Contraceptive choice and Use of methods among young women in Namibia

This paper examines social, demographic and behavioural factors that influence contraceptive use and method choice among young Namibian women. It also explores ways to improve the accessibility of health facilities and family planning services for young women. The logistic regression method has been applied to examine the determinants of contraceptive use and method choice. The study reveals that whilst there is provision, the accessibility and convenience of existing reproductive health services for young women is poor and levels of contraceptive use are still low. There is a lack of support from parents and health care providers especially in rural areas. Health facilities are also ranked by young women as user-unfriendly as most of them, as public spaces, lack confidentiality and privacy. These negative experiences of young women impact on their utilization of reproductive and health services and their use of contraceptives. The findings thus suggest that government strategies, which aim to increase the use of contraceptives amongst young women in Namibia, ought to enhance and improve parent-child communication and make a range of choices available. Young women (aged 15-24 years) are increasingly exposed to reproductive health risks such as sexually transmitted infections (STIs), unintended pregnancy and childbirth (Mfono, 1998; Creel & Perry, 2003). The exposure to these risks has attracted considerable research attention in different societies, in efforts both to understand its extent, causes and to address it as a problem. In Africa, studies (Muhwava, 1998; Burgard, 2004) have demonstrated that a large proportion of young women are exposed to the risk of conception, receive poor or no sex and contraceptive education, and experience a high incidence of adolescent childbirth. Although reports indicate a decline in teenage pregnancy, most of the premarital births still occur among young women aged 15-24 years, the majority of whom are neither economically nor emotionally ready to deal with parental responsibilities (Creel & Perry, 2003). Thus, improving young women’s reproductive health is key to improving the situation of women as well as the world’s future generations. Young women often lack basic reproductive health information. They need information on the consequences of unprotected sexual intercourse and they also need to be well informed on developmental body changes. In addition to the above-mentioned information, young women need skills in negotiating sexual relationships, and knowledge about affordable confidential reproductive health services. Many do not feel comfortable discussing sexual issues with parents or other key adults with whom they can talk about their reproductive health concerns (Meekers & Ahmed, 1997; Whitaker et al. 1999). Likewise, parents, health care workers, and educators frequently are unwilling or unable to provide complete, accurate, age-appropriate reproductive health information to young people. This is often due to their discomfort in discussing the subject or the false belief that providing the information will encourage increased sexual activity (Karim et al. 2003). Because of this, most young women enter into sexual relationships with very little knowledge on the consequences, either shared by their peers or from the media; and also contributed to a low prevalence of using protective measures i.e. contraceptives. Substantial evidence is also found in existing literature that broadening the choice of contraceptive methods increases overall contraceptive prevalence (Magadi & Curtis, 2003; Chen & Guilkey, 2003). The provision of a wide range of contraceptive methods increases the opportunity for individuals to obtain a method that suits their needs. Ross et al. (2001) confirm that prevalence of contraceptive use is highest in countries where access to a wide range of methods is uniformly high. However, studies of contraceptive use and contraceptive methods choice among young women in countries in subSaharan Africa are few, probably because of the generally low contraceptive prevalence in the region. Researchers have primarily focused on contraceptive use and method choice among married women, leaving the vulnerable unmarried young women unattended. A growing need, though, exists for an examination of contraceptive use and methods choice patterns among young women. In addition, improving contraceptive access and use is vital to overcome the challenge of unintended pregnancy among unmarried young women. Furthermore, several research studies (Bertrand et al., 2001; Magadi & Curtis, 2003; Rani & Lule, 2004) have looked at the individual and community influence on contraceptive use of young women but there is a dearth of knowledge in research on household influence, especially that of immediate family members on the use of contraceptives among young women. Although programmes that equip young women with sexual and reproductive health information exist in Namibia, parents and other family elders are left behind because there are very few programmes targeting them with regard to how they should communicate with their children on sexual issues. In response to the 1994 ICPD Programme of Action, the Namibian government introduced the reproductive health and family planning programme with the overall objective of promoting, protecting and improving the health of family members, especially women and children. The objectives of the programme was to reduce maternal and infant deaths, increase contraceptive use among women of reproductive age to enable reproductive women to space births and avoid unwanted pregnancies as well as promote and improve access to reproductive health services at all levels of health care delivery. The objectives of these programmes have not been fully achieved. Teenage pregnancy, unwanted premarital childbirths as well as prevalence of new HIV infections among young women have been on the increase in Namibia despite efforts on the part of the Ministry of Health and Social Services emphasizing on the provision of adolescent and youth friendly health including contraceptive services. Multi-purpose youth resource centres were established in all 13 regions of the country with the purpose of serving as resource base for young people and to provide youth friendly services to address the needs of the youth. How accessible and convenient these centres are has been the subject of many questions over the past few years. Do they meet the needs of young women, and if not, why not? Do these facilities readily offer contraceptives to young women and do young women have choices when selecting contraceptives? These are some of the questions that frame the larger research problem. This paper is, therefore, of importance as it probes availability, accessibility and convenience of sexual and reproductive health services and informs policy makers on the gaps in the policies that affect young women’s reproductive health and contraceptive needs. The paper addresses gaps in understanding the dynamics of contraceptive use among 15-24 year old young women by: • Identifying the demographic and behavioural determinants of contraceptive use and method choice among young women in Namibia. • Describing the key perceptions young women have about the availability, accessibility and convenience of sexual and reproductive health services. It should be emphasised that whilst these gaps are not novel, they require examination in the Namibian case. Little information is available to guide policymakers’ decisions or help programme managers design interventions to address sexual and reproductive health needs of young women in Namibia since no other study to date has addressed and found substantive answers to the basic research questions raised about the situation of young women in Namibia. Given the increasing vulnerability of young women to the risks of unintended pregnancy, it is of program and policy relevance to better understand the barriers to effective contraceptive use among sexually active young women in order to help them lead healthy sexual and reproductive lives.