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