Adolescent fertility and family planning in east asia and the pacific a review of dhs reports
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Adolescent fertility and family planning in East Asia and the Pacific: a review of DHS reports. Dr Elissa Kennedy Centre for International Health. Adolescent fertility: why it matters. 14-16 million births to adolescents aged 15-19 every year: 91% in low and middle income countries

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Adolescent fertility and family planning in East Asia and the Pacific: a review of DHS reports

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Adolescent fertility and family planning in east asia and the pacific a review of dhs reports

Adolescent fertility and family planning in East Asia and the Pacific: a review of DHS reports

Dr Elissa Kennedy

Centre for International Health


Adolescent fertility why it matters

Adolescent fertility: why it matters

14-16 million births to adolescents aged 15-19 every year:

  • 91% in low and middle income countries

  • >40% in Asia and the Pacific

Photo: WHO/P.Virot


Adolescent fertility why it matters1

Adolescent fertility: why it matters

Adolescent pregnancy accounts for 11% of all births, but almost 25% of the ill-health related to pregnancy and childbirth:

  • Leading cause of mortality for girls aged 15-19

  • Girls 15-19 are twice as likely to die as women over the age of 20

  • Babies have a 50-100% increased risk of death in the first month

Photo: WHO/P.Virot


Early pregnancy also impacts on a girl s education employment participation and empowerment

Early pregnancy also impacts on a girl’s education, employment, participation and empowerment

“The school stopped me from attending classes and said I could not return because that would tarnish their reputation; no good school had mothers in their classrooms……… Everyday I heard them say how I had shamed the family name. Everyday I heard my parents tell me I was good for nothing now, no good boy would even want to look at me….” 17 year old girl, Fiji (UNFPA)

Photo: Marie Stopes International


Efforts to prevent adolescent pregnancy rely on accurate information to inform policy and programs

Efforts to prevent adolescent pregnancy rely on accurate information to inform policy and programs

In low and middle income countries Demographic and Health Survey (DHS) reports are often relied upon by policymakers and programmers

  • Comprehensive national source of reproductive health information, including data on adolescents


Adolescent fertility and family planning in east asia and the pacific a review of dhs reports

Aims

  • To determine the extent to which DHS report data on adolescent fertility and family planning that is accessible to policymakers and programmers

  • Where data are available, summarise key findings relevant to fertility, knowledge, use and unmet need for contraception and access to information and services

  • To compare outcomes for adolescent girls compared with adult women, where possible


Methods

Methods

  • Most recent DHS report sought for low-middle income 33 countries in East Asia and the Pacific as defined by UNICEF and the World Bank

  • All indicators relevant to:

    • Sexual activity

    • Fertility and unintended pregnancy

    • Contraceptive prevalence

    • Unmet need for contraception

    • Knowledge of family planning

    • Exposure to family planning information

    • Access to health services

  • Reported data disaggregated by age and marital status sought for all indicators

  • Data analysed using Excel to determine outcomes for adolescents and compare with adults where possible


Dhs reports were available for 11 countries 1996 to 2009

DHS reports were available for 11 countries (1996 to 2009)


40 relevant indicators identified

40 relevant indicators identified

  • 27 (68%) indicators were age-disaggregated to report data for adolescents 15-19 years for at least one country

  • 12 (30%) indicators were age-disaggregated for all countries

  • 5 (13%) indicators were disaggregated by both age and marital status to report data for unmarried adolescents (only 4/11 countries included one or more of these indicators)


Adolescent fertility and family planning in east asia and the pacific a review of dhs reports

  • Some age-disaggregated information:

    • Age at first marriage / sex

    • Childbearing and age-specific fertility

    • Knowledge of contraceptive methods

    • Current and ever use of contraception

    • Met and unmet need for contraception

    • Exposure to family planning information

    • Problems accessing care

  • No age-disaggregated information:

    • Wanted fertility rate

    • Trends in contraceptive use

    • Source and cost of contraception

    • Informed choice about contraception

    • Intended future use and preferred method

    • Problems with current method

    • Discontinuation and reasons for non-use


Between 10 and 65 of adolescent girls aged 15 19 have ever had sex

Between 10% and 65% of adolescent girls aged 15-19 have ever had sex


Between 10 and 65 of adolescent girls aged 15 19 have ever had sex1

Between 10% and 65% of adolescent girls aged 15-19 have ever had sex


Adolescent fertility rates remain high in many countries

Adolescent fertility rates remain high in many countries


By the age of 19 between 10 5 and 48 5 of adolescents have commenced childbearing

By the age of 19, between 10.5 and 48.5% of adolescents have commenced childbearing


Many adolescent pregnancies are unintended

Many adolescent pregnancies are unintended


A significant proportion of adolescents rely on traditional methods of contraception

A significant proportion of adolescents rely on traditional methods of contraception


A significant proportion of adolescents rely on traditional methods of contraception1

A significant proportion of adolescents rely on traditional methods of contraception


Contraceptive prevalence is lowest among adolescents compared with adult women

Contraceptive prevalence is lowest among adolescents compared with adult women

Current contraceptive prevalence married women (%)


Between 1 and 52 of married adolescents report an unmet need for contraception

Between 1 and 52% of married adolescents report an unmet need for contraception


Many adolescent births are spaced less than 18 months apart

Many adolescent births are spaced less than 18 months apart


A greater proportion of married adolescent girls have not heard of modern methods

A greater proportion of married adolescent girls have not heard of modern methods


Fewer adolescent girls have been exposed to family planning messages in the media

Fewer adolescent girls have been exposed to family planning messages in the media

Married

All women


Adolescent fertility and family planning in east asia and the pacific a review of dhs reports

Less than one third of adolescents not using contraception have discussed family planning with a health worker

Married

All women


Between 75 and 97 of adolescent girls report at least one barrier to accessing health services

Between 75 and 97% of adolescent girls report at least one barrier to accessing health services

Married

All women


Conclusions

Conclusions

  • DHS reports provide useful data for policy makers and programmers, but are limited by:

    • Exclusion of unmarried adolescents

    • Failure to report data for unmarried adolescents

    • Lack of age-disaggregated data reported for some indicators

  • Sexual activity and pregnancy during adolescence are common in East Asia and the Pacific

  • Occurs in the context of low contraceptive prevalence and high unmet need

  • Adolescent girls have poorer knowledge about family planning and less access to information and services than adults


Adolescent fertility and family planning in east asia and the pacific a review of dhs reports

Efforts to increase access to family planning in the general population do not automatically benefit adolescents

Further research is needed to better understand the barriers facing married and unmarried adolescents and to identify effective strategies to overcome these


Thanks to

Thanks to….

Dr Natalie Gray

Dr Peter Azzopardi

Dr Mick Creati

www.wchknowledgehub.com.au

Photo: D Humphreys


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