1993 Contraceptive Prevalence Survey Jamaica Volume IV Sexual Behaviour and contraceptive Use Among Young Adults

Publication date: 1995

CONTRACEPTIVE PREVALENCE SURVEY JAMAICA 1993 VOLUME IV SEXUAL BEHAVIOUR AND CONTRACEPTIVE USE AMONG YOUNG ADULTS Leo Morris, Ph.D., M.P.H. Valerie Sedivy, M.P.H. Jay S. Friedman, M.A. Carmen P. McFarlane, M.Sc. (Econ.) NATIONAL FAMILY PLANNING BOARD March 1995 PRINTED BY: U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention Atlanta, Georgia 30333 PREFACE The 1993 Jamaica Contraceptive Prevalence Survey (CPS) is the fifth in a series of periodic enquiries conducted by the National Family Planning Board (NFPB). The Survey seeks to update measures of fertility and contraceptive use among women aged 15-44 years and, for the first time, included a special module for men aged 15-54, as well as for young adult men and women aged 15-24 years. The scope of the survey, as in earlier studies, is designed to gather information on a broad range of areas including knowledge, attitudes and practices in contraception; perceptions on the role of men and women, including views on sexuality, child bearing, child rearing and health care. This CPS, coming as it does in the last decade of the century, is of significance to the NFPB in particular and the wider community in general, as it heralds the beginning of the twenty first century and the realization of the goals of Jamaica's National Population Policy. It also comes against the gradual phased withdrawal of contraceptive procurement by the major funding agency, the United States Agency for International Development (USAID), by a twenty percent (20 percent) annual decline over the period 1993-1998 under the Family Planning Initiatives Project (FPIP), as well as the phased diminution of funding from other donor agencies such as the United Nations Fund for Population Activities (UNFPA). This CPS is in fact one of two surveys to be conducted during the life of the FPIP. Against this background, the NFPB has many challenges ahead which are, inter alia, not only to maintain but also to increase contraceptive prevalence and to achieve further milestones by the inception of the twenty-first century, such as a population of not more than 2.7 million and replacement level fertility of two children per woman. For contraceptive methods and family life services to impact on fertility and contribute to the processes of national development, it is vital that programme effectiveness be evaluated. The reliable and current data collected from the CPS will be of invaluable use in policy analysis and programme implementation for administrators and planners, not only in health but in those areas which impact on population issues at the broader national level. The Final Report of the 1993 CPS is presented in the following five volumes: I Administrative Report II Knowledge Of and Attitudes Towards Family, Contraception and AIDS III Sexual Experience, Contraceptive Practice and Reproduction IV Young Adults V Profiles of Health Regions In addition, an Executive Summary, containing a summary of the main findings of the Survey will be presented. Volume I - the Administrative Report, contains background information on historical, geographical, demographic and social features relating to Jamaica and its population, as well as the relationship of the Survey data to the population policies and programmes being implemented by the Government. In addition, the survey design and organization including the sample design as well as the outcome of the data collection are presented. Background variables used in the exposition of the data are also displayed. Finally, a summary report on the National Dissemination Seminar together with recommendations made by participants are included. Volume II presents data on knowledge of and attitudes towards family, contraception and AIDS of women aged 15-44 years and men aged 15-54 years, while Volume III contains information on their sexual experience, contraceptive practice and reproductive history. Volume IV, the present volume, is dedicated to young adults, female and male, aged 15-24 years and in particular to their sexual behaviour and contraceptive use. The last volume, Volume V, presents selected information at the health region level so as to assist planners to determine the success or otherwise of the programmes being provided in each of the four health regions. The 1993 CPS was funded by USAID and directed by Mrs. Carmen McFarlane, Survey Director, a former Director General of the Statistical Institute of Jamaica (STATIN), in collaboration with NFPB and the Ministry of Health, while field work and data entry were carried out by STATIN. Technical assistance was provided by the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA in the areas of survey design and sampling, questionnaire development and training, data processing and report preparation. STATIN and CDC were jointly responsible for printing. The National Family Planning Board wishes to place on record its sincere thanks to all those organizations which participated in the planning of the Survey, the development of the questionnaire and the review of the various modules. Main participants were the Ministry of Health, the Statistical Institute of Jamaica, the Planning Institute of Jamaica and the Fertility Management Unit of the University of the West Indies. Special acknowledgements are due to Mr. Vernon James, Director General, STATIN, for his leadership and support of STATIN's participation in the Survey; Miss Isbeth Bernard, Director of Surveys, for supervision of the field work and data entry, Mrs. Valerie Nam, Director of Censuses & Related Studies and Mrs. Merville Anderson, Senior Statistician, for their assistance in training on the questionnaires, all of STATIN; and to Ms. Margaret Watson and Mr. Daniel Wallace, computer specialists of CDC, for installation of the data entry/edit software and training of STATIN personnel in its use. The NFPB also wishes to thank all who participated in the development, implementation and finalization of the survey. Particular mention is made of Mrs. Carmen McFarlane, Survey Director; Dr. Leo Morris and Mr. Jay Friedman of CDC; Mrs. Betsy Brown, Director, Office of Health, Nutrition and Population and Mrs. Grace Ann Grey, Project Officer, both of USAID; Dr. Sheila Campbell-Forrester, SMO, Cornwall Regional Hospital, Dr. Beryl Irons, SMO/MCH, Drs. Peter Weller and Peter Figueroa of the Epidemiology Unit and Ms. Kristin Fox, Director, Health and Information Unit, of MOH; Dr. Olivia McDonald, Medical Director, Mrs. Eugenia McFarquhar, Family Planning Co-ordinator, Mrs. Ellen Radlein, Director, Projects & Research, Mrs. Janet Davis, Director, Information, Education & Communication, and Mrs. Marian Kenneally, Programme Co- ordinator, of the NFPB. Finally, for Volume TV, to the 2,221 young adults who gave up their time to answer so many questions, we owe a debt of gratitude for this information, which we are sure will be useful in enhancing their lives. Beryl Chevannes, Executive Director. February, 1995. CONTENTS LIST OF TABLES i 1 - INTRODUCTION AND METHODOLOGY 1 1.1 Objectives of the survey and coverage 1 1.2 Methodology 3 2 - BACKGROUND 5 2.1 Socio-demographic characteristics 5 2.2 Relationship status and partnership 6 3 - SEX EDUCATION AND KNOWLEDGE OF FERTILITY, CONTRACEPTION AND STD / AIDS 3.1 Sex education 7 3.2 Knowledge of fertility, contraception and STD 7 3.3 Knowledge of AIDS 8 4 - SEXUAL EXPERIENCE AND CONTRACEPTIVE USE 11 4.1 Sexual experience and contraceptive use at first intercourse 11 4.2 Current sexual activity and contraceptive use 13 5 - ATTITUDES TOWARD CONTRACEPTION AND FERTILITY 17 5.1 Attitudes toward contraception 17 5.2 Attitudes toward gender roles and fertility 17 6 - FERTILITY AND ITS EFFECTS ON SCHOOL STATUS 19 6.1 Fertility and unintended pregnancy 19 6.2 Effects on school status 19 7 - UNINTENDED PREGNANCY AND UNMET NEED 21 7.1 Planning status of last pregnancy 21 7.2 Need for family planning services 21 NOTES 23 TABLES i LIST OF TABLES 2.1.1 Age Distribution Young Adult Women And Men Aged 15 to 24 Compared To 1987 YARHS 2.1.2 Educational Attainment Young Adult Women And Men Aged 15 to 24 Compared To 1989 CPS 2.1.3 Employment Status By Current Age And Gender Young Adult Women And Men Aged 15 to 24 2.1.4 Socio-Economic Status Of Young Adult Women And Men Aged 15-24 2.1.5 Religious Affiliation Of Young Adult Women And Men Aged 15-24 2.1.6 Frequency Of Church Attendance By Religious Affiliation Young Adult Women And Men Aged 15 to 24 2.2.1 Relationship Status By Current Age And Gender Young Adult Women And Men Aged 15 to 24 3.1.1 Percent of Young Adult Women And Men Aged 15-24 Who Took A Course In Family Life Or Sex Education By Where Course Was Taken, Compared With 1987 YARHS 3.1.2 Proportion Of Young Adult Women And Men Aged 15-24 Whose School-Based Class Or Course On Family Life Or Sex Education Included Various Topics 3.1.3 Age At Which School-Based Class Or Course On Family Life Or Sex Education Was First Taken Young Adult Women And Men Aged 15-24 3.2.1 Percentage Of Young Adult Women Aged 15-24 Who Have Heard Of Various Methods Of Contraception By Whether They Have Taken A School-Based Class Or Course On Family Life Or Sex Education 3.2.2 Percentage Of Young Adult Men Aged 15-24 Who Have Heard Of Various Methods Of Contraception By Whether They Have Taken A School-Based Class Or Course On Family Life Or Sex Education ii 3.2.3 Beliefs About Specific Methods Of Contraception By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information About Modern Birth Control Methods Young Adult Women Aged 15-24 3.2.4 Beliefs About Specific Methods Of Contraception By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information About Modern Birth Control Methods Young Adult Men Aged 15-24 3.2.5 Beliefs About Contraception, Fertility And STD By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information About These Topics Young Adult Women Aged 15-24 3.2.6 Beliefs About Contraception, Fertility And STD By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information About These Topics Young Adult Men Aged 15-24 3.3.1 Proportion Of Young Adult Women And Men Aged 15-24 Who Have Heard Of AIDS And HIV And Who Believe That An HIV-Positive Person Can Be Asymptomatic By Selected Characteristics 3.3.2 Proportion Of Young Adult Women And Men Aged 15-24 Identifying Various Means Of AIDS Transmission When Asked To Name Two Means Of AIDS Transmission By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information On AIDS 3.3.3 Proportion Of Young Adult Women Aged 15-24 Who Believe Various Activities Can Result In AIDS Transmission By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information On AIDS iii 3.3.4 Proportion Of Young Adult Men Aged 15-24 Who Believe Various Activities Can Result In AIDS Transmission By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information On AIDS 3.3.5 Proportion Of Young Adult Women Aged 15-24 Who Believe Various Behavioural Activities Can Reduce The Risk Of AIDS Transmission By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information On AIDS 3.3.5 Proportion Of Young Adult Men Aged 15-24 Who Believe Various Behavioural Activities Can Reduce The Risk Of AIDS Transmission By Whether Respondents Have Taken A School-Based Class Or Course On Family Life Or Sex Education Which Included Information On AIDS 4.1.1 Proportion Of Young Adult Women Aged 15-24 Who Report Having Had Sexual Intercourse, By Selected Characteristics Age Compared With 1987 YARHS 4.1.2 Proportion Of Young Adult Men Aged 15-24 Who Report Having Had Sexual Intercourse, By Selected Characteristics Age Compared With 1987 YARHS 4.1.3 Relationship To First Partner By Age At First Intercourse Young Adult Women And Men Aged 15-24 Who Are Sexually Experienced 4.1.4 Mean Age At First Intercourse By Selected Characteristics Young Adult Women And Men Aged 15-24 Who Are Sexually Experienced 4.1.5 Age At First Sexual Intercourse By Age Of First Partner Young Adult Women And Men Aged 15-24 Who Are Sexually Experienced 4.1.6 Place Of First Sexual Intercourse By Age At First Intercourse Young Adult Women And Men Aged 15-24 Who Are Sexually Experienced iv 4.1.7 Proportion Of Sexually Experienced Young Adults Aged 15-24 Who Used Contraception At First Intercourse By Selected Characteristics And Age At First Intercourse Compared With 1987 YARHS 4.1.8 Method Used At First Sexual Intercourse By Age At First Intercourse Young Adults Aged 15-24 Who Used Contraception At First Intercourse 4.1.9 Which Partner Made Decision To Use Condoms At First Intercourse? By Selected Characteristics Young Adult Women Aged 15-24 Who Used Condoms At First Intercourse 4.1.10 Which Partner Made Decision To Use Condoms At First Intercourse? By Selected Characteristics Young Adult Men Aged 15-24 Who Used Condoms At First Intercourse 4.1.11 Source Of Condoms Used At First Intercourse Young Adult Women And Men Aged 15-24 Who Used Condoms At First Intercourse 4.1.12 Reasons For Not Using Contraception At First Intercourse By Age At First Intercourse Young Adult Women Aged 15-24 Who Did Not Use Contraception At First Intercourse 4.1.13 Reasons For Not Using Contraception At First Intercourse By Age At First Intercourse Young Adult Men Aged 15-24 Who Did Not Use Contraception At First Intercourse 4.2.1 Proportion Of All Young Adult Women And Men Aged 15-24 Currently Using Contraception By Selected Characteristics 4.2.2 Source Of Selected Contraceptive Methods Young Adult Women And Men Aged 15-24 Who Are Currently Using Contraception 4.2.3 Reasons For Not Currently Using A Contraceptive Method By Relationship Status Young Adult Women Aged 15-24 v 4.2.4 Percentage of Sexually Experienced Young Adult Women And Men 15-24 Who Report Having Sexual Intercourse Within The Past Month By Current Relationship Status 4.2.5 Percentage Of Sexually Active Young Adult Women And Men Aged 15-24 Who Are Currently Using Contraception By Relationship Status And Method 4.2.6 Reasons For Not Currently Using A Contraceptive Method By Relationship Status Sexually Active Young Adult Women Aged 15-24 4.2.7 Frequency Of Sexual Relations In Past Month By Current Relationship Status Sexually Active Young Adult Women And Men Aged 15-24 4.2.8 Number Of Sexual Partners In Past Month Sexually Active Young Adults Aged 15-24 4.2.9 Percentage of Sexually Experienced Young Adults Aged 15-24 Who Are Currently Sexually Active By Relationship With Last Sexual Partner 4.2.10 Relationship With Last Sexual Partner By Current Relationship Status Sexually Experienced Young Adult Women And Men Aged 15-24 4.2.11 Contraceptive Use At Last Sexual Intercourse By Relationship With Last Sexual Partner Sexually Experienced Young Adult Women And Men Aged 15-24 4.2.12 Percentage Of Sexually Experienced Young Adults Aged 15-24 Who: 1. Have Ever Used Condoms, Used Condoms At Last Intercourse 3. Used Condoms At Every Intercourse By Age, Number Of Partners In Past 5 Years And Number Of Partners In Past Month 5.1.1 Reason For Condom Use, By Age Group, Relationship Status, Number Of Partners In Past 5 Years And Number Of Partners In Past Month Sexually Experienced Young Adult Women Men Aged 15-24 Who Currently Use Or Who Have Ever Used Condoms vi 5.1.2 Reason For Condom Use, By Age Group, Relationship Status, Number Of Partners In Past 5 Years And Number Of Partners In Past Month Sexually Experienced Young Adult Women And Men Aged 15-24 Who Currently Use Or Who Have Ever Used Condoms 5.1.3 Reason For Not Using Condoms, By Age Group Sexually Experienced Young Adult Women And Men Aged 15-24 Who Currently Have Never Used Condoms 5.1.4 Contraceptive Method Perceived By Respondents As Most Appropriate For Young People By Age Group Of Respondent Young Adult Women And Men Aged 15-24 5.1.5 Percentage Of Young Adults Who Say They Could Afford The Contraceptive Method Perceived By Respondents As Most Appropriate For Young People By Methods Most Frequently Mentioned Young Adult Women And Men Aged 15-24 5.2.1 Perception Of Ways Used By Men To Get Women Into A Sexual Relationship By Age Group Young Adult Women And Men Aged 15-24 5.2.2 Perception Of Most Important Ways A Woman May Put Off Having Sex I If She Is Not Ready For It By Age Group Young Adult Women And Men Aged 15-24 5.2.3 Percentage Of Young Adult Women Aged 15-24 In Agreement With Statements About Cultural And Gender Roles With Respect To Fertility By Educational Attainment 5.2.4 Percentage Of Young Adult Men Aged 15-24 In Agreement With Statements About Cultural And Gender Roles With Respect To Fertility By Educational Attainment 5.2.5 Percentage Of Young Adult Women And Men Aged 15-24 In Agreement With Statement That A Woman Should Be A Virgin When She Marries By Relationship Status With First Sexual Partner vii 6.1.1 Cumulative Percentage Of Young Adult Women Aged 15-24 Who Have Achieved Menarche By Various Ages By Current Age 6.1.2 Proportion Of Young Adult Women Aged 15-24 Who Have Ever Been Pregnant Or Had A Live Birth By Selected Characteristics Compared With 1989 CPS 6.1.3 Number Of Pregnancies Young Adult Women Aged 15-24 By Age Group 6.1.4 Age-Specific Fertility Rates Young Adult Women Aged 15-24 Compared With 1987 And 1983 6.1.5 Mean Number Of Children Ever Born To Young Adult Women Aged 15-24 By Age Group And Relationship Status, Compared With 1989 6.2.1 Percentage Of Ever Pregnant Respondents Who First Became Pregnant While Still In School And Percent Distribution Of Educational Attainment At Time Of First Pregnancy, Young Adult Women Aged 15-24 6.2.2 Of Those Young Adult Women Who Became Pregnant While Still In School Who First Became Pregnant While Still In School The Percentage Who Returned To School After Birth Of Their First Child By Educational Attainment At Time Of First Pregnancy 6.2.3 Profile Of Educational Attainment Of Young Adult Women By Whether They Have Ever Been Pregnant Young Adult Women Aged 15-24 6.2.4 Of Those Young Adult Women Who Became Pregnant While Still In School The Percentage Who Received Help With Schooling From An Organization By Educational Attainment At Time Of First Pregnancy 6.2.5 Percentage Of Young Adult Women Aged 15-24 Who Receive Help With Care Of Their Children 6.2.6 Source Of Child Care Help By Type Of Help Received Young Adult Women Aged 15-24 Who Reported They Receive Help With Care Of Their Children vii 7.1.1 Planning Status Of Most Recent Pregnancy By Selected Characteristics Young Adult Women Aged 15-24 Who Had A Live Birth In The Past Five Years 7.2.1 Percent Of Young Adult Women Aged 15-24 Who Are In Need Of Family Planning Services By Selected Characteristics And Compared To 1989 CPS 7.2.1 Percent Of Young Adult Men Aged 15-24 Who Are In Need Of Family Planning Services By Selected Characteristics 1 CHAPTER I INTRODUCTION AND METHODOLOGY 1.1 OBJECTIVES OF THE SURVEYS AND COVERAGE The 1993 Jamaica Contraceptive Prevalence Survey (CPS) programme is the most recent in the continuing series of enquiries undertaken by the National Family Planning Board, aimed at obtaining information on levels of fertility in Jamaica and on related factors which impact on the size of the population and on the rate of growth. Earlier enquiries were conducted among females in 1974, 1979, 1983 and 1989 and among males between November 1983 to April 1985, with a more restricted enquiry carried out in 1987 among males and females in the age group 14-24 years. Other studies in this field have been undertaken by other institutions, chief of which is the government's statistical agency. Estimates of fertility rates are generally available from the decennial censuses of population carried out between 1861 until 1980 by the former Department of Statistics and more recently by the Statistical Institute of Jamaica, with intercensal estimates also being provided by these institutions. In addition, a more comprehensive study, the 1975/76 Jamaica Fertility Survey was carried out within the programme of the World Fertility Survey by the former Department of Statistics. The 1993 Survey is the most comprehensive of the enquiries to be undertaken, focusing on women and men in their most active reproductive ages, with specific emphasis on young adults in the group. The main aim of the survey programme is to obtain a wide range of information on the knowledge and practices of Jamaican men and women in general and their partners in particular in all matters relating to the determination of the levels of fertility of women in the population, the number of births and efforts made (if any) to regulate the number and spacing of their children. It also aims at assessing other related health conditions covering maternal-child health and behavioural risk factors. These insights will prove invaluable for projecting as well as for revising population targets and more generally, ensuring that the necessary data exist. The extension of the coverage to include men will enlarge the information which can be used among other things to develop meaningful male responsibility programmes for controlling the birth rate in Jamaica. The Survey should provide users including decision-makers with data which will assist in the development of policies which could lead to overall reductions in the birth rate through a more efficient spacing of children. In addition to the development of policies directly concerned with population growth, a further objective of the Survey is to provide information which could contribute to an effective family life education programme within and outside the formal education system which aim at improving knowledge and practices relating to the conception and care of children. Finally, information on selected behavioural risk factors which include smoking and alcohol use during pregnancy and knowledge of transmission and prevention of AIDS, are provided with a view to contributing to the effort of minimizing the impact which such 2 habits and/or diseases might have on the population as a whole and women in particular and in this context, providing information for the development of appropriate educational programmes. The 1993 CPS covers a wide cross-section of topics which include fertility, infant and child mortality and reproductive history, contraceptive usage, attitudes towards reproduction, maternal and child health, and behavioural risks. Background characteristics relating to the demographic and socio-economic status of the population surveyed are also included. These comprise age structure, educational attainment, employment status, frequency of church attendance and union status. A new classification, socio-economic index has been developed to assist in the analysis of the 1993 survey results. This index has been developed to assess the impact of social, economic and cultural factors on the respondent population and is derived mainly from the education and occupation of the head of the household. Its relevance has also been tested on elements pertaining to household density and access to media by household members. The items used in this latter comparison are number of rooms occupied by household members, possession by members of the household of radio and television, and readership of newspapers by household members. Four ranks have been employed in setting up the index. These are: "high", "medium", "low" and "very low".1 The 1993 Contraceptive Prevalence Survey has, for the first time, also included a special module for young adult men and women aged 15-24 years, on which this volume is based. Where possible, comparisons between 1993 and data on key indicators of behavior change from the 1989 CPS and the 1987 young adult survey are provided in this report . The knowledge, attitudes and practices of young adults will be measured against these background variables. Geographic coverage is national, with disaggregation according to urban and rural residence. Major urban areas throughout the country are identified and grouped. All other areas are classified as rural. Differentials in urban and rural areas of residence as well as by demographic and socio-economic characteristics will be identified in order to assess the impact of current programmes as well as to provide guidelines as to areas which might benefit from special or intensified program efforts.2 In Volumes I-III data on current fertility and levels of unintended fertility have been provided, as well as information on the reproductive history of men. The 1993 Contraceptive Prevalence Survey, in addition, provides information on current sexual activity of both young adult men and women, particularly in relation the use of contraceptives at first and subsequent acts of sexual intercourse. Details should be useful to planners of programmes in STD/HIV prevention. Concern about the high level of unintended teenage childbearing has indicated that some special analysis of the problem should be conducted. The current survey provides data for those involved in policy-making and program development by updating measures of fertility and contraceptive use and by gathering information on a broad range of areas including knowledge, attitudes and practices relating to contraception, as well as perceptions on the 3 role of women, sexuality, child rearing and health care. This report, specific to young adults, is the fourth of five volumes comprising the final report of the 1993 Jamaica CPS. Other volumes include the Administrative Report (Volume I), Knowledge of and Attitudes Toward Family, Contraception, and AIDS (Volume II), Sexual Experience, Contraceptive Practice and Reproduction (Volume III), and Profiles of Health Regions (Volume V). 1.2 METHODOLOGY The 1993 Jamaica Contraceptive Prevalence Survey utilized the design adopted for the Continuous Social and Demographic Surveys conducted by the Statistical Institute of Jamaica. This design is based on a two-stage stratified sample with the first stage being a selection of geographic areas and the second stage, of dwellings. For the selection of the first stage units, the country was divided into enumeration districts (EDs) which were grouped into sampling regions consisting of a predetermined number of strata approximately equal in size. Two EDs within each sampling region, selected with probability proportional to size, made up the sample at the first stage. At the second stage, a predetermined number of dwellings were selected systematically from lists of dwellings arranged in a circular basis in each of the EDs designated in the first stage of selection. This is not a self-weighting sample design, as smaller health regions have been oversampled. In addition, one respondent per household was selected with probability inverse to the number of eligible respondents in the household. Therefore, results are based on weighted data. However, the unweighted number of cases are shown in each table, since they represent the number cases needed for variance calculations. Additional details on the survey methodology are included in Volume I. There were 7,052 households included in both the male and female samples, yielding 3,799 women and 3,852 men. Interviews were completed for 3,110 women and 3.082 men. This report includes young women and men aged 15-24 years, for a sample size of 1,181 young women and 1,052 young men. 5 CHAPTER 2 BACKGROUND 2.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS The female sample is split 50% 15-19 year olds and 50% 20-24 year olds (Table 2.1.1). Compared with the 1987 Young Adult Reproductive Health Survey (YARHS), slightly more 20-24 years olds are in the sample. In the 1993 male sample, 54% of respondents are 15-19 years of age and 46% are 20-24. Non-response rates were higher for men 18 years of age and older, who are more likely to be in the labour force and unavailable for interview. Compared with 1987, fewer 18-19 year old males are included in the sample, but a higher representation of 23-24 year olds was obtained. Data on educational attainment, given in Table 2.1.2, show that in comparison with 1989 women are increasingly likely to achieve higher levels of education; the proportion of women completing 5 or more years of secondary education has increased by 27% since 1989 and the proportion with post-secondary education has almost doubled. Overall, 84% of females have achieved a level of education higher than primary school, as compared to 78% of males. Within every age group, men are more likely than women to report that they are currently working (Table 2.1.3). Approximately 4 out of 5 men 20-24 years of age report they are working. The proportions of men and women who are looking for work are highest among those aged 18-19. Women are much more likely to report that they are keeping house than men. As would be expected, the proportions in school decline with increasing age among both men and women. Data on socio-economic status, based on the educational level and occupational status of the head of household, are given in Table 2.1.4. Since the index is based on characteristics of the household head, it is not surprising that the data indicate that socio-economic status does not vary greatly between men and women. Overall, fewer than 10 percent of young adults are ranked "high" while the majority fit into the "low" or "very low" categories. Twice as many young men than women indicate that they practice no religion (Table 2.1.5). Of those who do identify themselves with a religion, the highest percentage belong to the Church of God. Frequency of church attendance varies widely by both religion and gender. Among men, Seventh-day Adventists are more likely to attend services at least once per week than those belonging to other religions (Table 2.1.6), while women describing themselves as Anglican, Pentecostal or Seventh-day Adventists are more likely to attend weekly than those belonging to other religions. Among men, Catholics are most likely to not attend church at all, while women not attending church are most likely to describe their religious affiliation as Anglican. 6 2.2 RELATIONSHIP STATUS AND PARTNERSHIP Data on the relationship status of women shown in Table 2.2.1 reveal that the highest overall proportions have a visiting partner (37%) or no current partner (31%). Of those in more stable unions, the vast majority are in common-law (16%) rather than legal marriages (2%). The proportion in a common law union increases with age, while those who report no steady partner declines rapidly after 15-17 years of age. The men have a similar pattern, but fewer men are married (1%) or in a common law union (6%) and twice as many report having a sexual relationship with a girlfriend. Not shown in Table 2.2.1. is that these patterns have changed very little since the 1989 survey. 7 CHAPTER 3 SEX EDUCATION AND KNOWLEDGE OF FERTILITY, CONTRACEPTION AND STD / AIDS 3.1 SEX EDUCATION Eighty percent of women have taken a course in sex or family life education, the vast majority in school (Table 3.1.1). Younger women are more likely to report receiving sex education only in school, while the few who have received sex education only outside of school tend to be older. Men are less likely to have received sex or family life education; almost one-third have received no sex education. Those aged 23-24 are less likely to have received sex education in school than those under age 23. For women there is no difference when compared with the 1987 YARHS, whereas for men, a slight improvement is seen as the percentage with no sex education has declined from 39% to 32%. Table 3.1.2 indicates that almost all of those who have received sex education in school report that the education included information about human reproduction, the menstrual cycle (women), pregnancy, and STD. Information about birth control was provided in over three-quarters of the cases. Information about AIDS was provided for about six in ten young men and women, while services for adolescents was addressed in less than half the cases. About two-thirds of women and almost 60% of men who have received sex education had their first class by age 14, while most of the remaining third had their first class by age 17 (Table 3.1.3). 3.2 EFFECTS OF SEX EDUCATION ON KNOWLEDGE OF FERTILITY, CONTRACEPTION AND STD With the exception of the first three methods shown in Table 3.2.1, young women whose sex education included information about birth control are more likely to have heard of the various contraceptive methods (p < 0.05). The largest differences are for the DUD, the diaphragm, vasectomy and rhythm. For men (Table 3.2.2) there is better recognition of all methods (p < 0.05), with the exception of the condom and the Billings Method. Differences seen between those who had and did not have school-based sex education are greater for men than for women. For both groups (those with and without school-based sex education), knowledge among women is equal or higher for all contraceptive methods. Table 3.2.3 shows that despite the data in Table 3.2.1 indicating a high proportion of young women exposed to education about contraception have heard of tubal ligation, injection, the pill, and the IUD, only two-thirds believe that tubal ligation is very effective at preventing pregnancy, and about one-half or slightly less han half believe that injections and the pill 8 are very effective. Only one-third believe the IUD is very effective. There are no statistical differences between those who have taken and those who have not taken a sex education course. These figures are identical for men (Table 3.2.4), with the exception that nearly three quarters of men believe tubal ligation to be effective if they have taken a course. Only for injection is there a statistical difference (p < 0.05) between those who have taken and those who have not taken a sex education course. About one-quarter of women believe that tubal ligation can cause the selected side effects shown in Table 3.2.3. In general, an even greater percentage, almost half in some cases, believe that the other methods shown can cause these side effects and there is no statistical difference between those who had and did not have a course. We can conclude that the courses that included information on contraceptive methods did not have any impact on these beliefs. For men, in several cases, those who have taken a course seem to have more, rather than less, misinformation. Two questions were asked about the condom. Less than 3% of women agreed that a condom can be used more than once whether they had information or did not have information on contraception in a family life or sex education course (Table 3.2.5). Men had similar responses (Table 3.2.6). The proportions in agreement were also similar for men and women for "condom does not reduce pleasure for women; forty-two percent of those with information on contraception and 34% to 38% for those with no such information. Although very low, a significantly greater proportion of women than men know that a woman is at greatest risk of pregnancy in the middle of the menstrual cycle (p < 0.05). However, there is no significant difference for females with information (30%), compared with those that did not have information (22%). For men, the corresponding proportions are 13% and 8%, respectively. A high percentage of both young women ( > 89%) and young men ( > 83%) know that a woman can become pregnant at first intercourse. However, once again, there is no statistical difference between those who had or did not have information on human reproduction in a sex education course. A minority of young people (13% to 21%) believed that a woman should have a baby before age 20 to prove her fertility. Once again, there is no difference by gender or by information received. In the past, many people in Jamaica asserted that the belief "sex with a virgin can cure gonorrhea". However, less than 5% of young people agreed with this statement. Also, a small percentage of women ( < 4%) and men ( < 6%) believed that the pill protects against STDS. Another 4 to 7% of women and 6 to 15% of men did not know. 3.3 KNOWLEDGE OF AIDS Table 3.3.1 shows that almost all young adults have heard of HIV or AIDS, and that there are almost no differences by age, residence, and educational level. On the other hand, the proportion of young adults of both genders who believe that an HIV-positive person can be asymptomatic (not show any signs of illness) is only about 80% and is directly correlated 9 with educational attainment. Whereas about 90% of both men and women with a post- secondary education are aware of this fact, this is true of only about 70% of young adults with a complete primary or lower education. Respondents were asked to identify two means by which a person could be infected with the virus that causes AIDS. Table 3.3.2 shows that almost all young adult men and women identified sexual transmission as one means of transmitting the virus; thus the other means of transmission listed in the table were by and large the second means of transmission identified. More than 40% of both genders identified blood transfusion and 15% of women and 20% of men identified using non-sterile needles when injecting intravenous drugs as the second means of AIDS transmission. Very few young men and women specifically identify mosquito bites and casual contact as a means by which to acquire the disease. There was almost no difference for either gender by whether the respondent had received information on AIDS in a school-based sex education course. Tables 3.3.3 and 3.3.4 indicate that although relatively few young adults believe that AIDS is transmitted by shaking hands, hugging, or being in the same room, three quarters of those educated about AIDS and almost two-thirds of those not educated believe that they can acquire the disease by donating blood. In addition, four in ten believe that the virus is transmitted by mosquito bites. When asked directly whether sex between men or between a man and a woman can transmit AIDS, nearly all young adults agree that these are possible modes of transmission. Table 3.3.5 shows that the most common ways of preventing AIDS transmission that was spontaneously identified by young women who are educated about AIDS are using condoms (83%), having one partner (50%), and not having sex (28%). The same pattern is apparent among young women not exposed to AIDS education, although slightly fewer of them identify using condoms (77%) and not having sex (21%) as methods of prevention. Patterns are identical among young men (Table 3.3.6). 11 CHAPTER 4 SEXUAL EXPERIENCE AND CONTRACEPTIVE USE 4.1 FIRST SEXUAL EXPERIENCE AND CONTRACEPTIVE USE AT FIRST INTERCOURSE Tables 4.1.1 and 4.1.2 show that the majority of both men and women aged 15-24 have had sexual intercourse (78% and 85%, respectively). As expected, the proportion increases with age; 35% of young women and 43% of young men are sexually experienced by age 15, and by age 23-24, nearly all men and women are sexually experienced. Overall, almost 60% of 15-19 year old women report sexual experience. The largest increase in sexual experience is seen between 16 and 17 years of age, from 35% to 61%. Compared with 1987, an increase from 27% to 35% is seen for 15 year olds but, given the sample size, is not a statistically significant increase. The largest percentage increase for young men is between 15 and 16 years of age, from 43% to 62%. Three-quarters of all 15-19 year old men report sexual experience. This compares with 78% in 1987, which is within sampling error. Although the likelihood of having sexual experience does not vary by residence among women, more men residing in urban areas report being sexually experienced than those in rural areas (90% vs. 82%). Patterns of sexual experience by education are different for men and women; among women, sexual experience is most common among those with the lowest educational attainment, while men with higher levels and the lowest level of educational attainment are slightly more likely to report sexual experience. Frequency of church attendance shows an inverse relationship with sexual experience; those who attend most frequently are less likely to report sexual experience. Virtually all women and men report that their first sexual experience occurs outside of a consensual union or legal marriage (Table 4.1.3). The vast majority of women describe their first partner as a boyfriend, with visiting partner increasing as age at first intercourse increases. In contrast, less than half of young men describe their first partner as a girlfriend, and most of the remainder describe her as "a friend" (lower panel of Table 4.1.3). Among men, an older age at first intercourse tends to be associated with a girl friend relationship, while friend shows an inverse relationship. Table 4.1.4 shows that the mean age at first intercourse reported by young women is two years older than that reported by men (15.9 vs. 13.9). Contrasting trends appear with respect to socio-economic status; men ranked highest in socio-economic status report a younger than average age at first intercourse (12.8), while similarly ranked women report an older than average age at first intercourse (17.6). A young woman's first sexual partner tends to be older than her, while a young man's first sexual partner is likely to be the same age or younger than him (Table 4.1.5). The 12 disparity between a young woman's age and that of her partner is greatest among those whose first intercourse took place at the youngest age; 62% of young women who were or younger than 13 at first intercourse had a partner at least six years older than they. At least half of all first sexual experiences occur at either the respondent's or the partner's home (Table 4.1.6). Young women are more likely to report that their first experience took place in the partner's home, while young men are more likely to report that their first experience took place at school or at a party, the beach or the bushes. As age at first intercourse increases for women, it is more likely to take place at their partner's home. Table 4.1.7 shows that less than half of young women report use of contraception at first intercourse (43%) and this proportion is virtually unchanged since 1987 (40%). As might be expected, similar to 1987, those who were older at first intercourse were more likely to use contraception. Women who did not report their age at first intercourse appear to be similar to those women with a very early age at first intercourse. Other characteristics associated with a greater likelihood of contraceptive use at first intercourse include higher educational attainment and higher socio-economic status. Only 22% of young men report use of contraception at first intercourse. However, this is twice the proportion of young men who reported use of contraception at first intercourse in 1987. It is still only half the level reported by women, in part attributable to their younger age at first intercourse. The likelihood of contraceptive use generally increases with age but, as for women, those not reporting an age tend to be similar to those with first intercourse at a very early age. There is no statistical difference for any other variable except relationship status. Both women and men in visiting or boy /girlfriend relationships at first intercourse are more likely to use contraception. Young women whose partners are the same age are the most likely to use contraception, although the age of a young man's first partner does not show a clear relationship with contraceptive use. The vast majority of young men and women who used a method of contraception at first intercourse, independent of age at first intercourse, report that they used a condom (93% and 84%, respectively). Most of the remainder report using withdrawal (Table 4.1.8). Nearly two-thirds of young women who used condoms at first intercourse report that both they and their partner jointly made this decision (Table 4.1.9), while only one-third of young men indicate that this decision was made with their partner (Table 4.1.10). Women of the highest educational levels and higher socio-economic status are more likely to report that the decision was made together than those of lower status. A joint decision was more likely if a male's first partner was a girl friend as compared with a friend. Among young women, the primary source of condoms used at first intercourse is the pharmacy, followed by the market or shops, and government clinics (Table 4.1.11). One- third of women, however, report that they do not know where their partner obtained the condom. Young men identify supermarkets and shops as their primary source of condoms, 13 followed by pharmacies and government clinics, but 40 percent report that they obtained the condom from other sources, mostly friends. Tables 4.1.12 and 4.1.13 show that nearly half of young women and one-third of men who did not use contraception at first intercourse report the reason is that they did not expect to have sexual intercourse. Another 21% of young women and one-third of young men state that they did not have knowledge of contraception at that time. Those who were younger than age 15 at first intercourse are even more likely to report lack of knowledge as their reason. Less than one percent of each gender reported that they desired a pregnancy. 4.2 CURRENT SEXUAL ACTIVITY AND CONTRACEPTIVE USE Forty percent of all young adult women and 50% of all young adult men are currently using a contraceptive method (Table 4.2.1). Current contraceptive use is higher among young adults of both genders who are older. Among young adult men, those who reside in an urban area and/or are better educated are more likely to be using contraception. Not shown in the table is that 18% of young women are using the condom and a further 15% are using the pill. Only 4% of young women are using injectables. Thirty-seven percent of young men are using condoms and another 10% report their partners are using the pill. As seen in Table 4.2.2, young women currently using the pill are equally likely to have obtained them from a government clinic or a pharmacy (47%), while those using condoms are more likely to have obtained them from a pharmacy than a government clinic (43% vs. 29%). The vast majority of those using injectables report obtaining them from a government clinic. The same pattern can be seen among young men, with the exception that the majority of young men report obtaining condoms from a supermarket or shop. Overall, two-thirds of young women who are not currently using contraception report the reason is that they are not sexually active, while another 12% report they are currently pregnant (Table 4.2.3). There are striking differences in these proportions by relationship status, as the percentage reporting a lack of sexual activity rises sharply as the relationship becomes more unstable, while at the same time the percentage reporting they are currently pregnant falls. Lack of sexual activity is given as the reason for non-use of contraception by nine of ten young women who have a boy friend without sexual relations and those who have no steady partner. About six in ten young men (63%) and women (59%) who have ever had sexual intercourse are currently sexually active, as indicated in Table 4.2.4. Not surprisingly, men and women in union are more likely to report being sexually active, while only about half of young women and men who describe their current relationship as being a boyfriend or girlfriend are sexually active. Only one-quarter of young men and less than 10% of young women who say they have no current partner are sexually active. 14 Table 4.2.5 shows that more than seven in ten sexually active young women (72%) and men (73%) are currently using contraception, mostly the condom and the pill. Among women, contraceptive use is similar for all relationships. For men, the proportion using is higher in less stable relationships, largely due to greater condom use by respondents in these relationships. Only one-third of young men with no steady partner reported the use of contraception (all condoms). This finding suggests that education of young men encouraging the use of condoms with those partners who are not well known to them could be encouraged by the authorities. Among sexually active young women who are not using a contraceptive method, 35% report the reason for non-use is that they are currently pregnant and another 14% report they desire pregnancy (Table 4.2.6). Eighteen percent of non-using young women say they "do not like to use" as their reason. There are only minor differences in these proportions by the two relationship status categories. The upper panel of Table 4.2.7 shows that legally married young women are much more likely to report a frequency of sexual relations exceeding 11 in the past month, while over half of those whose partner is a boyfriend report having sexual intercourse fewer than three times in the past month. The lower panel of the same table shows that young men are more likely than women to report having sexual intercourse more than eleven times in the past month (19% vs. 12%). Like the young women, the men in common-law and visiting relationships report a greater frequency than those whose partner is a girlfriend, and almost half of the latter group report having sexual intercourse three or fewer times in the past month. Nearly all young women (98%) and over two-thirds of men report having only one partner in the past month (Table 4.2.8). About six in ten young men and women who have ever had sexual intercourse are currently sexually active, as was indicated in Table 4.2.4 above. Not surprisingly, in general, Table 4.2.9 shows that as the relationship with the last sexual partner is less stable, both men and women are less likely to report being currently sexually active. An exception are those men who report their last partner to be a casual acquaintance. Most young women and men who are married, in a common-law union or who have a boy/girl friend with a sexual relationship, are likely to have had as their last sexual partner the person with whom they are having the relationship (Table 4.2.10). However, among those in a visiting relationship, more than 30% of women and more than half of men had as their last sexual partner a person with whom they were not in the visiting relationship. It is interesting that almost two-thirds of women and one-third of men who are sexually experienced, but report no steady partner, characterize their last sexual partner as a boy/girl friend. As shown in Table 4.2.11, 63% of sexually experienced young women used a contraceptive method at their last sexual intercourse, principally the condom (30%) or the pill (22%). However, the less stable the relationship with their last sexual partner the less likely they are to have used the pill at last intercourse and more likely to have used the condom. Among young men, a similar percentage overall (65%) used a method at last intercourse, 15 and similar differences by method are seen, although, overall, relatively few young men in the less stable relationships used a method at last intercourse. Men were more likely to use contraception if their last partner was a visiting relationship or a girl friend. About six in ten sexually experienced young women report having used a condom at least once, while about 30% used them at their last sexual intercourse. Less than 20% report that their partner uses them every time they have sexual intercourse (upper panel of Table 4.2.12). Young adult women at least 20 years old appear more likely to have ever used condoms, but less likely to have used them at their last or at every act of sexual intercourse. However, the differences are not statistically significant. Young women with a greater number of sexual partners in the past five years are less likely to have used at their last act of sexual intercourse. Sexually active women are more likely to report consistent condom use than those who are not currently sexually active. The lower panel of Table 4.2.12 shows that while a larger percentage of young men than young women have ever used condoms or have used them at their last sexual intercourse, the percentage of young men who report using them at every sexual intercourse, about 20%, is not statistically different than the percentage of young women. The proportion of men who have ever used condoms is greater among those who have had a greater number of sexual partners in the past five years, but young men who report having had more partners in the past five years and the past month are less likely to have used a condom every intercourse than those with only one partner. 17 CHAPTER 5 ATTITUDES TOWARD CONTRACEPTION AND FERTILITY 5.1 ATTITUDES TOWARD CONTRACEPTION Among young men and women who are current or past users of condoms, about 60% indicate that they use them to prevent both STD and pregnancy and another 32% use them to prevent pregnancy only (Tables 5.1.1 and 5.1.2). No important differences are found among young women. Among young men, the proportion who use condoms only to prevent STDs increases as the number of partners they have had in the past month increases. The reason young women who have never used condoms most frequently cite for not using condoms is that their partner "does not like to use them" (Table 5.1.3). Nine percent report that they do not use condoms because they have only one partner. About two in ten report problems with the condom itself as a reason for not using them; 9% say they diminish pleasure or spontaneity, and 8% think they are not effective at preventing pregnancy. Other problems cited less frequently include sexual inactivity, fear of the safety of condoms and disliking condoms altogether. Young men, however, are much less likely to indicate that their reason for not using condoms is due to the partner's disliking them, while almost twice as many men as women (17% vs. 9%) state they diminish pleasure or spontaneity as a reason for non-use of condoms. Thirteen percent of young men also cite having only one partner as a reason for not using condoms. Table 5.1.4 shows that over three-quarters of the young men think that the condom is the most appropriate method for people their age, while young women are equally likely to think that the condom or the pill is most appropriate (37% each). Women aged 20-24 are less likely to think that the condom is most appropriate (32%), and are more likely to think that the pill is most appropriate (44%). Almost 10% of women think that injectables are most appropriate, and women aged 20 and older are more likely to do so. Most young men and women think they could afford the method they think is most appropriate for people their age, although at least 20% of women believe they could not afford injectables (Table 5.1.5). 5.2 ATTITUDES TOWARD GENDER ROLES AND FERTILITY Table 5.2.1 indicates that the ways men use to get women into a sexual relationship most commonly identified by female respondents are offering money or material things (35%), followed by persistence (17%). One-fourth of young men perceive that offering money or material things is most likely to be used by men to get women into a sexual relationship, followed by coaxing (21%) or persistence (19%). Young men aged 20-24 were twice as likely as those aged 15-19 to identify persistence as a method, while those men under age 20 were somewhat more likely to identify giving money or material things as a method. 18 The ways women can put off having sex identified most frequently by young women are saying no (57%) and avoiding the man (18%), as seen in Table 5.2.2. Almost half (43%) of young men also say the woman should say no and 20% say she should avoid him. Seventeen percent of men identify pretending menstruation as a technique used to avoid sex, while only 6% of women identify this as a way to put off having sex. Table 5.2.3 shows that despite the fact that many young adults have used contraception, almost four in ten young men and women believe that God should decide how many children a woman should have. However, fewer women with post secondary education and men with at least 5 years of secondary education share this attitude. A significantly greater percentage of men (32%) than women (15%) agree with the statement that the man should decide how many children his wife/partner should have (p < 0.01). For both genders there is a strong inverse relationship with education. Since less than 2% of sexually experienced youth are virgins when they enter into a union, it is notable that 40% of young women and 34% of young men say that "a woman should be a virgin when she marries". Almost all young adults agree that a "man should have financial responsibility toward their children". However, this does not always happen (See Chapter 6). About the same proportions of women and men say that work (39%, 37%) and care of children (44%, 37%) is women's work. Both attitudes are strongly inversely related to education. As noted above, 40% of young women and 34% of young men agree with the statement that a woman should be a virgin when she marries. Among young adults who have never had sexual relations, a much higher proportion, 63% of women and 53% of men are in agreement with the statement (Table 5.2.4). More than one of every four women and men whose first relationship was with in a union, including visiting partners, thought that a woman should be a virgin when she "marries" (enters into a union). On the other hand, three-fourths did not think it important (Table 5.2.5). About one of every three women and almost one-third of young males still have the opinion that a women should be a virgin, although their first partner was a boy/girl friend, friend or casual acquaintance. 19 CHAPTER 6 FERTILITY AND ITS EFFECTS ON SCHOOL STATUS 6.1 FERTILITY Cohort data from the survey suggest that the age at menarche in Jamaica is falling. This is shown in Table 6.1.1 which compares the cumulative percentage of women who reached menarche at various ages according to their current age. By age twelve, 52% of women currently 15-17 years old reached menarche compared with 39% of women currently 18-19 years old and 30% or less of women aged 20 or older. This decline is supported by examining the average age at menarche, which is 12.5 for those aged 15-17 as compared with 13.3 for those aged 23-24. Table 6.1.2 shows that 45% of young women have been pregnant at least once and 41% have had a live birth, similar to the 1989 figures of 43% and 40%. Characteristics associated with a greater likelihood of having been pregnant or having had a live birth include less education, low or medium socio-economic status and being in a more stable relationship. However, entering into a union, in many cases, may have been precipitated by an unintended pregnancy. The number of pregnancies by to age group is shown in Table 6.1.3. As expected, the number of pregnancies increases with age. Less than 1% of women 15-17 years of age have had more than one pregnancy, while more than 40% of women 23-24 years of age had two or more pregnancies. Table 6.1.4 shows that the age-specific fertility rates for women aged 15-19 and women aged 20-24 have declined in the past ten years. The largest decline, however, took place between 1983 and 1987; since 1987 the decline has been less than 5% The slight increase in proportions of ever pregnant women among those under age 20 is reflected in Table 6.1.5, which shows that the mean number of children born to women aged 15-17 and 18-19 is higher than in 1989. The increase is offset by lower numbers among those aged 20 and over. As in 1989, the average number of children born is higher among those in more stable unions. 6.2 EFFECTS ON SCHOOL STATUS Table 6.2.1 shows that one of three (32%) young adult women who have ever been pregnant became pregnant for the first time while still in school and that almost 60% of these pregnancies occurred before the fourth year of secondary school. Of these women, only 16% returned to school after the birth of their first child, with no statistical difference by the level of education they had attained at the time they first became pregnant 20 (Table 6.2.2). Most of the young women (86%) who became pregnant while in primary school never advanced to secondary school. Only 19% of those in the first three years of secondary school completed four or more years of secondary school. The general relationship of pregnancy and education is seen in Table 6.2.3 which shows that a one half of young women who have never been pregnant have gone past the fourth year of secondary school, while this is true of only 36% of young women who have been pregnant at least once. Almost twice as many young women who have been pregnant never went beyond primary school. One reason for the low proportions of young women who return to school after pregnancy is that very few, only 7%, receive organizational assistance with their schooling once they become pregnant (Table 6.2.4). A somewhat higher proportion of those young women who become pregnant while still in primary school, 15%, receive such assistance. Not shown in a table, because the number of cases is very small, is that organized assistance with schooling may be effective in encouraging young women who become pregnant to return to school, as 38% do so compared with only 14% of young women who receive no assistance. Ninety-five percent of young women report they receive help with the care of their children, with almost no variation by age group (Table 6.2.5). Almost two-thirds of young women report that their husband or partner is the main source of help with child care, financial assistance or gifts. Approximately 20% report that their mother is the main source of help. There is almost no variation by the type of help received (Table 6.2.6). 21 CHAPTER 7 UNINTENDED PREGNANCY AND UNMET NEED 7.1 - PLANNING STATUS OF LAST PREGNANCY An assessment of the success young women have in preventing unintended pregnancies may be made through analysis of the planning status of their last pregnancy. All young adult female respondents were asked two questions concerning the planning status of their last pregnancy. "When you became pregnant, did you want to become pregnant?" If not, "Was it that you wanted no more children, or that you just wanted to wait longer before another pregnancy?" On the basis of responses to these questions, each last birth to a young woman in the last five years was classified as either "planned", "mistimed", "unwanted", "unplanned, unknown status" (not known whether mistimed or unwanted) or unknown. Planned births were defined as those that were wanted; mistimed were classified as those that were wanted, but at some time in the future; and unwanted births were those not wanted, even in a future time. Using this scheme, the mistimed, unwanted and unplanned, unknown status births can be combined as an estimate of unplanned or unintended births. Almost 70 percent of most recent pregnancies in the past 5 years were reported to be mistimed and another 7 percent were unwanted (Table 7.1.1). Only 21 percent, two in 10, were planned. There was almost no difference in planning status between rural and urban areas. However, unwanted pregnancies are positively associated with the number of live births and the number of pregnancies of young women (about 20% of births to young women who had two or more live births were unwanted). Nevertheless, the great majority of pregnancies of young adult women are mistimed, with the percentage decreasing in the older age groups and among those classified in the middle socio-economic status. 7.2 - NEED FOR FAMILY PLANNING SERVICES The survey data indicate that certain segments of the population have greater need of family planning services than others. A young adult woman was characterized as "in need of services" (or "at risk of an unplanned pregnancy") if she was fecund, sexually active, not currently pregnant, stated that she did not desire to become pregnant, and she was not using any method of contraception. Thus, the women defined in this study as "in need of services" are non-contracepting, fecund, sexually active women (regardless of marital status), who were not currently pregnant and did not desire to become pregnant at the time of the interview. Men were similarly defined as being in need of family planning services, using the fecundity and pregnancy status of their female partners. According to this definition, 15 percent of young adult women had an unmet need for family planning services, unchanged since 1989 (Table 7.2.1). The following points can be 22 made: (1) There was little variation in need according to residence and relationship status. (2) Unmet need is highest among women in the youngest age category. (3) Unmet need is lower among better educated young women. To summarize, the need for family planning services among women is approximately 15 percent for all sub-groups of the characteristics studied, except for the youngest women in the 15-17 year old category, of whom 18% are in need. Not shown in the data is that there is a relatively high proportion of these youngest women in the secondary 1-4 educational attainment category, which explains the relatively high level of need of this group. Although the overall proportion of young adults in need did not change between 1989 and 1993, the pattern did change for certain background characteristics. In 1989, the need among young women in union was over 20% and has been reduced to about 14% for those in a marital or consensual union or those in a visiting relationship. However, the need for sexually active young women who report no steady partner increased from 3% to 15%. Also, in 1989, need increased as age increased. But, in 1993, need has doubled and is highest among the youngest women, 15-17 years of age, representing a new challenge to service providers. Almost twice as many young adult men than women, 28 percent, are in need of family planning services (Table 7.2.2). Those men without a steady partner had a very high level of unmet need for family planning services, 53 percent, as do men who are under the age of 18 and men who did not complete secondary school. Not shown in a table, as is the case for women, a high proportion of men in this education category are in the youngest age group. Therefore, their high level of need is more a function of their young age than their level of education and, as stated above, youngest men have the greatest need for family planning services. As with young women, the greater need of men 15-17 years of age represents a challenge to service providers who have to reach these young people. 23 NOTES 1. For a more detailed description of the Socio-Economic Index, see Administrative Report - Volume I, 1993 JAMAICA CPS; Appendix II (1994). [One in a series of five reports on the 1993 Contraceptive Prevalence Survey, published by the National Family Planning Board]. 2. For a more detailed description of the delineation of urban and rural areas, see Administrative Report - Volume I of this series, and, in particular, Table 1.4 (page 4). Also see the geographic boundaries of the health regions on page 1 of Volume I. Cover VOLUME IV: SEXUAL BEHAVIOUR AND CONTRACEPTIVE USE AMONG YOUNG ADULTS PREFACE CONTENTS LIST OF TABLES CHAPTER I: INTRODUCTION AND METHODOLOGY 1.1 OBJECTIVES OF THE SURVEYS AND COVERAGE 1.2 METHODOLOGY CHAPTER 2: BACKGROUND 2.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS 2.2 RELATIONSHIP STATUS AND PARTNERSHIP Tables Tables 2.1.1 Tables 2.1.2 Tables 2.1.3 Tables 2.1.4 Tables 2.1.5 Tables 2.1.6 Tables 2.2.1 CHAPTER 3: SEX EDUCATION AND KNOWLEDGE OF FERTILITY, CONTRACEPTION AND STD / AIDS 3.1 SEX EDUCATION 3.2 EFFECTS OF SEX EDUCATION ON KNOWLEDGE OF FERTILITY, CONTRACEPTION AND STD 3.3 KNOWLEDGE OF AIDS Tables Table 3.1.1 Table 3.1.2 Table 3.1.3 Table 3.2.1 Table 3.2.2 Table 3.2.3 Table 3.2.4 Table 3.2.5 Table 3.2.6 Table 3.3.1 Table 3.3.2 Table 3.3.3 Table 3.3.4 Table 3.3.5 Table 3.3.6 CHAPTER 4: SEXUAL EXPERIENCE AND CONTRACEPTIVE USE 4.1 FIRST SEXUAL EXPERIENCE AND CONTRACEPTIVE USE AT FIRST INTERCOURSE 4.2 CURRENT SEXUAL ACTIVITY AND CONTRACEPTIVE USE Tables Table 4.1.1 Table 4.1.2 Table 4.1.3 Table 4.1.4 Table 4.1.5 Table 4.1.6 Table 4.1.7 Table 4.1.8 Table 4.1.9 Table 4.1.10 Table 4.1.11 Table 4.1.12 Table 4.1.13 Table 4.2.1 Table 4.2.2 Table 4.2.3 Table 4.2.4 Table 4.2.5 Table 4.2.6 Table 4.2.7 Table 4.2.8 Table 4.2.9 Table 4.2.10 Table 4.2.11 Table 4.2.12 CHAPTER 5: ATTITUDES TOWARD CONTRACEPTION AND FERTILITY 5.1 ATTITUDES TOWARD CONTRACEPTION 5.2 ATTITUDES TOWARD GENDER ROLES AND FERTILITY Tables Table 5.1.1 Table 5.1.2 Table 5.1.3 Table 5.1.4 Table 5.1.5 Table 5.2.1 Table 5.2.2 Table 5.2.3 Table 5.2.4 Table 5.2.5 CHAPTER 6: FERTILITY AND ITS EFFECTS ON SCHOOL STATUS 6.1 FERTILITY 6.2 EFFECTS ON SCHOOL STATUS Tables Table 6.1.1 Table 6.1.2 Table 6.1.3 Table 6.1.4 Table 6.1.5 Table 6.2.1 Table 6.2.2 Table 6.2.3 Table 6.2.4 Table 6.2.5 Table 6.2.6 CHAPTER 7: UNINTENDED PREGNANCY AND UNMET NEED 7.1 - PLANNING STATUS OF LAST PREGNANCY 7.2 - NEED FOR FAMILY PLANNING SERVICES Tables Table 7.1.1 Table 7.2.1 Table 7.2.2 NOTES

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