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Reproductive Health

Measuring Access to Family Planning Education and Services

Background

Senegal, like many other African countries, has undergone economic and cultural changes that have loosened social and family controls with a corresponding increase in premarital sexual activity. The consequences of this sexual activity are increased unwanted pregnancies, unsafe abortions and HIV or other sexually transmitted infections. To avoid unintended pregnancy or sexually transmitted disease, young adults need to have accurate information on reproductive health and family planning and access to services. In order to identify the reproductive health needs of young adults in Dakar, the Comite d'Etude sur les Femmes, la Famille et l'Environnement en Afrique (CEFFEVA) and Family Health International (FHI) conducted a study to measure access to family planning information and services among young people. The knowledge, attitudes and practices of young adults regarding family planning and reproductive health were assessed. In addition, the study also assessed actual and perceived barriers to family planning services and the attitudes of clinic personnel who provided services to young adults.

Study Design

Both quantitative and qualitative methods were used. To measure knowledge, attitude and practices, a household survey was conducted from April through October 1995 with 1,973 women aged 15 to 24 and 936 men 15 to 19 years old. In addition, two focus groups added insight to the survey findings. Finally, an evaluation using young adults who posed as clients provided first-hand information on the experiences of young adults who sought family planning information and services.

Table 1. Knowledge of Reproductive Health
  Women 15-19 n=1005 (%) Women 20-24 n=968 (%) Men 15-19 n=936 (%)
Heard of condoms 61 78 96
Heard of pills 44 66 44
Heard of spermicides 6 13 13
Think pills cause sterility 87 83 94
Heard of AIDS 99 99 99
Know time of menstrual cycle can get pregnant 38 59 32

Results

Gaps existed in knowledge of family planning methods and reproductive health matters (Table 1). Misconceptions about contraceptive methods include a belief that pills can cause sterility (cited by more than 80% of the respondents). Only one-third of women and men 15 to 19 correctly identified the time of the menstrual cycle when a woman can get pregnant. In contrast, awareness of condoms and AIDS was high.

Five percent of women aged 15 to 19 and 15% of 20 to 24 year-olds reported that they had sexual relations before marriage. A much higher percentage of men, 43%, reported premarital relations.

Of the women and men who reported they had sexual relations before marriage, fewer than 30% reported using a contraceptive method at the time of their first sexual experience. Reasons for not using a method included little knowledge of contraceptive methods and not knowing that they would have sex. Contraceptive use was much higher at the time of last sexual experience, with 70% of the single women and 85% of the single men reporting that they used a method, primarily condoms (Table 2).

Table 2. Contraceptive Use
in Premarital Relationships
  Women
n=214 (%)		 Men
n=446 (%)
Used contraception at first sexual experience 28 20
Used contraception at last sexual experience 70 85

Only half of 15 to 19 year-old women said they received reproductive health and family planning information, compared with 90% of the men.

  • The main sources of information were school and the media. Less than 10% of 15 to 19 year-old women and men reported attending a course in Family Life Education.
  • The young adults posing as clients cited many barriers in obtaining family planning services. They felt they were not well treated at the clinics and made to feel embarrassed. While clients usually received family planning information, they also received lectures on the dangers of sex before marriage. None of the mystery clients who requested a contraceptive method received one.

Conclusions

The findings demonstrate the need to increase efforts and develop better ways to educate young women and men about reproductive health and family planning. The results show the difficulties young people face in accessing family planning services. Special efforts are needed to provide nonjudgmental education and services in a way that will meet the unique needs and concerns of this group. These efforts should include making young adults feel comfortable, treating them with consideration, respecting their privacy and making sure that their contraceptive requests are met.

May 1996

This work was funded by the FHI Contraceptive Technology and Family Planning Research Program through a Cooperative Agreement with the US Agency for International Development.