Trends in Contraceptive Knowledge and Use Among Adolescent Married Women in Malawi

There is a growing interest in adolescent reproductive health. Teenage pregnancies are an important public health issue because they are associated with maternal, fetal, and neonatal adverse outcomes. Teenage girls who get pregnant are likely to drop out from school and teenage parents are unlikely to have the social and economic means to raise children. These, and many other reasons, justify the promotion of sexual abstinence among teenagers and/or contraception. In the United States, it has been estimated that 82% of pregnancies in women aged 15 to 19 years are unintended (1). There is an interest in the prevention of pregnancy among unmarried adolescents, but much less in married ones. Young married women may not use the most appropriate pregnancy prevention (2). Young women usually prefer certain types of contraceptives, usually relying on less effective methods. Santelli et al (3) found that overall hormonal method use among teenagers in the United States barely changed in the period from 1993-2001. There was, however, a decline in the pill use (from 25% to 20%) that was offset by a decreased use of injectable contraceptives. Much research on adolescent contraceptive use and reproductive health assumes that adolescent women are unmarried, which makes married adolescent women not recognized by researchers and not included in the design, implementation, and evaluation of reproductive health programs. The present article aims to explore the trends in contraceptive knowledge and use among married adolescent women in Malawi between 1992 and 2004. The Malawi Demographic and Health Surveys (MDHS) 1992, 2000, and 2004 and the Knowledge, Attitudes and Practices in Health Survey 1996 (MKAPHS 1996) (4-7) are nationally representative studies using multi-stage cluster sampling techniques. The prevalence of different estimates was obtained and reported. In the present study, the prevalence data on the knowledge and use of contraception among married adolescent women were analyzed to obtain odds ratio first with the 1992 results as the referent and then with the immediately preceding survey data as the referent. A total of 206 married adolescent women participated in the MKAPHS 1996, 388 in the MDHS 1992, 934 in MDHS 2000, and 788 in MDHS 2004. The adolescents were defined as persons under the age of 20 years. The percentage of married adolescent women who knew about at least one method of modern contraception was 84.5% in 1994, 97.2% in 1996, 96.3% in 2000, and 95.3%in 2004. Compared with 1992, the percentage of women with the knowledge of contraception was significantly increased in subsequent survey years (P