These estimates are the most current data available for adolescents and come from the 2016 Adolescent Adding It Up report. However, they are not directly comparable to Adding It Up 2017, which draws on more recent survey data and estimates for unintended pregnancies, abortions and costs. Updated estimates for adolescents are forthcoming.
Why Delaying Pregnancy Is Critical
- Preventing unintended pregnancy is essential to improving adolescents’ sexual and reproductive health and their social and economic well-being.
- Complications of pregnancy and childbirth are a leading cause of death among 15–19-year-old women in developing regions, and babies born to adolescent mothers face greater health risks than those born to older mothers.
- Adolescents having their first birth account for a disproportionate share of cases of obstetric fistula, a debilitating condition that results from obstructed and prolonged labor.
- Adolescent childbearing is associated with lower educational attainment among the mothers, and it can perpetuate a cycle of poverty from one generation to the next.
- Nearly half of pregnancies among adolescents aged 15–19 in Sub-Saharan Africa are unintended, and nearly half of these end in abortion. Almost all of these abortions occur in countries where the procedure is often unsafe.
Adolescents’ Needs for Contraception
- Among the 52 million women aged 15–19 in Sub-Saharan Africa, 22% (11.3 million) need contraception because they are married, or are unmarried and sexually active, and do not want a child for at least two years.
- Of these 11.3 million adolescents, 32% (3.6 million) are using modern contraceptives. The most common method is the male condom (accounting for about half of users), followed by injectables and the pill.
- The other 68% (7.7 million) are not using a modern method; these adolescent women have an unmet need for modern contraception. Among these women, 87% are using no method at all, and the remainder use traditional methods, which are less effective than modern methods.
- Younger adolescents have higher unmet need than do older adolescents: Seventy-two percent of sexually active 15–17-year-olds who want to avoid pregnancy are not using modern contraceptives, compared with 65% of those aged 18–19.
- Unmet need is higher among married adolescents aged 15–19 than among sexually active unmarried adolescents (74% versus 64%).
- Among Sub-Saharan Africa’s subregions, unmet need is highest in Middle Africa, where 78% of sexually active adolescents who want to avoid pregnancy are not using modern contraceptives. In Southern Africa, this proportion is 39%.
- Young African women’s reported reasons for not using contraceptives despite wanting to avoid pregnancy often include concerns about side effects, having infrequent sex, not being married, breast-feeding or not having resumed menstruation after a birth, and their or their partners’ opposition to contraception.
Cost of Meeting Contraceptive Needs
- In 2016, the estimated annual cost of providing contraceptive services to 3.6 million women aged 15–19 who use modern contraceptives in Sub-Saharan Africa is $36 million. This averages to $10 per user annually.
- Service costs include direct costs for contraceptives, related supplies and health worker salaries, as well as the indirect costs of management functions, construction and maintenance of facilities, information and education activities, and other types of program support.
- If services were improved for the 3.6 million adolescent women currently using contraceptives, costs would increase from $36 million to $113 million. Examples of improvements that would benefit adolescents include better contraceptive counseling and follow-up, consistent availability of a range of modern methods and providers who are trained to work with young people.
- If the 7.7 million adolescent women with unmet need were to use the same mix of modern methods as current users and receive improved services, total costs for current and new users would be $336 million annually.
- The expanded and im-proved services for all 11.3 million women who need them would cost $30 per user annually. Put differently, the cost per capita in Sub-Saharan Africa would be 34 cents. Much of the increase in cost is for upgrading the health systems that support contraceptive services.
Benefits of Meeting All Contraceptive Needs
- Increased use of modern contraceptives by adolescents wanting to avoid pregnancy would prevent unintended pregnancies, save lives and improve health.
- If all adolescent women who need modern contraceptives were to use them, total pregnancies would drop from 8.3 million to 5.6 million per year. Unintended pregnancies would drop by 2.7 million per year (70%), resulting in
— 1.1 million fewer unplanned births, a decline of 71%;
— 1.3 million fewer abortions (a decline of 70%), almost all of which would have been unsafe; and
— 300,000 fewer miscarriages of unintended pregnancies, a decline of 71%.
- Maternal deaths—those due to complications of pregnancy and childbearing—among women aged 15–19 would drop from the current level of 13,000 per year to 8,200.
- Meeting adolescent women’s contraceptive needs requires working on several fronts: ending child marriage, preventing sexual abuse and coercion, increasing girls’ education, empowering girls and women, and providing high-quality contraceptive services.
- Boosting girls’ education increases their ability to make autonomous decisions. Studies show that adolescents who are in school are less likely than those not in school to have sex and more likely to use contraceptives when they do have sex.
- Engaging young men in sexual and reproductive health programs can help bring about more gender-equitable attitudes.
- Adolescents need access to age-appropriate sexual and reproductive health information before they are sexually active. Policies and programs should be in place that address the needs of this age-group, including the provision of comprehensive sexuality education.
- The most effective approaches to providing sexual and reproductive health services to youth include a combination of health worker training; facility improvements geared toward welcoming adolescents and protecting their privacy; and information dissemination through schools, communities and the media.
- Contraceptive services must be provided in a way that protects young women’s rights to voluntary, informed and confidential contraceptive choice.
- The counseling provided with contraceptive methods must be strengthened. All young women need correct information about their risk of becoming pregnant, choices of contraceptive methods and possible side effects, and support in switching methods when desired.
The information in this fact sheet is drawn from Darroch JE et al., Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/adding-it-meeting-contraceptive-needs-....
This report was made possible by grants from the Bill & Melinda Gates Foundation, Children’s Investment Fund Foundation, the Swedish International Development Cooperation Agency and the UK Government. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donors.