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The pill accounts for the vast majority (86%) of this use. Overall, use of modern methods changed little in the decade covered by the three surveys, staying at 35–38% among these women.[12,18,19] However, the lack of overall change at the national level masks an increase in use between 20 in rural areas (from 30% to 37%), and a sharp decrease in urban areas (from 50% to 29%). Moreover, modern method use in urban areas declined not just among adolescents but among all women of reproductive age (15–49), from 68% to 60%.[12,18] (There was no change over the period in use among married women of all ages in rural areas.) The worst of the economic crisis in 2008—with its attendant deterioration of reproductive health services, migration from rural to urban areas and flight of medical professionals—likely contributed to a decline in the availability and accessibility of services for adolescents and all women in urban areas. Furthermore, the fact that urban authorities impose fees for contraceptive services may have also affected use more in urban areas than in rural ones.
The picture changes when we look at contraceptive use among adolescents who have the most to lose should they experience an unwanted pregnancy—those who are not married and are sexually active (i.e., have had sex in the previous three months).
Supporting adolescents’ needs will also bring the country closer to achieving two reproductive health–related Millennium Development Goals.
• As of 2011, 38% of young Zimbabwean women have had sex by age 18, as have 23% of young men; this difference has widened over time.
Females now first have sex nearly two years sooner than males.
• One-quarter of 15–19-year-old women have started childbearing; one-third of all births to adolescents are unplanned (wanted later or not at all).
• Patterns in unmet need for contraception followed suit: In urban areas, the proportion of married adolescents who wanted to postpone childbearing but were not using a method rose between 20 (from 14% to 28%); among their counterparts in rural areas, unmet need fell from 20% to 15% over this period.
• Single, sexually active adolescents have by far the greatest unmet need—62% as of 2011, compared with 19% among their married counterparts.
Despite increasing urbanization, Zimbabwe remains a primarily rural nation—67% of its population lives in rural areas. Much of the country remains entrenched in poverty: Gross annual income is US0 per person, even following improvement since the worst of the hyperinflation and economic crisis that occurred in 2008.
For decades, Zimbabwe has been one of the countries most severely affected by the pandemic, and until very recently HIV was involved in 30–40% of maternal deaths.[1,2] The country has thus made insufficient headway in lowering maternal mortality —even with improvements in pregnancy and delivery care—and despite considerable progress, Zimbabwe will be unable to halt the spread of HIV by 2015. This report presents a snapshot of adolescents’ ability to adequately protect their sexual and reproductive health.