Adolescent fertility remains high, particularly in Africa, despite some improvements over the past two decades. In 2018, the birth rate among adolescent girls (15–19 years) worldwide was 44 births per 1,000 women, a 22% decrease from 56 births per 1,000 women in 2000. In the same year, the highest regional adolescent birth rate (101 births per 1,000 females) was observed in sub-Saharan Africa (1). Adolescent childbearing remains a major public health concern most in the low- and middle-income countries(2–4) due to the high unwanted fertility (including shortly-spaced births) among young women(5). Approximately, every year 21 million girls aged 15–19 years in developing countries become pregnant and 12 million of them give birth (6). A study estimated that 90% of the over six million annual unplanned pregnancies, either unwanted or mistimed, among adolescent girls in sub-Saharan Africa, Latin America and the Caribbean, and South Central and Southeast Asia are due to nonuse of a modern method of contraception (6)
In sub-Saharan Africa, this group suffers enough consequences linked to unwanted pregnancies (7–9). Poverty, education drop out and subsequent lower educational attainment not only hold back personal development but reduce women’s lifetime earnings and hence their contribution to economic growth(9–13).
In Guinea, almost half of the population is under 24 years of estimate (14) and the fertility rate remains high among adolescent girls aged 15–19 years of estimate (146 births per 1,000 women). The birth rate among young women aged 20–24 years (202 births per 1,000 women) remains also high compared to the rate in sub-Saharan Africa (15, 16). In 2012, 67% of first-order births in Guinea were to mothers under the age of 20 years, and this percentage has remained approximately the same since 1999 (17). The percentage of sexually active adolescent girls and young women (15–24 years) using any contraceptives increased from 7.2% in 1999 to 11.4% in 2018 (18, 19). However, 20% of females in this age group had an unmet need for family planning in 2018 (18). In addition, the prevalence of modern FP methods among all women of reproductive age remains relatively low 15.4%) (18) even in areas with better access to family planning services and higher socio-economic status. According to the National Institute of Statistics, 36% of the total Guinean population live in urban areas and 16.6% were female adolescents and young women aged 15–24 years in 2018(20).
Prior studies have identified the determinants of the use of contraceptive methods among women of childbearing age (15–49 years) (21, 22) and the factors associated with this use in young sexually active women through a secondary analysis of Demographic and Health Surveys (DHS) from selected countries in Sub-Saharan Africa (7, 23–25). However, the trends over time and the factors influencing the use of contraception among adolescents and young women in Guinean urban areas are insufficiently understood. Such evidence would provide information critically needed for developing strategies and interventions to increase the use of contraceptives. More generally, this would facilitate addressing the challenges that persist in the sexual and reproductive health of adolescents and young people in urban areas, including human immunodeficiency virus (HIV) and sexually transmitted infections (26, 27).
The Ministry of Health of Guinea recognizes the existence of specific challenges in meeting the contraceptive needs of Guinean adolescents and young women.. young people’s concern was not prioritized until recently in FP policy development and the existing FP services were often unsuited to the needs of adolescent and young people (28). Hence, in 2015, the Government of Guinea drew up the 2015–2019 Strategic Plan for the Health and Development of Adolescents and Youth, then in September 2018, the budgeted 2019–2023 action plan for FP (28, 29). One of outlines this plan was advocacy with decision-makers for free FP services, in particular for adolescents and young people from 2019 to 2023 (28). In Guinea, funding for the health sector was focused on increasing service provision; however, there has been need for concurrent operations and action research to guide efforts to stimulate demand and improve service provision (15).
The main objective of this paper is to describe the levels and trends in unmet need for contraceptive and modern contraceptive use among urban adolescents and young women in Guinea using data from four Demographic and Health Surveys (DHS) conducted between 1999 to 2018. Specifically, we described the time-trends in modern FP method use among urban adolescent and young women aged 15–24 years and the factors associated to the use modern FP method use among sexually active urban adolescents and young women in Guinea.