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Youth in Sub-Saharan Africa: a CHARTBOOK on SEXUAL EXPERIENCE and REPRODUCTIVE HEALTH

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Youth in Sub-Saharan Africa: a CHARTBOOK on SEXUAL EXPERIENCE and REPRODUCTIVE HEALTH Youth in Sub-Saharan Africa: A CHARTBOOK ON SEXUAL EXPERIENCE AND REPRODUCTIVE HEALTH Population Reference Bureau ACKNOWLEDGMENTS This chartbook is a collaborative effort between Managing editor: Lisa M. Hisel, PRB the Population Reference Bureau (PRB) and ORC Design: Sharon Hershey Fay Macro. Dara Carr of PRB prepared this chartbook Cover illustration: Dan Sherbo with substantial contributions from Ann Way of Printing: Jarboe Printing ORC Macro and Rhonda Smith of PRB. Lori Ashford and Nancy Yinger of PRB provided com- This chartbook is available in English and French ments on several drafts. Data processing assistance on the World Wide Web at: was provided by Noureddine Abderrahim, Albert www.measurecommunication.org Themme, Marc Soulié, and Jeanne Cushing from ORC Macro. © April 2001 by the Population Reference Bureau PRB and ORC Macro gratefully acknowledge the U.S. Agency for International Development (USAID) for funding this project. This chartbook POPULATION was funded by USAID’s Bureau for Africa, Office of REFERENCE BUREAU Sustainable Development through the MEASURE Founded in 1929, the Population Reference Communication project (HRN-A-00-98-000001-00). Bureau is the leader in providing timely, objective information on U.S. and international population Special thanks are due to the following trends and their implications. PRB informs policy- reviewers: makers, educators, the media, and concerned citi- Vanessa Carroll, Pathfinder International zens working in the public interest around the Minki Chatterji, Sarah Harbison, Mai Hijazi, world through a broad range of activities includ- Marge Horn, Barbara Seligman, and ing publications, information services, seminars Krista Stewart, U.S. Agency for International and workshops, and technical support. PRB is a Development (USAID) nonprofit, nonadvocacy organization. Our efforts are supported by government contracts, founda- Alex Ezeh, African Population and Health tion grants, individual and corporate contribu- Research Center, Nairobi, Kenya tions, and the sale of publications. PRB is Wacango Kimani and Mary Mujomba, Centre for governed by a Board of Trustees representing African Family Studies, Nairobi, Kenya diverse community and professional interests. Youth in Sub-Saharan Africa: A CHARTBOOK ON SEXUAL EXPERIENCE AND REPRODUCTIVE HEALTH TABLE OF CONTENTS OVERVIEW CHILDBEARING Key Points for Policies and Programs.................4 Childbearing Among Adolescents......................25 Box 1: About the Data ..........................................5 Birth Rates Among Adolescents ........................27 Box 5: Single Motherhood .................................28 EDUCATION AND EXPOSURE TO INFORMATION Unintended Pregnancies Among Women’s Access to Formal Education ...............7 Adolescents .......................................................29 School Attendance Among Adolescents .............8 Box 6: Ideal Family Size .....................................29 Regular Exposure to the Mass Media: Radio, Box 7: Abortion ...................................................30 Television, and the Newspaper.......................10 CONTRACEPTION SEXUAL EXPERIENCE AND MARRIAGE Knowledge of Any Modern Method of Sexual Experience Among Adolescents ...........11 Contraception....................................................31 When Adolescents First Have Sexual Use of Modern Contraceptive Methods ...........32 Intercourse and Marry......................................13 Use of Traditional Contraceptive Methods.......33 Box 2: How Has the Timing of Sex and Contraceptive Methods Used by Women..........34 Marriage Changed? ..........................................14 Box 8: Use of Modern Contraception, Early Age at Sexual Initiation.............................15 1980s-1990s .......................................................34 Box 3: Female Genital Cutting ...........................16 Unmet Need for Contraception..........................38 Sexual Exchange..................................................17 MATERNAL HEALTH HIV/AIDS Use of Professional Maternity Care Services...39 HIV Prevalence Levels.........................................18 Infant Mortality Rates..........................................40 Awareness of HIV/AIDS Among Box 9: Very Early Childbearing .........................41 Adolescents .......................................................20 REFERENCES ............................................................42 Adolescents Who Know How to Prevent Sexual Transmission of HIV/AIDS..................21 APPENDIX TABLES Sexually Experienced Adolescents Who Appendix Table 1: Believe That They Have Little or No Risk Background Characteristics of Adolescents of Getting AIDS .................................................22 Surveyed, 1994-1998 .........................................43 Box 4: Major Reasons Given for Belief of Appendix Table 2: Little or No Risk of AIDS.................................23 Implementing Agencies for Demographic Condom Use in Sexual Encounters...................24 and Health Surveys...........................................44 1 SUB-SAHARAN AFRICAN COUNTRIES COVERED IN THIS CHARTBOOK MALIAI SENEGALEEA CÔTE D'IVOIRED IR GHANAH UGANDAAD KENYAKE Y TANZANIATA Z N ZAMBIA MOZAMBIQUEZ M UE ZIMBABWEZA MADAGASCARA A A CA 2 Overview SUB-SAHARAN AFRICA HAS ONE those younger than age 15 are important, of the world’s youngest populations. At the few national surveys collect information on beginning of the 21st century, about one out young adolescents and preteens. In some of every four people in sub-Saharan Africa is cases, limited information about younger 10 to 19 years old.1 This is the largest group age groups is available from household sur- of young people ever in the region to enter vey data. We have used data on household adulthood. background characteristics, for example, Helping African youth make a healthy to obtain school attendance estimates for transition to adulthood is critical to the those under the age of 15. continent’s development and the prosperity We use the terms “adolescents” and of its future population. What is a healthy “teenagers” interchangeably, although the transition to adulthood? Many population period of transition known as adolescence and health specialists suggest that contin- may differ from place to place and between ued school attendance as well as delayed boys and girls. Also, this chartbook strives sexual initiation, marriage, and childbear- to include survey results on young men as ing are important components. Ideally, ado- well as young women. In many cases, how- lescence is a time when young people ever, information on young men is not readi- develop—physically, emotionally, and intel- ly available. Women—more than men—have lectually—before becoming parents or been the traditional focus of survey data col- primary wage earners.2 lection efforts because of their reproductive To what extent are young people in the role and unique health needs. region prepared for adulthood? Youth in Sub-Saharan Africa examines factors that SOME OF THE KEY FINDINGS are important to a healthy transition, in- FROM THIS CHARTBOOK SHOW cluding education and exposure to informa- THAT: tion; sexual experience and marriage; HIV/AIDS; childbearing; contraception; and I Education levels have risen dramatical- maternal health. This chartbook profiles ly in most countries surveyed. Still, less adolescents in 11 sub-Saharan countries: than half of adolescents between the Côte d’Ivoire, Ghana, Kenya, Madagascar, ages of 16 and 20 attend school. Addi- Mali, Mozambique, Senegal, Tanzania, Ugan- tionally, “gender gaps,” or differences da, Zambia, and Zimbabwe. between boys and girls, persist in The purpose of this chartbook is to pro- school enrollment and in access to the vide decisionmakers with a better under- mass media. standing of the experiences and needs of I In nine out of 11 countries surveyed, at adolescents in the region. We focus pri- least one-third of young women married marily on adolescents between the ages of before age 18 and at least half had sex 15 and 19. Although the experiences of before age 18. The research also indi- 3 OVERVIEW cates that the premarital period is length- to rely on contraception than their ening: Young women spend a longer time married counterparts. Modern contra- single than their mothers did. ceptive use among single, sexually active women ranges from 5 percent in Mozam- I In countries with data available, 13 per- bique to 23 percent in Ghana. cent to 38 percent of single teenage women and 8 percent to 39 percent of I In eight out of 11 countries, at least 10 single teenage men have either received percent of 16-year-olds have started or given gifts or money in exchange for childbearing. This is of concern since sex during a recent period. In relation- very young mothers tend to be at a ships where payment is received for much higher risk of pregnancy-related sex, adolescents may be unable to nego- complications and infant death than tiate condom use or the fidelity of their women in their twenties or thirties. partners, leaving them at greater risk of I Although many adolescent mothers sexually transmitted infections and un- received antenatal care for recent intended pregnancy. births, access to professional delivery I In most of the countries surveyed, more care remains limited. In 10 out of 11 than half of adolescents believe that countries, less than 55 percent of young they have little or no risk of getting women reported receiving professional AIDS. In many of these countries,
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