Contraceptive Use and Discontinuation Among Adolescent Women in 55 Low- and Middle-Income Countries.

Abstract

Adolescent women aged 19 or younger make up a substantial and growing proportion of women of reproductive age in low- and middle-income countries. Several key features of the reproductive life course ground the need to disaggregate the contraceptive behaviors of adolescent women from those of older women, including relationship dynamics, resources and autonomy, and cultural and societal expectations regarding sexual activity and childbearing. Despite the importance and unique life course features of adolescent women, we lack the information about their contraceptive dynamics-especially their patterns of contraceptive discontinuation-needed to direct improvements to family planning programs for this oft-neglected group. We use Demographic and Health Surveys from 55 countries to describe contraceptive dynamics among adolescent women, comparing them with trends among women aged 20-49. We find that adolescent women tended to use reversible, short-acting methods, whereas those later in the reproductive life course tended to use long-acting methods and female sterilization. Across all regions, 12-month all-method discontinuation rates among those who discontinued their method while not wanting to get pregnant ranged from 16.7 to 34.2 discontinuations per person-month for adolescent women and from 12.0 to 28.8 discontinuations per person-month for older women. Side effects and health concerns were a leading discontinuation reason for both age groups in most regions, and infrequent sex and desire to become pregnant were more frequent discontinuation reasons for adolescent women in most regions. Not since 2009 have scholars compared contraceptive discontinuation rates across multiple countries and disaggregated by age. Furthermore, no prior publication has compared specific reasons for discontinuation between adolescent and older women. Understanding the distinct contraceptive dynamics of those earliest in their reproductive life course can help direct policy and programmatic interventions.