April 8, 2021
Ethiopia and Kenya Country Manager, International Youth Alliance for Family Planning
Executive Director, SERAC-Bangladesh
Over the past several years, achieving universal health coverage (UHC) has increasingly become a priority for the global community. Many world leaders have committed to achieving a future in which “all individuals and communities have access to quality health services where and when they need them, without suffering financial hardship.”1In the family planning space, thought leaders have established that family planning is an essential component of UHC. Yet adolescents and youth are often missing from these conversations—both in terms of considering their unique family planning needs and integrating their ideas, perspectives, skills, and strengths in UHC implementation efforts. To fully uphold the human right to equitable, quality health services—including family planning—youth must be intentionally included in the UHC agenda.
Why Are Adolescents and Youth Important to the UHC Discussion?
In 2021, adolescents and youth between ages 10 and 24 are estimated to make up approximately 24% of the world’s population, yet heath interventions often disregard the biological, social, and emotional needs that are unique to these life stages.2 The lack of investment in health policies and interventions tailored to youth’s needs has significant consequences. According to the World Health Organization (WHO), the improved health outcomes seen among younger children in recent decades were not matched in adolescents in part because of inadequate resources.3
Due to their age, young people often face unique barriers that prevent them from accessing high quality health services, especially family planning. Many adolescents and youth feel that public health care services are not intended for them due to a perceived or real lack of respect, privacy, and confidentiality; fear of stigma; discrimination; and imposition of health care providers’ moral values.4 These concerns are particularly pronounced when it comes to family planning services for youth; service providers often restrict young people’s access to contraceptives, deciding which methods to offer based on non-medical reasons such as their personal observations of a client’s age, marital status, and existing family size.5
Out-of-pocket costs associated with health services, such as family planning counseling and commodities, can also prevent adolescents and youth from accessing the services they need.6 These costs may include service fees, pharmaceuticals, and transportation. The cost burden is exacerbated for youth, who are three times more likely than adults ages 25 and older to be unemployed.7 The majority of those young people who are employed worldwide are engaged in informal employment that provides limited access to high quality and timely health care and leaves them financially unprotected against unpredictable illnesses.8
Many of these barriers are perpetuated by policy environments that are unsupportive of youth’s right to access and use family planning services. PRB regularly conducts thorough analysis of youth family planning policies and programming and has found that several policy barriers stand in the way of achieving UHC for youth.9 Only four of the 22 countries analyzed in 2020 had a law or policy that supports youth access to family planning services without consent from a parent or spouse, and fewer than half had a law or policy describing the obligation of providers to offer contraceptive services to youth without discrimination or bias. Four countries analyzed had a law or policy that explicitly restricts youth from accessing a full range of family planning methods based on age, marital status, or existing family size.
What Actions Are Needed to Ensure Youth’s Family Planning Needs Are Included in the UHC Agenda?
Achievement of UHC looks different for each country due to each one’s unique health system and financial resources but no matter what approach is taken, it is critical that adolescents and young people are at the center of these conversations and decisions. Adolescents and youth have a right to actively and meaningfully engage in all matters that affect their lives, and progress cannot be made toward achieving UHC without engaging in intentional, mutually respectful partnerships with young people to devise context-specific solutions. Around the world, youth have been proactively involved in conversations about the need to include family planning in UHC. Recent progress in Bangladesh and Kenya demonstrates how governments can work with youth to ensure they have access to the services they need and that those services are of high quality.
In 2016, SERAC-Bangladesh hosted the first-ever Bangladesh Youth Summit on Universal Health Coverage, a national event that engaged young people to showcase programs promoting the health and well-being of youth and hold policymakers accountable for ensuring equitable access to health services. Following the summit, the Bangladesh Youth Health Action Network (BYHAN) was founded, led by SERAC-Bangladesh, to educate young people on health rights and UHC issues. In the past four years, BYHAN has engaged more than 300 youth leaders from across the country to advance the rights of young people to access health care and family planning. In 2020, BYHAN co-hosted the 5th National Youth Conference on Family Planning, leading to a promise by the Joint Secretary of the Medical Education and Family Welfare Division of the Ministry of Health to extend service hours of adolescent-friendly health centers in the country to better accommodate adolescents’ school and work hours.
In Kenya, the national branch of the Organisation of African Youth (OAYouth) interviewed youth across 15 counties about the need to prioritize adolescent and youth sexual and reproductive health (AYSRH) as part of Kenya’s primary health care package within UHC. OAYouth consolidated the young people’s views into a communique that called on decisionmakers to meaningfully engage youth in UHC processes as they are being rolled out. The communique was presented at the 6th Annual Devolution Conference, which led the Council of Governors and the conference organizers to acknowledge and include prioritization of adolescent and youth health and well-being in their final commitments.9 It was also presented at the 3rd National UHC Conference, creating space for important dialogue between youth and decisionmakers on UHC and AYSRH in pilot counties in Kenya.
The progress in Bangladesh and Kenya is encouraging, but more work is needed! To ensure that the family planning needs of youth are included in the UHC agenda, decisionmakers at all levels in all countries must:
- Engage youth as equal partners in UHC dialogues, decisionmaking, and intervention design.
- Prioritize family planning services as part of the primary health care package.
- Invest in and support adolescent- and youth-friendly health services that young people trust and feel are intended for them. Actions include:
- Training and supporting providers to offer nonjudgmental services to adolescents and youth.
- Enforcing confidentiality and ensuring audio and visual privacy in service delivery.
- Offering a full range of contraceptive methods to adolescents and youth, including long-acting reversible methods.
- Providing free or subsidized services to adolescents and youth.
- Develop and implement policies and programming that respect, protect, and fulfill adolescents’ and youth’s rights to family planning information, products, and services regardless of age, sex, marital status, or parity.
- Address community and gender norms that prevent adolescents and youth from accessing the family planning services they need.
- Tailor UHC service delivery channels and financing mechanisms to the unique needs of informal sector workers.
- World Health Organization (WHO), Universal Health Coverage (UHC), 2019, https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc).
- United Nations, Department of Economic and Social Affairs, World Population Prospects: The 2019 Revision, https://population.un.org/wpp/DataQuery/. Note: WHO defines adolescents as ages 10-19 and youth as ages 15-24.
- WHO, Achieving Universal Health Coverage for the World’s 1.2 Billion Adolescents, https://www.who.int/maternal_child_adolescent/adolescence/universal-health-coverage/en/.
- WHO, Achieving Universal Health Coverage for the World’s 1.2 Billion Adolescents.
- Venkatraman Chandra-Mouli et al., “Contraception for Adolescents in Low and Middle Income Countries: Needs, Barriers, and Access,” Reproductive Health 11.1 (2014): 1.
- High-Impact Practices in Family Planning, Adolescent-Friendly Contraceptive Services: Mainstreaming Adolescent-Friendly Elements Into Existing Contraceptive Services (Washington, DC: USAID, 2015), https://www.fphighimpactpractices.org/briefs/adolescent-friendly-contraceptive-services/.
- International Labour Office (ILO), Global Employment Trends for Youth 2020: Technology and the Future of Jobs (Geneva, Switzerland: ILO, 2020), http://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/—publ/documents/publication/wcms_737648.pdf.
- Ricardo Bitran, Universal Health Coverage and the Challenge of Informal Employment: Lessons From Developing Countries, (Washington, DC: The World Bank, 2014), http://documents1.worldbank.org/curated/en/698041468180275003/pdf/870770REVISED00mal0Employment0FINAL.pdf; ILO, Global Employment Trends for Youth 2020.
- Christine Power, Youth Family Planning Policy Scorecard: Measuring Commitment to Effective Policy and Program Interventions (Washington, DC: Population Reference Bureau, 2020).
- 6th Annual Devolution Conference Report 2019, https://maarifa.cog.go.ke/assets/file/7f3e9f09-sixth-annual-devolution-conference-r.pdf.