Abstract
BackgroundStudies have shown that emergency contraception (EC) remains underutilised in preventing unintended pregnancy in sub-Saharan Africa (SSA). Small-scale surveys have attributed EC underutilisation to gaps in EC awareness among SSA women and girls. However, limited studies have explored trends in EC awareness in SSA. We address this gap by examining trends in EC awareness using data from 28 SSA countries. Our analysis was disaggregated by age distribution, place of residence, level of education, and wealth to show differences in EC awareness trend.MethodsWe analysed the Demographic and Health Surveys (DHS) data of 1,030,029 women aged 15 to 49 on emergency contraception awareness. EC awareness was defined as having ever heard of special pills to prevent pregnancy within 3 days after unprotected sexual intercourse. Frequencies and percentages were used to summarise trends in EC awareness between years 2000 and 2019.ResultsOverall, there was an upward shift in the level of EC awareness in all countries, except in Burkina Faso, Niger, Chad, and Ethiopia. While some countries recorded a significant upward trend in EC awareness, others recorded just a slight increase. Women in Kenya, Ghana, Gabon, and Cameroon had the highest upward shift in EC awareness. For example, only 28% of women were aware of EC in Ghana in 2003, but in 2014, 64% of women knew about EC, an increase of over 36 percentage points. Increase in EC awareness was starker among women aged 20–24 years, those who resided in urban areas, had higher education, and belong to the highest wealth quintile, than those aged 15–19, in rural areas, with no formal education and belonging to the lowest wealth quintile.ConclusionOur analysis shows that the level of EC awareness has increased substantially in most SSA countries. However, EC awareness still differs widely within and between SSA countries. Intervention to improve EC awareness should focus on women aged 15 to 19, those with no formal education, residing in rural areas, and within the lowest quintile, especially, in countries such as Chad, Niger, Burkina Faso, and Ethiopia where level of EC is low with lagging progress.
Highlights
Unplanned pregnancy and unsafe abortion are global social problems with severe socioeconomic, health, and demographic consequences
Overall, there was an upward shift in the level of emergency contraception (EC) awareness in all countries, except in Burkina Faso, Niger, Chad, and Ethiopia
Only 28% of women were aware of EC in Ghana in 2003, but in 2014, 64% of women knew about EC, an increase of over 36 percentage points
Summary
Unplanned pregnancy and unsafe abortion are global social problems with severe socioeconomic, health, and demographic consequences. An estimated 42% of pregnancies in sub-Saharan Africa are unintended [2]. Unintended pregnancy is the main reason women and girls seek abortion. When women experience unintended pregnancy, some carry it to term while others seek abortion services. In SSA, about 37% of women with unintended pregnancies terminate it. An estimated 6.2 million unsafe abortions occur each year in SSA, and 1.6 million women are treated for unsafe abortion-related complications [1]. Studies have shown that emergency contraception (EC) remains underutilised in preventing unintended pregnancy in sub-Saharan Africa (SSA). Small-scale surveys have attributed EC underutilisation to gaps in EC awareness among SSA women and girls. Limited studies have explored trends in EC awareness in SSA. Our analysis was disaggregated by age distribution, place of residence, level of education, and wealth to show differences in EC awareness trend
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