In developing countries, young women's use of modern methods of contraception is limited by a range of factors, a review of seven studies conducted in five countries suggests.
Lack of knowledge, access problems and side-effect fears were the "overarching themes" limiting the women's use of hormonal contraceptives such as the birth control pill or hormone implants, Dr Lisa M. Williamson of the MRC Social and Public Health Sciences Unit in Glasgow and her colleagues report.
The studies were conducted in sub-Saharan Africa and Southeast Asia and asked young women about their views on contraceptive use. Results showed that overall, the young women had gotten very little information on sex or contraception, and the information they did get was frequently misleading. For example, one young woman thought she only had to take the birth control pill before having sex.
The belief that hormonal methods might impair future fertility was widespread. In five of the studies, young women said they were reluctant to use modern contraceptive methods because they perceived them as intended for married women. Some feared that health clinic staff would treat them poorly or not help them.
Many women also feared having others find out they were using contraceptives, because they would be known to be having sex, or thought of as being unable to bear children later on. In four studies, women said their partners would pressure them or even use violence to prevent them from using contraception.
Generally the young women reported having an easier time accessing condoms, but many saw them as methods for preventing sexually transmitted infection, rather than as a contraceptive, and associated them with disease and promiscuity.
For these reasons, many of the women relied on traditional birth control methods, such as charms and herbs, or even aspirin and antibiotics. Women in Tanzania and Nigeria considered abortion to be an option in the case of unintended pregnancy, with one study saying the procedure was much less dangerous than using birth control pills. However, abortion is only legal in these countries to save a woman's life. Illicit abortions carry serious risks of their own, Williamson and her team note; there are 20 million unsafe abortions each year, and 70,000 deaths related to such abortions annually.
Lack of knowledge and access may be the easiest problems to address, Williamson said. Efforts must also be community-wide to help address negative perceptions of contraceptive use and to encourage older women, as well as younger women, to consider using modern methods, she added. Interventions also need to be "youth-friendly," Williamson said, and should help young women build the life skills they need to take control of their reproductive health.
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