Trends and determinants of modern contraceptive utilisation among adolescent girls aged 15-19 years in Sierra Leone: an analysis of Demographic and Health Surveys, 2008-2019

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Abstract

Background

Modern contraceptives are effective interventions for preventing unwanted pregnancies, but their use remain low among adolescent girls in sub-Saharan Africa. First, we aimed to assess the trends of modern contraceptive use among adolescent girls aged 15-19 years in Sierra Leone in the period 2008-2019. Second, we explored how individual and contextual determinants of their use changed during this period.

Methods

We used a combined sample of 8,774 adolescent girls aged 15-19 years from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys (SLDHS), respectively, to estimate the modern contraceptive prevalence rate (MCPR) and unmet need for family planning. We described the method mix and sources of contraceptives among modern method users. We then conducted a multivariable logistic regression to examine the determinants of modern contraceptive use among sexually active adolescent girls, separately for 2008 and 2019.

Results

MCPR increased from 5.9% (95% CI=4.5-7.8) in 2008 to 21.0% (95% CI=19.2-22.9) in 2019. Most of the increase had occurred by 2013. Norplant (48.8%) and injectables (39%) were the common methods in 2019. Unmet need for family planning declined from 15.4% (95% CI=13.2-17.9) in 2008 to 11.3% (95% CI=9.9-12.7) in 2019, while the prevalence of modern contraceptive use among sexually active adolescent girls increased from 13.1% (95% CI=10-17.0) in 2008 to 43.5% (95% CI=40.2-46.9) in 2019. In both the 2008 and 2019 surveys, the adjusted odds of using modern contraceptives among sexually active adolescent girls were higher among those with more than one sexual partner in the past 12 months, and with secondary or tertiary education. In 2019, the adjusted odds of using a modern contraceptive were also lower among adolescent girls who were married or living with a partner, had more than one child, and lived in the Western province.

Conclusions

The increase in contraceptive use among adolescent girls in Sierra Leone had stalled since 2013. Interventions, including increasing awareness and accessibility to modern contraceptives, are urgently needed, particularly for adolescents without formal education. Comprehensive and affordable community and school-based interventions, including adolescent-friendly services, would be helpful.

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Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents.

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Adolescent sexual and reproductive health: The global challenges

Jessica Morris, Hamid Rushwan (2015)

Adolescent sexual and reproductive health (ASRH) has been overlooked historically despite the high risks that countries face for its neglect. Some of the challenges faced by adolescents across the world include early pregnancy and parenthood, difficulties accessing contraception and safe abortion, and high rates of HIV and sexually transmitted infections. Various political, economic, and sociocultural factors restrict the delivery of information and services; healthcare workers often act as a barrier to care by failing to provide young people with supportive, nonjudgmental, youth-appropriate services. FIGO has been working with partners and its member associations to break some of these barriers-enabling obstetricians and gynecologists to effect change in their countries and promote the ASRH agenda on a global scale.