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Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Contraception and abortion knowledge, attitudes and practices among adolescents from low and middle-income countries: a systematic review

Authors: Margarate Nzala Munakampe, Joseph Mumba Zulu, Charles Michelo

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

Adolescents face significant barriers to contraception access and utilization that result in adverse health effects of early pregnancy and childbirth. Unsafe abortions continue to occur partly due to failure to prevent pregnancies, with Sub-Saharan Africa contributing the most significant burden of all unsafe abortions among young people globally, of which a quarter occurs in those aged 15–19 years. We aimed to conduct a systematic review of the contraceptive and abortion knowledge, attitudes and practices of adolescents in low and middle-income countries to increase the understanding of the sexual and reproductive health dynamics that they face.

Methods

Literature searches from 6 databases; PubMed, Science Direct, Google Scholar, BioMed Central, CINAHL, MEDLINE, were conducted, covering the period from 1970 to 2016 and concerning the adolescents aged 15–19 years and 21 studies were read and analyzed using thematic analysis.

Results

Limited knowledge about sexual and reproductive health among adolescents was a significant cause of reduced access to contraception and safe abortion services, especially among unmarried adolescents. Reduced access to reproductive health services for some resulted in extreme methods of contraception and abortion such as the use of battery acid and crushed bottles. Despite all adolescents having limited access to information and services, girls faced more consequences such as being blamed for pregnancy or dealing with the effects of unsafe abortions. Parents, health workers, and teachers were cited as trusted sources of information but often received the most information from peers and other family members instead, and the girls mostly confided in their aunties, cousins and peers while the boys resorted to peers, media and even pornography.

Conclusion

The reported observations suggest severe limitations in the access to safe and effective methods of contraception and safe abortion services. There is a need for an urgent response in reducing the “unmet needs” for contraception and to improve access to contraception, abortion information, and services in this group. Interventions which target the involvement of parents and teachers should be considered, to carry one wholesome message to the adolescents.
Literature
1.
2.
go back to reference Grimes D, et al. Unsafe abortion: the preventable pandemic. Lancet Sex Reprod Health Ser. 2006;368.CrossRef Grimes D, et al. Unsafe abortion: the preventable pandemic. Lancet Sex Reprod Health Ser. 2006;368.CrossRef
3.
go back to reference Darroch, J.E., et al., Costs and benefits of meeting the contraceptive needs of adolescents. 2016. Darroch, J.E., et al., Costs and benefits of meeting the contraceptive needs of adolescents. 2016.
5.
go back to reference Warenius LU, et al. Nurse-Midwives' attitudes towards adolescent sexual and reproductive health needs in Kenya and Zambia. Reproductive Health Matters. 2006;14(27):119–28.PubMedCrossRef Warenius LU, et al. Nurse-Midwives' attitudes towards adolescent sexual and reproductive health needs in Kenya and Zambia. Reproductive Health Matters. 2006;14(27):119–28.PubMedCrossRef
6.
7.
go back to reference Gage AJ. Sexual activity and contraceptive use: the components of the decisionmaking process. Stud Fam Plan. 1998:154–66.PubMedCrossRef Gage AJ. Sexual activity and contraceptive use: the components of the decisionmaking process. Stud Fam Plan. 1998:154–66.PubMedCrossRef
8.
go back to reference Campbell M, Sahin-Hodoglugil NN, Potts M. Barriers to fertility regulation: a review of the literature. Stud Fam Plan. 2006:87–98.PubMedCrossRef Campbell M, Sahin-Hodoglugil NN, Potts M. Barriers to fertility regulation: a review of the literature. Stud Fam Plan. 2006:87–98.PubMedCrossRef
9.
go back to reference Hindin MJ, Fatusi AO. Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. Int Perspect on Sexual & Reprod Health. 2009;35. Hindin MJ, Fatusi AO. Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. Int Perspect on Sexual & Reprod Health. 2009;35.
10.
go back to reference Siziya S, et al. Harmful lifestyles' clustering among sexually active in-school adolescents in Zambia. BMC Pediatr. 2008;8(1):1–7.CrossRef Siziya S, et al. Harmful lifestyles' clustering among sexually active in-school adolescents in Zambia. BMC Pediatr. 2008;8(1):1–7.CrossRef
11.
go back to reference Silumbwe A, et al. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa. BMC Public Health. 2017;17(1):484.PubMedPubMedCentralCrossRef Silumbwe A, et al. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa. BMC Public Health. 2017;17(1):484.PubMedPubMedCentralCrossRef
12.
go back to reference Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.PubMedCrossRef Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.PubMedCrossRef
13.
go back to reference Williamson LM, et al. Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reprod Health. 2009;6. Williamson LM, et al. Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reprod Health. 2009;6.
14.
go back to reference Jejeebhoy SJ. Adolescent sexual and reproductive behavior: a review of the evidence from India. Soc Sci Med. 1998;46(10):1275–90.PubMedCrossRef Jejeebhoy SJ. Adolescent sexual and reproductive behavior: a review of the evidence from India. Soc Sci Med. 1998;46(10):1275–90.PubMedCrossRef
15.
go back to reference Olukoya AA, et al. Unsafe abortion in adolescents. Int J Gynecol Obstet. 2001;75(2):137–47.CrossRef Olukoya AA, et al. Unsafe abortion in adolescents. Int J Gynecol Obstet. 2001;75(2):137–47.CrossRef
16.
go back to reference Jejeebhoy SJ. Adolescent sexual and reproductive behaviour: a review of the evidence from India. Soc Sci Med. 1998;46. Jejeebhoy SJ. Adolescent sexual and reproductive behaviour: a review of the evidence from India. Soc Sci Med. 1998;46.
17.
go back to reference Miller BC, Benson B, Galbraith KA. Family relationships and adolescent pregnancy risk: a research synthesis. Dev Rev. 2001;21(1):1–38.CrossRef Miller BC, Benson B, Galbraith KA. Family relationships and adolescent pregnancy risk: a research synthesis. Dev Rev. 2001;21(1):1–38.CrossRef
18.
go back to reference Qian X, Tang S, Garner P. Unintended pregnancy and induced abortion among unmarried women in China: a systematic review. BMC Health Serv Res. 2004;4(1):1.PubMedPubMedCentralCrossRef Qian X, Tang S, Garner P. Unintended pregnancy and induced abortion among unmarried women in China: a systematic review. BMC Health Serv Res. 2004;4(1):1.PubMedPubMedCentralCrossRef
19.
go back to reference Nichols D, et al. Sexual behavior, contraceptive practice, and reproductive health among Nigerian adolescents. Stud Fam Plan. 1986;17(2):100–6.CrossRef Nichols D, et al. Sexual behavior, contraceptive practice, and reproductive health among Nigerian adolescents. Stud Fam Plan. 1986;17(2):100–6.CrossRef
20.
go back to reference Astbury-Ward E, Parry O, Carnwell R. Stigma, abortion, and disclosure—findings from a qualitative study. J Sex Med. 2012;9(12):3137–47.PubMedCrossRef Astbury-Ward E, Parry O, Carnwell R. Stigma, abortion, and disclosure—findings from a qualitative study. J Sex Med. 2012;9(12):3137–47.PubMedCrossRef
21.
go back to reference Skinner SR, Hickey M. Current priorities for adolescent sexual and reproductive health in Australia. Med J Aust. 2003;179(3):158–61.PubMedCrossRef Skinner SR, Hickey M. Current priorities for adolescent sexual and reproductive health in Australia. Med J Aust. 2003;179(3):158–61.PubMedCrossRef
22.
go back to reference Chandra-Mouli V, et al. Contraception for adolescents in low and middle income countries: needs, barriers, and access Reproductive Health, vol. 11; 2014. Chandra-Mouli V, et al. Contraception for adolescents in low and middle income countries: needs, barriers, and access Reproductive Health, vol. 11; 2014.
23.
24.
go back to reference MacPhail C, et al. Contraception use and pregnancy among 15–24 year old south African women: a nationally representative cross-sectional survey. BMC Med. 2007;5(1):1–8.CrossRef MacPhail C, et al. Contraception use and pregnancy among 15–24 year old south African women: a nationally representative cross-sectional survey. BMC Med. 2007;5(1):1–8.CrossRef
25.
go back to reference Melaku YA, et al. Sexual and reproductive health communication and awareness of contraceptive methods among secondary school female students, northern Ethiopia: a cross-sectional study. BMC Public Health. 2014;14. Melaku YA, et al. Sexual and reproductive health communication and awareness of contraceptive methods among secondary school female students, northern Ethiopia: a cross-sectional study. BMC Public Health. 2014;14.
26.
go back to reference Wood K, Jewkes R. Blood blockages and scolding nurses: barriers to adolescent contraceptive use in South Africa. Reprod Health Matters. 2006;14.PubMedCrossRef Wood K, Jewkes R. Blood blockages and scolding nurses: barriers to adolescent contraceptive use in South Africa. Reprod Health Matters. 2006;14.PubMedCrossRef
27.
go back to reference Webb D. Attitudes to 'Kaponya Mafumo': the terminators of pregnancy in urban Zambia. Health Policy Plan. 2000;15(2):186–93.PubMedCrossRef Webb D. Attitudes to 'Kaponya Mafumo': the terminators of pregnancy in urban Zambia. Health Policy Plan. 2000;15(2):186–93.PubMedCrossRef
28.
go back to reference Sowmini CV. Delay in termination of pregnancy among unmarried adolescents and young women attending a tertiary hospital abortion clinic in Trivandrum, Kerala. India. Reproductive Health Matters. 2013;21(41):243–50.PubMedCrossRef Sowmini CV. Delay in termination of pregnancy among unmarried adolescents and young women attending a tertiary hospital abortion clinic in Trivandrum, Kerala. India. Reproductive Health Matters. 2013;21(41):243–50.PubMedCrossRef
29.
go back to reference Schuster S. Women's experiences of the abortion law in Cameroon: “what really matters”. Reproductive Health Matters. 2010;18(35):137–44.PubMedCrossRef Schuster S. Women's experiences of the abortion law in Cameroon: “what really matters”. Reproductive Health Matters. 2010;18(35):137–44.PubMedCrossRef
30.
go back to reference Nzioka C. Perspectives of adolescent boys on the risks of unwanted pregnancy and sexually transmitted infections: Kenya. Reprod Health Matters. 2001;9.PubMedCrossRef Nzioka C. Perspectives of adolescent boys on the risks of unwanted pregnancy and sexually transmitted infections: Kenya. Reprod Health Matters. 2001;9.PubMedCrossRef
31.
go back to reference Richter MS, Mlambo GT. Perceptions of rural teenagers on teenage pregnancy. Health SA Gesondheid. 2005;10. Richter MS, Mlambo GT. Perceptions of rural teenagers on teenage pregnancy. Health SA Gesondheid. 2005;10.
32.
go back to reference Macintyre AK-J, Montero Vega AR, Sagbakken M. From disease to desire, pleasure to the pill: a qualitative study of adolescent learning about sexual health and sexuality in Chile. BMC Public Health. 2015;15(1):1–14.CrossRef Macintyre AK-J, Montero Vega AR, Sagbakken M. From disease to desire, pleasure to the pill: a qualitative study of adolescent learning about sexual health and sexuality in Chile. BMC Public Health. 2015;15(1):1–14.CrossRef
33.
go back to reference Kennedy EC, et al. “These issues aren’t talked about at home”: a qualitative study of the sexual and reproductive health information preferences of adolescents in Vanuatu. BMC Public Health. 2014;14(1):1–12.CrossRef Kennedy EC, et al. These issues aren’t talked about at home”: a qualitative study of the sexual and reproductive health information preferences of adolescents in Vanuatu. BMC Public Health. 2014;14(1):1–12.CrossRef
34.
go back to reference Kennedy EC, et al. “Be kind to young people so they feel at home.” adolescents’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu. BMC Health Serv Res. 2013;13. Kennedy EC, et al. Be kind to young people so they feel at home.” adolescents’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu. BMC Health Serv Res. 2013;13.
35.
go back to reference Ganatra B, Hirve S. Induced abortions among adolescent women in rural Maharashtra India. Reproductive Health Matters. 2002;10(19):76–85.PubMedCrossRef Ganatra B, Hirve S. Induced abortions among adolescent women in rural Maharashtra India. Reproductive Health Matters. 2002;10(19):76–85.PubMedCrossRef
36.
go back to reference Char A, Saavala M, Kulmala T. Assessing young unmarried men’s access to reproductive health information and services in rural India. BMC Public Health. 2011;11. Char A, Saavala M, Kulmala T. Assessing young unmarried men’s access to reproductive health information and services in rural India. BMC Public Health. 2011;11.
37.
go back to reference Both R, Samuel F. Keeping silent about emergency contraceptives in Addis Ababa: a qualitative study among young people, service providers, and key stakeholders. BMC Womens Health. 2014;14(1):1–11.CrossRef Both R, Samuel F. Keeping silent about emergency contraceptives in Addis Ababa: a qualitative study among young people, service providers, and key stakeholders. BMC Womens Health. 2014;14(1):1–11.CrossRef
38.
go back to reference Barua A, Kurz K. Reproductive health-seeking by married adolescent girls in Maharashtra. India Reproductive Health Matters. 2001;9(17):53–62.PubMedCrossRef Barua A, Kurz K. Reproductive health-seeking by married adolescent girls in Maharashtra. India Reproductive Health Matters. 2001;9(17):53–62.PubMedCrossRef
39.
go back to reference Ilika A, Igwegbe A. Unintended pregnancy among unmarried adolescents and young women in Anambra state south east Nigeria. Afr J Reprod Health. 2004;8.PubMedCrossRef Ilika A, Igwegbe A. Unintended pregnancy among unmarried adolescents and young women in Anambra state south east Nigeria. Afr J Reprod Health. 2004;8.PubMedCrossRef
40.
go back to reference Otoide VO, Oronsaye F, Okonofua FE. Why Nigerian adolescents seek abortion rather than contraception: evidence from focus-group discussions. Int Fam Plan Perspect. 2001;27.CrossRef Otoide VO, Oronsaye F, Okonofua FE. Why Nigerian adolescents seek abortion rather than contraception: evidence from focus-group discussions. Int Fam Plan Perspect. 2001;27.CrossRef
41.
go back to reference Rasch V, et al. Adolescent girls with illegally induced abortion Dar Es Salaam: the discrepancy between sexual behaviour and lack of access to contraception. Reproductive Health Matters. 2000;8(15):52–62.PubMedCrossRef Rasch V, et al. Adolescent girls with illegally induced abortion Dar Es Salaam: the discrepancy between sexual behaviour and lack of access to contraception. Reproductive Health Matters. 2000;8(15):52–62.PubMedCrossRef
42.
go back to reference Dahlback E, et al. Unsafe induced abortions among adolescent girls in Lusaka. Health Care Women Int. 2007;28.PubMedCrossRef Dahlback E, et al. Unsafe induced abortions among adolescent girls in Lusaka. Health Care Women Int. 2007;28.PubMedCrossRef
43.
go back to reference Nguyen HN, Liamputtong P, Murphy G. Knowledge of contraceptives and sexually transmitted diseases and contraceptive practices amongst young people in Ho Chi Minh City Vietnam. Health Care Women Int. 2006;27(5):399–417.PubMedCrossRef Nguyen HN, Liamputtong P, Murphy G. Knowledge of contraceptives and sexually transmitted diseases and contraceptive practices amongst young people in Ho Chi Minh City Vietnam. Health Care Women Int. 2006;27(5):399–417.PubMedCrossRef
44.
go back to reference Nobelius AM, et al. Sexual and reproductive health information sources preferred by out-of-school adolescents in rural Southwest Uganda. Sex Educ. 2010;10.CrossRef Nobelius AM, et al. Sexual and reproductive health information sources preferred by out-of-school adolescents in rural Southwest Uganda. Sex Educ. 2010;10.CrossRef
45.
go back to reference Okereke CI. Assessing the prevalence and determinants of adolescents’ unintended pregnancy and induced abortion in Owerri. Nigeria J Biosoc Sci. 2010;42. Okereke CI. Assessing the prevalence and determinants of adolescents’ unintended pregnancy and induced abortion in Owerri. Nigeria J Biosoc Sci. 2010;42.
46.
go back to reference Plummer ML, et al. Aborting and suspending pregnancy in rural Tanzania: an ethnography of young people’s beliefs and practices. Stud Fam Plan. 2008;39.PubMedCrossRef Plummer ML, et al. Aborting and suspending pregnancy in rural Tanzania: an ethnography of young people’s beliefs and practices. Stud Fam Plan. 2008;39.PubMedCrossRef
Metadata
Title
Contraception and abortion knowledge, attitudes and practices among adolescents from low and middle-income countries: a systematic review
Authors
Margarate Nzala Munakampe
Joseph Mumba Zulu
Charles Michelo
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3722-5

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