The DYnamics of Contraception in Eswatini (DYCE) study is a high-frequency longitudinal survey that contacts young women (ages 18-24) in Eswatini on their phones – every two weeks – to understand the changes related to a young woman’s sexual and reproductive health.
Funded by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development Institute, the DYCE protocol was reviewed and approved by the Eswatini National Health Research Review Board in 2024 and Columbia University Medical Center Institutional Review Board in 2023. DYCE is implemented by ICAP at Columbia University in collaboration with Eswatini Ministry of Health.
The Eswatini Population-based HIV Impact Assessment survey (SHIMS3) provided the sample for DYCE. The DYCE sample frame includes all women ages 18-24 that completed the SHIMS3 interview, consented to follow-up for potential future research, and provided a phone number. Between March 16, 2024 – April 8, 2024, 326 participants consented and completed the baseline survey, and 321 consented to bi-weekly participation. Beginning April 10, 2024, these 321 participants were called bi-weekly to answer questions about socio-demographics, pregnancy and contraception, relationships, sexual activity and HIV.
Summary Sheet 1: Reproductive Health Knowledge Among a Sample of Young Women in Eswatini
Among this sample of young women in Eswatini, knowledge about PrEP’s purpose was high, as was knowledge about which contraceptive methods one can and cannot use together. Young women were less knowledgeable about correct condom use and the fertility cycle. Read the full summary sheet below for more findings and details.
Summary Sheet 2: Use of Youth Friendly Services Among a Sample of Young Women in Eswatini
More participants had visits for contraceptive use (39%) than STI services (17%) in the past 12 months. Most participants did not encounter any issues when seeking services. Among the approximately one-third that did have an issue, waiting rooms being too public and lack of confidentiality or privacy were most often cited. Most participants who accessed contraceptive or STI services chose the health facility because it was close to their home or work – i.e. easy to get to. Young women value easy access to facilities more so than facility reputation or discretion, underscoring the need for all facilities have youth-friendly, confidential services. Read the full summary sheet below for more findings and details.
Summary Sheet 3: Reproductive Autonomy Among a Sample of Young Women in Eswatini
Overall, DYCE participants reported agency in their relationships and contraceptive use. One in five DYCE participants said someone else would have input about the outcome of an undesired pregnancy, mainly their partner or their parents. Almost all women in a relationship reported agency over sexual activity and decisions about child bearing. Among women not using contraception, a few (16%) said they would be using contraception if their partner had no influence. Very few women using contraception (9%) said they were covertly using contraception. The vast majority of women using contraception with partners had partners supportive of their contraceptive use (72%).
Summary Sheet 4: Contraceptive Preference Among A Sample of Young Women in Eswatini
Ever-contraceptive use was common among DYCE participants (90% ever used a method in their lifetime) but drops to 48% lifetime use when condoms and emergency contraception (EC) are excluded. The majority of current contraception users are using their preferred method. Injectables and implants were the most preferred methods between nonusers, method stoppers, and current users. Most women who used EC (68%) used it more than once since DYCE has started. Given the high percent of EC users who used EC more than once, engaging those who distribute EC in family planning counseling could help young women better achieve their family planning needs.
Summary Sheet 5: Condom Access Among A Sample of Young Women in Eswatini
Most condom users sourced condoms recently and usually from their partners. Less than 5% of condom users reported bad experiences seeking condoms or cost being prohibitive. Participants’ comfort sourcing condoms differed by location — only 39% of all participants were very comfortable accessing at nearest health facility whereas 76% of condom users who sought condoms themselves were very comfortable sourcing condoms at their usual location.
Summary Sheet 6: Perception of HIV Risk Among a Sample of Young Women in Eswatini
Among sexually active young women, 72% reported sex without condoms or PrEP, but only 6% reported a moderate or high chance of acquiring HIV. When assessing their own, their best female friend, and their partners (when applicable) HIV risk over the next two weeks, six month and 12 months, risk increased over time and overall was highest for their partner followed by their best friend. Proportions for best female friend and partner’s HIV risk were almost always double that of respondents’ self-perceived HIV risk.
