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Adolescents and Family Planning: What the Evidence Shows

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Adolescents and Family Planning: What the Evidence Shows Adolescents and Family Planning: What the Evidence Shows International Center for Research on Women ICRW where insight and action connect 1 This review was made possible by the Definitions generous support of the Bill and Melinda • For the purposes of this • Supply is defined as the pro- Gates Foundation and was conducted study, adolescents are vision of reproductive health by Allison Glinski, Magnolia Sexton and defined as those ages 10-24 services, particularly family Suzanne Petroni, with technical and years old. planning, that are appropri- editorial guidance and input from Ellen • Demand is conceptualized ate for adolescents’ needs Weiss, Anjala Kanesathasan, Jeffrey with a nuanced understand- and are available in a way Edmeades, Jennifer McCleary-Sills, Ann ing of how gender dynam- that is accessible to them. Warner, Kirsten Stoebenau and Gwennan ics influence adolescents’ • Accessibility in this context Hollingworth, all of the International reproductive desires. These includes issues such as the Center for Research on Women (ICRW). include the number, timing availability of an appropri- and spacing of children, as ate mix of contraceptive well as whether they want to methods, infrastructure, Photos by Jennifer Abrahamson, David Snyder, Robyne Hayes use various options to control health systems and provider © 2014 International Center for Research on Women (ICRW). their fertility and have the knowledge, attitudes and Portions of this report may be reproduced without express agency to do so effectively. competence.1 permission from but with acknowledgment to ICRW. Adolescents and Family Planning: What the Evidence Shows Introduction The International Center for Research on Women (ICRW) conducted a review of the literature to identify barriers to adolescents’ access to and use of family planning services, programmatic approaches for increasing access and uptake of those services, gaps in the evidence that require further research, and areas that are ripe for future investment. The Importance of Family Planning for Adolescents Roughly one-quarter of the world’s adolescents, the need is significantly population — 1.8 billion people — is greater among 15-19 year olds, as between 10 and 24 years of age.2 compared to those ages 20-24.4 Indeed, marital status is a factor Among the many sexually active that cannot be overlooked in a adolescents worldwide, large world where one-third of girls in numbers want to avoid, delay developing countries are wed before or limit pregnancy but lack the age 18, and one in nine is married by knowledge, agency or resources the age of 15.5 While both married to make decisions regarding their and unmarried girls are sexually reproduction. On average, unmet active, some 90 percent of the need for contraception is greater births experienced by adolescent among unmarried adolescents than mothers occur within marriage.6 those who are married, however married adolescents ages 15-19 Socio-cultural and structural barriers experience a higher percentage often prevent adolescents from of unmet need than all married achieving their reproductive desires, women.3 Among unmarried which can result in unintended Methods ICRW’s literature review in- adolescent family planning in- their perspectives on what is and instead fall within a more cluded 24 systematic reviews formation and/or services. The needed to advance adolescent comprehensive framework of published since 2000 that analysis was supplemented sexual reproductive health and sexual and reproductive health evaluated programs providing with reviews of more than 200 rights and family planning. and rights. Finally, limited family planning information additional peer-reviewed arti- Limitations of this re- evidence is available about and services. All of these cles and grey literature reports search: Adolescents may not which strategies and programs studies used experimental or that identified best practices, demonstrate measurable most effectively reach distinct quasi-experimental methods. recent findings and innovative behavioral results until well groups of adolescents, such While not every study focused solutions for different types after the end of the program as married and unmarried, specifically on adolescents of programmatic approaches. or evaluation, so successful rural and urban, and younger and family planning (i.e., some Finally, to corroborate and ex- interventions may be missed and older youth. Evidence included family planning for pand upon the gaps in the ev- in the literature. Also, few regarding effective strategies adults or primarily addressed idence that were identified in adolescent-focused initiatives for reaching very young ad- HIV prevention), all included the literature, we interviewed are specifically defined as olescents (10-14 years old) is 3 some level of attention to several donors to understand “family planning” programs particularly thin. Adolescents and Family Planning: What the Evidence Shows and unhealthy pregnancies, Conceptual Framework among other outcomes. To help adolescents better access and The following conceptual framework traditional demand-side and supply- use family planning services, we was developed to guide ICRW’s side components to contraceptive must understand the barriers analysis, and is based on past use. For example, even if adolescents they encounter in defining their examinations of reproductive want to use family planning methods reproductive intentions, and health barriers and programmatic and there are high-quality, youth- in demanding, accessing and approaches, as well as ICRW’s friendly methods available, if they do using contraceptives. And we Women’s Demand for Reproductive not have the confidence to walk into a must understand what works in Control paper.7 It postulates that clinic and ask for contraception, they empowering them to overcome adolescents must achieve three will not be able to use it. these obstacles. demand-side objectives and two supply-side objectives, though not Objectives 4 and 5 represent the Effectively addressing these issues necessarily in sequencea, in order “supply-side” components. Achieving results in stronger families and to sustainably and effectively use Objective 4 means that adolescents societies: When girls grow up family planning to fulfill their desired have access to family planning healthy, educated and empowered, reproductive outcomes throughout methods at a location, time and they become productive and their lifetimes. price that is feasible and convenient. effective leaders, earners, providers Objective 5 is attained when services and, if they so choose, mothers. This The first three objectives operate are not only available for adolescents, in turn has a ripple effect on children, primarily on the demand side. but they are high quality, youth- households, communities and Achieving Objective 1 signifies that friendly and offer a variety of methods nations. And when girls and boys are adolescents want to avoid, delay, that are appropriate for them. By provided with education, information limit or space their pregnancies. achieving all of these objectives, and services to protect and promote They understand the benefits of adolescents are able to effectively use their sexual and reproductive health, waiting to initiate sexual activity family planning methods in line with they are better equipped to engage or of having [more] children and their fertility intentions throughout in healthy decisions and behaviors want to control their reproduction. their lives. This is an important now and for decades to come. With Objective 2, adolescents distinction, as reproductive desires Such positive outcomes therefore have a desire to use family planning and appropriate methods will change make it critical for us to understand methods, which demands a basic over one’s reproductive lifetime. adolescents’ reproductive desires understanding of contraceptive and enable them to achieve these methods and how reproduction Accomplishing these objectives aspirations by providing them with occurs. However, wanting to use is dependent on the individual appropriate, high-quality information family planning methods is not adolescent. This is also strongly and services. sufficient to enable adolescents to influenced by — but not limited to — actually use them. Adolescents need the social norms of the environment to be able to achieve Objective 3 — in which adolescents live, as well as possess the agency to access and the local political atmosphere, health use contraceptives — which means sector and the legal frameworks. they must be empowered with the The young person’s partner, parents, knowledge and self-efficacy to make family, peers and community also and act on their decisions.8 While we play a role in how he/she forms and have categorized Objective 3 as a achieves his or her reproductive “demand-side” factor, it can also be desires. viewed as the bridge between the 4 The Conceptual Framework T Goal: Sustained, effective use of family planning EN M Adolescents are effectively able to use family N O planning methods to reach their reproductive desires IR V over their life course. N E L A Objective 5: Provision of quality, C I youth-friendly services T I Not only do adolescents have access to services, L t n but the services are of high quality and are O S e SUPPLY P M m appropriate for their reproductive needs. n R O o r N i Objective 4: Access to family planning services v L n Adolescents have access to services at a time, A I E location, and price point that are C g t convenient for them. O n n S K i l e R b O m a Objective 3: Agency to use family planning n n W Not only do adolescents wish to use family planning o E E r i methods to avoid, delay, space, or limit births, but M v A they have the ability to act on their desires and n R E R DEMAND make decisions regarding their reproduction. F g O L n T A i l C G Objective 2: Desire to use family planning b E E a S L Not only do adolescents wish to avoid, delay, space, n H or limit births, but they want to use family planning E T L methods to do so.
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