Ann K. Blanc

Sexual behavior and contraceptive knowledge and use among adolescents in developing countries.

This article offers an overview of sexual behavior and contraceptive knowledge and use among adolescent women across a large number of developing countries. The results demonstrate that almost universally in sub-Saharan Africa and in the majority of countries in other regions, the gap between age at first sexual intercourse and age at first marriage has increased across age cohorts. The predominant pattern is one in which both age at marriage and age at first intercourse have risen, but the increase in age at marriage is greater, resulting in a widening gap. In most countries in sub-Saharan Africa, current contraceptive use is higher among sexually active, unmarried teens than it is among married teens, whereas in Latin America and the Caribbean, current-use levels are higher among married teens. The results also show that adolescents are unlikely to use a contraceptive the first time they have sex and are more likely than older women to experience a contraceptive failure.

Negotiating reproductive outcomes in Uganda

In Uganda, the Negotiating Reproductive Outcomes study is investigating the nature of negotiation within sexual unions. Data were gathered from focus groups held in the Masaka and Lira districts during February and March 1995 and during surveys of women aged 20-44 and their male partners carried out from October 1995 to February 1996. The data suggest that much of the bargaining and negotiating that occurs is indirect and nonverbal and, thus, leads to a great deal of misinterpretation. Even direct communication is fraught with complexity, misinterpretation, and mistrust. These results indicate that male partners are important in influencing the reproductive attitudes and behavior of women and that further work should be undertaken to understand the roles of various actors in reproductive decision-making.

Patterns and trends in adolescents' contraceptive use and discontinuation in developing countries and comparisons with adult women.

CONTEXT The reproductive choices made by young women and men have an enormous impact on their health, schooling, employment prospects and overall transition to adulthood. As the largest cohort of young people in history enter their childbearing years, their reproductive behavior will determine the growth and size of the worlds population for decades to come. METHODS Demographic and Health Survey data from more than 40 countries were used to examine the proportions of 15-19-year-old women who are currently married or are unmarried but sexually active; their rates of contraceptive adoption, current use, discontinuation, method switching and contraceptive failure; trends in these indicators; and comparisons with older women. RESULTS In many countries, the proportion of adolescent women using contraceptives increased substantially over the last two decades; prevalence among adolescents increased faster than among older women. Greater proportions of adolescents than of older women discontinued using a contraceptive method within a year or experienced contraceptive failure. CONCLUSIONS Adolescent contraceptive use is growing, and compared with adult use, is characterized by shorter periods of consistent use with more contraceptive failure and more stopping for other reasons. Use through the reproductive years is likely to grow, fueled further by growth in the numbers of young people. An expanded demand for contraceptive supplies, services and information can be expected to challenge the preparedness, capacity and resources of existing family planning programs and providers.

Gender and decision-making over condom use in two districts in Uganda.

Based on a survey of couples in long-term unions in Masaka and Lira districts in Uganda, we critically examine the role of gender inequality in the domain of decision-making about fertility and sex in the discussion and use of condoms. First, we document the sexual context and process of condom negotiation from the perspectives of women and men. Next, we test the hypothesis that increases in the relative influence of women, compared to their male partners, in decision-making about sex and fertility should enhance the likelihood of discussion and use of condoms. The result point to barriers that exist for both men and women but show a clear disadvantage for women. They also suggest that, for both partners, a sense of control over fertility has a positive effect on condom use, and that the effect of womens empowerment does not seem to diminish the effect of mens empowerment.