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. 2017 Oct 17;14(1):130.
doi: 10.1186/s12978-017-0393-3.

Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda

Mardieh L Dennis  1 , Emma Radovich  2 , Kerry L M Wong  2 , Onikepe Owolabi  3 , Francesca L Cavallaro  2 , Michael T Mbizvo  4 , Agnes Binagwaho  5   6   7 , Peter Waiswa  8 , Caroline A Lynch  2 , Lenka Benova  2
Affiliations

Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda

Mardieh L Dennis et al. Reprod Health. .

Abstract

Background: Despite efforts to make contraceptive services more "youth friendly," unmet need for contraception among young women in sub-Saharan Africa remains high. For health systems to effectively respond to the reproductive health needs of a growing youth population, it is imperative to understand their contraceptive needs and service seeking practices. This paper describes changes over time in contraceptive need, use, and sources of care among young women in four East African countries.

Methods: We used three rounds of DHS data from Kenya, Rwanda, Tanzania, and Uganda to examine time trends from 1999 to 2015 in met need for modern contraception, method mix, and source of care by sector (public or private) and type of provider among young women aged 15-24 years. We assessed disparities in contraceptive coverage improvements over time between younger (15-24 years) and older women (25-49 years) using a difference-in-differences approach.

Results: Met need for contraception among women aged 15-24 years increased over time, ranging from a 20% increase in Tanzania to more than a 5-fold increase in Rwanda. Improvements in met need were greater among older women compared to younger women in Rwanda and Uganda, and higher among younger women in Kenya. Injectables have become the most popular contraceptive choice among young women, with more than 50% of modern contraceptive users aged 15-24 years currently using the method in all countries except for Tanzania, where condoms and injectables are used by 38% and 35% of young users, respectively. More than half of young women in Tanzania and Uganda receive contraceptives from the private sector; however, while the private sector played an important role in meeting the growing contraceptive needs among young women in Tanzania, increased use of public sector services drove expanded access in Kenya, Rwanda, and Uganda.

Conclusions: Our study shows that contraceptive use increased among young East African women, yet, unmet need remains high. As youth populations continue to grow, governments must develop more targeted strategies for expanding access to reproductive health services for young women. Engaging the private sector and task-shifting to lower-level providers offer promising approaches; however, additional research is needed to identify the key facilitators and barriers to the success of these strategies in different contexts.

Keywords: Adolescents; Contraception; Family planning; Kenya; Private sector; Rwanda; Tanzania; Uganda.

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Conflict of interest statement

Ethics approval and consent to participate

This study used de-identified DHS data and aggregated population statistics. The DHS received government permission to conduct the surveys, obtained informed consent, and assured the confidentiality of participants’ responses. Ethical approval for the secondary analysis of these data was received from the Institutional Review Board at the London School of Hygiene and Tropical Medicine.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Need for modern contraception among women aged 15–24 years
Fig. 2
Fig. 2
Met need for contraception among women in need aged 15–24 years
Fig. 3
Fig. 3
Method mix among current users of modern contraception aged 15–24 years
Fig. 4
Fig. 4
Contraceptive use and source of care among women aged 15–24 years. a Source of care among women in need in contraception aged 15-24 years. b Absolute need and source of care aged 15-24 years
Fig. 5
Fig. 5
Provider type among young women using modern contraception from public or private sector source
See this image and copyright information in PMC

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