Percent of sexually active young people who used contraception at first/last sex

Definition:

The percent of respondents aged 15-24 years who say they used contraception the first or last time they had sex of those who have had sex in the last 12 months. Evaluators must decide whether to look singly at first or last sex or both indicators. “Contraception” refers to modern methods of family planning (FP) (e.g. condoms, injectables, implants, pills, etc.).

This indicator is calculated as:

(The number of respondents aged 15-24 who report using contraception the first/last time they had sex / Total number of respondents who report that they had sex in the last 12 months) X 100

Data Requirement(s):

Self-reported data from survey respondents.

The indicator should be presented as separate percentages for males and females and can be disaggregated by age (or age groups) and other characteristics such as urban/rural and in or out of school.

Evaluators may include questions on the type of contraceptive methods used to capture the method mix among young people. Ideally, evaluators will tabulate the indicator separately for married and unmarried adolescents, because the circumstances surrounding contraception and choice of method are quite different for each group.

Evaluators may want to disaggregate by the following age ranges: 10-14, 15-19, and 20-24.

Data Source(s):

UNAIDS general population survey; DHS AIDS Module; FHI BSS- youth survey

Purpose:

This indicator measures the prevalence of contraceptive use among 15 – 24 year olds at two important reference points. Reported use at first intercourse indicates the effectiveness of programs encouraging the use of contraception among youth who become sexually active – an especially important message for programs focusing on younger adolescents. Contraception use at last intercourse approximates the current contraceptive prevalence rate among young people (assuming that last sexual encounters occurred in the recent past).

This indicator measures progress towards establishing safe behavior from the outset of people’s sexually active lives. It is generally believed that it is easier
to maintain safe behaviors established from the onset of sexual activity than
to change risky behaviors once they have become habitual.

Although most people become sexually active during adolescence, young people often have limited access to FP services and education and are therefore at high risk for unwanted pregnancy. This indicator can track the
impact of programs aimed at increasing access to modern FP methods, promoting youth-friendly health services, and other campaigns aimed at destigmatizing adolescent sexual activity.

Issue(s):

Reports of contraceptive use do not necessarily reflect consistent and correct use, measured by Percent of sexually active, unmarried adolescents who consistently use condoms, where contraceptives can be substituted for condoms in the indicator. Also, in areas where there have been major campaigns promoting FP or healthy timing and spacing of pregnancy, youth may be more likely to report contraceptive use at last sexual intercourse when, in fact they did not use contraception. It is not uncommon for young people to have more than one partner and patterns of contraceptive use may differ with different partners—e.g. a girls having sex with an older partner where sex is transactional may have trouble negotiating contraceptive use, compared to regular partner or vice versa, so further questions about the nature of the relationship with their first/last sexual partner may be useful in showing trends in contraceptive use among different types of partners.

Keywords:

family planning, behavior, adolescent

Gender Implications:

Young women’s knowledge about, access to and ability to negotiate use of contraception, including condoms) may be limited by cultural gender norms affecting women’s mobility, exposure to media and FP information, access to health care services, resources to purchase contraception, and unbalanced power dynamics within sexual relationships. Women may be less informed about their fertile times of the month and different family planning options, especially in more rural areas, and may be reluctant to seek out information that could make them look sexually active (if unmarried) or promiscuous. Health care workers may not discuss contraception with women clients and, where rates of female literacy are low, women may not benefit from media and communication strategies that rely on printed materials.