Contraceptive use among young women in Namibia : determinants and policy implications

Abstract

The present study examines social, demographic and behavioural factors that influence contraceptive use and method choice among young Namibian women. The study also explores ways to improve the accessibility of health facilities and family planning services for young women. The research is based on both quantitative and qualitative data provided by the 2000 Namibian Demographic and Health Survey and focus group discussions with young women (15-24 years) respectively. The data have been used to analyse the factors affecting contraceptive use and method choice among young women in Namibia. The logistic regression method has been applied to examine the determinants of contraceptive use and method choice. The study examines knowledge of contraceptive methods and sources of supply, decisions leading to contraceptive use and views about service delivery and the availability of contraceptive methods. The study reveals that whilst there is provision, the accessibility of existing reproductive health services for young women is poor in rural areas. There is a lack of support from parents, nurses, and the broader community. Part of the problem here is that older people are not fully aware of the sexual rights of young women, which leads to misunderstandings with regard to sexual and reproductive health issues. Nurses, especially in rural areas, are deemed to be judgmental and reluctant to provide contraceptives to young female scholars. Health facilities are also ranked by young women as user-unfriendly as most of them, as public spaces, lack confidentiality and privacy. These negative experiences of young women impact on their utilization of reproductive and health services and their use of contraceptives. Levels of contraceptive use among all age groups, including young women, in Namibia are still low. The choice of contraceptive method is restricted to injectables and to some extent, condoms. Uninformed and unsupportive parents are identified as major barriers to young women’s sexual health and their ability to use contraception consistently. Apart from this, individual use of contraception is greatly influenced by individual and community characteristics. The education level, marital status, number of children and work status are important individual factors affecting whether and what kind of contraception young women will use. Other issues related to the individual women concern whether she discusses family planning with her partner or parent, and whether she has access to the media and to health facilities. For example, findings from the multivariate analysis showed that increased education was significantly associated with a greater likelihood of using contraception. Unmarried young women were more likely to use condoms than married women. Higher condom use was also reported among young women of 15-19 years old than among 20-24 year olds. Furthermore, young women in urban areas had more positive attitudes towards using contraceptives, as well as more forthcoming friends and parents than those in the rural areas. The findings thus suggest that government strategies, which aim to increase the use of contraceptives amongst young women in Namibia, ought to enhance and improve parent-child communication, engage young women’s social networks, and seek to counteract negative assumptions of service providers who could potentially cater for a growing number of young women users and also make a range of choices available.