Elizabeth Futrell is an associate technical officer at FHI, where she works on activities related to community-based family planning and youth sexual and reproductive health.
In late 2010, MTV aired No Easy Decision, a reality show that followed American teen mother Markai Durham and her partner James as they experienced a second unintended pregnancy before their firstborn child was a year old. A spinoff of the popular reality show 16 and Pregnant, No Easy Decision highlights the widespread problem of repeat adolescent pregnancy. In parts of the United States, one in four adolescent mothers experiences a repeat pregnancy within two years. In other regions of the world where early marriage is common and access to family planning services is scarce, the number is likely higher.
After the birth of her first child, Markai began using the injectable contraceptive Depo-Provera. Then Markai missed an appointment for Depo reinjection, but she didn’t worry. “I didn’t know that if you miss your Depo appointment that the Depo is completely out of your system. I thought I still had birth control inside of me.”
Markai is not alone. Among adolescents who have access to contraception, poor compliance, inconsistent use, and discontinuation are common and often result in unintended pregnancy. Longer-acting family planning methods—including contraceptive implants—provide more effective coverage than shorter-acting methods such as Depo-Provera and oral contraceptives (OCs). Researchers estimate that if 20 percent of the 17.6 million women using OCs and Depo in sub-Saharan Africa who wanted long-term protection switched to implants, more than 1.8 million unintended pregnancies could be averted over a five-year period.
According to the World Health Organization, implants are safe and appropriate for adolescents. Implants are discreet, easy to use, and effective for 3-5 years without any need for resupply or regular action by the user. In addition, implants remove the challenge of user compliance and therefore have a very low failure rate. Emerging research from Kenya shows that young women who plan to use OCs or injectables will often choose implants if they are appropriately counseled on this option. Preliminary results show that after six months, only 11 percent of young implant users switched methods or discontinued use compared to 42 percent of OC and Depo users. In this period, the young women using implants experienced no unintended pregnancies, while the young women using OCs or Depo had four unintended pregnancies and one intended pregnancy. Additional studies in the United States have reflected similar patterns. According to one study that tracked 309 adolescent mothers for two years, those using a method other than the implant or no method at all were 35 times more likely to experience a repeat pregnancy within a year than those using an implant.
Yet globally, relatively few adolescents are counseled on implants as a contraceptive option. In some cases, this is due to provider bias or unsubstantiated concerns about risks related to infertility, side effects, and patient acceptability. Furthermore, while many providers are trained to insert and remove implants, some report a low level of comfort or experience with this task. Anecdotal evidence also suggests that some providers in resource-poor settings save their limited supply of implants for older clients, whom providers assume are more sure they want to space or limit their pregnancies.
As No Easy Decision illustrates, adolescents face many social, cultural, financial, and geographical barriers to consistent use of family planning. These barriers include pressure from partners or family members to become pregnant or refrain from using a method; incomplete or incorrect knowledge of contraceptive options and how they work; and lack of access to youth-friendly services. Offering implants to more young clients—particularly adolescents who have already experienced a pregnancy and want to delay or limit future pregnancies—has the potential to greatly reduce rates of unintended pregnancy; unsafe abortion; and the related physical, social, financial, and emotional risks.
For more information, see the Extending Service Delivery project’s fact sheet, Implants for adolescents: An option worth considering for healthy timing and spacing of pregnancy and the FHI technical brief, Preliminary Report: Contraceptive Implants in Sub-Saharan Africa—Reaching Young Women.