Adolescent abortion and contraceptive use in Ethiopia

Policy environment on adolescence: The Ministry of Health launched several strategies to promote adolescent & youth reproductive health including the “National Reproductive Health Strategy”, the “National Adolescent & Youth Reproductive Health Strategy” and “Standards on Youth Friendly Reproductive Health Services”. The implementation of the standards was however, constrained by the limited capacity of stakeholders for implementation. The Ministry of Health launched the National Reproductive Health Strategy in 2006 (Ministry of Health 2006). Subsequently, the National Adolescent and Youth Reproductive Health Strategy was developed. Goal 1 of the National Adolescent and Youth Reproductive Health Strategy reads as follows: “To meet the immediate and long-term RH needs of young people through increased access and quality of reproductive health services for adolescents and young people in Ethiopia;”and Objective 1.1: “To improve access to quality reproductive health and STI/HIV services”, which includes “Develop and Revise National Guidelines and Standards”. This component of the objective stipulated that the development of guidelines and national standards is an immediate key priority. Although, attempts have been made by different stakeholders (UNICEF, UNFPA, IFHP, FGAE, SC-USA and others) to undertake Youth Friendly Services in health facilities by training health workers, assigning focal persons and reorganizing service areas, the general nationwide picture reflected that many service providers are not trained in youth friendly services and may not have the required skills and attitude to provide such services (Ministry of Health 2006 c). The services are generally not provided in adolescent & youth friendly environment.

Adolescent Population: The World Health Organisation state that in the Federal Democratic Republic of Ethiopia, there are 24 million adolescents aged 10–19 years – 20.0% of the country’s total population. Over three quarters of adolescents live in rural areas, 78.9% of adolescent girls and 80.6% of adolescent boys. By age 19, the mean number of years of schooling attended by adolescent girls is 4.8, while for adolescent boys it is 5.7. Among adolescents who become parents before age 20, the average age at which Ethiopian adolescent girls have their first baby is 17.0 years, while the average age at which adolescent boys first become fathers is 18.0. Analysis of data from the Ethiopian Demographic Health Survey shows that nearly 2 million Ethiopians 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, among adolescents who had sex before age 20, adolescent girls and boys both first have sexual intercourse at age 15.8 years. Among unmarried adolescents, 6.8% of adolescent girls report ever having sex and 2.2% are currently sexually active; among adolescent boys, 7.8% report ever having sex, while 3.8% are currently sexually active. Among all Ethiopian adolescents, 19.1% of adolescent girls and 2.1% of adolescent boys are in a union. Among these adolescents, the mean age of the first union is 15.7 years for adolescent girls and 17.2 for adolescent boys.

Adolescents Contraceptive Use: According to Ethiopian Demographic Health Survey analyses, 55.9% of unmarried, sexually active adolescent girls report not wanting a child in the next two years, yet only 38.1% 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 (30.7%)
• infrequent sex (25.1%)
• fear of side-effects or health concerns (12.6%)
Among all unmarried, sexually active adolescent girls aged 15–19, 59.9% are not using a method of contraception. Injectable contraceptives and pills are the most common modern methods used (22.6% and 8.5% of these adolescent girls, respectively), while implants, which are considered to be one of the most effective methods, are used by 3.2%. According to Ethiopian Demographic Health Survey analyses, 57.0% of adolescent girls in a union report not wanting a child in the next two years, yet only 29.2% of them are currently using any method to prevent pregnancy. The main reasons these adolescents report for not using a contraceptive method include:
• menses has not returned after giving birth (17.3%)
• breastfeeding (15.4%)
• husband or partner is opposed (8.1%)
Among all adolescent girls in a union aged 15–19, 76.2% are not using a method of contraception. Injectable contraceptives are the most common modern method used (18.9% of these adolescent girls), while 1.6% are using implants, one of the most effective methods. Periodic abstinence, a traditional method, is used by 0.8% (Source of information World Health Organisation).

Adolescent abortion:  Sedgh et al. reported that as of 2008 the number of abortions to women aged 15–19 was 46,860 with 9 % of pregnancies to women 15–19 ending in abortion. Article 551 of the Penal Code of the Federal Democratic Republic of Ethiopia. Termination of pregnancy by a recognized medical institutions within the period permitted by the profession is not punishable where: The pregnancy is a result of rape or incest; or The continuation of the pregnancy endangers the life of the mother or the child or the health of the mother or where the birth of the child is a risk to the life or health of the mother; or The fetus has an incurable and serious deformity; or The pregnant women owing to a physical or mental deficiency she suffers from or her minority, is physically as well as mentally unfit to bring up the child.

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