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

1. Adolescent fertility and family planning in East Asia and the Pacific: a review of DHS reports Dr Elissa Kennedy Centre for International Health

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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)

10. 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

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

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

13. Adolescent fertility rates remain high in many countries

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

15. Many adolescent pregnancies are unintended

16. A significant proportion of adolescents rely on traditional methods of contraception

17. A significant proportion of adolescents rely on traditional methods of contraception

18. Contraceptive prevalence is lowest among adolescents compared with adult women Current contraceptive prevalence married women (%)

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

20. Many adolescent births are spaced less than 18 months apart

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

22. Fewer adolescent girls have been exposed to family planning messages in the media Married All women

23. Less than one third of adolescents not using contraception have discussed family planning with a health worker Married All women

24. Between 75 and 97% of adolescent girls report at least one barrier to accessing health services Married All women

25. 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

26. 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

27. Thanks to…. Dr Natalie Gray Dr Peter Azzopardi Dr Mick Creati www.wchknowledgehub.com.au Photo: D Humphreys