Adolescent contraception a major local challenge
Over the past decade, global efforts to enhance sexual and reproductive health have gained significant momentum. In sub-Saharan Africa, an exceptionally high rate of adolescent pregnancy proves we still have a long way to go.
The Sustainable Development Goals (SDGs) 3 and 5 set ambitious targets to ensure universal access to SRH services and rights by 2030. These goals align with the UN Secretary-General’s Global Strategy for Women’s, Children’s, and Adolescents’ Health. As a testament to this commitment, the number of countries pledging support for Family Planning 2020 has increased to 59, and bilateral aid for family planning rose by 32% between 2012 and 2014.
One critical area identified for focused intervention is adolescent sexual and reproductive health. The Lancet Commission on Adolescent Health and Wellbeing, established in May 2016, emphasised that failing to address the unique challenges faced during adolescence could undermine past progress in sexual and reproductive health. The expanded Global Strategy now includes comprehensive objectives to address the needs of women, children, and adolescents, aiming to achieve universal access to contraception and meet the unmet needs of adolescents.
CHALLENGES IN ADOLESCENT CONTRACEPTION
Adolescents, navigating the transition from childhood to adulthood, face distinct biological and social changes that influence their sexual behaviours and decisions. For adolescent girls, these issues are particularly pressing due to their heightened biological vulnerability to sexually transmitted infections (STIs), the significant childcare burdens they bear, and the stigma they may encounter if they have children outside culturally accepted norms.
These factors can severely impact their future educational, social, and economic prospects. However, efforts to improve adolescent sexual and reproductive health have been hampered by insufficient funding, political and cultural barriers, and a lack of comprehensive knowledge about their health needs.
In sub-Saharan Africa (SSA), addressing adolescent sexual and reproductive health is especially urgent. SSA has the highest proportion of adolescents globally, with 44% of its population under the age of 15. This youth bulge presents potential for positive economic and social development. Yet, ineffective family planning programmes could lead to a significant youth dependency burden if demand for contraception is unmet. Maternal mortality is a leading cause of death among young people (ages 15-24) in SSA, accounting for 15% of all deaths, further underscoring the need for effective contraceptive access.
METHODS OF CONTRACEPTION
Contraceptive methods have evolved significantly since the 1960s, when hormonal contraceptives first emerged. Today, contraceptives are categorised into natural methods, barrier methods, short-acting hormonal methods, long-acting reversible contraceptives (LARCs), and irreversible methods. Each category offers distinct benefits and drawbacks.
- Natural Methods: These include fertility-awareness methods, coitus interruptus, and sexual abstinence. Fertility-awareness methods involve tracking ovulation through various indicators such as cervical mucous, basal body temperature, or calendar calculations. While these methods are inexpensive and generally acceptable, their reliability is variable and highly dependent on accurate user application.
- Barrier Methods: Barrier methods include male and female condoms, as well as caps and diaphragms. Condoms are widely used and provide protection against STIs, but their effectiveness depends on proper use and quality. The Pearl Index for condoms ranges from 2 to 18 pregnancies per 100 women years, depending on usage.
- Short-Acting Hormonal Methods: The Combined Oral Contraceptive Pill (COCP) combines oestrogen and progestogen to prevent ovulation. It remains one of the most popular methods, with its formulation evolving to reduce side effects and risks such as venous thromboembolism (VTE). Variations in hormonal dosage and delivery methods, such as the introduction of oestetrol-containing pills, aim to improve safety and efficacy.
- Long-Acting Reversible Contraceptives (LARCs): LARCs, including intrauterine contraceptive devices (IUCDs) and contraceptive implants, offer highly effective, low-maintenance options. IUCDs can be copper-based or hormone-releasing, with the latter providing additional benefits like reduced menstrual bleeding. Implants, such as Implanon and Norplant, offer continuous contraception for several years and are favoured for their ease of use and effectiveness.
- Injectable Contraceptives: Depot medroxyprogesterone acetate (DMPA) is a commonly used injectable method that provides reliable contraception for three months. Its advantages include high efficacy and minimal user dependency, though it may be associated with decreased bone mineral density and potential risks of breast cancer.
- Irreversible Contraceptives: Irreversible methods include vasectomy for men and tubal ligation for women. These procedures offer permanent solutions to contraception but require thorough counselling due to their irreversible nature.
- Emergency Contraception: Emergency contraception methods, such as oral pills (levonorgestrel or ulipristal acetate) and copper IUCDs, are used to prevent pregnancy after unprotected sex. They must be administered within specific time frames to be effective.
CONCLUSION
The evolution of contraceptive methods reflects ongoing advancements in SRH, aiming to enhance safety, efficacy, and accessibility. Despite significant progress, challenges remain, particularly in regions like SSA where adolescent SRH needs are acute. Addressing these challenges requires continued investment in education, healthcare infrastructure, and tailored interventions to meet the diverse needs of young populations globally.
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REFERENCES
Pollacco, J, et al, 2023. An Overview of Current Contraceptive Modalities and Historical Perspectives: A Review. Gynecological and Reproductive Endocrinology and Metabolism 2024; 5(1):21-26.
Smith, J, et al, 2020. Improving Adolescent Access to Contraception in Sub-Saharan Africa: A Review of the Evidence. African Journal of Reproductive Health March 2020; 24 (1):152.
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