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Use of Family Planning and
Maternal and Child Health Services by
Adolescents and Young Women
in 5 Sub-Saharan Countries
Ma...
Background
Adolescents and Young Women
• Pregnancy and childbirth: leading causes of death for 15- to
19-year-olds in deve...
Background
Use of Family Planning (FP) and Maternal
and Child Health (MCH) Services
• Use of FP contributes to lower mater...
Background
Research Questions
1. Have adolescent girls and young women increased their
use of FP and MCH services in the p...
Family planning
and reproductive
health outcomes
• Use of modern
contraceptives
• Age
• Marital status
• Age of
marriage
•...
Demographic and Health Surveys
• Democratic Republic of the Congo (DRC): 2007, 2013−2014
• Uganda: 2001, 2006
• Mali: 2006...
a) Current use of modern method of FP
• Pill, IUD, injectables, diaphragm, condoms, sterilization,
implants, foam, jelly, ...
• Age (15−19 years; 20−24 years; 25−29 years [ref])
• Survey year (Year 1; Year 2)
• Respondent visited by FP worker or an...
• Age (15−19 years; 20−24 years; 25−29 years [ref])
• Survey year (Year 1; Year 2)
• Respondent visited health facility in...
• Urban/rural residence
• Highest level of education
• Religion
• Wealth quintile
• Marital status
• Employment status
• K...
• Urban/rural residence
• Highest level of education
• Religion
• Wealth quintile
• Marital status
• Employment status
• L...
• Accounted for clustered and stratified design of DHS and
used weighted data
• Separate analysis by country
• Examined de...
• Entire sample: Multivariable logistic regression, regressing
each DV on age; survey year; and age x survey year
• Entire...
Results
Demographic Characteristics
Some secondary
school or higher
Married/living
together
Had more than 1 child
15−19
ye...
Results
FP and MCH Outcomes
Unmet need for
FP
Current use of
modern FP
≥4 ANC visits 3 doses of DPT
15−19
years
20−24
year...
Results
Did FP and MCH service use increase over time among female
parents ages15−24 years?
Current Use of
Modern FP
≥4 AN...
Results
Is the rate of increase of use of FP and MCH services among 15-
to19- and 20- to 24-year-old women similar to that...
Results
15- to 19-year-olds
• Completing 3
doses of DPT for
most recent born
child
• Knowledge of ≥3
modern methods
of con...
Results
15- to 19-year-olds
• Order of survey
(3 countries)
• Visited
healthcare facility
in past 12 months
(2 countries)
...
Results
15- to 19-year-olds
• Survey year
(Uganda,
Zambia, Ghana)
• Survey year (Uganda,
Zambia, DRC)
20- to 24-year-olds
...
Summary of Results
Overall Changes in FP and MCH Over Time
• Use of FP and MCH services among adolescent girls and
young w...
Discussion
Differences in Predictors of Use of FP and
MCH Services
• Implicit or explicit bias among healthcare staff rega...
Discussion
Limitations
• Analysis does not include variables measuring gender
norms or inequities
• Sample sizes too small...
Discussion
Programmatic and Policy Considerations
• Address social and cultural biases against youth in healthcare
setting...
Thispresentationwas produced with thesupportof the United StatesAgency for International
Development(USAID)underthe termso...
Questions?
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Use of Family Planning and Maternal and Child Health Services by Adolescents and Young Women in 5 Sub-Saharan Countries

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Presented during a January 2018 webinar.

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Use of Family Planning and Maternal and Child Health Services by Adolescents and Young Women in 5 Sub-Saharan Countries

  1. 1. Use of Family Planning and Maternal and Child Health Services by Adolescents and Young Women in 5 Sub-Saharan Countries Mahua Mandal, PhD Paul Brodish, PhD MEASURE Evaluation, UNC-Chapel Hill January 9, 2018 USAID/Washington, DC
  2. 2. Background Adolescents and Young Women • Pregnancy and childbirth: leading causes of death for 15- to 19-year-olds in developing countries • One-third of adolescent pregnancies is unintended • Reproductive health (RH) of 15- to 24-year-old women is especially important o Adolescents and young women make up one-third of the population in developing countries
  3. 3. Background Use of Family Planning (FP) and Maternal and Child Health (MCH) Services • Use of FP contributes to lower maternal morbidity and mortality • Use of MCH services lowers poor maternal and infant outcomes • Demographic and Health Survey (DHS) trend data over 25 years is encouraging ○ Women in sub-Saharan Africa (SSA) have increasingly used FP, antenatal care (ANC), health facilities for delivery, skilled birth attendants, and immunized their children • Unclear whether use of services among sexually active adolescents and young women has followed similar trend
  4. 4. Background Research Questions 1. Have adolescent girls and young women increased their use of FP and MCH services in the past decade? 2. If use of FP and MCH services increased, is the rate of increase similar to that of 25- to 29-year- old women? 3. To what extent do predictors of use of FP and MCH services differ among adolescent girls and young women compared to women ages 25-29 years? • Especially interested in interaction with health workers
  5. 5. Family planning and reproductive health outcomes • Use of modern contraceptives • Age • Marital status • Age of marriage • SRH knowledge and attitudes • Fertility awareness • Self-efficacy • Parity • Desired fertility • Age difference • Couple communi-cation • Shared sexual and reproductive decision making • Partner’s desired fertility • Violence and coercion • Quality of sexual and reproductive health (SRH) services • FP provider bias Conceptual Framework • Policies and laws • Methods mix • Equitable gender norms • Economic opportunities • RH education
  6. 6. Demographic and Health Surveys • Democratic Republic of the Congo (DRC): 2007, 2013−2014 • Uganda: 2001, 2006 • Mali: 2006, 2012−2013 • Zambia: 2007, 2013−2014 • Ghana: 2008, 2014 Subset sample of females ages 15−24 who had at least one child at time of survey Numbers range from 1,180 (Ghana, 2009) to 6,595 (DRC, 2013−2014) Methods Data and Sample
  7. 7. a) Current use of modern method of FP • Pill, IUD, injectables, diaphragm, condoms, sterilization, implants, foam, jelly, lactational amenorrhea method (LAM), and other country-specific (yes vs. no) b) Use of ANC for most recent birth • ≥4 ANC visits for most recent birth (yes vs. no) c) Use of immunization for most recent child born • 3 doses of diphtheria, pertussis, and tetanus (DPT) for most recent born child (yes vs. no) Methods Dependent Variables
  8. 8. • Age (15−19 years; 20−24 years; 25−29 years [ref]) • Survey year (Year 1; Year 2) • Respondent visited by FP worker or any health facility staff talked to respondent about FP in 12 months preceding interview (yes vs. no) • Respondent reported ≥4 ANC visits for most recent birth (yes vs. no) • Respondent reported 3 doses of DPT vaccination for most recent born child (yes vs. no) Methods Primary Independent Variables: FP
  9. 9. • Age (15−19 years; 20−24 years; 25−29 years [ref]) • Survey year (Year 1; Year 2) • Respondent visited health facility in past 12 months (yes vs. no) • Distance to facility was perceived problem for getting care for oneself if sick (yes vs. no) Methods Primary Independent Variables: ANC and Child Immunizations
  10. 10. • Urban/rural residence • Highest level of education • Religion • Wealth quintile • Marital status • Employment status • Knowledge of ≥ 3 modern FP methods • Ideal number of children Methods Control Variables: FP
  11. 11. • Urban/rural residence • Highest level of education • Religion • Wealth quintile • Marital status • Employment status • Last child wanted Methods Control Variables: ANC and Child Immunization
  12. 12. • Accounted for clustered and stratified design of DHS and used weighted data • Separate analysis by country • Examined demographic characteristic of sample by each DV and by age group • By age group: Pearson’s chi-square tests to compared each DV by survey year Methods Analysis
  13. 13. • Entire sample: Multivariable logistic regression, regressing each DV on age; survey year; and age x survey year • Entire sample and stratified by age group: Multivariable logistic regressions regressing each DV on primary IVs, controlling for demographic variables Methods Analysis
  14. 14. Results Demographic Characteristics Some secondary school or higher Married/living together Had more than 1 child 15−19 years 20−24 years 15−19 years 20−24 years 15−19 years 20−24 years DRC, 2013− 2014 49.9 47.6 66.5 77.9 19.8 54.7 Uganda, 2011 2011 19.9 31.7 68.1 80.8 23.0 62.1 Mali, 2014 19.2 13.8 85.5 94.6 19.6 60.2 Zambia, 2013− 2014 46.4 49.8 55.6 70.9 8.7 55.3 Ghana, 2014 60.8 58.8 41.8 66.6 10.0 43.4
  15. 15. Results FP and MCH Outcomes Unmet need for FP Current use of modern FP ≥4 ANC visits 3 doses of DPT 15−19 years 20−24 years 15−19 years 20−24 years 15−19 years 20−24 years 15−19 years 20−24 years DRC, 2013− 2014 35.4 31.1 8.7 9.4 46.6 50.1 41.5 48.7 Uganda, 2011 26.8 32.1 19.0 22.2 50.9 49.1 54.2 61.5 Mali, 2014 28.2 25.1 9.5 11.5 42.0 42.2 49.1 50.4 Zambia, 2013− 2014 27.0 21.4 37.3 43.4 51.9 52.3 70.7 76.7 Ghana, 2014 45.7 32.0 21.4 26.8 81.9 83.8 59.4 69.3
  16. 16. Results Did FP and MCH service use increase over time among female parents ages15−24 years? Current Use of Modern FP ≥4 ANC Visits 3 Doses of DPT 15−19 years 20−24 years 15−19 years 20−24 years 15−19 years 20−24 years DRC Uganda Mali Zambia Ghana
  17. 17. Results Is the rate of increase of use of FP and MCH services among 15- to19- and 20- to 24-year-old women similar to that of 25- to 29- year-old women? Yes, statistically, but…
  18. 18. Results 15- to 19-year-olds • Completing 3 doses of DPT for most recent born child • Knowledge of ≥3 modern methods of contraception • Being visited by an FP worker or staff at health facility talking to respondent about FP • Completing 3 DPT doses for children 20- to 24-year-olds • Completing 3 doses of DPT for most recent born child • Knowledge of ≥3 modern methods of contraception How do predictors of use of modern FP differ between adolescent and young women and 25- to 29-year-olds? 25- to 29-year-olds
  19. 19. Results 15- to 19-year-olds • Order of survey (3 countries) • Visited healthcare facility in past 12 months (2 countries) • Order of survey (3 countries) • Visited healthcare facility in past 12 months (3 countries) • Distance to health facility perceived as problem (3 countries) 20- to 24-year-olds • Order of survey (3 countries) • Visited healthcare facility in past 12 months (2 countries) How do predictors of use of ANC differ between adolescent and young women and 25- to 29-year-olds? 25- to 29-year-olds
  20. 20. Results 15- to 19-year-olds • Survey year (Uganda, Zambia, Ghana) • Survey year (Uganda, Zambia, DRC) 20- to 24-year-olds • Survey year (Uganda and Zambia) How do predictors of child’s immunization differ between adolescent and young women and 25- to 29-year-olds? 25- to 29-year-olds
  21. 21. Summary of Results Overall Changes in FP and MCH Over Time • Use of FP and MCH services among adolescent girls and young women have improved over time, albeit inconsistently • Increase in use of modern FP driven by implant use (all age groups) and injectables (15- to 19- year-olds) • Unmet need for contraception has decreased over time but remains high: 21% to 46% • ≥4 ANC visits increased over time in 2 countries • 3 DPT doses increased over time in 4 countries
  22. 22. Discussion Differences in Predictors of Use of FP and MCH Services • Implicit or explicit bias among healthcare staff regarding FP communication with adolescent girls and young women • Value of girls and young women determined by their fertility • Distance to health facility not reported as a barrier by adolescent girls and young women – more likely to rely on others for transportation and don’t get sick as often as other women • Predictors of DPT similar across age groups
  23. 23. Discussion Limitations • Analysis does not include variables measuring gender norms or inequities • Sample sizes too small to include measures of experience of intimate partner violence or partners’ controlling behaviors • Variables related to adolescent and young women’s interaction with healthcare staff do not measure the quality of interactions and communication
  24. 24. Discussion Programmatic and Policy Considerations • Address social and cultural biases against youth in healthcare settings, including improving provider attitudes and healthcare policies • Increase access to private sector (Example: youth voucher program in Madagascar) • Reach adolescents and young women in their communities (Example: Promoting Change in Reproductive Behavior of Adolescents (PRACHAR) program in India) • Increase education; increase age of marriage
  25. 25. Thispresentationwas produced with thesupportof the United StatesAgency for International Development(USAID)underthe termsof MEASUREEvaluationcooperativeagreementAID- OAA-L-14-00004.MEASUREEvaluationis implementedby theCarolinaPopulationCenter, Universityof NorthCarolinaat Chapel Hill in partnershipwith ICFInternational;JohnSnow,Inc.; ManagementSciences for Health;Palladium; and TulaneUniversity.Viewsexpressedare not necessarilythoseof USAID or the United Statesgovernment. www.measureevaluation.org
  26. 26. Questions?

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