A never-before opportunity to strengthen investment and action on adolescent contraception, and what we must do to make full use of it

Abstract

BackgroundIncreasingly, the health and rights of adolescents are being recognized and prioritized on the global agenda. This presents us with a “never-before” opportunity to address adolescent contraception. This is timely, as there are enormous numbers of adolescents who are currently unable to obtain and use contraceptives. From research evidence and programmatic experience, it is clear that we need to do things differently to meet their needs/fulfil their rights.Main bodyIn this commentary, we call for action in several key areas to address adolescents’ persistent inability to obtain and use contraceptives. We must move away from one-size-fits-all approaches, from a ‘condoms-only’ mind set, from separate services for adolescents, from ignoring the appeal of pharmacies and shops, and from one-off-training to make health workers adolescent friendly. Our efforts to expand access to quality contraceptive services to adolescents must be combined with efforts to build their desire and ability to use them, and to do so consistently. In order for these changes to be made, action must be taken on several levels. This includes the formulation of sound national policies and strategies, robust programme implementation with monitoring, regular programmatic reviews, and implementation research. Further, high-quality collection, analysis, and dissemination of data must underlie all of our efforts. As we move ahead, we must also recognize and draw lessons from positive examples of large scale and sustained programmes in countries that have led the way in increasing contraceptive use by adolescents.ConclusionThis unprecedented moment in history gives us a real opportunity to bring about transformational change, particularly when there is so much at stake.

Increasing Contraceptive Use Among Young Married Couples in Bihar, India: Evidence From a Decade of Implementation of the PRACHAR Project

“…Doing so would address critical unmet need for family planning and contribute to achievement of national and global goals and priorities, such as Family Planning 2020 (FP2020) and the Sustainable Development Goals 10 , 11 . Some efforts have been made to increase contraceptive use among married adolescents and youth and to prevent rapid repeat pregnancies, and recent papers have synthesized the primary strategies used in these programs 7 , 8 , 12 .…”

Gender norms associated with adolescent sexual behaviours in Uganda

“…Yet messages around gender norms that influence behaviour are transmitted early in life, and by adolescence are internalised in a young person's world-view (Vu et al 2017). Therefore, adolescents' gender perspectives and inequitable gender norms found to affect sexual and reproductive health service uptake need to be addressed in the design of adolescent health programmes (Chandra-Mouli et al 2017). This is because gender inequitable norms often lead to gender power imbalance and affects adolescents' ability to negotiate safe sex (UNESCO 2017), thereby putting them at risk of HIV and unplanned pregnancies (UBOS 2018).…”

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development

“…However, progress has been uneven across issues and geography. It has raced ahead sometimes and has stalled or even moved backwarddmanydother times [217,234]. In response to the paper's second question (i.e., what contribution did the ICPD make to this), in some cases, there is a direct documented link between the participation of national decision-makers in the ICPD and their establishment of national bodies and ambitious national initiatives to address ASRHR; Mozambique's Geracao Biz 25 is a case in point [235].…”

“…Adolescents and young people too have become increasingly better organized and more effective in championing their cause (e.g., the International Youth Alliance for Family Planning and the International Federation of Medical Students' Associations). The concerted advocacy of all these groups on the demographic, public health, economic, and human rights rationale for investment in adolescent health has contributed enormously to placing ASRHR on global and regional agendas [217]. So have high profile international consultative processes such as the UN Commission on Population and Development, deliberations and resolutions passed by the UN General Assembly, the UN Human Rights Council, and the WHO, as well as regularly convened international conferences on HIV, family planning, and girls' rights.…”