An array of societal pressures and a lack of access to appropriate information and services discourage contraceptive use among married adolescents in South and Southeast Asia, according to "Reproductive Choices for Asian Adolescents: A Focus on Contraceptive Behavior," an analysis by Saroj Pachauri and K.G. Santhya of the Population Council, New Delhi. Because early, frequent childbearing can endanger the health of young women and their children, the authors argue that more attention must be paid to adolescents' needs for accurate information about contraceptives and user-friendly supplies and services.
The analysis, published in the December 2002 issue of International Family Planning Perspectives, uses national survey data from Bangladesh, India, Indonesia, Nepal, Pakistan, the Philippines, Sri Lanka, Thailand and Vietnam to examine adolescents' contraceptive behavior. The authors point out that although nearly all of the young women surveyed in most countries had heard of at least one contraceptive method, many were not aware of specific reversible methods (particularly the condom), and many did not know where to go to obtain a method. Use of modern methods varied among countries, ranging from 2% of married adolescents in Pakistan to 44% in Indonesia.
Married Asian adolescents face societal and familial pressures to have children. In all nine countries, a large proportion of births to adolescents were unplanned. In addition, they may be discouraged from using contraceptives by provider resistance, religious beliefs or fear of side effects. Married adolescents are likely to need to space, not limit, births, yet the most promoted (and, therefore, most widely known) contraceptive methods may not meet these needs: In India, for example, 89% of adolescents were aware of tubal sterilization, while only 59% were aware of the condom, the only method that protects against both pregnancy and STIs. The available evidence also indicates that unmarried Asian adolescents are increasingly likely to be sexually active, and that a large majority of those who are sexually active are having unprotected sex. Like their married peers, unmarried adolescents need better access to contraceptive information and services.
Assessing adolescents' sexual and reproductive health needs, suggest the authors, is the crucial first step toward building effective programs. The nearly universal knowledge of at least one form of modern contraception found in the analysis suggests that more targeted and effective information could encourage contraceptive use. Programs designed specifically for adolescents, married and unmarried, are necessary to ensure their access to appropriate supplies and services and to combat societal pressures and misconceptions about contraception.
Two other articles in the December issue of International Family Planning Perspectives address contraceptive services and supplies in Asian countries:
• "Reconciling Cost Recovery with Health Equity Concerns in a Context of Gender Inequality and Poverty: Findings from a New Family Health Initiative in Bangladesh," by Sidney Ruth Schuler, Lisa Bates and Md. Khairul Islam
• "Accessibility and Use of Contraceptives in Vietnam," by Nguyen Minh Thang and Dang Nguyen Ahn
Also in this issue:
• "Knowledge and Opinions About Abortion Law Among Mexican Youth," by Davida Becker, Sandra G. Garcia and Ulla Larsen
• Viewpoint: "Donor Dealings: The Impact of International Donor Aid on Sexual and Reproductive Health Services," by Susannah H. Mayhew
• Viewpoint: "In Search of Seamless Transition to Post-Lactational Amenorrhea Method Contraception," by John Stanback and Heidi W. Reynolds