PRB

Voluntary family planning methods are more widely available than ever before in many low- and middle-income countries, supporting women’s plans for whether and when to have children. But among women who say they don’t wish to become pregnant, 218 million of them—including 14 million adolescents—are not using modern contraception methods. Many of them may not be able to access contraceptives; 38% of women had previously used a modern family planning method but stopped. Younger women in particular are more likely to discontinue using contraception.

We wanted to know why.

PRB’s mission is to provide data that can be used by policymakers and others to improve lives around the world. By seeking to understand the issues and challenges that inhibit young people who wish to delay or avoid pregnancy from using contraceptives, we hope to gain useful insights for those seeking to support youth to achieve their reproductive intentions.

In many countries, women and girls ages 15 to 24 have higher rates of contraceptive discontinuation than their older counterparts. While side effects and poor quality of care contribute to low rates of continued contraceptive use across age groups, younger women may be particularly sensitive to side effects and could face higher barriers to accessing quality family planning care, including provider bias.

To explore youth satisfaction with family planning care at public and private health facilities, we analyzed data from Afghanistan, Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. Women and girls in six of the seven countries cited long waiting times for family planning services at health facilities as the top issue they encountered during a family planning visit (see figure).

Figure. Long Waiting Time Is the Most Common Issue Reported During a Family Planning Visit to a Health Facility Among Women Under Age 25

Percent Reporting Issues with Family Planning Visit to Health Facility, Women <25

Source: PRB analysis of DHS Service Provision Assessment data in 7 countries, from PRB, “Best Practices for Sustaining Youth Contraceptive Use,” 2021.

Every year at least four out of 10 pregnancies around the world are unplanned. The number of unplanned pregnancies means that policies that address obstacles to youth’s continued use of contraceptives could have a significant impact on unmet need. Such policies could include support for high-quality counseling, active follow-up processes, and access to the full complement of contraceptive methods—all of which are best practices for sustaining contraceptive use among youth who wish to prevent, space, or delay pregnancies.

Based on our analysis, countries should consider the following policy recommendations for increasing contraceptive continuation among youth:

• Elevate attention and resources to supporting existing family planning users while also promoting initiation among new users.
• Support youth access to the full range of family planning methods regardless of age, marital status, and parity, and without requiring the consent of a third party.
• Provide client-centered care in recognition of youth’s diverse reproductive health needs.
• Train and support providers to offer high-quality, supportive contraceptive counseling to youth.
• Strengthen youth’s ability to access contraceptives in the private and informal sectors.
• Include a range of active follow-up processes between appointments.
• Ensure that health care delivery points maintain the full complement of methods and advance distribution of self-administered methods.

A version of this blog was originally published on Knowledge SUCCESS, a global project led by a consortium of partners and funded by USAID’s Office of Population and Reproductive Health to support learning, and create opportunities for collaboration and knowledge exchange within the family planning and reproductive health community. To learn more about this topic, read the full policy brief (available in English and French) and watch a panel discussion between policymakers and youth advocates in West Africa (in French).