Addressing Adolescents’ Barriers to Family Planning

Programmatic efforts that address the barriers adolescents face when using and accessing family planning services have been successful in changing their knowledge and attitudes, according to new findings from the International Center for Research on Women.

The study, “Adolescents and Family Planning: What the Evidence Shows,” looks at 24 systematic reviews and more than a hundred individual studies that evaluated programs providing sexual and reproductive health information and services.

ICRW conducted a review of literature to identify socio-cultural and structural obstacles that adolescents must overcome in order to have the desire and ability to access family planning services. The study aimed to determine which programmatic efforts were most effective and where gaps in evidence require further research. Funded by the Bill and Melinda Gates Foundation, the report looks at how a variety of initiatives have addressed the “supply” of resources and services and adolescents’ “demand” to use them, emphasizing the factors that prohibit adolescent girls and boys from understanding their own reproductive desires and from seeking or utilizing reproductive health services to achieve those desires.

Young people aged 10 to 24 years comprise roughly one-quarter of the world’s population. These nearly two billion adolescents, many of whom are sexually active, often lack the knowledge, agency or resources to make decisions to avoid, delay or limit pregnancy. With adequate sexual and reproductive health information and services, both married and unmarried adolescents can be empowered to make decisions about their reproductive desires that allow for fewer unwanted and unhealthy pregnancies throughout their lives. But information and services alone are not sufficient; they must first overcome a range of barriers.

“For years, donors and program implementers have been asking ‘What works?’ in regard to expanding access to reproductive health services by adolescents,” said Dr. Suzanne Petroni, co-author of the study and Senior Director for Gender, Population and Development at ICRW. “Through reviewing the evidence base and analyzing common threads, this study begins to expand our understanding of the barriers that adolescents face in accessing such services, and importantly, how to help them overcome those barriers. At the same time, this research demonstrated just how important it is for the research community to share findings about adolescents and their sexual and reproductive health needs.”

This study was guided by a conceptual framework that defines the necessary conditions for adolescents to achieve sustained, effective use of family planning over the course of their reproductive lives as: an adolescent’s desire to avoid, delay, space or limit childbearing; his or her desire and agency to use family planning; as well as the need to both ensure appropriate access by adolescents to family planning information and services and to guarantee high quality, youth-friendly services. ICRW found the “demand-side” barriers that limit adolescents’ desire to avoid, delay or space childbearing generally involved stringent understandings of gender roles. For an adolescent girl, this might include a cultural expectation that her primary role in society is that of a mother, for example. For an adolescent boy, socially constructed gender roles may dictate his desire to prove his masculinity through producing offspring. The study found adolescents’ reticence to use family planning methods was also underscored by taboos that make it difficult to discuss or seek information about sexual and reproductive health. In terms of having the agency to use family planning, both sexes were found to be restricted by their limited self-efficacy to access services and achieve their reproductive desires. Girls, however, were far more burdened by their subservient roles in society and relationships.

Information and education, in varying forms, were found to be important ways to challenge some of these barriers. One of the most effective ways to increase adolescents’ desire to plan and control their reproduction was through indirect measures, such as youth development programs and conditional cash transfers that encourage school enrollment. This type of programming can build adolescents’ self-confidence and provide them with a greater sense of opportunities. Additionally, various educational programs and media campaigns were effective in positively changing adolescents’ desire and agency to seek and use family planning, including through de-stigmatizing the topic.

Although it is important youth have an understanding of their ability to control their family planning, if facilities and service providers aren’t able to meet their unique concerns and needs, they will still face further barriers. Using community-based distribution and improving the “youth-friendliness” of facilities are a few of the interventions that have demonstrated success in ensuring adolescents have access to these services.

“We know that youth-friendly services are crucial, but more research is needed to resolve the nuanced contradictions we found in our study,” lead author Allison Glinski said.  “It is that much clearer that enabling youth to make decisions about their reproductive health, free of social pressures, can ensure a legacy of health and empowerment for individuals, families and communities.”

To read the full review of literature, click here.

To read the 8-page synthesis of this report, click here.