planning.

[86]  Nigeria.,et al.  Nigeria Demographic and Health Survey 2008 , 2004 .

[87]  A. Barros,et al.  BMC Medical Research Methodology , 2003 .

[88]  Rutstein So,et al.  Guide to DHS statistics. , 2003 .

[89]  Matthias Doepke.  Child mortality and fertility decline: Does the Barro-Becker model fit the facts? , 2002 .

[90]  D. Wulf,et al.  Family planning can reduce high infant mortality levels. , 2002, Issues in brief.

[91]  J. Ross,et al.  Contraceptive Use, Intention to Use and Unmet Need during the Extended Postpartum Period , 2001 .

[92]  D. Lindstrom,et al.  The effects of breastfeeding and birth spacing on infant and early childhood mortality in Ethiopia , 2000, Social biology.

[93]  J. Konje,et al.  Barriers to uptake and use of modern methods of contraception in developing countries , 1999, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[94]  B. Cohen.  The emerging fertility transition in sub-Saharan Africa , 1998 .

[95]  D. Kirk,et al.  Fertility levels, trends, and differentials in sub-Saharan Africa in the 1980s and 1990s. , 1998, Studies in family planning.

[96]  N. Madise,et al.  Assessment of the quality of birth history data in the Demographic and Health Surveys. , 1995 .

[97]  Kung-Yee Liang,et al.  Conditional logistic regression models for correlated binary data , 1988 .

[98]  J. Caldwell,et al.  The Cultural Context of High Fertility in Sub-Saharan Africa , 1987 .

[99]  J. Bongaarts.  The proximate determinants of fertility in sub-Saharan Africa , 1984 .

[100]  B. Winikoff.  The effects of birth spacing on child and maternal health , 1983, Studies in family planning.

[101]  A. Conde-Agudelo,et al.  Contraception and Health , 1976, The Lancet.

[102]  David R. Cox,et al.  Regression models and life tables (with discussion , 1972 .