Young women who got pregnant unintentionally are 3.5 times more likely to use contraceptives in future

Researchers are calling for better sex education in South Africa to prevent unwanted teen pregnancies, which were still 1 of the top 10 risk factors for death in this age group in 2015. 

They studied women between the ages of 15 and 24, and found that many only learnt about contraception, or pregnancy prevention, from their healthcare team after an unintended pregnancy.

Researchers know that South Africa has battled high adolescent pregnancy rates for decades. Despite this, the unintended pregnancy rates have remained consistently high since about the year 2000.

In this study, researchers looked at a lack of education about sex and contraception as a major driver of pregnancy in teens and young women.

So, they wanted to find out how common condom use is for young South African women. Condoms are a type of contraception used to prevent pregnancy.

They also wanted to see if getting pregnant at a young age affects the chance that a woman will use a contraceptive to prevent pregnancy in the future.

The researchers analysed the existing 2014 to 2017 AYAZAZI sexual and reproductive health study data. It included 207 women aged 16 to 24 from Durban or Soweto, South Africa. The data included information about their sexual behaviour, contraceptive use, and any previous pregnancies.

Nearly half of the women (47%) had been pregnant before age 25, and almost all of the pregnancies (96%) were unintentional. 

About 75% of women who had been pregnant when they were between ages 15 and 19 used contraceptives at the time of the study. On the other hand, only 67% of those who became pregnant between ages 20 and 24, and 47% of women who had never been pregnant, used contraceptives. 

The researchers concluded that people who were pregnant as an adolescent had 3.5 times greater odds of using contraceptives afterwards.

These results suggest that people seek contraceptives only after an unintended pregnancy. More than half of the women in the study said that they learned about contraception from a nurse, doctor, or counsellor, and less than 10% learned about it from school. 

This highlights a need for better early sexual education and youth-friendly sexual and reproductive health services.

The researchers said that these results might not apply to other places in South Africa, because many participants were from similar communities. But, they mention that these results are similar to other studies done in South Africa. Even so, they suggest that future studies look at other provinces and other age groups.

The researchers were from South Africa and Canada. 

They say that some of the results might be relevant to other African countries, but some key differences might change the outcomes there. For instance, despite access to contraceptives generally being lower in other countries, they seem to have lower unintended pregnancy rates outside marriage.

Abstract

High rates of adolescent pregnancies in South Africa continues to be a pressing public health concern. This study examines (1) the prevalence of current contraceptive use; and (2) the independent association between adolescent pregnancy and effective contraception use.

This study uses baseline cross-sectional data from a youth-centered sexual and reproductive health (SRH) cohort study among youth (aged 16–24) in Soweto and Durban (2011–2017). Among 207/253 females reporting consensual sexual activity, crude and adjusted logistic regression examine associations between ever having an adolescent pregnancy (aged 15–19) or pregnancy at age 20–24 (ref no pregnancy) and effective contraception use (barrier and/or hormonal methods) in the last 6 months.

Over one-third (34.3%, n = 71) of females reported a history of adolescent pregnancy and 13.0% (n = 27) had a pregnancy at age 20–24. Nearly all (95.9%, n = 94) first pregnancies were unintentional. Current effective contraceptive use was reported by 74.6% (n = 53) with an adolescent pregnancy, 66.6% (n = 18) of those pregnant at 20–24 years, and 46.8% (n = 51) of never pregnant females (p < 0.001). All effective contraceptive users pregnant at 20–24 years and 83% (n = 44) of the adolescent pregnancy group reported using hormonal methods vs. 52.9% (n = 27) of never pregnant females. In the adjusted model, a history of adolescent pregnancy was associated with 3.45 (95%CI = 1.75–6.82) times greater odds of effective contraceptive use (vs. no pregnancy).

The results suggest that adolescent females are accessing effective methods of contraception including hormonal methods only after a pregnancy event, highlighting the need for earlier provision of youth-friendly SRH services.

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