Contraceptive use among married adolescent girls

Photo: star archive

In Bangladesh, although contraceptive prevalence rate (CPR) has increased over the last decade it has not yet reached the desired level. Presently the CPR rate is 61.7 %, according to BDHS. Use of contraceptive among female users is the lowest among adolescent girls. They have limited access to and use of contraception. According to the United Nations Population Fund (UNFPA), in developing countries overall, 22 per cent of adolescent girls (aged 15-19) who are married or in union use contraceptives, compared to 61 per cent of married girls and women aged 15-49. According to Family Planning Department, only 47% of adolescent married girls between 15-19 years have access to contraceptive methods in Bangladesh.
The common causes of lower contraceptive use among married adolescent girls are ignorance, illiteracy, shyness, fear, religious sentiment, low inter-spousal communication on family planning. Adolescent girls do have little decision making power as many are uneducated and disempowered. Due to the social expectation to have children soon after marriage they start child bearing early, despite being children themselves.
Men's negligible participation in use of contraceptive methods puts adolescent wives at risk of unwanted pregnancy or pregnancy before her own body is ready for childbearing. Inadequate male participation is one of the factors  why the contractive prevalence rate is not higher than it is. Active participation by men and adolescent boys would shift part of the burden of contraceptive use from women to men. Currently, the use of male methods is only 0.6 percent of the contraceptive prevalence rate. When asked DGFP admitted that they do not have disaggregated data on adolescent boy's contraceptive usage. It seems that adolescent boys remain largely unreached.
The problem exacerbates as access to appropriate sexual and reproductive health information and services to the adolescents is inadequate in Bangladesh. Reproductive health education has not been part of the education curriculum. And the service delivery system is not adequately catering to the married adolescents. According to NIPORT, 2003 report the unmet need for contraception among the mothers aged less than 20 years is 27%.
When asked about government initiatives Gias Uddin, Deputy Director (Services), MCHS, DGFP, said to The Daily Star that they are small adolescent corners in some of the Mother and Child Welfare Centres which are not adequate to meet the demand. If any adolescent comes to seek any information on reproductive health, they provide them special care but they do not have enough capacity to reach the adolescents at their door steps.
To increase contraceptive use among married adolescents our family planning program should find out the potential adolescent users, who are presently not using a contraceptive but have an attitude resembling a contraceptive user. We have to reach their door steps because women who have access to the family planning service within a short distance from their home have higher prevalence than those who do not. Increased communication about family planning between the couples should be promoted in order to achieve successful contraception and better reproductive outcomes, particularly among adolescents. Studies have found that prevalence of contraceptive use is higher among the women who had discussed family size with their husband. "Ensuring access to voluntary family planning is one of the best contributions to empowering girls and women, and one of the most cost-effective investments a country can make in its future," said former UNFPA Representative Arthur Erken.
Last but not the least, increasing the female literacy rate is one of the most importsnt interventins to address many of the development issues in Bangladesh. Education level is inversely related to fertility and also positively related to practice of using contraception. The educational levelof the wife is found to have relatively more effect on fertility and contraceptive practice than the husband's education.