Every year, lack of access to family planning services contributes to approximately 7.4 million unintended pregnancies among adolescents. The unmet need for contraception among adolescents is as as high as 68% in some regions, such as sub-Saharan Africa, South-central Asia, and Southeast Asia. Although young people might not be accessing family planning services, youth are increasingly using HIV testing services.
Young people who use voluntary counseling and testing (VCT) services likely engage in sexual behaviors that that put them at risk for both HIV and unintended pregnancy. Globally, there has been a push to integrate contraceptive services at HIV testing sites; however, little is known about the effectiveness of providing contraceptive services at VCT centers.
In 2009, researchers from FHI 360 set out to determine the factors associated with contraceptive uptake among young people visiting VCT centers. The study was conducted in Kenya at both youth VCT clinics and general VCT clinics. At each facility, researchers conducted baseline and follow-up client interviews, provider interviews, and clinic observations to determine which client-, provider-, or facility-based characteristics were associated with same-day uptake of contraception, intention to use contraception, and use of contraceptives three months after a VCT visit.
Before visiting the VCT center, 72% of youth participants reported sexual activity in the past three months, and 37% of all participants were currently using contraceptives. Only 18% were using a modern contraceptive method other than the male condom and only 18% always used a condom. One-third of the clients reported they did not want to get pregnant, were not using a method and did not intend to use a method. Seventy-eight percent of providers reported ever counseling VCT clients on contraceptive use in the past week, and only 17% reported always asking female clients about whether they wanted to get pregnant.
After visiting the VCT center, many clients reported they were never screened for family planning need, were not given contraceptives by the VCT provider and/or did not intend to follow up on a provider referral for contraceptive services. Youth who had a current partner, higher levels of education, more children, and a desire to delay pregnancy were significantly more likely to begin using a contraceptive method at the time of their visit. Young people who intended to use family planning before visiting the clinic, and who were provided with contraceptives at the time of visit, were more likely to use contraceptives at the three month follow-up.
Youth who visited VCT centers that had higher scores of HIV /family planning integration were more likely to begin a contraceptive method at the time of their visit. Clients of providers who were younger or who had received training in family planning were more likely to use contraceptives at the three month follow-up. Youth clinics (compared to general clinics) received better scores on integration and youth friendliness but clients were less likely to use contraceptives after visiting; however, youth clinics might be serving a higher-risk group of youth.
The research results demonstrate that young people visiting VCT centers have a high risk for unintended pregnancy. However, very few clients who attended the clinics were counseled on contraceptive methods other than condoms, received contraception at the time of visit, or were referred to other family planning services. Further research is needed to better understand the specific factors that influence contraceptive uptake among young people so that programs integrating VCT and family planning can best meet the needs of their clients. Because young people might be more likely to visit VCT centers than family planning clinics, programs must ensure there are no missed opportunities in meeting the contraceptive needs of young people attending VCT centers.
To learn more about this issue, read the full study “Service delivery characteristics associated with contraceptive us among youth clients in integrated voluntary counseling and HIV testing clinics in Kenya.”