Low Contraceptive Use Research Articles

Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis

BackgroundSub-Saharan Africa has among the highest prevalence of teenage pregnancy in the world. Teenage mothers and their children are at risk to a host of medical, social and economic challenges....

Timing between age at first sexual intercourse and age at first use of contraception among adolescents and young adults in Niger: What role do education and place of residence play?

Background: Low contraceptive use among women in Niger is one of main causes of early childbearing and unwanted pregnancies, which affect maternal and child health. Education and place of residence have been cited as factors affecting modern contraceptive use. Methods: We investigated the separate and joint effects of the place of residence and education on the time to modern contraceptive uptake among women aged 15-24 in Niger. The study used data from the second round of the 2016 Niger Performance Monitoring and Accountability 2020 (PMA2020) project. Survival analysis was applied for 830 women. Results: Nelson-Aalen curves show that urban women had higher hazards of (and shorter delays in) modern contraceptive uptake as compared to their rural counterparts. Also, the higher the level of education, the higher the hazards of (and the shorter the delays in) modern contraceptive uptake. Findings from the multivariate (survival) analysis confirms these figures and provides the net effect of the place of residence on modern contraceptive uptake. Whether living in urban or rural areas of Niger, what matters more is the level of education. Conclusions: Family planning programmes concerning adolescent and young women should focus more on women with no education and those that are illiterate.

Decision Making and Communication About Child Spacing Among Somali Couples in Minnesota.

Since civil unrest broke out in Somalia in the 1990s, large numbers of Somalis have immigrated to Western countries, including the United States. It is unknown whether these immigrants maintain their cultural norms of low contraceptive use and high fertility when they live in settings with different norms. In 2016, interviews were conducted in Minnesota with Somali immigrants and refugees to explore couple communication and decision making regarding child spacing. Nineteen married men and women aged 25-51 were interviewed. After a coding scheme was developed, key themes were identified and examined by participants' sex, number of children and age of arrival in the United States. Most participants discussed child spacing with their spouse and had positive or neutral experiences. Some participants, especially those with multiple children, stated that living in their new country had influenced their fertility desires. Only those who had arrived after the age of 20 mentioned that experiencing closely spaced births had motivated them to discuss child spacing. Participants emphasized the importance of information sharing, compromise and joint decision making with their spouse. Priority for child-spacing decision making was granted to women, largely because of their primary role in childbirth. Men who had arrived in the United States before turning 20 were more definitive about giving women decision-making priority. These findings provide insight into how Somali immigrant and refugee couples communicate and make decisions about child spacing, and may be helpful in informing the development of culturally specific reproductive health programs.

Attitudes and practices related to intrauterine devices for nulliparous women among Chinese health care providers

BackgroundUnintended pregnancy and induced abortion among young (unmarried or nulliparous) women have become serious social and health issues in China, which are thought to partly result from low use of long-acting reversible contraception, such as intrauterine devices (IUDs). Considering that providers may play an especially important role in increasing use of this particular method, we investigated Chinese health care providers’ attitudes and practices regarding IUDs use for nulliparous women, and further examine the potential factors and reasons contributing to their attitudes and practices.MethodsWe recruited health care providers at two Chinese national academic conferences and surveyed them about knowledge of IUDs, willingness to recommend IUDs to nulliparous women, and their related practices. Modified Poisson regression was used to examine the potential factors related to their attitudes and practices.ResultsApproximately a half of respondents reported unwillingness to recommend IUDs to nulliparous women. Providers with more misperceptions about the safety and contraindications were more likely to be unwilling to recommend IUDs to nulliparous women. Moreover, 71.0% of respondents rarely or never recommended or provided IUDs to nulliparous women. Providers’ unwillingness to recommend IUDs to nulliparous women was associated with their infrequent practices (aPR=1.43; 95% CI: 1.04, 1.96). In addition to concerns about the side effects or complications, traditional sexual concept against premarital sex was often cited as a reason by Chinese health providers for their negative attitudes towards IUDs use for nulliparous women, a large proportion of whom are unmarried.ConclusionsOur findings suggest that negative attitudes and infrequent practices regarding IUDs use for nulliparous women are common in Chinese health care providers. Moreover, misperceptions about IUDs, as well as traditional sexual concept, contribute to Chinese health care providers’ negative attitudes towards IUDs use for nulliparous women, and may further reduce their provision. Educational interventions are needed to improve providers’ accurate knowledge of IUDs and fill the gap between traditional sexual concept and young women’s needs of contraceptive services.

Access to Information on Family Planning and Use of Modern Contraceptives Among Married Igbo Women in Southeast, Nigeria.

This study was conducted among married Igbo women in Nigeria who have the lowest median birth interval coupled with a culture of sex preference and low use of modern contraceptives. We examined the relationship between access to information on family planning and sex preference on the use of modern contraceptive (MC). The 2013 Nigeria Demographic and Health Survey data were used. The data of 1,661 women of reproductive age were analyzed in this study. Access to information on family planning was low, and almost half (48.6%) of the women had a score of zero. Controlling for possible confounding variables, the data show that women who have good (odds ratio [ OR]= 3.92; CI [2.28, 6.75], p < .001) and poor ( OR = 2.56; CI [1.85, 3.56], p < .001) access to information on family planning were more likely to use MC than those with no access to information on family planning. Sex preference showed no relationship with the use of MC. Families where husbands want more children than their wives inhibit ( OR = 0.62, CI [0.42, 0.90], p < .05) the use of MC compared with those families where husbands and wives fertility desire is the same. Public health programs by government and donors should intensify interventions to increase access to family planning information to promote the use of MC among married Igbo women.

Men on the move and the wives left behind: the impact of migration on family planning in Nepal

Nepali migration is longstanding, and increased from 2.3% of the total population in 2001 to 7.2% in 2011. The estimated 1.92 million migrants are predominantly men. Consequently, 32% of married women have husbands working abroad. Social structures are complicated as many married women live with their in-laws who typically assume decision-making power, including access to health services. This study compares access to reproductive health services, fertility awareness, and decision-making power among a sample of married women aged 15–24 years (n = 1123) with migrant husbands (n = 485), and with resident husbands (n = 638). Predictably, women with migrant husbands had significantly lower contraceptive use than other married women (9.3% vs 30.3%, respectively), and expressed a higher intention to become pregnant in the next year. Despite their intentions, women with migrant husbands scored lower on a fertility awareness index, were less likely to discuss pregnancy planning with their spouse, and less likely to describe their relationships positively. Decision-making for both groups of married women was dominated by both husbands and in-laws in different ways. Yet, across multiple normative scales, fewer women with migrant husbands felt pressure to conform to existing social norms. Married women with migrant husbands reflect a subset of women, with unique fertility issues and desires. Interventions that increase knowledge of fertility among this subset of women, promote healthy preconception behaviours. Linking women for counselling opportunities throughout the pre and postnatal periods may help improve health outcomes for mothers and children.

Use of Contraceptive Methods among Young Married Women in Nepal

Nepal has a fairly high adolescent fertility rate and low use of contraception. Lack of contraceptive use is a major contributor to the high rates of unintended pregnancies amongst youth. There is also lack of specific studies dealing with contraceptive behavior among young married women. This study examines the use and determinants of contraceptive methods over the time period of 15 years (2001-2016) among young women in Nepal. Trend and bi-vatiate analysis of this study is based on the Nepal Demographic and Health Survey (NDHS), 2001, 2006, 2011 and 2016 data. The multivariate analysis is based on NDHS 2016 data of 2059 currently married non-pregnant young women aged 15-24 years. Logistic regression is used to assess the net effect of independent variables on dependent variable. The study shows that the contraceptive prevalence rate of young women is only 34 percent. Number of living children, spousal separation, husband education, women, occupation, wealth status, caste/ethnic affiliation, fertility preference, decision making status, ideal number of children they prefer and media exposure, are statistically associated to the use of contraception among young women in Nepal. There is a need to strengthen income generating activities so as to improve young women's socio-economic status which will translate into female economic and social empowerment hence ability to discuss sexuality related issues. Family planning programmes should be designed so as to address the contraceptive need of young women especially the low parity and Muslim adolescents.

Spatial Variations in Utilization of Modern Contraceptives in Ethiopia

Background: Even though modern contraceptives are known to be important for fertility control, utilization of these services varies across different geographical areas. A geographically linked data analysis using population and health facility data is important to investigate and map the use of family planning services. Thus, this study aimed to assess the spatial patterns of modern contraceptive use and to identify its associated factors among married women in Ethiopia. Method: A secondary data analysis of the 2016 Ethiopia Demographic and Health Survey and the 2014 Ethiopian Service Provision Assessment was conducted. A multilevel analysis was conducted to identify the potential factors associated with the use of modern contraceptives among married women in Ethiopia using the SAS GLIMMIX procedure. Furthermore, a spatial analysis was done to identify the potential hot spot areas of modern contraceptive prevalence rates using ArcGIS. Results: Being exposed to family planning messages, having a higher number of living children, husbands'/partners' education level, and wealth were strongly associated with increased use of modern contraceptives. More importantly, a one unit increase in the mean score of health facilities' readiness to provide short-term modern contraceptives in a typical region was associated with a 20 fold increase in the odds of modern contraceptive use. 24.47% of the variation in the use of modern contraception was accounted for by location. Moreover, the spatial analysis found that Addis Ababa and the Amhara region had high clusters of modern contraceptive use rates as compared to clusters of low contraceptive use rates in the Afar and Somali regions. Conclusion: There were significant variations in the use of modern contraceptives across the different regions of Ethiopia. Therefore, regions with low contraceptive rates and high fertility rates should be targeted for scaling up and tailoring of services to the lifestyles of the population of those regions. Funding: Not applicable. Declaration of Interest: The authors declared that they have no competing interests. Ethical Approval: Ethical approval was obtained from the Human Research Ethics Committee, The University of Newcastle. We also got the Ethiopian Public Health Institute (EPHI) and the Measure DHS program approval to access the datasets.

Family planning needs of mountain communities in western Uganda

Background: Mountain settings are characterised by limited access to reproductive, maternal and child health services. The scope of health research in these communities limits understanding of contextual needs that are critical in the implementation of effective health programmes. Aims: To establish the family planning needs among couples residing on the slopes of the Rwenzori Mountains in Kasese District, western Uganda. Methods: A cross-sectional, interviewer-administered questionnaire surveyed 400 couples in the mountainous sub-counties of Kilembe and Mahango between June and July 2015. Simple descriptive statistics were used to describe participants' family planning needs. Findings: The majority of the participants (66%) were female. On average every couple had 5 children and 35.5% wanted no additional children. While all participants knew of at least one method of contraception, 32.5% did not know where to obtain family planning services. Use of contraception was 16.3%. Only 2 in 10 individuals who reported wanting no additional children reported using any method. Conclusions: There is low contraceptive use and a high unmet need for family planning among couples residing on the slopes of Rwenzori Mountain in Kasese district. Just over one-third of participants were unaware of where to obtain family planning services. These findings have important implications for effective family planning programmes for mountain residents with low levels of education.

Hazards of Repeat Pregnancy during Adolescence: A Case-control Study.

To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers. A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues. Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults. Moreover, adolescents with more than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy. There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.

Changes in demand for children between 2003 and 2013 in Nigeria: Evidence from survey data

Abstract Nigeria has one of the highest fertility rates in Africa. Data from 2013 Demographic and Health Surveys indicate a virtual stagnation of fertility rate since 2003. Low contraceptive use and pronatalist attitudes are among the factors contributing to the high fertility rate in Nigeria. In this manuscript, we pooled data from three most recent waves of Demographic and Health Surveys to examine trends in demand for children over time and identify the factors associated with change in demand for children. The data show that demand for children has declined since 2003 although not monotonically so. Variables that were positively associated with increased likelihood of desiring no additional children were residence in the South-West (as opposed to residence in the North-Central), exposure to family planning (FP) messages on the mass media, number of children ever born, educational level, and urban residence. In contrast, uncertainty about fertility desire was more widespread in 2008 compared to 2013 although less widespread in 2003 than in 2013. The likelihood of being undecided about fertility desire was positively associated with discrepancies in family size desires between husband and wife, parity and Islamic religious affiliation. Programs should aim to increase access to effective contraceptive methods and promote demand for contraceptives as a way of fostering a sustainable reduction in demand for children. Furthermore, strategies that address uncertainty by fostering women’s understanding of the social and health implications of large family sizes are relevant.

High pregnancy incidence and low contraceptive use among a prospective cohort of female entertainment and sex workers in Phnom Penh, Cambodia

BackgroundWhile HIV and unintended pregnancies are both occupational risks faced by female sex workers, the epidemiology of pregnancy and its drivers in this population remains understudied. This includes Cambodia, where the drivers of pregnancy among female entertainment and sex workers (FESW) remain unknown. The current study aimed to examine factors associated with incident pregnancy, as well as describe contraceptive use among FESW in Phnom Penh, Cambodia.MethodsThis analysis drew from the Young Women’s Health Study (YWHS)-2, a 12-month observational cohort of 220 FESW aged 15–29 years, conducted between August 2009 and August 2010. Interviewer-administered questionnaires were conducted at baseline and quarterly thereafter, alongside HIV and pregnancy testing. Bivariate and multivariable extended Cox regression analysis was used to examine correlates of incident pregnancy.ResultsAt baseline, 6.8% of participants were pregnant, and only 10.8% reported using hormonal contraceptives, with 11.3% reporting an abortion in the past 3 months. Pregnancy incidence was high, at 22/100 person-years (95% CI: 16.3–30.1). In multivariable analysis, younger age (19–24 years versus 25–29 years) (Adjusted Hazards Ratio (AHR): 2.28; 95% Confidence Interval (CI) 1.22–4.27), lower income (400,000–600,000 Riel (≤150$USD) versus > 600,000 Riel (> 150$USD)) (AHR 2.63; 95% CI 1.02–6.77) positively predicted pregnancy, while higher self-reported condom self-efficacy were associated with reduced pregnancy incidence (AHR 0.89; 95% CI 0.81–0.98).ConclusionsResults document high incidence of pregnancy and unmet reproductive health needs among FESWs in Cambodia. Findings point to an urgent need for multi-level interventions, including venue-based HIV/STI and violence prevention interventions, in the context of legal and policy reform. High pregnancy incidence in this population may also undermine recruitment and retention into HIV prevention intervention trials. The exploration of innovative and comprehensive sex worker-tailored sexual and reproductive health service models, also as part of HIV prevention intervention trials, is warranted.

CONTRACEPTIVE USE AND FAMILY SIZE PREFERENCES AMONG RURAL WOMEN IN SOKOTO STATE, NIGERIA

Background: The interplay of high fertility, low contraceptive use and high maternal mortality continues to decimate populations across sub-Saharan Africa. This study aimed to determine contraceptive use and family size preferences among rural women in Sokoto State, Nigeria. Methods: It was a cross-sectional study conducted in rural communities of Sokoto State, Nigeria, using both quantitative and qualitative methods of data collection. It involved interviews to a random sample of 202 women of child bearing age using semi-structured interviewer- administered questionnaires, and focus group discussions among women and men. The quantitative data were analyzed using the IBM SPSS version 17 computer statistical package; while the qualitative data were transcribed, sorted, categorized and analyzed thematically. Results: The mean age of the women was 27.9 + 8.0 years, most of them had no formal education (85.6%) and were aged 14-19 years when they had their first pregnancy (84.2%). Of the 202 respondents only 10 (5.0%) were using modern contraceptives, most commonly pills 4 (40.0%), and injectable contraceptives 4 (40.0%). The main barriers to use of modern contraceptives were religious beliefs, desire for more pregnancies, poor understanding of FP concept/ disapproval by husbands; and lack of communication between couples. Almost all the respondents 197 (97.5%) preferred large family sizes and most of them 149 (73.8%) were willing to have as many children as possible. Conclusion: These findings underscore the need for governments and other stakeholders to make female education the central focus of FP promotion programs, in addition to involving men and religious leaders. Keywords: Contraceptive use, modern contraceptives, family size preferences, rural women, SokotoÂ

Reproductive health profile and circumcision of females in the Hali semi-urban region, Saudi Arabia: A community-based cross-sectional survey.

BACKGROUNDImproving the reproductive health of females has become the focus of the developmental efforts of many nations.OBJECTIVESTo identify the reproductive health style of married females, and to determine the prevalence and predictors of circumcision among girls aged ≤18 years in Hali semi-urban region.DESIGNA cross-sectional household surveySETTINGHouses in Hali, Al-Qunfudhah governorate, western Saudi Arabia during 2017.SUBJECTS AND METHODSA multistage systematic cluster random sampling method was used to select participants. A validated questionnaire was used in interviewing the head of the selected houses.MAIN OUTCOME MEASURESReproductive health profile of women, and circumcision of girls.SAMPLE SIZE365 households.RESULTSReproductive life starts early in the Hali region as 41.4% of women are married at or before 18 years of age. Consanguinity was recorded in 57.0% of houses. The prevalence of grand multiparity (GMP) was 54.7%; it was significantly associated with current maternal age, age at marriage, low educational levels of both parents and husbands with non-professional jobs. Current use of birth control methods was reported by 28.9% of families, and oral contraceptives (OCs) were the commonest method. Contraceptive use was significantly associated with higher educational levels of both parents and with women having professional work. The prevalence of circumcision was 80.3%. Circumcision was most frequent (59.4%) at age 7 years or less, and almost always done by doctors (91.4%). Hemorrhage (2.9%) and fever (2.3%) were the minimal recorded complications. Girls with higher parental education, enough income, no parental consanguinity, and whose mothers married at an older age had slightly lower rates of circumcision, but the difference was without statistical significance.CONCLUSIONThe pattern of early female marriage, high consanguinity, GMP, low contraceptive use, and a high frequency of circumcision in girls was apparent in Hali. Public health education and legislative policies are needed.LIMITATIONSRecall bias may affect the reported frequency of circumcision, and related complications.

Factors associated with adolescent school girl's pregnancy in Kumbo East Health District North West region Cameroon.

IntroductionTeenage pregnancy is a social problem in Cameroon in general and in Kumbo East in particular. This results in physical, psychological and socio-economic consequences on the teenage mother, family and the society as a whole. In spite of studies and interventions that have been and are being implemented, the prevalence of unplanned teenage pregnancy in Kumbo East Health District is still high, suggesting that more efforts are required to achieve effective preventive measures. The aim of this study was to determine factors associated with adolescent school girl's pregnancy in Kumbo East health district.MethodsA cross-sectional descriptive study design was used and a simple random sampling technique was used to select 293 respondents aged 15 to 19year. The district hospital antenatal clinics and the Health Centres were selected. Data was obtained from 292 participants under the age of 20 years who were willing using a questionnaire administered through face-to-face interviews.ResultsThe study show a high prevalence (60.75%) of teenage pregnancy in the sampled antenatal clinics of Kumbo East Health District attributable to inadequate considerations given to factors associated with school girl's pregnancy. This study has indicated that the age of teenager at first pregnancy, low contraceptive use, socio-economic status and physical violence are factors that are greatly associated with teenage pregnancy. Among the reasons contributing to the low use of contraceptives are: sexually activity, lack of knowledge, fear of side effects, including sterility, condoms disappearing in the womb and inequality of power with sexual partners. This study shows that teenagers obtain information mainly from school (53%) and relatives (20%).ConclusionThe use of contraceptive alone may not reduce teenage pregnancy, however double method is very effective but addressing the impact of poverty on teenagers, empowering them on their rights and information in order to make right choices is very important.

Assessing the influence of mass media on contraceptive use in Nigeria: A secondary analysis of 2013 Nigerian national demographic and health survey

Background: The low contraceptive use in Africa has been severally linked to ignorance and misconceptions. Media platforms provide potential avenues for addressing these misconceptions. This study is aimed at evaluating the influence of media exposure on contraceptive use among Nigerian women. Materials and Methods: We conducted a weighted analysis of data from the 2013 Nigerian Demographic and Health Survey that included 38,948 women aged 15–19 years using STATA software, version 12.0 SE (Stata Corporation, TX, USA) to investigate the influence of media exposure on contraceptive use among Nigerian women using logistic regression models. The result was presented in odds ratio (OR) and 95% confidence interval (CI). Results: The contraceptive use among the respondents was 14.88%, comprising mainly of modern methods (64.2%; n = 3006). After controlling for age, educational status, religion, wealth status, and other potential confounding variables, the use of contraceptives was significantly associated with reading newspapers for at least once a week (OR = 1.16; 95% CI = 1.03–1.32), listening to radio for at least once a week (OR = 1.16; 95% CI = 1.01–1.32), and watching television for at least once a week (OR = 1.39; 95% CI = 1.20–1.61). There was an improvement in the odds in favor of contraceptive use among the women when the frequency of media exposure was increased to at least once a week. Conclusion: Contraceptive use among women in Nigeria is positively influenced by exposure to media which improves with increasing frequency of exposure. This finding provides a potential opportunity for improving contraceptive utilization in the country using the various mass media platforms.

Socio-Demographic Determinants of Family Planning Service Utilization among Women of Reproductive Age in Urban Communities of Imo State, Nigeria

Introduction: Many developing countries are characterized by rapid population growth, which is partly attributed to high fertility rates, high birth rates, accompanied by steady declines in death rates, low contraceptive use and high but declining mortality rate. AIM: To determine the factors influencing family planning method use among women of reproductive age in urban communities of Imo state, Nigeria. Methodology: The study was a community based descriptive cross-sectional study involving 560 women of reproductive age who met the inclusion criteria and were selected using the multistage sampling technique. The data were collected using a pretested, semi-structured and interviewer administered questionnaire and were analyzed using EPI-INFO version 3.2.1. A p-value ≤ 0.05 was considered significant. Results: The mean age of the respondents was 32.7 ± 7.7 years with most of the women (99.1%) being aware of family planning. The common methods known were; pills (65.2%), injections (62.5%), condoms (61.3%) and natural family planning methods (49.5%). The prevalence of ever use and current use of family planning was 54.1% and 35.1% respectively and the commonest method ever (36%) and currently (26%) used was the condom. The factors found to significantly influence family planning method use in the study were: age of women, religion, family size, number of male children, monthly income, being able to access and pay for family planning services without partners financial support, contraceptive knowledge, prior discussion of family planning with partner, partner being in support of modern family planning methods use and previous use of any form of contraception. Conclusion: Most of the factors found to influence use can be modified by appropriate intervention programs.? Thus there is need to institute these intervention programs by authorities concerned so as to increase utilization of services and reduce consequent problems.

Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India

ObjectivesTo explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD)...

High birth rates despite easy access to contraception and abortion: a cross-sectional study.

The aim of this study was to describe and compare contraceptive use, fertility, birth, and abortion rates in the Nordic countries. National data on births, abortions, fertility rate (1975-2013), redeemed prescriptions of hormonal contraceptives and sales figures of copper intrauterine devices (2008-2013) among women 15-49 years of age in the Nordic countries were collected and analyzed. Use of hormonal contraceptives and copper intrauterine devices varied between 31 and 44%. The highest use was in Denmark (39-44%) and Sweden (40-42%). Combined hormonal contraception followed by the levonorgestrel-releasing intrauterine system were the most common methods. During 1975-2013 abortion rates decreased in Denmark (from 27/1000 women to 15/1000 women aged 15-44/1000 women) and Finland (from 20 to 10/1000 women), remained stable in Norway (≈16) and Sweden (≈20) and increased in Iceland (from 6 to 15/1000 women). Birth rates remained stable around 60/1000 women aged 15-44 in all countries except for Iceland where the birth rate decreased from 95 to 65/1000 women. Abortion rates were highest in the age group 20-24 years. In the same age group, Sweden had a lower contraceptive use (51%) compared with Denmark (59%) and Norway (56%) and a higher abortion rate 33/1000 compared with Denmark (25/1000) and Norway (27/1000). In contrast to the declining average fertility and birth rates in Europe, rates in the Nordic countries remain high and stable despite high contraceptive use and liberal access to abortion on women's request.

Contraceptive Services Available to Unmarried Sexually Active Adolescents

Background: Low contraceptive use amongst unmarried sexually active young men and women presents an ethical dilemma in Indonesia, particularly in realising reproductive rights as a fundamental human right. This study aims to address the difficulties in extending access to family planning for unmarried sexually active youths. Methods: A review of the laws relating to the provision of family planning was combined with a secondary data analysis of the 2012 Indonesian Demographic Health Survey throughout 6 provinces on the island of Java. The sample population included 5,150 unmarried adolescents, aged 15 to 24 years. The 2012 Indonesian Demographic Health Survey was the first and only survey that included unmarried young women in Indonesia. The association between subjects who had 'ever had sex' and three groups of predictors (demographic characteristics, peer influences, and knowledge of contraceptive methods) were examined using multivariate logistic regressions. Results: Results of the study found that subjects who were unmarried but had engaged in sexual activity were more likely to be those aged 19 to 21 years (OR = 2.36) and 22 to 24 years (OR = 6.81), of low education status (OR = 2.1), with a boyfriend or girlfriend (OR = 2.38), and those who approved of pre-marital sex (OR = 8.5). Conclusions: Results from this research suggest that new interpretations of the Law 52/2009 regarding family planning and Law 36/2009 that prohibits health services to unmarried sexually active youths are required in order to address the issues faced by Indonesia's youth