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Empowering accessible rights-based, family planning.
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High-quality, comprehensive family planning services for adolescents and young people are crucial for improving sexual and reproductive health, reducing the risk of unwanted pregnancy and sexually transmitted diseases, keeping girls in school, and empowering young women to participate fully in society.
The Family Planning High Impact Practices (HIPs) partnership identifies adolescent-responsive contraceptive services as a High Impact Practice with demonstrated effectiveness for increasing adolescent contraceptive use.
Unmet need in this age group is high:
In most of the countries, more than 1 in 5 sexually active young women have an unmet need for contraception. Appropriately, all 15 country commitments prioritize adolescent and youth services.
Key life events
On average, women in these countries first have sex around age 17.5, get married for the first time around age 19, and give birth for the first time around age 20. Since most women do not start having sex until after age 17, the majority of girls in the 15–19 age group have never had sex (Figure 4).
However, as they enter the next age group (20–24), virtually all have started engaging in sexual activity (Figure 5).
The gap between first sex and first birth is typically about 2.5 years. But differences in marriage patterns across countries determine how much of this gap takes place within or outside of marriage. In Rwanda, for example, the average age of first sex is 20.7, with first marriage following at age 22.8 and first birth at 23.
At the opposite end of the spectrum is Niger, where the average age of first marriage is 15.7, with first sex following at age 15.9 and first birth at age 18.6. (Niger is the only country in our sample where the start of sexual activity typically occurs for young women after they are married.)
To ensure that young women are able to make informed decisions about contraceptive use before they get married or become sexually active, programs should tailor messages to reach girls as soon as they enter their reproductive years. Programs should also be responsive to the different needs of sub-populations.
One group that is easily overlooked is unmarried young women who have not recently been sexually active, with recency defined as being within the past 30 days (yellow bars in Figures 4 and 5). This group is in fact a larger proportion of the population than unmarried young women with recent sexual activity (orange bars)
Programs will need to take into consideration the life experiences and specific needs of this group and other sub-populations to ensure that outreach strategies are appropriate.
Figure 4
Marital and Sexual Activity Status Among Women Aged 15-19
Married
Unmarried Sexually Active (30 days)
Unmarried Not Recently Sexually Active
Unmarried Never Had Sex
Graphic notes: Percentages less than 2% are not listed on this graphic.
Figure 5
Marital and Sexual Activity Status Among Women Aged 20-24
Married
Unmarried Sexually Active (30 days)
Unmarried Not Recently Sexually Active
Unmarried Never Had Sex
Graphic notes: Percentages less than 2% are not listed on this graphic.
Contraceptive Use and Unmet Need
Contraceptive use among married and unmarried sexually active women aged 15–24 is generally higher in East & Southern Africa than in West Africa (Figure 6). The difference is especially pronounced among young married women: In East & Southern Africa, the modern contraceptive prevalence, or MCP, rate for married women aged 15–24 ranges from 21.4% in Mozambique to 61.1% in Rwanda; in West Africa, it ranges from 6.4% in Nigeria to 30.2% in Burkina Faso.
Unmet need for unmarried sexually active young women is also generally higher in West Africa, especially for those aged 15–19. In three countries (Benin, Mali, and Nigeria), over 50% of unmarried sexually active women aged 15–24 have an unmet need for family planning.
Figure 6
Modern Contraceptive Prevalence and Unmet Need Among Married Women (MW) and Unmarried Sexually Active Women (UMSA) Aged 15-24
Modern Contraceptive Prevalence (Married Women 15-24)
Unmet need for family planning (Married Women 15-24)
Modern Contraceptive Prevalence (UMSA Women 15-24)
Unmet need for family planning (UMSA 15-24)
Graphic notes: For contries without data for unmarried sexually active women (Mauritania, Niger, and Senegal), either sample sizes were too small or surverys did not capture this population.*
Nigeria and Unmet Need
Nigeria’s high population means that even small percentages translate into large absolute numbers. At 14.9% , Nigeria’s percentage of young married women with unmet need for family planning is not as high as in the other West African countries we examined. But because of population size, that 14.9% equates to 1.3 million women—by far the most of any country in our sample.
By the same token, Nigeria’s 6.4% MCP among married women aged 15–24 is the lowest of all 15 countries we analyzed. But that works out to approximately 550,000 users—more than four times the number in Rwanda, which has the highest MCP for young married women of any country in our study ( 61.1% ).
Regional differences in method choice
Different youth populations in the two subregions rely on various modern methods (Figures 7 and 8). Modern contraceptive method choice generally tracks with marital status (married versus unmarried and sexually active) rather than age cohort (15–19 versus 20–24), so the figures show disaggregation by marital status only.
Even though married women aged 15–24 overwhelmingly use short-acting contraceptive methods in both East & Southern Africa and West Africa, there are regional and country-specific differences (Figure 7). Injections are more popular in East & Southern Africa, making up over 50% of the modern method mix for married women aged 15–24 in Ethiopia, Madagascar, and Uganda.
West African countries have more varied method use, with less dominance by a single method. Mauritania is the only country where pills were used by over half the married modern contraceptive users aged 15–24. In Guinea, where contraceptive use is low among married women, most of the married women aged 15–24 who are using a modern contraceptive method use the lactational amenorrhea method (LAM).
Figure 7
Method Prevalence Among Married Women Aged 15-24
UID
Implants
Injections
Pill
Male Condom
LAM
Traditional Method
Graphic notes: Percentages less than 2% are not listed on this graphic.
Additionally, among unmarried sexually active young women in Burkina Faso, self-injections are more popular with the 15–19 age group ( 7.3% ) than the 20–24 age group ( 3.4% ), however, it should be noted that the sample size for both groups is very small.
Unmarried sexually active young women in West Africa use long-acting reversible methods, especially implants, at a higher rate than women in East & Southern Africa. Between 2012 and 2018, the use of implants in Benin, Guinea, and Mali more than doubled among this population, and today more than 1 in 5 unmarried sexually active contraceptive users in these countries are using implants.
Among unmarried sexually active women aged 15–24, condom use is the leading contraceptive method in the majority of countries (Figure 8). In East & Southern Africa, injections are also very popular and are the leading method in Ethiopia and Madagascar.
Figure 8
Method Prevalence Among Unmarried Sexually Active Women Aged 15-24
UID
Implants
Injections
Pill
Male Condom
LAM
Emergency Contraception
Standard Days (SDM)
Other Modern Method
Traditional Method
Graphic notes: Percentages less than 5% are not listed on this graphic. No data for Mauritania, Niger, and Senegal for UMSA Chart.
Regional- and country-level differences in contraceptive method use can have significant implications for family planning programs, including the types of counseling and service delivery that should be offered for various youth populations.
Recent method use trends among unmarried sexually active young women in Benin, Burkina Faso, Guinea, and Mali, for example, might signal that this population would opt to use methods other than condoms if those methods were readily available and accessible.
The different contraceptive method use patterns between married and unmarried young women may be due to where they are obtaining their methods. In all countries in our sample, most married women aged 15–24 obtained their most recent modern contraceptive method from a government health facility.
Most unmarried sexually active young women aged 15–19 in Benin, Mozambique, Nigeria, Tanzania, Togo, and Uganda obtained their methods from private sources such as shops and pharmacies; these are also countries where condom use makes up over 50% of the modern method mix for unmarried sexually active women aged 15–19 .
Greater reliance on the private sector by unmarried young women, especially those aged 15–19 , might indicate a lack of public sector reach with this segment of the population or poor quality of service provision for the youngest women.
It is important for countries to evaluate their method mix as well as the source of those methods to understand if the family planning program is meeting the needs of all young people—and where there might be bottlenecks.
For more information, analysis and reports:
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