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With contraceptive methods available in Jamaica, why is there a problem with teenage pregnancy? » Family Planning

With contraceptive methods available in Jamaica, why is there a problem with teenage pregnancy?

October 30th, 2008 by jliebner@stanford.edu Leave a reply »

Note: whenever I refer to “young adult” males or females, I am referring to men and women ages 15-24.

Last week I talked about the efforts the Jamaican government has made to make contraceptive methods available in Jamaica.  In response to Maggie’s post about injection contraceptives in Madagascar and its potential in Jamaica, I wanted to clarify that injections are actually the most commonly form of contraception used in Jamaica (used by ~50,000 women in 2000), followed by the pill (~37,000), and then condom usage (~15,000).  The pill is the preferred method among adolescents, while injection was more popular among older women.  The accumulated total number of women who had undergone sterilization by 2000 was 53,0000.   75,500 women have been sterilized (voluntarily) (see Product and Services, Family planning board).

However, it seems that contraceptive methods are not being targeted at a particularly vulnerable portion of the population, adolescents, despite the high rates of unplanned and teenage pregnancies.  In a 1999 Statement of Jamaica to the Hague Forum, it was acknowledged that “adolescents have historically been marginalized both by structure and operations of the reproductive health programme”.  In the next few weeks, I will try to address the barriers to contraception that adolescents face and more recent efforts that particularly this part of the population.

Teenage girls account for nearly a quarter of all births in the country.  This is a result of two main factors: early age of first sex and low contraception use.  It appears that youth in Jamaica are having sex and their first pregnancy at young ages, with what appears to be difficultues accessing contraception or information about pregnancy.

Early sex
A contributing factor is that adolescents are beginning to have sexual experiences at relatively young ages.  Despite the strong Christian roots and teaching in the country, adolescents are becoming sexually active as early at 14. The 1997 Reproductive Health Survey reports that 70% of young adult females and 84.9% of young adult males have ever had sexual relations, with a greater percentage of sexually active males than female in each age bracket.  The median age at first sex among young women is 17.

Early sex and pregnancy can be associated with many factors – cultural, social, and economic – including poverty, the absence of male role models, cultural approval of early-childbearing, coercive relationships, and rape.  In Jamaica, women risk being labeled as “mules” (sterile) if they don’t have a child by their twenties.  While this cultural ideal may contribute to 19 and 21 as the respective median ages of first pregnancy and birth among Jamaicans, young women also face economic pressures that can involve them in transactional relationships with men, where they receive money or gifts in exchange for sex.  Also, many teens become pregnant involuntary due to rape or incest.  20% of women 15-49 report having been forced to have sex at some point during their lives, particularly among young girls ages 15-19, low SES, and with little education.

What I mean to report here is not that Jamaican adolescents are becoming pregnant because they are having sex at young ages.  There are definitely ways to have safe sexual experiences without getting pregnant, if the right methods are used.  The problem is that it appears that these methods are not being used.  In particular, the younger adolescents begin sexual activity, the less likely they are to use contraception (given awareness and access), which increases their risk of pregnancy.

Low use of contraception
The UN Population Fund reports that contraceptive use among Jamaican teens is low. While the reported contraceptive use rate in Jamaica is 69%, the National Family Planning Board reports that 66% of all births are not planned and 43% are mistimed.  For women under the age of 20, the impact is even greater – 40% have been pregnant at least once, where 85% of these pregnancies were unplanned (International Conference on Population & Development (ICPD) Paragraph 7.2).  From the 1997 Reproductive Health Survey, only 56% of females and 31% of males report using a contraceptive method at the time of their first intercourse.  Young adult females explain that they did not expect to have sex when they did (rape may be a factor) and males reveal that they did not know of any methods.  Surveys show that the mean age of first use of contraception is 19.5.  However, the median age at first sex among women ages 15-49 is 17.

Failure of education programs?
From these statistics, we see that contraceptive use is particularly low among adolescent men, and that young people in general are facing obstacles in using contraception when they decide to have sex.  Either they are not planning on having sex when they do (rape, again) or that they are not aware of contraceptive methods.  I initially thought that this was due to the failure of educational systems to promote basic reproductive health information among adolescents, influenced by the efforts of conservative groups.  According to the International Conference on Population and Development (ICPD) paragraph 7.2, in 1994, only 64.5% of young adult women ages 15-24 reported having received information on pregnancy before their first period and even less (62.8%) reported having received information on pregnancy before having sex for the first time.  Exposure to this type of information increased with the number of years of education and socioeconomic status.

I was initially going to harp about the failures of abstinence only education, thinking that religion was influencing national politics.  However, statistics from the National Family Planning Board (from 2000) suggest that knowledge about contraception is relatively high among Jamaican adolescents, higher among young women than young men.  85% of young women and ~72% of young men ages 15-19 report having received a course on family life or sex education either in school or outside of school and 87.7% of young women and 82.8% of young men knew where to go to receive information on contraceptives or on sexual relations.  Young women report receiving health information mostly from parents or health personnel, where as men report receiving health information mostly from parents and peers/friends/siblings.  Condoms, pills, and injections appear to be the most common taught methods of contraception.

Despite such prevalent knowledge of contraceptive methods though, contraception use is low among Jamaican adolescents.  This suggests that barriers to access and not lack of knowledge (although efforts focused towards male adolescents could be improved) is what is preventing adolescents from obtaining and using contraception, among other factors.  I just discovered the USAID 2000-2007 Evaluation of Jamaica Adolescent Reproductive Health Activity Report (yay for some more recent data) and I promise (as I have for the past several weeks), that my next blog will address these barriers to access.

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3 comments

  1. heather7@stanford.edu says:

    It’s so interesting to hear that lack of knowledge doesn’t seem to be the problem here; it’s the other social factors at work! If Jamaican women for whatever reason don’t have access to contraceptive methods to have on hand or are being forced into sexual relationships having knowledge about reproductive health wouldn’t really help. Furthermore It sounds like this problem may not really be solved by increasing access to contraceptives to teens since there is such a large social pressure to have babies early or suffer social stigmas. Perhaps interventions that focus on educating women would empower them and allow them to have jobs and a purpose in life other than producing babies. This could also allow them some economic freedom to refuse sexual exchanges as well.

  2. Max Romano says:

    I have to admit that I was confused by a few of your statistics: how could only 62.8% of young adult women report having received information on pregnancy before having sex for the first time while 85% of young women report having received a course on family life or sex education either in school or outside of school. Are the courses not covering the topic of pregnancy? Or are the people having their sex before they attend the courses?

    Regardless, I like your elucidation of the point that “information” is not the missing link in reproductive health for most people. People are often convinced that education is the only way to help others. You know the old saying: If you give a man a fish, you feed him for a day; if you teach a man to fish, you feed him for a lifetime. Well education is certainly important, but a belief that the rich establishment’s knowledge is the only thing missing from poor peoples’ lives is rather arrogant. I think the ready accessibility of contraceptives and stigmas surrounding their use, especially as it relates to gender norms, are probably very important in dictating rates of use all over the world. I’m curious to see what you come up with in your analysis of barriers to contraceptive use next week.

  3. Maggie Chen says:

    I was surprised and pleased to read that knowledge about sex/family planning is at a decent level for teens. It seems like, in this post, you’re bumping up against the very challenging link (or absence thereof) between knowledge and behavior. Sometimes people who are knowledgeable about sex, STIs, pregnancy, etc. make the riskiest choices. I’ve come to believe that behavior change comes about when one is truly invested in the change and its consequences, and one is in an environment that supports the change. (In terms of change, I’m referring to the example of using BC or condoms.) I wonder whether the Jamaican government is stuck on thinking that education = behavior change, or whether they are thinking about this missing link.

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