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首页> 外文期刊>Reproductive Health >Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda
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Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda

机译：扩大覆盖面的途径：肯尼亚，卢旺达，坦桑尼亚和乌干达的青少年和年轻妇女避孕需求和使用的时间趋势分析

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Despite efforts to make contraceptive services more “youth friendly,” unmet need for contraception among young women in sub-Saharan Africa remains high. For health systems to effectively respond to the reproductive health needs of a growing youth population, it is imperative to understand their contraceptive needs and service seeking practices. This paper describes changes over time in contraceptive need, use, and sources of care among young women in four East African countries. We used three rounds of DHS data from Kenya, Rwanda, Tanzania, and Uganda to examine time trends from 1999 to 2015 in met need for modern contraception, method mix, and source of care by sector (public or private) and type of provider among young women aged 15–24?years. We assessed disparities in contraceptive coverage improvements over time between younger (15–24?years) and older women (25–49?years) using a difference-in-differences approach. Met need for contraception among women aged 15–24?years increased over time, ranging from a 20% increase in Tanzania to more than a 5-fold increase in Rwanda. Improvements in met need were greater among older women compared to younger women in Rwanda and Uganda, and higher among younger women in Kenya. Injectables have become the most popular contraceptive choice among young women, with more than 50% of modern contraceptive users aged 15–24?years currently using the method in all countries except for Tanzania, where condoms and injectables are used by 38% and 35% of young users, respectively. More than half of young women in Tanzania and Uganda receive contraceptives from the private sector; however, while the private sector played an important role in meeting the growing contraceptive needs among young women in Tanzania, increased use of public sector services drove expanded access in Kenya, Rwanda, and Uganda. Our study shows that contraceptive use increased among young East African women, yet, unmet need remains high. As youth populations continue to grow, governments must develop more targeted strategies for expanding access to reproductive health services for young women. Engaging the private sector and task-shifting to lower-level providers offer promising approaches; however, additional research is needed to identify the key facilitators and barriers to the success of these strategies in different contexts.
机译：尽管努力使避孕服务更加“青年友好”，但撒哈拉以南非洲年轻女性对避孕的需求仍未得到满足。为了使卫生系统能够有效满足不断增长的青年人口的生殖健康需求，必须了解其避孕需求和寻求服务的做法。本文描述了四个东非国家中年轻女性在避孕需求，使用和护理来源方面随时间的变化。我们使用了来自肯尼亚，卢旺达，坦桑尼亚和乌干达的三轮DHS数据，研究了1999年至2015年的时间趋势，以满足现代避孕药具，方法组合以及按部门（公共或私营）和提供者类型提供医疗服务的需求15-24岁的年轻女性。我们采用差异差异方法评估了年轻（15-24岁）和老年妇女（25-49岁）之间避孕覆盖率随时间的改善存在差异。随着年龄的增长，15-24岁女性对避孕的需求逐渐增加，从坦桑尼亚的20％增加到卢旺达的5倍以上。与卢旺达和乌干达的年轻妇女相比，老年妇女满足需求的改善更大，而肯尼亚的年轻妇女则更大。注射剂已成为年轻女性中最流行的避孕选择，在除坦桑尼亚（坦桑尼亚分别使用安全套和注射剂的比例分别为38％和35％）的所有国家中，目前有超过50％的15-24岁年龄段的现代避孕方法使用者使用该方法分别是年轻用户。坦桑尼亚和乌干达一半以上的年轻妇女从私营部门获得避孕药具;然而，尽管私营部门在满足坦桑尼亚年轻女性不断增长的避孕需求方面发挥了重要作用，但公共部门服务的使用增加推动了肯尼亚，卢旺达和乌干达的普及。我们的研究表明，年轻的东非妇女使用避孕药具的情况有所增加，但未满足的需求仍然很高。随着青年人口的不断增长，政府必须制定更有针对性的战略，以扩大年轻妇女获得生殖健康服务的机会。与私营部门合作并把任务转移到较低级别的提供者提供了有前途的方法;但是，还需要进行其他研究，以确定在不同情况下这些策略成功的关键推动因素和障碍。

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