1.2.05 Family Planning for Adolescents




Wednesday, November 13, 2013


Lindsey Gottschalk, Johns Hopkins Bloomberg School of Public Health, Bill and Melinda Gates Institute for Population and Redproductive Health
Nuriye Ortayli, UNFPA, Sexual and Reproductive Health

Title of Abstract / Titre:

Improving adolescents’ access to contraceptive services in low- and middle-income countries: a review of the evidence base

Abstract Type / Type de résumé:

Youth Research Abstract

Topic / Sujet:

Family planning and adolescents

Significance/background / Importance/contexte :

Following a revitalization of the international family planning movement, many policy-makers and programmers are concerned with addressing the contraceptive needs of adolescents. With the highest burden of unmet need concentrated in low- and middle-income countries (LMICs) it is necessary to understand which strategies work to reach adolescents in these regions. Recent literature reviews about adolescent sexual and reproductive health have included few effective adolescent contraceptive services and interventions in LMICs.

Main question/hypothesis / Question principale/hypothèse:

To identify and evaluate the existing evidence base on contraceptive services and interventions for adolescents in LMICs.

Methodology / Méthodologie:

Structured literature review of published and non-published papers about contraceptive services and interventions for adolescents in LMICs that report an impact on contraceptive behavior outcomes.

We searched PubMed using a comprehensive search string to capture the target population, including variations on ‘adolescents,’ ‘young people,’ and ‘youth,’ the target intervention or service, including ‘contraceptives,’ ‘family planning,’ and ‘pregnancy prevention,’ and all possible low- and middle-income country settings, which yielded 6292 papers from 1990 to 2012. Additional databases are currently being searched.

We also considered unpublished papers and reports and performed an extensive hand search of bibliographies, grey literature, and relevant program web pages. A request was sent to UNFPA country officers to share any program reports or publications about increasing young persons’ access to contraceptives. Titles and abstracts for the database and the hand search were screened to remove any papers clearly meeting exclusion criteria. Full papers were screened and potential inclusions retained for data abstraction. All potential inclusions were screened by a second reader to confirm inclusion in the final review. Papers were ranked as high, medium, or low according to characteristics of the study design, using a quality assessment tool adapted from prior systematic reviews about family planning interventions.

Results/key findings / Résultats/conclusions principales:

Fourteen papers met all inclusion criteria. Half took place in sub-Saharan Africa (n=7), four in Latin America, and one each in Central Asia, East Asia, and South Asia. Interventions took place across a wide range of settings, including urban areas (n=5), rural areas (n=4), a suburban area of a major city, and both urban and rural areas (n=4). The majority of studies were of medium quality (n=9), four were low quality, and one was high quality.

We categorized interventions and services into three groups: those that generated demand for contraceptives by adolescents, those that improved the supply of contraceptives within the health system for use by adolescents, and those that attempted to do both. We identified program elements used repeatedly across programs either in isolation or in combination, including youth friendly services, peer education, multimedia, community engagement, school-based educational interventions, non-school-based educational interventions, and engagement of close adults.

Most of the included studies report at least one significant positive contraceptive outcome (n=12), one study found no differences, and another reported that contraceptive outcomes were significantly worse following the intervention. Outcomes included ever use of contraception, ever use of condoms, condom/contraceptive use at first sex, and condom/contraceptive use at last sex.

Knowledge contribution / Contribution aux connaissances sur le sujet:

Though the evidence base is weak, there are promising foundations for adolescent contraceptive interventions in nearly every region of the world, which may include a context-specific combination of the approaches described above. We offer recommendations for programmers and identify gaps in the evidence base to guide future research.

Successful programs noted that they should involve adolescents in the planning process, gain community buy-in, and use a combination of elements that fit with the needs of that particular community. The most effective programs were those that were sustained over longer periods of time. Shorter programs may be able to change behaviors in the short-term, but long-term results may be limited. It is also important to look at the context when generalizing results; for example, peer-to-peer programs may be more effective for school-based programs.

Contraceptive interventions and services tend to be geared at older, school-going adolescents. Overall, few programs serve adolescents under 18 years old. While older adolescents and youth are still priority age groups with a high unmet need for family planning, they may have fewer legal barriers and face less stigma in accessing contraceptives than their younger adolescent counterparts. Future research is needed to identify approaches that are effective in reaching younger groups of adolescents.


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