According to a new study of trends in the sexual behavior of young women in Central America, the proportion of 15–19-year-olds who have ever used a modern method of contraception has risen significantly in El Salvador, Guatemala, Honduras and Nicaragua over the past 15 years, but Nicaragua was the only country in which a significant decline in first births occurred in this age-group. At the same time, the proportion of adolescents having sex for the first time rose in El Salvador, Honduras and Nicaragua, and stayed the same in Guatemala. The authors, Ghazaleh Samandari and Ilene S. Speizer of the University of North Carolina at Chapel Hill, believe that these patterns reflect the persistence of unmet need for contraception, inconsistent contraceptive use and high contraceptive failure rates in these countries.

Samandari and Speizer suggest, for example, that increases in young women’s contraceptive use may not have translated into delayed first births because adolescents continue to experience high rates of contraceptive failure, a finding supported by another recent multi-country study. They also point out that measuring contraceptive use by ever having used a method instead of current use may mask unmet need and inconsistent use of contraceptives. Last, the authors suggest that the discrepancy between increased contraceptive use and lack of decline in first births could reflect adolescents using contraceptives to prevent a second birth as well as to avoid a first birth.

The study finds that socioeconomic status and education level are important predictors of young women’s sexual and reproductive outcomes in these countries. Poorer adolescents were more likely to have had sex or to have ever been married and were less likely to have used a modern contraceptive than were their better-off counterparts. Adolescents who had never gone to school were more likely than those with primary or secondary schooling to have had sex and to have been married, and were less likely to have used contraceptives. However, education was not associated with the timing of first births except in Nicaragua, where young women with secondary education were less likely to have given birth.

Given these results, the authors recommend that programs and policies in these countries focus on improving young women’s overall well-being as a means of improving their sexual health; they suggest the use of interventions to increase basic levels of education, provide comprehensive sex education and improve adolescents’ economic situation.

The study, "Adolescent Sexual Behavior and Reproductive Outcomes in Central America: Trends over the Past Two Decades," analyzed data from nationally representative surveys (four for each country) conducted between 1987 and 2007. It appears in the March 2010 issue of International Perspectives on Sexual and Reproductive Health.

Also in this issue of International Perspectives on Sexual and Reproductive Health:

Caring for Women with Abortion Complications in Ethiopia: National Estimates and Future Implications by Hailemichael Gebreselassie et al.;

The Estimated Incidence of Induced Abortion in Ethiopia, 2008 by Susheela Singh et al.;

Indonesian Couples’ Pregnancy Ambivalence and Contraceptive Use by Janine Barden-O’Fallon and Ilene Speizer;

Postabortion Family Planning: Addressing the Cycle of Repeat Unintended Pregnancy and Abortion by Carolyn Curtis et al.