Adolescent abortion and contraceptive use in Zambia

Policy environment on adolescence: Youth Friendly Corners (YFC) were introduced in Zambia in 1996. The Zambian Ministry of Health (ZMoH) has stated that “Even though adolescent health has been mentioned in various national and sector policies and strategies, it has not been adequately addressed.” They also concluded that the status of adolescent health services in Zambia is weak. The ZMoH also stated that even though YFCs have been established in selected health facilities, these are inadequate and not appropriately supported. The ZMoH Adolescent Health Strategic Plan 2011-2015 was introduced to “provide the necessary strategic framework to support the development of appropriate and comprehensive “Adolescent Friendly Health Services (ADFHS).”” The plan was also introduced to:

  • Ensure availability of an appropriate, comprehensive and affordable adolescent friendly health services in at least 60% of health facilities and communities in 37 districts by 2015.
  • Ensure availability of health workers and communities, with appropriate skills in ADFHS, with all health facility having at least 50% of core health workers trained in ADFHS by 2015.

Other policy responses include the National Population Policy 2007, the National Reproductive Health Policy 2008, the National Strategy for the Prevention of HIV and AIDS 2009, the National Youth Policy, and the School Health and Nutrition (SHN) Policy and strategic framework.

Adolescent Population: (Source: WHO, 2016). In the Republic of Zambia, there are 3.7 million adolescents aged 10–19 years – 23.9% of the country’s total population. Just over half of adolescents live in rural areas, 56.6% of adolescent girls and 58.9% of adolescent boys. By age 19, the mean number of years of schooling attended by adolescent girls is 8.2, while for adolescent boys it is 8.5. Among adolescents who become parents before age 20, the average age at which Zambian adolescent girls have their first baby is 17.4 years, while the average age at which adolescent boys first become fathers is 18.1. Analysis of data from the Zambian Demographic Health Survey 2013-14  shows that over 531 000 Zambians aged 15–19 are currently sexually active – they are either unmarried and have had sex in the last three months or they are in a union (i.e. married or living together). On average, adolescent girls first have sexual intercourse at age 16.4 years and adolescent boys at 16.2 years. Among unmarried adolescents, 38.7% of adolescent girls report ever having sex and 18.7% are currently sexually active; among adolescent boys, 47.1% report ever having sex, while 25.9% are currently sexually active. Among all Zambian adolescents, 16.9% of adolescent girls and 1.1% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 16.7 years for adolescent girls and 18.1 for adolescent boys

Adolescents Contraceptive Use: (Source: WHO, 2016). Unmet need for contraception is high among married female adolescents aged 15–19 (22 percent), and even higher among sexually active adolescents who are not married (64 percent) (Anderson et al., 2013). According to Zambian Demographic Health Survey 2013-14 analyses, 73.3% of unmarried, sexually active adolescent girls report not wanting a child in the next two years, yet only 20.6% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include:
• not married (61.7%)
• infrequent sex (37.3%)
• fear of side-effects or health concerns (8.6%)
Among all unmarried, sexually active adolescent girls aged 15–19, 81.9% are not using a method of contraception. Injectable contraceptives and condoms are the most common modern methods used (6.5% and 6.3% of these adolescent girls, respectively), while implants, which are considered to be one of the most effective methods, are used by 2.5%. Only a small proportion (0.3%) are using a traditional method (withdrawal). According to Zambian Demographic Health Survey 2013-14 analyses, 50.8% of adolescent girls in a union report not wanting a child in the next two years, yet only 43.3% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include:
• breastfeeding (28.5%)
• menses has not returned after giving birth (26.5%)
• not having sex (14.9%)
Among all adolescent girls in a union aged 15–19, 62.5% are not using a method of contraception. Injectable contraceptives are the most common modern method used (21.0% of these adolescent girls), followed by pills (6.4%) and male condoms (4.4%). Implants, one of the most effective methods, are used by 2.6%. Few (1.7%) are relying on a traditional method, withdrawal

Adolescent abortion:  The Zambian Termination of Pregnancy Act, enacted in 1972 and amended in 1994, legalised induced abortion in a wide range of circumstances, including a risk to a woman’s physical or mental health or that of any existing children, taking into account her age or her environment. Zambia’s relatively liberal abortion laws make the country a rare case in sub-Saharan Africa, where abortion is generally prohibited altogether or permitted only to save a woman’s life. However, unsafe abortion is common. The majority of women seeking abortion-related care in Zambia do so for PAC – post-abortion care to address problematic outcomes of unsafe induced abortion. Induced abortion is more likely when unmet need for effective contraception is high.  In Zambia, pregnancies reported as unplanned are common: 16% of births are reported as unwanted, and 26% are reported as being mistimed.  Unmet need for effective contraception among married women (an underestimate of the unmet need for women overall) is 27%, and it is estimated that if all married women with an unmet need for contraception were to use a method, the contraceptive prevalence rate would rise to 67% from 41%.

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