Abstract
BackgroundThe unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch.ObjectiveTo determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda.MethodsA randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care.ResultsAdolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition.ConclusionOur data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents’ fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.
Highlights
The unmet need for contraception remains high globally, with the largest numbers among adolescents, migrants, urban slum dwellers and refugees [1]
Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1 24, 95% CI: 1 03 to 1 50, p = 0 023)
Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should be considered in future efforts to prevent adolescent pregnancies in refugee settings
Summary
The unmet need for contraception remains high globally, with the largest numbers among adolescents, migrants, urban slum dwellers and refugees [1]. About 13 million female adolescents who are sexually active or in union, report a wish to delay childbearing, but are not using any contraceptives [2], illuminating a large unmet need for contraception in this population. Among female adolescents in humanitarian settings, the unmet need for contraception is reported to be more than 30% [3,4,5] and the contraceptive prevalence is low. The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Regarding the sexual and reproductive health characteristics, most of the participants had had their first sex by 16 years, had ever been pregnant, and had at least one child alive (Table 1). 15 to 17 18 to 19 Religion Catholic Anglican Adventist Other (Pentecostal, EFC, AIC) Ethnicity Acholi Nuer Dinka Lotuho Other (Shilluk, Luo, Bari) Education None Primary Secondary Tertiary Occupation Unemployed Employed/Self employed Peasant farmer Student Marital status Single Cohabiting Married Separated/Divorced/Widowed Age at first sex (Mean, SD) Ever been pregnant Yes No Number of children alive (Mean, SD) Age of partner 16 to 25 26 to 35 36 to 60 Partner’s education None Primary Secondary Tertiary Partner’s occupation Employed/Self employed Unemployed
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