title: Patterns and trends of contraceptive use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria: evidence from cross-sectional studies.
abstract: BACKGROUND
  The benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women's empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations' human capital.
  
  
  OBJECTIVE
  The objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes.
  
  
  METHODS
  Data are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15- to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables.
  
  
  RESULTS
  There are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation.
  
  
  CONCLUSIONS
  Addressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration.
authors.affiliation: United Nations Population Fund, New York, NY, USA; hounton@unfpa.org.
authors.forename: Sennen
authors.initials: S
authors.lastname: Hounton
authors.affiliation: International Center for Equity in Health, Federal University of Pelotas, Capão do Leão, Brazil.
authors.forename: Aluisio J D
authors.initials: AJ
authors.lastname: Barros
authors.affiliation: UNICEF, New York, NY, USA.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Shiferaw
authors.affiliation: Centre for Demographic Research, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.|Institut Supérieur des Sciences de la Population, Ouagadougou University, Ouagadougou, Burkina Faso.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Maïga
authors.affiliation: Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: Akanni
authors.initials: A
authors.lastname: Akinyemi
authors.affiliation: United Nations Population Fund, New York, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Friedman
authors.affiliation: United Nations Population Fund, New York, NY, USA.
authors.forename: Desmond
authors.initials: D
authors.lastname: Koroma
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001721:Birth Intervals; D002050:Burkina Faso; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000639:trends*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005002:Ethiopia; D005193:Family Planning Services; D005260:Female; D006801:Humans; D009549:Nigeria; D011247:Pregnancy; D012923:Social Class; D055815:Young Adult
keywords: adolescents; childbearing; modern contraception; sub-Saharan Africa