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Table 1 Barriers and potential approaches to increasing demand for and supply of contraception among adolescents

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

Objective Barriers Successful programme approaches Examples
Demand for contraception
 Desire to avoid, delay, space or limit child bearing Gendered roles (expectations to be a mother, wife), need to prove fertility, religious values, path to adulthood Enhance the acceptability of avoiding, delaying, spacing, and limiting childbearing Conditional cash transfers have transformed life trajectories of girls in Mexico and Malawi [59, 60]
 Desire to use contraception Stigma, taboos (communication and cultural), lack of understanding (fear of side effects) Improve the understanding of contraceptive methods and sexual and reproductive health (SRH) Life skills education and vocational training programmes in Uganda and India have been shown to increase contraceptive use [61, 62]
Working with influential family members in India helped build support and overcome resistance [63]
 Agency to use contraception Early marriage, family pressure, sexual coercion/violence, limited decision-making autonomy and power Increase agency for girls and women to exert agency and make their own decisions Engaging adolescents directly and their communities in Bangladesh and India has been shown to improve girls’ agency and to prevent early marriage [64, 65]
Supply of contraception
 Access to contraceptive services Lack of awareness of services, inaccessible location, inconvenient operating hours, costs, wait times Expand access to contraceptive services through various channels Community-based outreach involving provision of information and services through the national Health Extension Programme (HEP) led to remarkable improvements in uptake of modern contraception among adolescents in Ethiopia [54]
 Provision of adolescent-friendly services Lack of provider sensitivity, provider reluctance to offer contraceptives to adolescents/bias, gender biases, lack of privacy/confidentiality, contraceptives unavailable or out of stock Increase provision of high-quality, youth-friendly services for adolescents, tailored to meet adolescents’ needs Making services responsive to the needs of adolescents has been shown to improve contraceptive use thereby preventing first pregnancies in China and repeat pregnancies in Kenya. [24, 66] Evidence from studies and projects has been applied at scale in Colombia, and Estonia [57, 67]
  1. Source: Adapted from ICRW [18]