Fertility Awareness in Adolescents in Sub-Saharan Africa: Evidence From Demographic and Health Surveys

Abstract

Introduction: Adolescents in sub-Saharan Africa report an unmet need for contraception with some adolescents using periodic abstinence as their current contraceptive method. Undesired pregnancies in sub-Saharan African adolescents are associated with significant maternal and neonatal morbidity, and fertility awareness in this population needs to be further explored.

Methods: Nationally representative Demographic and Health Surveys (USAID) interviewed 45,054 adolescents (aged 15-19 years) from 18 least developed sub-Saharan African nations regarding contraception and fertility awareness. Analyses evaluated fertility awareness, contraceptive use, and unwanted pregnancies.

Results: Adolescents using contraception (n=3,384) reported periodic abstinence (n=596, 17.6%) as their current contraceptive method. All adolescents (n=45,054) were queried regarding timing of ovulation, but only 18.4% (n=8,306) were able to correctly identify this as occurring in the middle of her cycle. Adolescents using periodic abstinence were significantly more likely (68.2% compared with 33.5% of those using another method, P<.001) to correctly identify timing of ovulation. Adolescents who had completed secondary or higher education (n=269) were significantly more likely to be able to correctly identify timing of ovulation (secondary odds ratio [OR] 2.888, 95% confidence interval [CI] 2.193-3.805, higher OR 7.866, 95% CI 3.433-18.021).

Conclusions: A majority of adolescents in sub-Saharan Africa are unaware of timing of ovulation in regard to their menstrual cycles, and a significant number are using periodic abstinence as their contraceptive method. A multidisciplinary approach is key because education regarding fertility awareness and contraceptive options may be a key step in decreasing unintended pregnancies.

Comment: While many adolescents in this study practice “periodic abstinence”, which is a not very reliable method to begin with, the majority of them were not aware of time of ovulation. Much education is needed, not only about the menstrual cycle, but also about more reliable methods of contraception. (HMV)