Some 23 million sexually active adolescent women in developing regions around the world are at risk for untended pregnancy because they are not using modern contraceptives, according to a new report from the Guttmacher Institute.
Meeting these young women's contraceptive needs would markedly reduce the number of unintended pregnancies and maternal deaths, write Jacqueline E. Darroch, PhD, from the Guttmacher Institute, and colleagues.
"Making it possible for young women to avoid unintended pregnancy and childbearing until they feel ready to become mothers can have a profound impact. It allows them to achieve healthier lives for themselves and their children, more education and better job opportunities," Dr Darroch said in a Guttmacher Institute news release. "The positive impact of investing in sexual and reproductive health services for adolescent women is undeniable."
Modern contraceptives include oral contraceptives, injectables, intrauterine devices, implants, female and male sterilization, female and male condoms, other barrier methods, and modern fertility-awareness methods. Traditional contraceptive methods are much less reliable and include primarily periodic abstinence and withdrawal, according to the report.
The authors write that 252 million adolescent women aged 15 to 19 years live in developing regions, and of those women, an estimated 38 million are sexually active and do not want to become pregnant in the next 2 years, but 23 million of them have an unmet need for modern contraception. Most are using no contraceptive method (84%), and the remaining women (16%) are using traditional contraceptive methods.
Maternal Deaths, Abortions, Would Be Reduced
Meeting these adolescents' contraceptive needs would drastically reduce the number of abortions: 15 million adolescent women in developing regions currently use modern contraceptive methods, preventing an estimated 5.4 million unintended pregnancies annually. The researchers estimate that 2.9 million of these pregnancies would have resulted in abortions, "many of which would have been unsafe."
"Unsafe abortion is a major preventable cause of maternal death worldwide. Research shows that compared with older women, adolescents are less likely to obtain safe abortions; more likely to terminate their pregnancies after the first trimester, when the procedure is more dangerous; and more likely to delay seeking medical care for complications following unsafe abortions," the authors write. "They are also more likely to seek abortions from traditional providers, go to untrained providers or to attempt to induce abortion themselves."
At this time, modern contraceptive use prevents 3000 maternal deaths each year in developing regions.
Modern contraceptive use also helps infants born to adolescent mothers, who have the highest risk for infant and child mortality and other health problems.
"The babies of adolescent mothers also face greater health risks than those born to older mothers, in part because young mothers may be undernourished or may not have completed physical development, and in part because younger mothers are more likely to live in disadvantaged circumstances," the researchers explain.
Costs, Benefits of Meeting Contraceptive Needs
The authors estimate that providing modern contraceptives to the 15 million adolescent women who currently use them costs a total of $222 million each year. Improving existing services to those women to include making accurate information and education more available and offering a range of modern contraceptives would increase the cost to $313 million annually.
Meeting the needs of the 23 million sexually active adolescent women who do not currently use modern contraception and do not want to get pregnant would raise the total cost to $770 million per year. Regionally, costs would add up to $351 million in Africa, $222 million in Asia, and $196 million in Latin America and the Caribbean.
Provision of high-quality contraceptive services to all sexually active adolescent women who want to avoid pregnancy would cost, on average, $21 per user each year.
Meeting the contraceptive needs of all sexually active adolescent women who want to avoid pregnancy would result in:
6.0 million fewer unintended pregnancies each year (a decline of 59%);
2.1 million fewer unplanned births each year (a decline of 62%);
3.2 million fewer abortions each year (a decline of 57%), 2.4 million of which would be unsafe abortions;
700,000 fewer miscarriages in women with unintended pregnancies each year (a decline of 60%); and
5600 fewer maternal deaths associated with unintended pregnancies (a decline of 71%).
Multipronged Approach Needed
Program planners and policymakers must work to prevent human rights violations such as child marriage, coerced sex, and sexual abuse, which are responsible for some sexual activity among young women. "Women often have less power than their partners in relationships, especially if they are much younger than their partners, and this makes it difficult to negotiate sexual activity and use of contraceptives, particularly condoms," the authors explain.
Supporting the education of adolescent women and improving the status of girls and women in society are also critical to preventing unintended pregnancy. "Boosting girls' education can increase their knowledge and their ability to make autonomous decisions; studies have shown that adolescents who are in school are less likely to have sex and more likely to use contraceptives when they do have sex. Early marriage and pregnancy are also important — and preventable — reasons girls may drop out of school," the researchers write.
Provision of comprehensive sex education and contraceptive counseling and services to adolescent women and protecting their rights to "voluntary, informed and confidential contraceptive choice" are also vital, the authors said.
Adolescents who become pregnant need services, too, according to the researchers. "Adolescents who become pregnant need antenatal and delivery care and access to safe abortion services; adolescents with complications from unsafe abortion require postabortion care. Following a birth or an abortion, adolescents should receive contraceptive services to help them avoid becoming pregnant again too soon or having repeated unintended pregnancies," they explain.
The researchers analyzed data from a broad range of sources, including survey data from adolescent women in developing regions, to document the number of adolescent women with an unmet need for contraception, the costs and benefits of meeting their needs, and obstacles to providing necessary services to adolescent women.
The authors have disclosed no relevant financial relationships.
"Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents." Guttmacher Institute. Full text
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Cite this: Millions of Teenagers in Developing Regions Lack Contraception - Medscape - May 19, 2016.