1. Are condoms a contraceptive method
Are condoms a contraceptive method? A comparison of reports of adolescent condom use for pregnancy prevention and HIV prevention
Michelle J Hindin1 and Amanda M Kalamar2 1Population Council 2Population Services International
Summary In high HIV prevalence countries, there is a substantial discrepancy in reports of condom use by adolescent girls when they report on methods used for pregnancy prevention versus condom use at last sex.
Summary The gap cannot be explained by dual use (adolescents also using more effective contraceptive methods than the male condom).
BACKGROUND
RESULTS
In some settings, condoms are not seen as a contraceptive method. Potential reasons include:
Condoms marketed for HIV prevention.
“Family planning” or “contraception” is often synonymous with hormonal and/or medicalized methods.
The meaning of condom use is important to understand, particularly for adolescents who are often the age group most likely to use condoms.
Is there is a discrepancy between reporting of condom use when asked in the context of pregnancy prevention vs. the context of sexual behavior?
Most recent DHS in 8 high HIV prevalence countries (Kenya, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe).
Compared responses in “Contraception” (doing anything to avoid pregnancy) and “Sexual Activity” (used condom at last sex) modules, with time since last sex.
% of contraceptive users who report using methods less effective than the condom (female condom, EC, SDM, LAM, rhythm, withdrawal, and no method) vs. % used condom at last sex.
Adolescents report more condom use in the sexual activity module than in contraceptive module:
From sexual activity module: For adolescents who report having sexual intercourse in the past 3 months, condom use at last sex ranges from 37% in Zambia to 84.7% in Lesotho.
From contraception module: Between 5.7% in Zambia and 55.7% in Lesotho report using condoms as their most effective modern method.
Most of the gap can be explained by adolescent girls who report no method of contraception but report using condoms at last sex. The gap is not due to reporting use of more effective contraceptive methods than the male condom.
Characteristics of year old adolescent girls
% sexually active 3 months
% using condoms as FP
% used condoms at last sex
Country, Year
Kenya, 2014
17.1
22.4
57.7
Lesotho, 2014
25.4
57.8
84.7
Malawi,
24.0
20.8
56.9
Namibia, 2013
34.1
43.3
73.3
Tanzania,
27.8
14.0
37.0
Uganda, 2016
21.8
21.1
45.5
Zambia,
26.4
6.0
Zimbabwe, 2015
9.6
17.9
46.6
Source: Demographic and Health Surveys.
Percentage of adolescents not “counting” condoms as contraception but reporting condom use at last sex
METHODS
CONCLUSION
With substantially more reporting of condom use in the sexual activity module compared with the contraception module, further research is needed to explore whether the discrepancy is due to:
The framing of the questions (i.e., adolescents are not using condoms to prevent pregnancy but they are using them to prevent HIV)?
Overreporting of condom use due to social desirability bias (i.e., knowing they should say they used condoms at last sex).
Do these findings hold in settings with low HIV prevalence? Among older women?
CONTACT INFORMATION
For more information, contact
Michelle J. Hindin
Amanda M. Kalamar