Barriers to adolescent contraceptive use in South Africa

One third of young women in South Africa become pregnant before the age of 20 despite contraception being free-of-charge. The figure has halved since the 1990s when 70 percent of teenagers became pregnant. What barriers are preventing them from using contraception?

The Medical Research Council, Pretoria, carried out a study to find out what barriers were preventing South African teenagers from using contraception. Many South Africans today become sexually active at an early age, have unprotected sex, have more than one partner and often do not use contraception. Teenagers are now at the forefront of the AIDS epidemic in South Africa. The latest national survey into HIV prevalence recorded that 16 percent of pregnant women under the age of 20 tested HIV positive.

Individual in-depth interviews were carried out with 35 girls aged between the ages of 14 and 20 in Limpopo province over a three week period in 1997. Limpopo province is one of the poorest parts of the country. Discussions with small groups of girls were also carried out and nursing staff were interviewed at the 14 clinics taking part in the study.

Nurses’ attitudes were a major barrier to teenagers getting hold of contraception. The nurses were uncomfortable about providing teenagers with contraception as they felt they should not be having sex. They responded to requests for contraception in a manner that was highly judgemental and unhelpful. The girls described it as 'harassment'.

The study found that often social pressures prevented young women from using contraception. The girls felt they would only be accepted as women once they had proved their fertility and men put pressure on their girlfriends to get pregnant. Despite public concern about teenage pregnancies, many mothers wanted their teenage daughters to become pregnant so they could have a baby at home again.

If the girls did use contraception, inaccurate information about reproduction often prevented them from using it correctly:

• The teenagers were worried that a condom could be left inside the vagina and would have to be removed by a doctor in hospital.
• They believed the contraceptive injection could cause infertility. If menstruation was irregular they called it a ‘blockage’ and would stop using contraception until the bleeding started again.
• Some of the teenagers believed that they could prevent pregnancy by taking contraceptive pills on the days their boyfriends visited them, but not on other days.
• Some young women also believed that changing their sexual partners regularly or abstaining from sex in the second half of their menstrual cycle could prevent pregnancy.

In order to reduce the number of teenage pregnancies, the study recommends:

• sex education at school before the age of 14 when young people become sexually active
• more information for teenagers about avoiding sexually transmitted diseases
• providing detailed information about contraception and its side effects
• better management and training for nurses so they can deal sympathetically with teenagers requiring contraception and provide the necessary information
• education campaigns that take away the stigma of teenage sexuality so that girls are not afraid to ask for contraception.

Source(s):
‘Blood Blockages and Scolding Nurses: Barriers to Adolescent Contraceptive Use in South Africa’, Reproductive Health Matters 14(27), pages 109-118, by Kate Wood and Rachel Jewkes, 2006
HINARI subscribers can access the full-text article here. Full document.

Funded by: Reproductive Health Research Fund of the Health Systems Trust, South Africa

id21 Research Highlight: 15 December 2006

Further Information:
Rachel Jewkes
Gender and Health Research Unit
Medical Research Council
Private Bag X385
Pretoria 0001
South Africa

Tel: +27 12 339 8500
Contact the contributor: rjewkes@mrc.ac.za

Gender and Health Research Unit, South African Medical Research Council, Pretoria

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