Use of Reproductive Health Services by Adolescents in Kinshasa, Democratic Republic of the Congo: Opportunities for Social and Behavior Change Communication

Ensuring the health, education, and productivity of these youth is critical to the country's long-term development goals and poverty reduction. However, the country has the second-highest adolescent fertility rate in the world, putting young Congolese women at high risk of pregnancy-related complications and death. Education levels are low, with only 18.7% of girls aged 20-24 having completed secondary school or higher. Many girls are likely to drop out of school when they become pregnant. The DRC has one of the highest rates of adolescent fertility in the world, with 27% of girls aged 15-19 having already begun childbearing. Adolescent fertility rates vary widely by province, from a low of 13% in Kinshasa to a high of 40% in the Oriental province. There is a high prevalence of violence against women in the DRC, with over a quarter of sexually active women aged 15-49 and 16.4% of women aged 15-19 having been victims of sexual violence at some point in their lives. Over 38% of women aged 15-19 have been victims of physical violence since the age of 15, with the violence inflicted most often by a spouse/partner or family member. The use of modern contraceptives among adolescents is low, with only 11% of 15-19 year old women using any contraceptive method and only 5% using a modern method. Many Congolese adolescents also lack basic knowledge about HIV/AIDS, with only 43.2% of women and 57.6% of men knowing that the virus can be prevented by using condoms and also knowing that it can be prevented by having sex with only one uninfected partner. Rates of HIV testing among 15-19 year old adolescents are extremely low, with just 7.6% of women and 2.3% of men reporting ever having been tested and receiving the results. Access to reproductive health services in the DRC is limited, with only half of the country's 516 health zones offering family planning services. The National Program for Adolescent Health (PNSA) has implemented an integrated package of adolescent reproductive health activities within the national health system and at youth centers in four provinces, including Kinshasa. However, these services are very limited in scope and only available in 12 health zones. The study aimed to identify knowledge, attitudes, and current practices of adolescents in Kinshasa related to sexual and reproductive health, the use of health services, and the use of modern contraception. The study explored issues such as perceptions of sexual health, reasons for early marriage, use of ARH services, adolescents' perception of quality of ARH services, obstacles and opportunities influencing the use of ARH services, and use of modern contraceptive methods. The study was conducted in two health zones of Kinshasa (N'Sele and Binza) in October 2013. The study methods included eight focus group discussions (FGDs) with 15-19 year old adolescents and 20 individual in-depth interviews (IDIs) with key informants. The study received approval from the Ethical Committee of the University of Kinshasa's School of Public Health and the FHI 360 Protection of Human Subjects Committee, and the PNSA reviewed and validated the study protocol and instruments. The study found that adolescents in Kinshasa have limited knowledge and access to reproductive health services, and that there are significant barriers to the use of modern contraceptive methods. The study highlights the need for increased access to reproductive health services, particularly for adolescents, and for social and behavior change communication efforts to promote the use of modern contraceptive methods and improve knowledge and attitudes towards reproductive health.