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  • Title: Adolescent knowledge and use of injectable contraceptives in developing countries.
    Author: Singh S.
    Journal: J Adolesc Health; 1995 May; 16(5):396-404. PubMed ID: 7662691.
    Abstract:
    PURPOSE: To review recent survey data on knowledge and use of injectable contraceptives among adolescents and young women in developing countries. The proportion of adolescents who are aware of this method, who have ever used it, and who are currently using the method, are described. Use of the injection is compared to overall use of any method, as well as to use of two other specific methods, the contraceptive pill and the condom. METHODS: The data reported here come from a series of nationally representative surveys carried out in 25 developing countries, in the mid to late 1980s, as part of the Demographic and Health Surveys (DHS) project. These are surveys of 5,000-10,000 women aged 15-49 years that obtain information on whether women have heard about each specific method, as well as on ever-use and current use of contraception. The data presented here are compiled from published sources, and focus on currently married young women (15-24 year olds), and adolescents (15-19 year olds). RESULTS: Although the injection is recognized by a moderately high proportion of young women and adolescents (40-70% in most countries), use of this method is extremely low in almost all countries. The exceptions, based on DHS data, are 3 Asian countries (Indonesia, Sri Lanka and Thailand) and to a lesser extent, two Latin American countries (Colombia and Mexico). Other countries with moderately high levels of use of Depo-Provera, based on other sources, are China, Jamaica and New Zealand. However, apart from these few countries, when adolescents and young women do choose to use contraception, it is the pill that they are much more likely to choose. CONCLUSIONS: Problems of availability of supplies of the injection may explain some of the observed variation in levels of use of this method. Supplies are mostly provided by international donor agencies such as United Nations Fund for Population Activities and International Planned Parenthood Federation. The lack of approval of the method by the United States until recently also probably had a negative effect on the likelihood of some other governments approving this method or promoting it. Now, with the approval of the United States, supplies may become more available and there may be a greater willingness to use Depo-Provera and other injectables in the developing countries. A review of the findings of Demographic and Health Surveys carried out in 25 developing countries (10 in sub-Saharan Africa, 3 in North Africa, 3 in Asia, and 9 in Latin America and the Caribbean) in 1986-90 indicates a high degree of awareness of injectable contraception but very low levels of use. Over 80% of women 15-49 years of age in Indonesia, Sri Lanka, Thailand, Botswana, Colombia, and Mexico knew of the injectable contraceptive Depo-Provera; in the other countries, awareness was in the 40-70% range. In countries for which separate data were available for women 15-19 years of age, knowledge of injectable contraceptives tended to be 10-20% less than that for all women. In 13 of the 25 countries, knowledge of injectables was 20-30% less than that of the pill; however, injectable contraception was more recognized than the condom in 17 countries. There were only five countries--Indonesia, Sri Lanka, Thailand, Colombia, and Mexico--in which 10% or more of married women have used Depo-Provera. Among married adolescents, the highest rate of Depo-Provera use (7%) was found in Indonesia and Thailand; in other countries for which data on adolescents were available, use levels were in the 1-2% range. These low use levels are assumed to reflect both women's health concerns and the nonavailability of supplies from international donor agencies. However, recent approval by the US of Depo-Provera use is expected to increase its availability in developing countries.
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