Long term trends in behaviour to protect against adverse reproductive and sexual health outcomes among young single African women

Mohamed M Ali,John Cleland

doi:10.1186/s12978-018-0576-6

Mohamed M Ali, John Cleland

Open Access

https://doi.org/10.1186/s12978-018-0576-6

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Abstract

BackgroundHIV and unintended pregnancy are major interrelated concerns in sub-Saharan Africa. Focussing on single women aged 15-24 years we assess trends in key behaviours that affect both outcomes.MethodsWe performed a secondary analysis of public-access data sets from 112 surveys from 36 countries in the region, conducted between 1991 and 2015. We examined trends over 20 years in primary abstinence (virginity), secondary abstinence (no sex in past 3 months) among sexually experienced women, current use of modern contraception and condom use at most recent coitus among sexually active women.ResultsLittle change occurred in primary or secondary abstinence. Over the 20 year period, contraceptive use in the region rose from 14.7 to 33.4%, with significant increases observed in 18 of 30 countries with multiple surveys. Since 2001–2005, the proportion of contraceptive users reporting condoms as their method fell from 61.1 to 51.3%, while use of oral contraceptives or injectables rose from 19.9 to 24.0%. Between 1996 and 2000 and 2006–2010, condom use at last coitus rose from 21.3 to 40.5% but then plateaued. A strong correlation between condom use and national HIV prevalence was found. About half of condom users at last sex had earlier in interviews reported this method for pregnancy-prevention.ConclusionsThough condoms tend to be overlooked by both HIV and family planning agencies, their contribution to the health of single women remains central. Current efforts to promote non-barrier contraceptive methods may inadvertently increase HIV risk. Condom promotion for pregnancy-prevention should be re-invigorated by social marketing campaigns and other means.

Highlights

HIV and unintended pregnancy are major interrelated concerns in sub-Saharan Africa
We focus on single women aged 15 to 24 years living in sub-Saharan Africa
We focussed on 4 self-reported behavioural outcomes: primary abstinence; secondary or temporary abstinence in sexually experienced women; current use of modern contraceptive methods among women who had been sexually active in the 3 months preceding the survey; and condom use at most recent coitus among the sexually active

Summary

Introduction

HIV and unintended pregnancy are major interrelated concerns in sub-Saharan Africa. Prominent among concerns are reproductive and sexual health, in sub-Saharan Africa ( Africa). Because of the combination of high birth rates and declining mortality, the youth population in this region is large, accounting for 38% of the total. Maternal mortality ratios in young women and abortion rates in unmarried women are estimated to be higher in Africa than elsewhere and, because of restrictive laws, many abortions are unsafe [3, 4]. A very large literature has accumulated on the reproductive and sexual health, and associated behaviour, of young women in Africa. Contraceptive use among sexually active unmarried teenagers has increased though contraceptive failure and discontinuation are more common in this group than among older women [9]. Unmet need for contraception--non-use in those wanting to avoid pregnancy-- in African adolescents remains high [10]

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