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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.”
Last night the Interagency Youth Working Group (IYWG) hosted its annual
meeting as an auxiliary event at the International Family Planning Conference. Hosting the meeting at the conference was an amazing opportunity. Attendees included youth, government officials, donors, and a wide range of professionals. It was truly inspiring to be surrounded by so many people who share a common goal of improving the sexual and reproductive health (SRH) outcomes of young people.
At the meeting, participants shared their incredible insights and experiences. There were some outstanding discussions about approaches to meeting youth SRH needs among a range of populations and through a diversity of interventions. The topics discussed included the SRH needs of married adolescents, addressing cross generational relationships, the SRH needs of young people living with HIV, and many more.
Commitment to improving young people’s sexual and reproductive health has been a common thread throughout the entire conference. One goal of this year’s IYWG meeting was to explore how we, as a community of youth sexual and reproductive health champions, can ensure that the conference’s focus on youth is maintained after the meeting closes. By joining together to share lessons learned from the conference, participants were able to discuss how to translate these lessons into action in the field.
“I will share the information I learned tonight with our networks to help lives” –Participant Senegal
The IYWG will develop a set of strategy recommendations based on the discussions that were held at this meeting. These recommendations will be available on our website. We will also be hosting a follow-up e-forum to continue the meeting dialogue. The e-forum will be held from January 25 to January 27 2011; if you were not able to attend this meeting, we invite you to participate in the e-forum. Check our website for more details.
It is day one of the International Family Planning Conference (ICFP) and young people will play a pivotal role in this year’s conference. There are more than 150 young people attending, and there are a number of presentations, sessions, and other events dedicated to the sexual and reproductive health of this population.
“This is an opportunity not just to talk about issues of youth and family planning but for young people to be present as well.” Dr. Robert Blum
The international attention being paid to the unique needs of young people could not be more timely. In developing countries, as many as one-third of adolescent girls give birth before their 20thbirthday. Furthermore, lack of access to family planning services leads to approximately 7.4 million unintended adolescent pregnancies every year. This conference provides an excellent opportunity for young people and professionals in the field of youth sexual and reproductive health to gather together for one collective purpose—ensuring that the needs of youth are met today so that they can achieve the promise they hold for the future.
The Interagency Youth Working Group (IYWG) is thrilled to be a part of this monumental event. FHI 360, on behalf of the IYWG, is hosting several exciting sessions and events, including our annual meeting, that focus on youth sexual and reproductive health. To learn more about the IYWG-sponsored events at the ICFP, please visit our website and check our blog for daily updates.
In November “more than a 1,000 family planning experts will gather in Senegal to examine cutting edge research and family planning programs” at the second International Conference on Family Planning (ICFP). This year’s conference has dedicated one of its tracks to the family planning needs of youth. The international attention to the unique needs of this population could not be more timely. In developing countries, as many as one-third of adolescent girls give birth before their 20th birthday. Furthermore, lack of access to family planning services leads to approximately 7.4 million unintended adolescent pregnancies every year.
To help ensure that the attention on the family planning needs of young people is translated into action in the field, the IYWG is hosting our annual meeting as a conference auxiliary event. This year’s meeting, “What’s Next? Maintaining the Focus on Youth After Dakar” will focus on applying conference lessons to the field of youth sexual and reproductive health. If you are attending the ICFP in Dakar, please join us as leading experts on youth sexual and reproductive health, programmers, researchers and young people share their insights and experience in an informal setting. To learn more about our annual meeting and about the other exciting events the IYWG is sponsoring at the ICFP, please visit our website. We look forward to seeing you in Dakar.
Leonard Bufumbo is a research associate with FHI in Uganda. He worked on an operations research project focusing on voluntary counseling and testing with youth. The project was funded by USAID in 2000–2002 and implemented by Sociology Department of Makerere University, Kampala, Uganda.
As part of a youth assessment in Uganda, I led a team of data collectors in an effort to understand the sexual and reproductive health needs of youth. Our study consisted of focus group discussions with young people, interviews with government stakeholders, and assessments of health facilities that young people reported as being “youth-friendly.” Observations from this assessment confirmed that youth in Uganda face a number of challenges. Rates of teen pregnancy are high, use of family planning is low, and adolescents face many difficulties in accessing care.
After this trip, this is what I think. Youth have not yet been understood. The health workers think they understand them, but they don’t. That’s the biggest challenge! When young people present a complaint to a provider, the complaint often does not reflect what they truly need. When youth seek services, they often seek help with psychosocial issues that have more to do with relationships, both sexual and non-sexual, than they do with clinical issues. Sometimes, youth will even go to the clinic, not report anything at all, and just hang idly around. The youth do this because they believe it will provide them an entry point to services. These same youth will continue to try and access services, and sometimes they have to bring up the same problem at every visit to a clinic. Can you imagine? While this trend demonstrates positive health-seeking behavior among youth, it clearly shows that youth are not receiving the treatment that they really need. Furthermore, the service statistics reflect the issues youth initially report, NOT the real issues faced by youth.
In addition to the communication barriers, it seems clinic staff may simply not have enough time to deal with youth issues. Staff workload and staff shortages seem to take a toll on providers. Remember, these clinics are not only serving youth; there are many other members of the population that cannot be ignored.
Currently, there is an ‘impunity gap’ between national youth policies, guidelines, and strategies and the actual care provided at public health facilities. It is truly alarming! Something needs to be done structurally, behaviorally, and professionally to lessen this gap.
One way to immediately address this issue may be through peer networks. Peer educators can have great influences on peer members. Peer networks should focus on using positive deviance to sustainably change behavior; I believe this can be done without compromising the structure of the peer network.
While most of us enjoy working with youth because they are fun, we cannot forget that they are also vulnerable. There is still much that needs to be done to ensure that the reproductive health needs of young people are met.
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.
A study published nearly 10 years ago in Family Planning Perspectives noted an interesting trend: the modern contraceptive methods most relied upon among sexually active American teens ages 18-19 were the least effective methods for this age group. Almost nine percent of teens using highly popular oral contraceptive pills got pregnant within the first year. Male condoms yielded a 17.7 percent pregnancy rate in the same time period. Failure rates are particularly high among teens because they are less likely than adults to use these methods consistently and correctly. To make matters worse, half of condom users and one-third of pill users discontinue use within a year. Meanwhile, teen users of long-acting reversible contraceptives (LARCs)—the injectable contraceptive Depo-Provera, the intrauterine device (IUD), and the contraceptive implant—only experienced a 4.3 percent pregnancy rate within the first year. In general, among people who correctly and consistently use these LARCs, the pregnancy rate is less than one percent. However, far fewer teens rely on these methods than on pills and condoms. As a result, the U.S., with one of the worst family planning records in the developed world, experiences 800,000 annual teen pregnancies, 80 percent of which are unintended.
These trends ring true in many parts of the world, and not much has changed in the 10 years since the study described above was published. Globally, young people use less effective contraception and use contraception less consistently than adults, although unintended pregnancy often poses far more negative consequences for adolescents than adults. Adolescent girls ages 15-19 are twice as likely to die during pregnancy as women in their 20s, and the risks are much higher for girls younger than 15. In fact, pregnancy and childbirth-related complications are the leading cause of death of girls ages 15-19 worldwide, killing 70,000 girls annually and leaving millions more with lifelong disabilities or chronic ailments. Yet each year, 16 million girls ages 15-19 give birth, and up to 4 million more adolescent pregnancies end in unsafe abortion.
LARCs have been proven to be highly effective, acceptable, convenient, and cost-effective, and the World Health Organization has deemed them appropriate for youth. So why aren’t more young people using LARCs? Among the barriers are:
- Misinformation and lack of information among providers. Many providers avoid presenting IUDs as an option for young clients due to unsubstantiated concerns about risks related to STIs, infertility, postpartum use, side effects, and patient acceptability. Concerns about the negative effect of Depo-Provera on bone mineral density in adolescents are also common, although the Society of Adolescent Medicine issued a position paper in 2006 stating that the pregnancy posed greater health risks to adolescents than Depo-Provera and recommending that physicians continue to prescribe it with proper counseling to adolescents who wish to prevent pregnancy.
- Inadequate training. Though many providers are trained to insert and remove IUDs and implants, some report a low level of comfort or experience with these tasks.
- Low demand due to misinformation and lack of information among patients. Recent studies have shown that many women have little or no knowledge about LARCs and that unfounded concerns about their safety, effect on fertility, and side effects are widespread.
- High up-front cost. While these methods are cost-effective in the long-term, their up-front cost is often significantly higher than that of condoms or pills.
To increase access to LARCs for young people who wish to prevent pregnancy, the public health community must conduct research to understand provider biases and youth barriers, including policies dictating access to contraception for youth. We must use these findings to develop and implement strategies to better serve the contraceptive needs of youth. We must continue to publish and promote clear, medically accurate information and training materials to bridge knowledge gaps and dispel misinformation among both providers and patients. To embrace LARCs, young people need to understand what they are and how they work. They must be able to access them and afford them. Expanding access to long-acting reversible methods for young people will drastically reduce the rate of unintended pregnancies, unsafe abortions, and maternal and infant morbidity and mortality across the world. The benefits of offering these options to young people far outweigh the risks.