Improving access to and use of contraception by adolescents: What progress has been made, what lessons have been learnt, and what are the implications for action?

Abstract

This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.

Return to pregnancy after contraceptive discontinuation to become pregnant: a pooled analysis of West and East African populations

“…Unmet need for family planning remains high in Africa at 23.5% of married women [ 2 ]. Individuals and couples in the region face a number of barriers to the adoption and continued use of contraception, including lack of access to high quality contraceptive information, services, and methods; a social context that highly values childbearing; and significant fear of side effects and health effects of using a method [ 2 – 6 ]. Among youth in sub-Saharan Africa, barriers to contraceptive use also include a lack of knowledge about contraceptive methods and services; the costs of obtaining family planning services; laws and policies that restrict access to young people; provider restrictions for provision of contraception to young people; fears, embarrassment and shyness around the topic of family planning; and social pressures to bear a child soon after marriage [ 7 – 11 ].…”

“…One of the key fears youth have about contraceptive use is the fear of infertility and concerns about a delayed return to fertility, especially following hormonal contraceptive use [ 6 , 12 – 17 ]. Qualitative research from across sub-Saharan Africa finds that the fear of infertility is a frequently mentioned reason for non-use of contraception: this was found among urban youth in Mali and urban and peri-urban youth in Kenya [ 13 , 15 ].…”

Perceptions of Peer Contraceptive Use and its Influence on Contraceptive Method Use and Choice among Young Women and Men in Kenya: A Quantitative Cross-Sectional Study

“…Targeted messaging about STI and HIV appears to have reached young people, as concerns about STI and HIV transmission were high among the sample of Nairobi youth with 55.8% of unmarried, sexually active young men and 28.8% of unmarried, sexually active young women who said they always use a condom [15]. In addition, young people may face fewer barriers to accessing condoms over other modern methods due to providers restricting access to hormonal methods and a wider range of sources for condoms, including pharmacies and shops, which are frequently more accessible, more convenient, and provide privacy and con dentiality [12,50,51,52]. These factors contribute to condoms frequently being an entry point to contraceptive use for young people and may further contribute to normalizing condom use amongst this population [53].…”

Identification of young people at risk of sexual ill health : implementing a new tool in youth clinics

“…Unintended pregnancies among adolescents are a global problem, but they are more likely to occur in marginalized families and communities [14]. Unintended pregnancy does not necessarily equate to unwanted pregnancy, but without proper planning, it may lead to a range of health risks and complications for the expected child and parents.…”