The Youth Family Planning Policy Scorecard dashboard allows users to access, interpret, and compare countries' youth family planning policies and programming. Users can assess the extent to which a country's current policy environment enables and supports youth access to and use of family planning.

This assessment uses eight indicators—listed in the dashboard below—that have been shown to be directly linked to increased youth contraceptive use. Countries are classified into one of four color-coded categories to show how well they are performing for each indicator. We invite you to explore the dashboard by clicking on an indicator or country of your choice. The dashboard will also provide you with detailed information about each country's youth family planning policies.

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What is Parental and Spousal Consent?

This indicator assesses the extent to which a country’s policy environment supports youth access to FP services without parental or spousal consent.

What is Provider Authorization?

This indicator assesses the extent to which a country’s policy environment requires providers to deliver FP services to youth without discrimination or bias.

What are Age Restrictions?

This indicator assesses the extent to which a country’s policy environment supports youth access to FP services regardless of age.

What are Marital Status Restrictions?

This indicator assesses the extent to which a country’s policy environment supports youth access to FP services regardless of marital status.

What is Access to a Full Range of FP Methods?

This indicator assesses the extent to which a country’s policy environment supports youth access to a full range of contraceptive methods, including the provision of long-acting reversible contraception.

What is Comprehensive Sexuality Education?

This indicator assesses the extent to which a country’s policy environment supports comprehensive sexuality education (CSE) for all youth, in accordance with the United Nations Population Fund guidelines on essential components of CSE.

What is Youth-Friendly FP Service Provision?

This indicator assesses the extent to which a country’s policy environment supports youth-friendly FP service delivery, in accordance with three service delivery core elements identified in the Adolescent-Friendly Contraceptive Services High-Impact Practices in Family Planning guide: provider training, confidentiality and privacy, and free or subsidized services.

What is Enabling Social Environment?

This indicator assesses the extent to which a country addresses the two enabling environment elements of youth-friendly contraceptive service provision as outlined in the Adolescent-Friendly Contraceptive Services High-Impact Practices in Family Planning guide: build community support and address gender norms.

Many countries have taken a protectionist approach to legislating youth’s access to family planning (FP) services, based on a belief that young people need to be protected from harm and that parents or spouses should be able to overrule their reproductive health decisions. In practice, these laws serve as barriers that inhibit youth’s access to a full range of sexual and reproductive health (SRH) services, including FP. For example, an International Planned Parenthood Federation study in El Salvador reports that laws requiring parental consent for minors to access medical treatment create a direct barrier for youth to access FP. The study recommends: “Primary legislation should clearly establish young people’s right to access SRH services, independent of parental or other consent; to avoid ambiguity and the risk that informal restrictions will be applied at the discretion of service providers.”

Global health and human rights bodies stress the importance of recognizing young people’s right to freely and responsibly make decisions about their own reproductive health and desires. The 2012 International Conference on Population and Development's Global Youth Forum recommended that “governments must ensure that international and national laws, regulations, and policies remove obstacles and barriers—including requirements for parental and spousal notification and consent; and age of consent for sexual and reproductive services—that infringe on the sexual and reproductive health and rights of adolescents and youth.”

Laws around consent to FP services are often unclear or contradictory. The Scorecard intends to recognize countries that explicitly affirm youth’s freedom to access FP services without parental or spousal consent. Countries that have created such a policy environment have been placed in the green category, signifying the most favorable policy environment, because their definitive legal stance provides the necessary grounding from which to counteract social norms or religious customs that may restrict young people’s ability to access FP services. If a policy document mentions that youth are not subject to consent from one of the third parties—spouse or parent—but does not mention the other, the country is classified in the yellow category. Any country that requires consent from a parent and/or spouse is placed in the red category. If a country does not have a policy in place that addresses youth access to FP services without consent, it is placed in a gray category.

Providers often refuse to provide contraception to youth, particularly long-acting reversible methods, because of non-medical reasons. Service providers may impose personal beliefs or inaccurate medical criteria when assessing youth family planning (FP) needs, creating a barrier to youth contraceptive uptake. Three-quarters of Ugandan providers queried on their perspective of providing contraception to youth believed that youth should not be given contraception, and one-fifth of providers said they would prefer to advise abstinence instead of providing injectables to young women. To address this barrier, national laws and policies should reflect open access to medically-advised FP services for youth, without their being subject to providers’ personal beliefs.

Policies that explicitly underscore the obligation of providers to service youth without discrimination or bias are considered fully supportive of youth access to contraception and receive a green categorization under this indicator. Any country that generally supports the World Health Organization medical eligibility criteria for contraceptive use but does not explicitly require providers to service youth despite personal beliefs is placed in the yellow category. Any country that supports providers’ non-medical discretion when authorizing FP services for youth is placed in the red category, indicating a legal barrier for youth to use contraception. Countries that lack any policy addressing non-medical provider authorization are placed in the gray category.

Youth seeking contraceptives continue to face barriers to accessing services because of their age. A study in Kenya and Zambia found that less than two-thirds of nurse-midwives agreed that girls in school should have access to family planning (FP).

In 2010, a World Health Organization expert panel concluded that “the existence of laws and policies that improve adolescents’ access to contraceptive information and services, irrespective of marital status and age, can contribute to preventing unwanted pregnancies among this group.” The 2012 International Conference on Population and Development's Global Youth Forum recommended that “governments must ensure that international and national laws, regulations, and policies remove obstacles and barriers—including… age of consent for sexual and reproductive services—that infringe on the sexual and reproductive health and rights of adolescents and youth.”

Countries that explicitly include a provision in their laws or policies that support youth access to FP regardless of age are considered to have a supportive policy environment and are placed in the green category. Countries that restrict youth access to FP, by defining an age of consent for sexual and reproductive health services, are considered to have a restrictive policy environment and are placed in the red category. Countries that do not have a policy that supports youth access to FP regardless of age are placed in the gray category.

A 2014 systematic review identified laws and policies restricting unmarried youth from accessing contraception as an impediment to youth uptake of contraception. In the absence of a legal stance on marital status, health workers can justify refusal to provide contraception to unmarried youth. Thus, strong policies providing equal access to family planning (FP) services for married and unmarried youth are necessary to promote uptake of contraceptive services among all youth.

Countries are determined to have the most supportive policy environment for this indicator if they explicitly include a provision in their laws or policies for youth to access FP services regardless of marital status. If a country recognizes an individual’s legal right to access FP services regardless of marital status but includes policy language that places particular emphasis on married couples’ right to FP, it is considered to have a promising yet inadequate policy environment, and is classified in the yellow category because the policy leaves room for interpretation. A country is placed in the red category if its policies restrict youth from accessing FP services based on marital status. Finally, if a country has no policy supporting access to FP services regardless of marital status, it is placed in the gray category.

Youth seeking contraception, particularly long-acting and reversible contraceptives (LARCs), are frequently faced with scrutiny or denial from their provider based on their age, marital status, or parity. The World Health Organization (WHO) medical eligibility criteria for contraceptive use, however, explicitly state that age and parity are not contraindications for short-acting or long-acting reversible contraception.

Provision of LARCs as part of an expanded method mix is particularly effective in increasing youth uptake of contraception. One of the studies identified in a 2016 systematic review offered implants as an alternative contraceptive option to young women seeking short-acting contraceptives at a clinic in Kenya. Twenty-four percent of the women opted to use an implant, and their rate of discontinuation was significantly lower than those using short-acting methods. Of the 22 unintended pregnancies that occurred, all were among women using short-acting methods. However, many youth around the world do not know about LARCs, and if they do, they may be confused about their use and potential side effects, hesitant to use them due to social norms, or face refusal from providers.

The “Global Consensus Statement: Expanding Contraceptive Choice for Adolescents and Youth to Include Long-Acting Reversible Contraception” calls upon all youth sexual and reproductive health and rights programs to ensure that youth have access to a full range of contraceptive methods by:

  • Providing access to the widest available contraceptive options, including LARCs (specifically, contraceptive implants and intrauterine contraceptive devices) to all sexually active adolescents and youth from menarche to age 24, regardless of marital status and parity.
  • Ensuring that LARCs are offered and available among the essential contraceptive options, during contraceptive education, counseling, and services.
  • Providing evidence-based information to policymakers, ministry representatives, program managers, service providers, communities, family members, and adolescents and youth on the safety, effectiveness, reversibility, cost effectiveness, acceptability, continuation rates, and the health and nonhealth benefits of contraceptive options, including LARCs, for sexually active adolescents and youth who want to avoid, delay, or space pregnancy.

This indicator differs from the Restrictions Based on Age indicator by focusing on the range of methods offered to youth. Countries should have in place a policy statement that requires health providers to offer short-acting and long-acting reversible contraceptive services regardless of age. In addition, the policy should leave no ambiguity in the scope of the directive but rather explicitly mention youth’s legal right to access a full range of contraceptive services, including LARCs. Therefore, countries with an explicit policy allowing youth to access a full range of contraceptive services—regardless of age—receive a green categorization for promoting the most supportive policy environment. Countries with policies that state that youth can access a full range of methods, but do not specify that LARCs are included in the method choice, are placed in the yellow category. These countries are on the right track but would have a stronger enabling environment if their policies explicitly mentioned youth’s right to access LARCs.

A country is placed in the red category if it has a policy in place that restricts access to family planning services, including specific methods, based on age, marital status, or parity, or other characteristics that do not align with WHO medical eligibility criteria. Countries that do not have a policy addressing youth access to a full range of contraceptive methods are placed in the gray category.

It is important to note that the Scorecard does not assess policies’ inclusion of emergency contraception (EC) in the full range of methods for youth when determining categorization of countries for this indicator. This indicator is focused on whether short-term methods and LARCs are included in the method options that are made available to youth. Therefore, countries that do not list EC in the available methods for youth can still receive a green categorization if they’ve included access to LARCs. However, due to the growing attention toward EC as an available method for youth, the summary of this indicator in each country section makes note of whether EC was included in the range of methods for youth.

The World Health Organization recommends educating adolescents about sexuality and contraception to increase contraceptive use and ultimately prevent early pregnancy and poor reproductive health outcomes. Comprehensive sexuality education (CSE) is a specific form of sexuality education that equips young people with age-appropriate, scientifically accurate, and culturally-relevant SRH knowledge, attitudes, and skills regarding their SRH rights, services, and healthy behaviors.

A growing body of evidence demonstrates that informing and educating youth about sexuality and sexual and reproductive health (SRH) have a positive impact on their reproductive health outcomes. Sexuality education offered in schools helps youth make positive, informed decisions about their sexual behavior and can reduce sexually transmitted infections (STIs) and unintended pregnancies, in part due to increased self-efficacy and use of condoms and other contraception. A study in Brazil that implemented a school-based sexual education program in four municipalities measured a 68 percent increase in participating students’ use of modern contraception during their last sexual intercourse. To be most effective, sexuality education should be offered as part of a package with SRH services, such as direct provision of contraception or links to youth-friendly family planning (FP) services.

Many approaches exist to implement sexuality education in and out of schools. The Scorecard considers CSE as the gold standard and relies on the “UNFPA Operational Guidance for Comprehensive Sexuality Education,” which focuses on human rights and gender as a framework to effectively implement a CSE curriculum. The United Nations Population Fund (UNFPA) Operational Guidance outlines nine essential components of CSE that are concise and easy to measure across countries’ policy documents. Further, these guidelines recognize gender and human rights and build on global standards discussed in the United Nations Educational, Scientific and Cultural Organization’s “International Technical Guidance on Sexuality Education.”

The nine UNFPA essential components for CSE are:

  1. A basis in the core universal values of human rights.
  2. An integrated focus on gender.
  3. Thorough and scientifically accurate information.
  4. A safe and healthy learning environment.
  5. Linking to SRH services and other initiatives that address gender, equality, empowerment, and access to education, social, and economic assets for young people.
  6. Participatory teaching methods for personalization of information and strengthened skills in communication, decisionmaking, and critical thinking.
  7. Strengthening youth advocacy and civic engagement.
  8. Cultural relevance in tackling human rights violations and gender inequality.
  9. Reaching across formal and informal sectors and across age groups.

A country is determined to have the most supportive policy environment and is classified in the green category if its policies not only recognize the importance of sexuality education broadly but also include each of the nine elements of CSE.

A country is considered to have a promising policy environment if it clearly mandates sexuality education in a national policy but either does not outline exactly how sexuality education should be implemented or has guidelines that are not fully aligned with the UNFPA CSE essential components. Under these criteria, it is classified in the yellow category.

While evidence proves that sexuality education equips youth with the necessary skills, knowledge, and values to make positive SRH decisions, including increased contraceptive use, little evidence exists that abstinence-only education is similarly effective. The 2016 Lancet Commission on Adolescent Health and Wellbeing recommends against abstinence-only education as a preventive health action and found it was ineffective in preventing negative SRH outcomes. In fact, some reports suggest that an abstinence-only approach increases the risk for negative SRH outcomes among youth. Therefore, a country that supports abstinence-only education is seen as limiting youth’s access to and use of contraception and, as a result, is grouped in the red category. Any country lacking a sexuality education policy is placed in the gray category.

The World Health Organization “Guidelines on Preventing Unintended Pregnancies and Poor Reproductive Outcomes Among Adolescents in Developing Countries” recommend that policymakers make contraceptive services adolescent-friendly to increase contraceptive use among this population. This recommendation aligns with numerous findings in the literature. A 2016 systematic assessment to identify evidence-based interventions to prevent unintended and repeat pregnancies among young people in low- or middle-income countries found that three out of seven interventions that increased contraceptive use involved a component of contraceptive provision.

Additional evaluations show that when sexual and reproductive health (SRH) services are tailored to meet the specific needs of youth, they are more likely to use these services and access contraception. The Scorecard draws upon the four service-delivery core elements identified in the United States Agency for International Development’s High-Impact Practices in Family Planning (HIPs) brief, “Adolescent-Friendly Contraceptive Services,” as the framework for assessing the policy environment surrounding family planning (FP) service provision. One of the four elements is addressed in a separate indicator, Access to a Full Range of FP Methods, which evaluates the extent to which a country’s policy environment supports youth access to a wide range of contraception. The remaining three service-delivery elements are addressed in this indicator, Youth-Friendly FP Service Provision. These three elements are:

  1. Train and support providers to offer adolescent-friendly contraceptive services.
  2. Enforce confidentiality and audio/visual privacy.
  3. Provide no-cost or subsidized services.

Many countries have adolescent-friendly health initiatives that include a wide range of health services, but for a country to be placed in the green category, its policies should specifically reference providing FP services to youth as part of the package of services. A country is placed in the green category for this indicator if its policy documents reference the three adolescent-friendly contraceptive service-delivery elements as defined above. Simply referencing the provision of FP services to youth, but not adopting the three service-delivery elements of adolescent-friendly contraceptive services, indicates a promising but insufficient policy environment, and the country is placed in the yellow category.

Countries that do not have a policy that promotes FP service provision to youth are placed in the gray category.

The HIPs brief recommends three additional enabling-environment elements of adolescent-friendly FP service provision. Two of these elements are evaluated in the separate Scorecard indicator, Enabling Social Environment.

The final indicator addresses demand-side factors, specifically efforts to make youth access to and use of a full range of contraceptive methods more acceptable and appropriate within their communities. To support youth’s acceptance of contraception and ensure they are comfortable seeking contraceptive services, it is imperative to spread awareness and build support for a wide range of contraceptive methods among the broader communities in which they live. The 2016 Lancet Commission on Adolescent Health and Wellbeing identified community-support interventions as a critical component of strong SRH service packages.

Group engagement activities that mobilize communities through dialogue and action, rather than by only targeting individuals, are considered a promising practice to change social norms around sexual and reproductive health, including contraceptive use. Group engagement can be useful to change the discourse around youth sexuality and address misconceptions about contraception within communities.

This indicator assesses the extent to which a country addresses enabling-environment elements as outlined in the adolescent-friendly contraceptive service provision HIPs brief:

  • Link service delivery with activities that build support in communities.
  • Address gender and social norms.

Countries that outline specific interventions to build support within the larger community for youth family planning (FP) and address gender and social norms are considered to have a strong policy environment and are placed in the green category. Countries that include a reference to building an enabling social environment for youth FP, without providing any specific plan for doing so, are placed in the yellow category. Additionally, countries that discuss one, but not both, of the enabling social environment elements in detail are placed in the yellow category. Countries without any reference to an activity to build an enabling social environment for youth FP are placed in the gray category.

The High-Impact Practices in Family Planning (HIPs) brief recommends a third enabling-environment element: “Ensuring legal rights, policies, and guidelines that respect, protect, and fulfill adolescents’ human rights to contraceptive information, products, and services regardless of age, sex, marital status, or parity.” This element overlaps with the first four indicators of the Scorecard and is not assessed separately under this indicator. The extent to which a country addresses all seven elements of adolescent-friendly contraceptive services provision, as outlined in the HIPs, can be found in the Discussion of Results section.

Law or policy exists that supports youth access to FP services without consent from both third-parties (parents and spouses).

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include LARC methods.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.

Law or policy exists that supports youth access to FP services without consent from one but not both third parties.

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Policy supports the provision of sexuality education AND mentions all nine UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.

Law or policy exists that supports youth access to FP services without consent from one but not both third parties.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

No law or policy exists addressing youth access to a full range of FP methods. 

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both HIPs-recommended elements.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services:

  • Address gender norms.
  • Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include LARC methods.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting and reversible contraceptives (LARCs).

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services:

  • Address gender norms.
  • Build community support.

Law or policy exists that supports youth access to FP services without consent from one but not both third parties (parents and spouses).

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both HIPs-recommended elements.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

No law or policy exists addressing youth access to a full range of FP methods. 

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

No policy exists to build an enabling social environment for youth FP services. 

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization.

Law or policy exists that supports youth access to FP services regardless of age

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Policy promotes abstinence-only education or discourages sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.

Law or policy exists that supports youth access to FP services without consent from one but not both third parties.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that restricts youth access to FP services based on marital status.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy promotes abstinence-only education OR discourages sexuality education.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services:

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both HIPs-recommended elements.

Law or policy exists that supports youth access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports youth access to FP services regardless of marital status.

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.

Law or policy exists that supports youth access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically-advised youth FP services but does not address personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Policy promotes abstinence-only education or discourages sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

The ‘right to non-discrimination’ in the “Loi n° 2003-04 du 03 Mars 2003 Relative à la Santé Sexuelle et à la Reproduction” states that parental and partner consent is not required for patients to receive reproductive health care:

L’autorisation du partenaire ou des parents avant de recevoir des soins en matière de santé de la reproduction peut ne pas être requise, pourvu que ce procédé ne soit pas contraire à La loi.

Benin is placed in the green category for this indicator because its policies adequately prohibit parental and spousal consent.

The “Plan d’Action National Budgétisé pour le Repositionnement de la Planification Familiale 2014-2018 au Bénin” acknowledges that provider bias toward young people, particularly those who are unmarried, is a pervasive issue preventing young people from accessing family planning (FP) services.

Quant aux adolescents et jeunes non en union, ils craignent de rencontrer leurs parents et les autres adultes dans les points d’accès à la PF et jugent que leur utilisation de la PF est mal perçue par les prestataires qui préfèrent offrir les méthodes uniquement aux femmes en union.

Benin’s policies, however, do not explicitly state that providers must refrain from applying their personal biases and beliefs when providing FP services to youth. Therefore, Benin falls into the gray category for this indicator.

The “Loi n° 2003-04 du 03 Mars 2003 Relative à la Santé Sexuelle et à la Reproduction” supports individuals’ access to reproductive health care regardless of age or marital status: 

Article 2 : Caractère universel du droit à la santé de la reproduction.

Le droit à la santé de reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans aucune discrimination fondée sur l’âge, le sexe, la fortune, la religion, l’ethnie, la situation matrimoniale.

Article 7 : Droit à la non-discrimination.

Les patients sont en droit de recevoir tous les soins de santé de la reproduction sans discrimination fondée sur le sexe, le statut marital, le statut sanitaire ou tout autre statut, l’appartenance à un groupe ethnique, la religion, l’âge ou l’habilité à payer.

The “Loi n° 2015-08 portant Code de l’enfant » states that individuals under 18 years have the reight to access to RH.

Article 156 : Santé de la reproduction de l’enfant

L’enfant doit avoir accès à la santé de la reproduction sans aucune forme de discrimination, de coercition ou de violence. Il a le droit à l’information la plus complète sur les avantages et les inconvénients de la santé de la reproduction, sur les méthodes de planification familiale et de contraception ainsi que sur l’efficacité des services de santé sexuelle et reproductive.

Benin is placed in the green category because the policy environment confirms that youth must be permitted access to family planning services regardless of age.

The “Loi n° 2003-04 du 03 Mars 2003 Relative à la Santé Sexuelle et à la Reproduction” supports individuals’ access to reproductive health care regardless of age or marital status: 

Article 2 : Caractère universel du droit à la santé de la reproduction.

Le droit à la santé de reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans aucune discrimination fondée sur l’âge, le sexe, la fortune, la religion, l’ethnie, la situation matrimoniale.

Article 7 : Droit à la non-discrimination.

Les patients sont en droit de recevoir tous les soins de santé de la reproduction sans discrimination fondée sur le sexe, le statut marital, le statut sanitaire ou tout autre statut, l’appartenance à un groupe ethnique, la religion, l’âge ou l’habilité à payer.

Benin guarantees access to reproductive healthcare regardless of marital status; therefore, it is placed in the green category.

While Benin’s policy environment protects the right of individuals to a full range of methods and to the method of their choice, it falls short of addressing youth access to a full range of contraceptive methods.

For example, the “Loi n° 2003-04 du 03 Mars 2003 Relative à la Santé Sexuelle et à la Reproduction” states that the full range of legal contraceptives must be authorized and available after consultation as part of each individual’s right to choose from a range of effective and safe contraceptive methods. However, it does not specify that this same right must be extended to youth:

La contraception comprend toute méthode approuvée, reconnue effective et sans danger. Elle comprend les méthodes modernes (temporaires, permanentes), traditionnelles et populaires. Toute la gamme des méthodes contraceptives légales doit être autorisée et disponible après consultation. Le droit de déterminer le nombre d’enfants et de fixer l’espacement de leur naissance confère à chaque individu la faculté de choisir parmi toute gamme de méthodes contraceptives effectives et sans danger celle qui lui convient.

The “Stratégie Nationale Multisectorielle,” which is specifically concerned with youth reproductive health, defines reproductive health as including the right of individuals to the contraceptive methods of their choice, without explicitly stating that youth should be able to access a full range of contraceptive options:

La santé de la reproduction suppose par conséquent que les individus aient une vie sexuelle satisfaisante et sûre, ainsi que la capacité de se reproduire et la liberté de décider quand et à quelle fréquence le faire. Cette dernière question repose implicitement sur les droits des hommes et des femmes à être informés et à accéder à des méthodes de planification familiale (PF) sûres, efficaces, abordables et acceptables qu’ils auront choisies eux-mêmes, ainsi qu’à d’autres méthodes de leur choix de régulation de la fécondité qui soient conformes à la législation.

Because Benin does not have a policy extending access to a full range of methods for youth specifically, it is placed in the yellow category for this indicator. To move to the green category, Benin should clarify that youth can access a full range of methods, including long-acting and reversible contraceptives.

Benin’s policy environment supports the provision of sexuality education to in-school and out-of-school youth. The “Plan d’Action National Budgétisé pour le Repositionnement de la Planification Familiale 2014-2018 au Bénin” has a planned activity to develop an SRH education curriculum and introduce it into primary, secondary, and higher education institutions. To reach rural and out-of-school youth, sexual and reproductive health (SRH) and family planning (FP) messages will be shared through youth recreation centers and collaborations with cultural and sports associations.

The “Stratégie Nationale Multisectorielle de Santé Sexuelle et de la Reproduction des Adolescents et Jeunes au Bénin 2010-2020” tasks the Ministry of Secondary Education and Technical and Vocational Training with extending SRH education to technical and vocational secondary schools and promoting SRH awareness activities at colleges. The Ministry of Family and National Solidarity is tasked with reaching vulnerable groups of youth with SRH information.

The “Stratégie Nationale Multisectorielle” also recognizes the need to tailor information to the specific needs of youth:

Principales options de promotion de la SRAJ/VIH/sida :
La prise en compte de l’âge, du genre et des conditions socio-culturelles des adolescents et jeunes dans la définition des types et contenus des services d’information, de conseil et de prestations cliniques ou communautaires en SRAJ/VIH/sida.

These policies address two essential components of comprehensive sexuality education (CSE) by personalizing information and reaching across formal and informal sectors and across age groups.

A third component of CSE addressed in Benin’s policy documents is strengthening youth advocacy and civic engagement. The “Stratégie Nationale Multisectorielle” places strong emphasis on youth advocacy for adolescent reproductive health information and services:

Les Organisations de jeunesse :
Ces organisations jouent actuellement d’important rôle de mobilisation de jeunes. Elles doivent poursuivre les activités de mobilisation des jeunes et adolescents afin d’être de puissants instruments dans la mise en œuvre de la présente Stratégie Nationale Multisectorielle. Elles doivent contribuer à la promotion de la CCC en SRAJ, des prestations de services à base communautaire et le plaidoyer en vue de la mobilisation des leaders communautaires et des partenaires techniques et financiers.

The “Stratégie Nationale Multisectorielle” and the “Programme National de Santé de la Reproduction 2011-2015” include a specific objective to strengthen involvement of youth in SRH programming:

Axe : Implication et responsabilisation des jeunes dans la promotion de la SSR/VIH/sida

Objectif spécifique : Renforcer l’implication des structures de jeunes organisées à toutes les étapes du processus de prise de décision, de planification, de mise en œuvre et de suivi évaluation.

Although the “Stratégie Nationale Multisectorielle” acknowledges gender issues facing youth, such as gender-based violence and forced or early marriages, it does not describe integrating gender into a comprehensive sexuality education program. 

Benin’s policy environment is supportive of sexuality education but does not reference all nine of the United Nations Population Fund’s (UNFPA) essential components of CSE. Therefore, Benin is placed in the yellow category for this indicator. Going forward, additional sexuality education policies should consider all nine UNFPA essential components of CSE.

The three service delivery elements of adolescent-friendly contraceptive services are mentioned in Benin’s policy environment.

For example, the “Stratégie Nationale Multisectorielle de Santé Sexuelle et de la Reproduction des Adolescents et Jeunes au Bénin 2010-2020” and the “Programme National de Santé de la Reproduction 2011-2015” both include specific objectives to train providers at various levels to offer adolescent-friendly contraceptive services. Provider training described in the “Plan d’Action National Budgétisé pour le Repositionnement de la Planification Familiale 2014-2018 au Bénin” aims to reduce provider bias against youth in the provision of family planning (FP) methods:

Il s’agit de renforcer les capacités des prestataires…dans le domaine de l’offre des services de PF adaptés aux adolescents et jeunes permettra de lever l’obstacle lié à l’attitude inappropriée des prestataires face aux adolescents et jeunes qui se présentent dans les centres de santé pour adopter les méthodes de PF.

The “Stratégie Nationale Multisectorielle” states that a youth-friendly service setting should be confidential and affordable:

La formation sanitaire attrayante pour les adolescents et jeunes se définit comme un centre d’accueil ou de conseil, une maison des jeunes, offrant un bon accueil, une ambiance de gaité, d’aise, de confidentialité, une prise en charge adéquate, un traitement et des produits à moindre coût.

Therefore, Benin is placed in the green category for youth-friendly FP service provision.

The “Stratégie Nationale Multisectorielle de Santé Sexuelle et de la Reproduction des Adolescents et Jeunes au Bénin 2010-2020” includes an activity to involve local leaders in information and communication activities:

Objectif spécifique N°2 : Renforcer l’implication des Elus locaux, des leaders communautaires et religieux dans les actions d’information sur la SRAJ/VIH/sida chez les adolescents et jeunes.

2.1 Organiser au niveau de chaque commune du pays un atelier d’élaboration des plans opérationnels de communication en SRAJ/IST/VIH/sida au profit des élus locaux et les leaders communautaires et religieux en tenant compte des réalités de chaque commune.

The “Politique Nationale de la Jeunesse 2001” contains a specific objective and corresponding strategy to consider gender in the sexual and reproductive health of adolescents:

Objectif Spécifique 11 : Contribuer au développement de la santé physique, mentale, psychique, sexuelle et de la reproduction des adolescents et des jeunes selon l'approche genre.

Stratégie 11- 3 : Promotion de la santé sexuelle et de reproduction des adolescents et jeunes et d'un environnement physique, légal et social favorisant l'approche genre.

Additionally, the “Stratégie Nationale Multisectorielle de Santé Sexuelle et de la Reproduction des Adolescents et Jeunes au Bénin 2010-2020” aims to take gender into account when designing youth reproductive health information and services:

3.2. Principales options de promotion de la SRAJ/VIH/sida

…2- La prise en compte de l’âge, du genre et des conditions socio-culturelles des adolescents et jeunes dans la définition des types et contenus des services d’information, de conseil et de prestations cliniques ou communautaires en SRAJ/VIH/sida.

3.3 Principes directeurs

…La prise en compte des valeurs socioculturelles, de l’éthique et du genre dans la programmation des interventions.

These policies outline a detailed strategy to build community support for youth family planning services and to address gender norms, including specific interventions. Therefore, Benin is placed in the green category for this indicator.

Burkina Faso’s “Politiques et Normes en Matière de Santé de la Reproduction au Burkina Faso 2010” states that access to reversible contraceptive methods should not require spousal consent:

Les femmes et les hommes en âge de procréer pourront avoir accès aux méthodes contraceptives réversibles sans recours au consentement de leur conjoint. Toutefois, l’accent doit être mis sur l’importance du dialogue dans le couple pour l’adoption d’une méthode contraceptive.

However, Burkina Faso’s policies do not adequately address parental consent. Therefore, Burkina Faso is placed in the yellow category because its policies address one but not both forms of consent.

While the “Plan Stratégique Santé des Adolescents et des Jeunes 2015-2020” describes provider judgment as a barrier to youth access to healthcare, it does not include an explicit statement that providers may not use personal bias or discrimination when offering youth family planning services. Therefore, Burkina Faso is placed in the gray category for this indicator.

The “Loi Portant Santé de la Reproduction 2005” states that all individuals, including adolescents, have equal rights and dignity in reproductive health throughout their life, regardless of age or marital status:

Article 8 : Tous les individus y compris les adolescents et les enfants sont égaux en droit et en dignité en matière de santé de la reproduction.

Le droit à la santé de la reproduction est un droit fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu.

Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l'âge, le sexe, la fortune, la religion, l'ethnie, la situation matrimoniale ou sur toute autre considération.

Because the law guarantees youth access to family planning regardless of age, Burkina Faso is placed in the green category.

The “Loi Portant Santé de la Reproduction 2005” states that all individuals, including adolescents, have equal rights and dignity in reproductive health throughout their life, regardless of age or marital status:

Article 8 : Tous les individus y compris les adolescents et les enfants sont égaux en droit et en dignité en matière de santé de la reproduction.

Le droit à la santé de la reproduction est un droit fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu.

Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l'âge, le sexe, la fortune, la religion, l'ethnie, la situation matrimoniale ou sur toute autre considération.

Because the law guarantees youth access to family planning regardless of marital status, Burkina Faso is placed in the green category.

The “Loi Portant Santé de la Reproduction 2005” states that adolescents have the right to make decisions about their reproductive health and to obtain information about all methods of contraception.

Article 11 : Tout individu y compris les adolescents et les enfants, tout couple a droit à information, à l'éducation concernant les avantages, les risques et l'efficacité de toutes les méthodes de régulation des naissances.

The “Protocoles de Santé de la Reproduction 2009” state that adolescents should have access to all methods regardless of age or marital status:

Les adolescents et jeunes quel que soit leur âge, leur statut matrimonial doivent avoir accès à toutes les méthodes contraceptives.

Further, the “Protocoles” include long-acting and reversible contraceptives in the list of contraceptives that should be available to youth.

Similarly, the “Politique Nationale de Population du Burkina Faso 2000” contains an objective to promote use of reproductive health services among adolescents, including a specific aim to provide a full range of methods:

a) Objectif intermédiaire 1.1 : Promouvoir une grande utilisation des services de santé de la reproduction en particulier par les femmes, les jeunes et les adolescents.

Axes stratégiques :

1.1.2. Mise à la disposition de la population de services de santé de la reproduction de qualité y compris une gamme complète de méthodes contraceptives sûres, fiables et à un coût abordable.

The “Plan National d’Accélération de Planification Familiale du Burkina Faso 2017-2020” includes an objective to widen the range of methods, including LARCs, to benefit young people.

Objectif 2 : Garantir la couverture en offre de services de PF et l’accès aux services de qualité en renforçant la capacité des prestataires publics, privés et communautaires et en ciblant les jeunes ruraux et les zones enclavées avec l’élargissement de la gamme des méthodes y compris la mise à l’échelle des MLDA et PFPP, l’amélioration de la prestation aux jeunes.

Therefore, Burkina Faso is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, it is worth noting that the “Protocoles” do not include EC in the list of contraceptives that should be available to youth.

Several policies in Burkina Faso acknowledge the importance of sexuality education and describe plans for improving its implementation. The “Politiques et Normes en Matière de Santé de la Reproduction au Burkina Faso 2010” state that young people have the right to sexuality education.

Les jeunes ont droit à l’éducation à la vie sexuelle et à la vie familiale.

The “Politique Nationale de Population du Burkina Faso 2000” describes plans for family life and sexuality education in formal and informal education settings and for increasing institutional capacity for population education:

1.5.3. Promotion de l’éducation à la vie familiale et l’éducation sexuelle dans les structures d’enseignement formel et non formel.

2.2.1. Accroissement et/ou consolidation des capacités institutionnelles en matière de formation et d’enseignement en population et développement aux différents niveaux du système éducatif.

The “Troisième Programme d’Action en Matière de Population 2012-2016” explains that Burkina Faso’s population education program, l’Éducation en Matière de Population (EMP), which could not be obtained for this analysis, includes modules on emerging themes such as citizenship, human rights, HIV/AIDS and other sexually transmitted infections, and youth sexual and reproductive health. EMP was introduced in primary and secondary schools in Burkina Faso in the mid-1980s and has since been extended to reach students in informal settings. The “Troisième Programme” includes a specific objective to increase the effectiveness of population and citizenship education in formal and informal settings:

Objectif spécifique 3 : Rendre effective l’éducation en matière de population et de citoyenneté (EmPC) dans 100% des structures du système formel et 95% des structures non formelles.

Similarly, the “Plan National de Relance de la Planification Familiale 2013-2015” includes an activity to revitalize population education in both formal and informal education settings, including training school nurses and staff at youth centers in the ‘youth approach.’ The “Plan Stratégique Santé des Adolescents et des Jeunes 2015-2020” has a general activity to introduce sexuality education into education and training settings. Furthermore, the “Plan National d’Accélération de Planification Familiale du Burkina Faso 2017-2020” includes priority actions to incorporate modules on comprehensive sexuality education (CSE) in teaching curricula, build the capacity of students and teachers on CSE, and implement a CSE approach for out-of school young people.

Burkina Faso’s policy environment is promising because it supports the provision of sexuality education and includes some of the essential components of CSE within its sexuality education program, such as reaching youth across formal and informal sectors, human rights, and citizenship. However, all nine components of CSE are not mentioned within a comprehensive sexuality education program. Therefore, Burkina Faso is placed in the yellow category for CSE. Future plans for revitalizing sexuality education in Burkina Faso should consider including all nine United Nations Population Fund essential components of CSE.

The “Plan Stratégique Santé des Adolescents et des Jeunes 2015-2020” describes provider judgment as a barrier to youth access to health care:

L’offre de SSR de qualité se trouve limiter par… l’insuffisance de compétences du personnel de santé. En effet, les éléments suivants participent à entraver la qualité des soins et des services pour les adolescents et les jeunes: attitude des prestataires non respectueuse et de jugement, droit à la confidentialité non respecté…

The “Plan Stratégique” then includes an adjoining aim to train and supervise providers in youth sexual and reproductive health service provision:

Axe 2 :  Renforcement de l’offre de soins et des services de SRAJ de qualité

Formation continue des prestataires au niveau des formations sanitaires

Renforcement de la supervision des prestataires

The “Plan Stratégique” includes specific plans to make services more financially accessible to youth by providing free services and alternative payment options. Additionally, the “Directives Nationales sur la Santé Scolaire et Universitaire au Burkina Faso 2008” assert that youth centers should provide affordable contraceptives for students and emphasize the importance of confidentiality when providing services to youth.

In December 2018, the Council of Ministers adopted a decree on behalf of the Ministry of Health granting free FP care in Burkina Faso. The Council noted that this policy change would especially benefit adolescents and youth.

I.2. Au Titre du devéloppement du Capital Humain, le Conseil à adopté :

Pour le compte du ministère de la Santé :

  • un décret portant gratuité des soins de la planification familiale au Burkina Faso.

L’adoption de ce décret permet la mise en œuvre de la mesure de gratuité de la planification familiale dans les structures de santé publique de notre pays et une intensification de l’offre des services de la planification familiale au profit des populations notamment les adolescents, les jeunes et les populations vivant en milieu rural.

Burkina Faso has a strong policy environment for the provision of youth-friendly family planning services and is accordingly placed in the green category for this indicator.

Burkina Faso’s policies support an enabling social environment for youth-friendly service provision through addressing gender norms and building support in communities. For example, the “Politiques et Normes en Matière de Santé de la Reproduction au Burkina Faso 2010” acknowledge the multisectoral nature of reproductive health and the required collaboration around gender-related issues, such as:

  • la promotion de la scolarisation des jeunes filles et de l’alphabétisation des femmes,
  • la promotion de l’autonomisation financière des femmes,
  • la promotion d’un environnement physique, politique, juridique, social et économique favorable à la santé, dans un esprit d’équité entre les sexes.

The “Plan Stratégique Santé des Adolescents et des Jeunes 2015-2020” describes specific activities to promote a social environment conducive to the health of adolescents and to reach community leaders and parents about youth sexual and reproductive health:

Axe 6: Promotion d’un environnement social et juridique favorable à la santé des adolescents et des jeunes

Renforcement du dialogue parents enfants dans l’éducation sexuelle et les bonnes habitudes d’hygiène et de vie des adolescents et des jeunes

  • Formation à la vie familiale des parents et des adolescents et des jeunes
  • Communication média sur le rôle des parents
  • Utilisation des NTIC pour rappeler le rôle attendu des parents (SMS)
  • Communication média sur l’éducation sexuelle, les bonnes habitudes d’hygiène et de vie

Implication des leaders communautaires et religieux dans l’éducation sexuelle et les bonnes habitudes d’hygiène et de vie des adolescents et jeunes

  • Plaidoyer
  • Communication média sur l’éducation sexuelle et les bonnes habitudes d’hygiène et de vie

Burkina Faso outlines a detailed strategy to build community support for youth family planning services and to address gender norms. Therefore, it is placed in the green category for this indicator.

The “Plan d’Action National Budgétisé de Planification Familiale, Côte d'Ivoire 2015-2020” explains that provider and parental judgment toward adolescents, particularly unmarried adolescents, is a barrier to accessing family planning services:

Quant aux adolescents et jeunes non en union, ils craignent de rencontrer leurs parents et d’autres adultes dans les points d’accès à la PF et jugent que leur utilisation de la PF est mal perçue par les prestataires qui préfèrent offrir les méthodes uniquement aux femmes en union.

Côte d’Ivoire’s policy environment, however, does not adequately prohibit parental and spousal consent. Côte d’Ivoire should consider addressing these forms of external authorization unequivocally in future legislation, such as in the reproductive health law being drafted at the time of this writing. Until then, Côte d’Ivoire is placed in the gray category for this indicator.

The “Standards des Services de Santé Adaptés aux Adolescents et aux Jeunes en Côte d’Ivoire (no date),” which include contraception in the minimum package of services, emphasize the importance of providers having adequate skills and attitudes for YF service provision:

Standard II : Tous les prestataires du PPS [Points de Prestations de Service] ont les connaissances, les aptitudes et les attitudes requises pour offrir des services adaptés aux besoins des A&J [Adolescent et Jeune].
Raisons - d’être :
- Les A&J déplorent le mauvais accueil, la stigmatisation et la discrimination dont ils font l’objet lorsqu’ils désirent les services de santé de la reproduction ;
- Les prestataires des PPS n’ont pas souvent la formation requise pour offrir des services adaptés aux besoins des A&J au cours de leur formation de base.

Because the “Standards” say definitively that providers must have an attitude void of stigma and discrimination, Côte d’Ivoire is placed in the green category for this indicator.

The “Document de Politique Nationale de la Santé de la Reproduction et de Planification Familiale (2ème édition) 2008” guarantees equitable access to sexual and reproductive health (SRH) care regardless of age:

Au regard de ces droits, la politique nationale de la SSR exige l’accès équitable à l’information et aux soins sans distinction de sexe, d’âge, de race, d’ethnie, de religion, de région, de classe sociale. Elle insiste également sur le droit pour tout individu de décider librement, de façon éclairée, de sa sexualité et de sa reproduction.

Dans cette optique, la présente déclaration de politique nationale de la santé de la reproduction repose sur des valeurs essentielles suivantes : la solidarité, l’équité, l’éthique et le respect de la spécificité du genre.

The “Politique Nationale de Population 2015” includes a specific objective to empower women, which will be achieved through promoting universal access to SRH for women, girls, and young people:

Objectif général 4
Assurer l’autonomisation de la femme et l’équité de genre

Objectif spécifique 4.1
Réduire les inégalités de genre et les violences basées sur le genre

Pour ce faire, il faut : défendre l’accès universel à la santé sexuelle et reproductive, en particulier pour les femmes, les filles et les jeunes, y compris pendant les périodes de conflits et de situations d’urgence.

Because these policies address access to family planning services regardless of age, Côte d’Ivoire is placed in the green category.

The “Plan d’Action National Budgétisé de Planification Familiale, Côte d'Ivoire 2015-2020” explains that provider and parental judgment toward adolescents, particularly unmarried adolescents, is a barrier to accessing family planning (FP) services. The “Programme d'Orientation sur la Santé des Adolescents Destiné aux Prestataires de Soins de Santé 2006,” a World Health Organization training document officially adopted by the National Program for School and University Health in the Ministry of Health and Public Hygiene for training providers in youth-friendly services, includes guidance on providing contraceptive services to unmarried youth:

Adolescentes non mariées

...Les adolescentes, surtout celles qui ont une relation exclusive, peuvent également souhaiter utiliser d’autres méthodes plus durables [que les préservatifs]. Les prestataires de services de contraception doivent soutenir cette décision.

Because a policy exists that supports youth access to FP for unmarried adolescents, Côte d’Ivoire is placed in the green category for this indicator.

The “Programme d'Orientation sur la Santé des Adolescents Destiné aux Prestataires de Soins de Santé 2006,” a World Health Organization (WHO) training document officially adopted by the National Program for School and University Health in the Ministry of Health and Public Hygiene of Côte d’Ivoire, includes eligibility criteria for all contraceptive methods. However, this document represents outdated WHO medical eligibility criteria for intrauterine devices (IUDs) and implants. It includes restrictions for IUDs based on age and parity:

Méthode déconseillée aux moins de 20 ans en raison d’un grand risque d’expulsion chez les plus jeunes femmes nullipares

It also includes restrictions for progestin-only injectables based on age:

Méthode déconseillée aux moins de 18 ans en raison d’un trouble possible du développement osseux

For Côte d’Ivoire to move into the green category, it needs to adopt the updated WHO medical eligibility criteria (2015), which state that these methods are generally safe for youth and nulliparous women and that “the advantages of using the method generally outweigh the theoretical or proven risks.” As it is currently written, the “Programme” discourages providers from providing these methods to youth who fall within the above-mentioned restrictions, rather than clarifying that they are generally safe for young women regardless of age and parity.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that the “Programme” also includes EC in the list of methods.

The “Programme National de l’Education Sexuelle Complète de Côte d’Ivoire 2016-2020” describes the country’s comprehensive sexuality education (CSE) program, which includes all nine of the essential United Nations Population Fund (UNFPA) components of CSE.

For example, the CSE program includes an integrated focus on gender through which youth learn about the role of gender norms in society and the impact of gender norms on sexual and reproductive health (SRH):

6. Genre
Promouvoir l’égalité de genre est un impératif moral. Cette unité aborde efficacement la question du genre, pour les filles comme pour les garçons. Elle décrit le jeu des normes de genre dans la société (dans les relations familiales, à l’école, dans l’expérience de la violence, dans les médias et ailleurs) et explique l’effet des rôles de genre sur la sexualité et la santé sexuelle.

The CSE program also includes components on improving communication skills and decisionmaking in SRH:

2. Relations interpersonnelles et communication
Cette composante explique les relations et les liens avec les membres de la famille, les amis, les voisins, les connaissances, le ou la petit(e) ami(e), ses enseignants, ses camarades, etc. Le but de cette composante est d’aider les adolescent(e)s à mieux comprendre leurs relations et à les aborder avec plus de confiance.

3. Valeurs et attitudes
Les jeunes aiment apprendre comment parler de sujets intimes sans gêne et avec confiance. Il s’agit dans cette unité de mettre l’accent sur les attitudes et les valeurs telles que le Respect de soi et d’autrui, l’Estime de soi, la prise de décisions qui permettent aux adolescents et aux jeunes d’être confiant en leurs capacités afin de bénéficier d’une meilleure santé et préparer un avenir radieux.

The program aims to reach youth in and out of school with information that is culturally and age appropriate:

Fournir des conseils aux acteurs concernés sur la manière d’élaborer des matériels et des programmes d’éducation sexuelle conçus pour répondre aux besoins, culturellement pertinents et adaptés à l’âge des bénéficiaires.

…Renforcer les capacités des acteurs de l’éducation formelle et non formelle
Cette stratégie nécessite l’organisation d’ateliers de renforcement des capacités de la communauté éducative et des partenaires sociaux.

The “Plan Accéléré de Réduction des Grossesses à l'Ecole 2013-2015,” which lays the groundwork for the “Programme National,” provides a clear link between sexuality education and gender norms by focusing on empowering girls to stay in school and manage their SRH needs. It also has a strong emphasis on linking sexuality education with youth-friendly services.

In addition to these programs, Côte d’Ivoire plans to publish “Supports pédagogiques pour les leçons de vie,” extensive teaching materials on SRH topics such as early pregnancy and parent-child communication on SRH; contraception and youth rights in SRH; gender-based violence and early marriages; and sexually transmitted infections and HIV/AIDS. The materials will be published for four groups: teacher trainees and primary school, secondary school, and college level students.

Côte d’Ivoire has a strong policy environment for CSE, including reference to all nine UNFPA essential components of CSE, and is placed in the green category for this indicator.

The “Politique Nationale de Population 2015” includes a strategy to develop and expand youth-friendly sexual and reproductive health (SRH) services, and the “Plan Stratégique de la Planification Familiale 2012-2016” includes an activity to develop standards for youth SRH services.

The “Plan Stratégique National de la Santé des Adolescents et des Jeunes 2016-2020” discusses training providers in youth-friendly (YF) services, including SRH. The “Plan Stratégique de la Planification Familiale 2012-2016” includes specific activities to establish YF family planning services, including training providers. The “Plan d’Action National Budgétisé de Planification Familiale, Côte d'Ivoire 2015-2020” includes specific activities to develop training manuals, train and supervise providers, and to evaluate the performance of centers offering YF services:

Activité O3.1: Formation des prestataires de 25% des FS [Formation Sanitaire] pour offrir des services de PF adaptés aux adolescents et jeunes

  • Elaboration/Adaptation des manuels de formation en prise en charge des jeunes et adolescents dans les FS offrant la PF;
  • Recensement chaque année de 250 FS appropriées pour la prise en charge des adolescents et jeunes;
  • Organisation annuelle de 10 sessions de formation de 5 jours de 25 prestataires en prise en charge des jeunes au niveau des chefs-lieux de régions;
  • Suivi des activités de formation dans les régions;
  • Renforcement de l’équipement des FS pour attirer plus d’adolescents et jeunes;
  • Aménagement des services (espace horaire, activités, etc.…) pour prendre en compte les besoins des jeunes;
  • Supervision des prestations offertes par les prestataires formés;
  • Evaluation de la performance des centres offrant des services aux jeunes.

The “Standards des Services de Santé Adaptés aux Adolescents et aux Jeunes en Côte d’Ivoire (n.d.)” include activities to train providers to have an attitude free of stigma and discrimination for providing YF services (see Provider Authorization). The “Standards” also describe the right of youth to privacy and confidentiality when accessing services. The “Plan Stratégique de la Planification Familiale 2012-2016” and the “Plan Stratégique de la Santé de la Reproduction 2010-2014” include the same activity to advocate for reduced costs for youth SRH services:

Organiser des activités de plaidoyer en direction du gouvernement pour la réduction des coûts des soins de santé sexuelle et reproductive de tous les adolescents et jeunes dans tous les établissements sanitaires.

Côte d’Ivoire’s policy environment is strong in that it addresses all three elements for YF services. Côte d’Ivoire is placed in the green category for this indicator.

The “Plan Stratégique de la Santé de la Reproduction 2010-2014” offers a strategy to strengthen the capacity of communities to address youth sexual and reproductive health (SRH) issues:

Stratégie 3: Renforcement des capacités des individus, des ménages et des communautés en matière de SR des adolescents et des jeunes

Interventions prioritaires

1. Développer et mettre en œuvre un plan de communication sur la santé sexuelle et reproductive des adolescents et jeunes.

2. Renforcer la capacité des relais communautaires sur la santé sexuelle et reproductive des adolescents et jeunes.

The “Stratégie Nationale de Développement Basée sur la Réalisation de l'OMD Version 4 2007-2015” describes plans for community awareness campaigns that would focus on reducing pregnancies among girls in school and would contain information on contraceptive methods:

En outre, des campagnes de sensibilisation média et communautaires sur la santé sexuelle et de la reproduction seront menées pour réduire les taux d’abandons des filles liés aux grossesses et accouchements précoces. Ces campagnes devront mettre en relief les inconvénients de la précocité de la vie sexuelle et des comportements sexuels à risque, les méthodes contraceptives, etc.

The “Plan National de Développement 2016-2020” notes that improved family planning (FP) use depends on empowering women and ensuring schooling for girls:

Les effets escomptés à terme à travers la réalisation de la « révolution contraceptive », ne seront perceptibles que si des progrès notables sont réalisés dans la scolarisation et en particulier la scolarisation des jeunes filles et l’autonomisation de la femme. Ainsi, il sera question à ce niveau, de garantir un meilleur accès à l’éducation pour toutes les jeunes filles et de favoriser l’autonomisation de la femme à travers des activités génératrices de revenu.

The “Politique Nationale de Population 2015” includes a specific objective to promote universal access for SRH for women and girls:

Objectif général 4 Assurer l’autonomisation de la femme et l’équité de genre

Objectif spécifique 4.1 Réduire les inégalités de genre et les violences basées sur le genre

Pour ce faire, il faut :

défendre l‟accès universel à la santé sexuelle et reproductive, en particulier pour les femmes, les filles et les jeunes, y compris pendant les périodes de conflits et de situations d’urgence ;

Because Côte d’Ivoire’s policies provide specific intervention activities for building community support for youth FP services and address gender norms, it is placed in the green category for this indicator.

“Les Codes Larcier de la République Démocratique du Congo, Tome I Droit Civil et Judiciaire” gives husbands full control over the legal rights of married women:

Art. 444. — Le mari est le chef du ménage. Il doit protection à sa femme; la femme doit obéissance à son mari.

Art. 448. — La femme doit obtenir l’autorisation de son mari pour tous les actes juridiques dans lesquels elle s’oblige à une prestation qu’elle doit effectuer en personne.

Art. 450. — Sauf les exceptions ci-après et celles prévues par le régime matrimonial, la femme ne peut ester en justice en matière civile, acquérir, aliéner ou s’obliger sans l’autorisation de son mari. Si le mari refuse d’autoriser sa femme, le tribunal de paix peut donner l’autorisation. L’autorisation du mari peut être générale, mais il conserve toujours le droit de la révoquer.

In 2018, the "Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa", originally adopted by the African Union in 2003 and also known as the "Maputo Protocol", was published in the Journal Officiel de la République Démocratique du Congo, officially binding the DRC to the protocol. In line with the Protocol, the "Loi n° 06/015 du 12 juin 2006 Autorisant l’Adhesion de La Republique Democratique Du Congo au Protocole a la Charte Africaine des Droits de l’Homme et Des Peuples, Relatif Aux Droits de la Femme En Afrique” gives women the right to exercise control over their fertility, including the number of children they have and the spacing of births.

Article 14 : Droit à la santé et au contrôle des fonctions de reproduction. 

1. Les États assurent le respect et la promotion des droits de la femme à la santé, y compris la santé sexuelle et reproductive. Ces droits comprennent :

a) le droit d’exercer un contrôle sur leur fécondité ;

b) le droit de décider de leur maternité, du nombre d’enfants et de l’espacement des naissances ;

c) le libre choix des méthodes de contraception ;

d) le droit de se protéger et d’être protégées contre les infections sexuellement transmissibles, y compris le VIH/SIDA ;

e) le droit d’être informées de leur état de santé et de l’état de santé de leur partenaire, en particulier en cas d’infections sexuellement transmissibles, y compris le VIH/SIDA, conformément aux normes et aux pratiques internationalement reconnues ;

f) le droit à l’éducation sur la planification familiale.

DRC’s new public health law, the "Loi n°18/035 du 13 décembre 2018 Fixant les Principes Fondamentaux Relatifs à l’Organisation de la Santé Publique,” legally protects a women’s ability to choose to use family planning even if her spouse objects.

Article 82 :

Pour les personnes légalement mariées, le consentement des deux conjoints sur la méthode contraceptive est requis.

En cas de désaccord entre les conjoints sur la méthode contraceptive à utiliser, la volonté du conjoint concerné prime.

Article 84 :

Les conjoints ont le droit de discuter librement et avec discernement du nombre de leurs enfants, de l’espacement de leurs naissances et de disposer des informations nécessaires pour ce fair. En cas de désaccord, la volonté de la femme prime.

While spousal consent is required for contraceptive use, the will of the individual seeking contraception is considered supreme in the case of a disagreement. Similarly, the law encourages spousal discussions on the number of children and spacing of births but, in the case of a disagreement, the woman’s will is supreme.

The 2013 “Politique Nationale Santé de l’Adolescent (PNSA)” states that the provision of contraceptives to youth is subject to parental consent, which providers must respect. At the same time, somewhat contradictorily, the policy encourages providers to support the self-determination of youth to use reproductive health services. This language does not define the circumstances when parental consent is warranted: 

2. La prestation des méthodes contraceptives chez les jeunes doit être subordonnée le cas échéant par le consentement des parents et l’agent de santé est tenu à se plier à cette obligation dans le respect des principes d’administration et d’éthique de ces méthodes. Par contre, il faut recommander l’achat des préservatifs à la pharmacie et les milieux appropriés et les pilules dans un centre de santé.

3. Les prestataires doivent soutenir l’auto détermination et le libre choix des adolescents à utiliser les services de santé de la reproduction dans le respect de leur dignité et de leur diversité d’opinion ou de culture.

More recently, however, the “Democratic Republic of Congo Family Planning National Multisectoral Strategic Plan, 2014-2020” included an activity to:

Create a law favorable to family planning, to protect minors and adolescents, and to promote gender.

Recent legal changes, most notably the new public health law, are very promising and have removed the requirement for spousal consent as a barrier. However, because parental consent for youth's use of contraception is still permitted under the PNSA, the DRC is placed in the yellow category for this indicator. The country has the potential to move into the green category if future laws are enacted that explicitly prohibit spousal consent in all cases.

The “Interventions de Santé Adaptées aux Adolescents et Jeunes, 2012” detail how providers in health centers should interact with youth when discussing sexual and reproductive health. Providers should ensure confidentiality; use friendly, clear, and respectful communication; avoid judgment; recognize stigma experienced by sexually active youth; and ensure autonomy in decisionmaking:

3° Réserver un accueil chaleureux et une communication sympathique à l’adolescent et au jeune.

  • Aménager des espaces / environnement sûr et favorable à l’entretien.
  • Préserver la confidentialité et l’intimité des adolescents et jeunes.
  • Adopter des attitudes attrayantes :
  • Se montrer ouvert et accessible ;
  • Adopter un ton doux et rassurant ;
  • Faire attention à votre attitude (geste, mimique, réaction d’étonnement, de réprobation, de condamnation).
  • Traiter les adolescents et jeunes avec courtoisie (saluer avec respect et sympathie, offrir le siège, se présenter).
  • User de patience (un certain temps peut être nécessaire pour que les adolescents et jeunes qui ont des besoins particuliers fassent part de leurs problèmes ou prennent une décision).
  • Laisser parler l’adolescent ou le jeune sans l’interrompre.
  • Eviter de porter de jugement.
  • Faire preuve de compréhension quant aux difficultés que les adolescents et jeunes éprouvent à parler de sujets touchant à la sexualité (peur que les parents le découvrent, réprobation des adultes et de la société).

Because the policy explicitly states that providers must be nonjudgmental, open, and respectful, the Democratic Republic of the Congo is placed in the green category for this indicator.

The “Loi n°18/035 du 13 décembre 2018 Fixant les Principes Fondamentaux Relatifs à l’Organisation de la Santé Publique” states that any person of reproductive age can access contraceptives.

Article 81 :

Toute personne en âge de procréer peut bénéficier après avoir été éclairé, d'une méthode de contraception réversible ou irréversible sur consentement libre. En cas de contraception irréversible, le consentement est écrit, après avis de trois médecins, et du psychiatre.

In addition, the “Plan Stratégique National de la Santé et du Bien-Etre des Adolescents et des Jeunes, 2016-2020” seeks to improve the sexual and reproductive health status of adolescents and youth ages 10 to 24. 

Because the new public health law addresses access to contraception regardless of age, DRC is placed in the green category.

“Les Codes Larcier de la République Démocratique du Congo, Tome I Droit Civil et Judiciaire” gives husbands full control over the legal rights of married women:

Art. 444. — Le mari est le chef du ménage. Il doit protection à sa femme; la femme doit obéissance à son mari.

Art. 448. — La femme doit obtenir l’autorisation de son mari pour tous les actes juridiques dans lesquels elle s’oblige à une prestation qu’elle doit effectuer en personne.

Art. 450. — Sauf les exceptions ci-après et celles prévues par le régime matrimonial, la femme ne peut ester en justice en matière civile, acquérir, aliéner ou s’obliger sans l’autorisation de son mari. Si le mari refuse d’autoriser sa femme, le tribunal de paix peut donner l’autorisation. L’autorisation du mari peut être générale, mais il conserve toujours le droit de la révoquer.

In 2018, the "Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa", originally adopted by the African Union in 2003 and also known as the "Maputo Protocol", was published in the Journal Officiel de la République Démocratique du Congo, officially binding the DRC to the protocol. In line with the Protocol, the "Loi n° 06/015 du 12 juin 2006 Autorisant l’Adhesion de La Republique Democratique Du Congo au Protocole a la Charte Africaine des Droits de l’Homme et Des Peuples, Relatif Aux Droits de la Femme En Afrique” gives women the right to exercise control over their fertility, including the number of children they have and the spacing of births.

Article 14 : Droit à la santé et au contrôle des fonctions de reproduction

1. Les États assurent le respect et la promotion des droits de la femme à la santé, y compris la santé sexuelle et reproductive. Ces droits comprennent :

a) le droit d’exercer un contrôle sur leur fécondité ;

b) le droit de décider de leur maternité, du nombre d’enfants et de l’espacement des naissances ;

c) le libre choix des méthodes de contraception ;

d) le droit de se protéger et d’être protégées contre les infections sexuellement transmissibles, y compris le VIH/SIDA ;

e) le droit d’être informées de leur état de santé et de l’état de santé de leur partenaire, en particulier en cas d’infections sexuellement transmissibles, y compris le VIH/SIDA, conformément aux normes et aux pratiques internationalement reconnues ;

f) le droit à l’éducation sur la planification familiale.

DRC’s new public health law, the "Loi n°18/035 du 13 décembre 2018 Fixant les Principes Fondamentaux Relatifs à l’Organisation de la Santé Publique,” legally protects a women’s ability to choose to use family planning (FP) even if her spouse objects.

Article 82 :

Pour les personnes légalement mariées, le consentement des deux conjoints sur la méthode contraceptive est requis.

En cas de désaccord entre les conjoints sur la méthode contraceptive à utiliser, la volonté du conjoint concerné prime.

 Article 84 :

Les conjoints ont le droit de discuter librement et avec discernement du nombre de leurs enfants, de l’espacement de leurs naissances et de disposer des informations nécessaires pour ce fair. En cas de désaccord, la volonté de la femme prime.

While spousal consent is required for contraceptive use, the will of the individual seeking contraception is considered supreme in the case of a disagreement. Similarly, the law encourages spousal discussions on the number of children and spacing of births but, in the case of a disagreement, the woman’s will is supreme.

While these policies address spousal consent, they do not explicitly recognize marital status as a criterion for provision or refusal of FP services. Providers and clients may differently interpret this statement, potentially creating a barrier for youth who want to access contraception. To strengthen the eligibility criteria, the guideline’s eligibility statement should specifically recognize segmented parts of the population, such as married and unmarried youth. Because no policy exists addressing marital status in access to FP services, DRC is placed in the gray category.

While the “Plan Stratégique National de la Santé et du Bien-Etre des Adolescents et des Jeunes, 2016-2020” aims to reach 3,870 facilities with contraceptive supplies, including condoms for adolescents and youth, it does not indicate the provision of a full range of contraceptives nor any guidelines around provision of contraceptives to this age group.

The 2013 “Politique Nationale Santé de l’Adolescent (PNSA)” states that contraceptive methods beyond the preferred method of abstinence must be made available to youth, but only references pills and condoms. The related document, “Paquet d’Activités PNSA dans la Zone de Santé,” describes plans for family planning activities that include youth-friendly (YF) contraceptive methods, rather than explicitly including a full range of methods.

The “Interventions de Santé Adaptées aux Adolescents et Jeunes, 2012” encourage condom and contraceptive distribution at the community level and indicate in general terms that youth should be informed about how to prevent unwanted pregnancy in visits to health centers. This policy does not describe providing youth with a full range of contraceptive methods.

The “Standards des Services de Santé Adaptés aux Adolescents et Jeunes, 2014” describe the minimum package of YF services at each level of the health system, including the community level. The reproductive health (RH) policy emphasizes providing information on RH to youth, rather than contraceptive provision. One exception is the distribution of oral contraception and condoms to youth, which is included in the minimum package of services at the community level.

The “Loi N°18/035 du 13 décembre 2018 Fixant les Principes Fondamentaux Relatifs à l’Organisation de la Santé Publique” specifically states that youth can benefit from both reversible and irreversible contraceptives. Furthermore, the “Loi N° 06/015 du 12 juin 2006” binds the DRC to the Maputo Protocol, which acknowledges a woman’s right to choose any method of contraception.

However, neither policy explicitly mentions youth’s legal right to access a full range of contraception, including LARCs. As the DRC does not have a policy extending access to a full range of methods for youth, it is placed in the gray category for this indicator.

The 2013 “Politique Nationale Santé de l’Adolescent (PNSA)” acknowledges the importance of sexuality education and places emphasis on involving youth, parents, schools, and communities. It does not describe any details or components of what a comprehensive sexuality education (CSE) program should include.

The “Democratic Republic of Congo Family Planning National Multisectoral Strategic Plan, 2014-2020” identified poor integration of CSE in primary and secondary schools as a key family planning (FP) demand-generation problem. To address this concern, the strategic plan includes CSE activities to increase demand for FP services among youth:

Integrate Family Planning in the curriculum of secondary schools, higher education and universities and train teachers in comprehensive sexual education for youth and adolescents.

The “Plan Stratégique National de la Santé et du Bien-Etre des Adolescents et des Jeunes, 2016-2020” incorporates a priority focus on activities that support behavior change through comprehensive sexual and reproductive health education in and out of schools:

Les interventions de santé en faveur des adolescents et des jeunes reposent sur la communication pour le changement de comportement soutenue par l’offre des services de prévention. Il s’agit de : l’éducation complète sur la santé reproductive et sexuelle en milieu scolaire et parascolaire. 

The plan also includes several activities that contribute to CSE, including promoting the core universal value of human rights for adolescents and young people and the provision of safe and healthy learning environments:

Les objectifs spécifiques assignés à ce Plan sont les suivants :

Améliorer le niveau de connaissance et les compétences des adolescents et jeunes sur leurs problèmes spécifiques de santé y compris leurs droits.

D’ici 2020 au moins 50% des adolescents et jeunes adoptent des attitudes et compétences favorables au respect de leurs droits dans les 258 zones. 

D’ici 2020, 890 espaces d'information et communication pour jeunes sont créés dans les 178 zones supplémentaires.

Au moins 50% d’adolescents et jeunes participent aux activités récréatives et socio-éducatives dans les 258 zones d’ici 2020.

The reference to CSE in these strategic plans indicates that the policy environment is promising toward its implementation. However, additional guidelines, in line with the nine UNFPA essential components, are necessary to inform the delivery of CSE. Thus, the Democratic Republic of the Congo is placed in the yellow category for this indicator.

The policy environment in the Democratic Republic of the Congo (DRC) recognizes the need for youth-friendly (YF) family planning (FP) service provision. The “Democratic Republic of Congo Family Planning National Multisectoral Strategic Plan, 2014-2020” includes the following activity:

Extend integrated youth-friendly services to all health zones.

Further, the “Plan Stratégique National de la Santé et du Bien-Etre des Adolescents et des Jeunes, 2016-2020” references the provision of YF services and presents plans for how the country aims to scale up the program. For example, the strategic plan explicitly states the importance of having trained staff capable of offering youth services, setting up “spaces” suitable for young people, and providing contraceptives (defined only as male and female condoms) to this age group.

Ce système devra particulièrement disposer d’un personnel compétent et apte à offrir les soins de santé spécifiques à ce groupe, supprimer le plus possible les barrières à cette cible sans ressources conséquentes, aménager au sein des établissements de soins les espaces d'information et communication pour jeunes, fournir régulièrement les médicaments y compris les contraceptifs et autres intrants (préservatifs féminins et masculins, etc.). 

The “Standards des Services de Santé Adaptés aux Adolescents et Jeunes, 2014” recognize the rights of adolescents to quality and confidential health services. These services include distribution of oral contraception and condoms. The standards include plans for training providers in YF services, including having the right attitude, and measuring youth satisfaction with these services:

Standard 3 : Tout prestataire de service a les connaissances, les attitudes et les compétences requises lui permettant d’offrir aux adolescents et aux jeunes des services et soins de santé de manière efficace, efficiente et conviviale.

The 2013 “Politique Nationale Santé de l’Adolescent (PNSA)” describes training providers and ensuring confidentiality in the context of adolescent health broadly. However, the policy does not mention plans to offer youth free or subsidized contraceptive provision. The “Plan Stratégique National de la Santé et du Bien-Etre des Adolescents et des Jeunes, 2016-2020” encourages use of a discount for “care of adolescents and young people,” but makes no explicit provision for offering contraceptive products or services at no cost or at subsidized costs.

Therefore, the policy environment is understood to be promising but incomplete, and the DRC is placed in the yellow category for FP service provision. When expanding YF service protocols, policymakers should consider including all three elements identified in the High-Impact Practices in Family Planning “Adolescent-Friendly Contraceptive Services” to improve adolescent and youth uptake of contraception.

The Democratic Republic of the Congo (DRC) policy environment recognizes building community support for family planning (FP). The “Democratic Republic of Congo Family Planning National Multisectoral Strategic Plan, 2014-2020” includes an activity to mobilize the community surrounding FP. However, the activity is not specific to youth FP.

The “Paquet d’Activités” that accompanies the 2013 “Politique Nationale Santé de l’Adolescent (PNSA)” broadly outlines activities for building community support for youth health in general, such as advocacy aimed at community leaders and community-outreach activities using multimedia/mass media platforms. However, these activities are not specific to building support for youth access to contraception.

The “Plan Stratégique National de la Santé et du Bien-Etre des Adolescents et des Jeunes, 2016-2020” has as one of its chief priorities the need to promote the health of young people through empowering communities to find solutions to problems affecting adolescent health:

La promotion de la santé des jeunes doit viser notamment la responsabilisation des communautés de base dans la recherche des solutions sur les problèmes affectant la santé des adolescents.

While there is no explicit reference to community support for youth FP services, there is a strategic focus on community mobilization for the promotion of adolescent and youth health, including human immodeficiency virus (HIV) services, comprehensive sexual and reproductive health (SRH) education, promotion and availability of condoms, and strengthening the provision of services at the community level:

Axe stratégique 1 : Communication stratégique et mobilisation communautaire pour la promotion de la santé des adolescents et des jeunes

Les interventions de santé en faveur des adolescents et des jeunes reposent… Il s’agit de : (i) services de conseil et dépistage volontaire sur le VIH, (ii) l’éducation complète sur la santé reproductive et sexuelle, (iii) la promotion et la disponibilité des préservatifs, (iv) la promotion de la prophylaxie post exposition (en cas de viols), (v) la prévention des violences, ainsi que (vi) le renforcement du système communautaire en synergies avec les secteurs nationaux clés et de la société civile à fournir des services.

The policy environment aims to build community support for youth SRH education and access to condoms, but does not reference building community support for youth access to FP services that include a broader range of contraceptive methods. The 2013 “Politique Nationale Santé de l’Adolescent (PNSA)” mentions gender, primarily related to gender-based violence, in the context of adolescent health broadly. Because the DRC does not include specific interventions related to building an enabling social environment, the country is placed in the yellow category for this indicator.

The “National Adolescent and Youth Health Strategy, 2016-2020” refers to a prohibition against third-party consent requirements for youth seeking contraception:

A law permits adolescents and youth to use contraceptives without third party consent.

However, this law is not identified by name and could not be located. Unless confirmation of such a law or policy can be made, Ethiopia is placed in the gray category for this indicator. To strengthen the policy environment, the country should consider establishing or re-affirming and disseminating direct language allowing youth to access FP services without parental or spousal consent.

Ethiopian policy documents acknowledge the rights of youth to receive family planning services, and the barrier that provider bias can pose. The “National Adolescent and Youth Health Strategy, 2016-2020” states: 

When adolescents and youth attempt to utilize services, they encounter unfriendly environments including breaches in confidentiality, judgmental and disapproving attitudes relating to sexual activity and substance use, and discrimination. This results in failure to provide important services and increase the vulnerability of particular groups.

The policy also outlines multiple priority actions to promote supportive attitudes by providers:

  • Build the capacity of health providers to manage and provide [Adolescent and Youth Friendly Health Services] AYFHS with a compassionate, respectful and caring manner
  • Promote supportive attitudes and behavior by health workers to better engage adolescents and youth in health care services and programs

While these statements are a positive step, the “National Adolescent and Youth Health Strategy, 2016-2020” does not explicitly instruct providers to offer youth-friendly services without judgment or bias. However, the “Standards on Youth Friendly Reproductive Health Services & Minimum Service Delivery Package on YFRH Services: Service Delivery Guideline” mandate that services be provided in adherence with the WHO definitions of adolescent-friendly health services, including:

Adolescent friendly health care providers who…are non-judgmental and considerate[,] easy to relate to and trust worthy.

Ethiopia is placed in the green category for this indicator because the policy environment includes provisions discouraging provider judgement or discrimination.

Policies reviewed thoroughly address youth’s right to access family planning (FP) services, regardless of age. The “National Guidelines for Family Planning Services in Ethiopia, 2011” underscore the right of all people to access FP care without discrimination based on age or other nonmedical criteria:

Access to services: Clients have a right to services that are affordable, are available at convenient times and places, are fully accessible with no physical barriers, and have no inappropriate eligibility requirements or social barriers, including discrimination based on sex, age, marital status, fertility, nationality or ethnicity, social class, religion, or sexual orientation.

Similarly, the “Standards on Youth Friendly Reproductive Health Services & Minimum Service Delivery Package on YFRH Services: Service Delivery Guideline” explicitly prohibit age from consideration:

Any person male or female who can conceive or cause conception regardless of age or marital status is eligible for family planning services including family planning counseling and advice.

Based on these inclusions, Ethiopia is placed in the green category for this indicator. Policy documents directly recognize the rights of young people to receive FP services.

As with policies surrounding potential age restrictions, Ethiopia has a strong policy environment supporting youth’s right to access family planning (FP) services regardless of marital status. The right to access services in the “National Guidelines for Family Planning Services in Ethiopia, 2011” includes the right to access FP services regardless of marital status. Additional language in the same policy document further emphasizes this right:

Any reproductive age person, male or female regardless marital status is eligible for Family Planning services including information, education and counseling.

The “National Guidelines for Family Planning Services in Ethiopia” also recognize the unique context of both married and unmarried adolescents, further addressing the need to provide tailored services to this population:

Married adolescents require FP services to delay and space childbirth;

Unmarried adolescents may have more than one sexual partner that predisposes them to STIs more than older people. Hence, dual use of FP method should be included in counseling sessions.

Ethiopia is placed in the green category for this indicator because relevant policies directly support married and unmarried youth receiving FP services.

Ethiopian policies support youth’s access to a full range of family planning methods regardless of age and marital status. The “Standards on Youth Friendly Reproductive Health Services & Minimum Service Delivery Package on YFRH Services: Service Delivery Guidelines” state as an objective:

To enable youth [to] have access to a range of contraceptive methods and information so that they would be able to decide on when and how they would be able to have children and get protected from unplanned pregnancy and its squeal.

These standards, further, affirm youth access to all contraceptive methods:

Ensure availability and accessibility of all types of modern contraceptives, including LARC [(long-acting reversible contraceptives)], for adolescents and youth who are sexually active. 

Ethiopia is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, it is worth noting that the policy environment in Ethiopia supports youth accessing EC. The “National Adolescent and Youth Health Strategy, 2016-2020” specifically mentions a priority intervention to distribute EC:

Increase access to quality contraceptive services, including emergency contraception, through social marketing.

The “Standards on Youth Friendly Reproductive Health Services & Minimum Service Delivery Package on YFRH Services: Service Delivery Guideline” also include EC in the package of comprehensive sexual and reproductive health services to which youth should have access.

The “National Adolescent and Youth Health Strategy, 2016-2020” includes a priority intervention related to “comprehensive life skills, family life and sexuality education” and a related target to increase access to comprehensive sexuality education (CSE) to 62.5 percent of adolescents and youth by 2020. Noting weaknesses in CSE implementation to date, the strategy identifies priority actions that touch on some of the UNFPA essential components of CSE, including reaching out-of-school and vulnerable youth. However, several of the UNFPA essential elements of CSE, such as an integrated focus on gender and ensuring scientifically accurate sexual and reproductive health information, are not addressed in these priority actions.

The “Education Sector Policy and Strategy on HIV & AIDS, 2009” provides further guidance on the provision of sexuality education. The policy includes some elements of the CSE essential components, but is limited in the breadth of instruction regarding sexuality, sexual behavior, and RH. The policy does include an integrated focus on gender:

As HIV and AIDS impacts differently on men and women due to the biological, economic and socio-cultural factors, all aspects of this policy will be applied in a way that is responsive to the different vulnerabilities and susceptibilities of men, women, boys and girls.

Additionally, the “Education Sector Policy and Strategy on HIV & AIDS” includes an emphasis on a safe and healthy learning environment:

Provide a safe and sanitary environment in schools and other learning institutions.

To create a supportive and protective learning environment in schools and other learning institutions.

Like the "National Adolescent and Youth Health Strategy," other policies suggest additional emphasis will be placed on educating Ethiopian youth regarding family planning. The “Costed Implementation Plan for Family Planning in Ethiopia, 2015/16-2020” incorporates an activity that seeks to work through the Ministry of Education (MoE) to strengthen sexuality education:

MC1.4 Advocate with the MOE to assess the capacity of schools to integrate SRH and family planning into the curriculum, including sexual education in the school health programme.

Ethiopia is placed in the yellow category for the CSE indicator. Policies directly support providing some form of sexuality education and indicate that the development of a more robust curriculum is a priority for the country.

The policy environment in Ethiopia strongly supports the provision of youth-friendly family planning (FP) services. Multiple policies reviewed incorporate youth-friendly FP services.

The “National Reproductive Health Strategy, 2006-2015” is the earliest policy reviewed that discusses the pressing need for services to be tailored to meet the needs of youth. To comprehensively address the range of health issues faced by youth in Ethiopia, the Ministry of Health broadened the scope of the most recent adolescent health policy, the “National Adolescent and Youth Health Strategy, 2016-2020.” Sexual and reproductive health remains a key feature in this policy, which seeks to increase contraceptive prevalence among youth, reduce unmet need for modern contraception, and reduce unintended adolescent pregnancy.

The “Standards on Youth Friendly Reproductive Health Services & Minimum Service Delivery Package on YFRH Services: Service Delivery Guideline” detail specific elements of youth-friendly service delivery that align with the High-Impact Practices in Family Planning core elements of service delivery:

SRH services for the youth should be provided at an affordable cost or for those who can not pay for free.

Provision of very essential services like counseling, pregnancy and HIV testing, dispensing of different contraceptive methods should be carried out as much as possible by a single service provider or in an arrangement that ensures the privacy of the youth client.

Health workers are trained to provide services in a non-judgmental and friendly way.

All three service-delivery elements of adolescent-friendly contraceptive service provision are recognized in the policies reviewed. Thus, Ethiopia is placed in the green category for this indicator.

The importance of building community support for youth family planning (FP) services features in the priority interventions of Ethiopia’s “National Adolescent and Youth Health Strategy, 2016-2020:"

  • Leverage existing community health structures to provide adolescent and youth health information and age appropriate CSE - utilize the Health Extension Program involving Health Extension Workers and Health Development Army.
  • Undertake community-based initiatives for demand creation through peers, health extension workers, counselors and others.
  • Strengthen and engage community-based forums and faith-based organizations, including religious institutions, one-to-five networks, and community support groups, in improving adolescent health.
  • Strengthen community involvement in prevention of early and unintended pregnancy.
  • Promote education of parents and the community on the health and rights of adolescents and youth.

This strategy recognizes gender inequalities and includes related priority actions:

  • Mainstream gender and address its concerns in all adolescent and youth health programs.
  • Empower adolescents to challenge gender stereotypes, discrimination and violence within peers/families, educational institutions, workplaces and public spaces.
  • Assess and identify key structural forces that affect health and drive disparities, including gender-related structural and institutional biases across sectors.

Community support for youth sexual and reproductive health is featured in other documents, including the “Standards on Youth Friendly Reproductive Health Services & Minimum Service Delivery Package on YFRH Services: Service Delivery Guideline.” Ethiopia is placed in the green category, as policy documents reviewed thoroughly address building community support for youth FP services and address gender norms.

The “Plan d’Action National de Repositionnement de la Planification Familiale en Guinée 2014-2018” notes that parental and provider judgment are common barriers to youth seeking family planning services:

S’agissant des adolescents et jeunes, ils craignent de rencontrer leurs parents et les autres adultes dans les points d’accès à la PF, jugent que leur utilisation de la PF est mal perçue par les prestataires qui préfèrent offrir les méthodes uniquement aux femmes en union.

These policies, however, do not adequately address parental or spousal consent. Therefore, Guinea is placed in the gray category for this indicator. 

The “Plan National de Développement Sanitaire 2015-2024” aims to integrate youth sexual and reproductive health services into health facilities with a specific target to reduce experiences of stigmatization or judgment among youth:

80% des ado-jeunes utiliseront les services de santé sexuelle et reproductive sans stigmatisation ni jugement

However, Guinea’s policy environment does not explicitly prohibit providers from exercising personal bias or discrimination. The “Normes et Procédures en Santé de la Reproduction 2016” uses direct language when discussing the conduct of providers in HIV/AIDS screening, stating that providers must avoid stigmatization and discrimination. For Guinea to be placed in the green category, a definitive statement, similar to that provided for HIV/AIDS services, is needed that says providers may not use personal bias and discrimination against youth in family planning services. Guinea is placed in the gray category for this indicator.

The “Loi Portant la Santé de la Reproduction 2000” states that reproductive health is a right guaranteed to all individuals regardless of age or marital status:

Article 2: Caractère universel du droit à la santé de la reproduction

Tous les individus sont égaux en droit et dignité en matière de santé de la reproduction. Le droit à la santé de la reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l'âge, le sexe, la fortune, la religion, la situation matrimoniale ou sur toute autre considération.

Further, the “Standards de Services de Santé Adaptés aux Adolescents et aux Jeunes 2013” state that youth have the right to quality health services regardless of age:

L’élaboration des présents standards de Services de Santé Adaptés aux Adolescents et Jeunes (SSAAJ) a été guidée par les principes suivants :

…Le respect des droits humains et en particulier le droit des adolescents/jeunes à l’accès aux services de santé de qualité sans aucune discrimination liée à leur âge, sexe, religion ou condition sociale.

The “Standards de Services” include contraception in the minimum package of services for adolescents and support youth access to these services regardless of age. Guinea is placed in the green category for this indicator.

The “Loi Portant la Santé de la Reproduction 2000” states that reproductive health (RH) is a right guaranteed to all individuals regardless of age or marital status:

Article 2: Caractère universel du droit à la santé de la reproduction

Tous les individus sont égaux en droit et dignité en matière de santé de la reproduction. Le droit à la santé de la reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l'âge, le sexe, la fortune, la religion, la situation matrimoniale ou sur toute autre considération.

This statement is somewhat contradicted by preceding language in the law that refers specifically to married couples when defining RH:

Par Santé de la Reproduction… elle suppose que toute personne se trouvant dans un lien de mariage peut mener une vie sexuelle satisfaisante en toute sécurité, qu'elle est capable de procréer en toute liberté. Cette dernière condition implique d'une part que les conjoints ont le droit d'être informés et d'utiliser la méthode de planification ainsi que d'autres méthodes de planification non contraires à la loi.

Because the law extends access to family planning services regardless of marital status, but places particular emphasis on the rights of married couples, it creates room for confusion in its applicability to unmarried youth. Therefore, Guinea is placed in the yellow category for this indicator.

The “Standards de Services de Santé Adaptés aux Adolescents et aux Jeunes 2013” outline the minimum package of services for adolescents, which states that all contraceptive methods should be available to youth. However, the “Standards de Services” do not define all methods as including long-acting and reversible contraceptives. Therefore, Guinea is placed in the yellow category for this indicator.

In Guinea, access to information and education about sexual and reproductive health (SRH) is a recognized right described in the “Loi Portant la Santé de la Reproduction 2000”:

Article 4 : Droit à l'information et à l'éducation
Tout individu, tout couple a le droit à l'information et à l'éducation relatif aux risques liés à la procréation et à l'efficacité de toutes les méthodes de régulation des naissances.

Several policies describe plans for introducing sexuality programming in schools. The “Plan d’Action National de Repositionnement de la Planification Familiale en Guinée 2014-2018” describes a specific activity to develop a sexuality education curriculum to introduce into schools:

Activité D3.2 : Sensibilisation sur la SSR en milieu scolaire en synergie avec les ministères en charge de l’enseignement et de l’éducation civique
Il s’agit d’introduire l’enseignement de la SSR dans les écoles à travers l’élaboration d’un module SSR et de former les enseignants. Les enseignants à leur tour travailleront avec les élèves sur des questions de SSR au moyen du module. Des dépliants comportant les messages essentiels seront élaborés pour les élèves.

One of the essential comprehensive sexuality education (CSE) components is to reach youth in formal and informal settings. The “Feuille de Route Nationale Pour Accélérer la Réduction de la Mortalité Maternelle, Néonatale et Infanto-Juvénile 2012-2016” and the “Plan Stratégique en Santé et Développement des Adolescents et des Jeunes en Guinée 2015-2019” describe plans to reach youth in and out of school with sexuality education, in addition to broader awareness campaigns to spread SRH information.

Another essential component of CSE aims to strengthen youth advocacy and civic engagement. The “Plan Stratégique” emphasizes youth participation in designing and implementing health programs, but it does not include plans for teaching youth about youth advocacy and civic engagement within a CSE program.

Guinea’s policies do not describe specific components that should be included in a sexuality education program, with the exception of reaching youth in formal and informal settings. Therefore, Guinea is placed in the yellow category for this indicator.

Guinea’s policy environment is promising in its acknowledgement of the importance of health services tailored to youth, but it does not outline all three service delivery elements of adolescent-friendly contraceptive services.

The “Standards de Services de Santé Adaptés aux Adolescents et aux Jeunes 2013” note that adolescents face provider discrimination when they seek sexual and reproductive health services. To remedy this, the “Standards de Services” include a goal to ensure that providers are trained to offer youth-friendly (YF) services:

Tous les prestataires ont les connaissances, les compétences, et les attitudes positives (requises) pour offrir des services adaptés aux besoins des adolescents et des jeunes.

The “Plan d’Action National de Repositionnement de la Planification Familiale en Guinée 2014-2018” defines a specific target to increase provider capacity for youth-friendly family planning (FP) services:

Il s’agit de renforcer les capacités des prestataires de 25% des FS [Formations Sanitaires] … pour offrir les services de PF adaptés aux adolescents et aux jeunes… en 2014 et 2015.

The “Normes et Procédures en Santé de la Reproduction 2016” describe the procedures that providers should follow when attending to youth at each level of the health system. For example, the document encourages providers to listen attentively to youth. The “Plan Stratégique National de la Santé Maternelle, du Nouveau-né, de l’Enfant, de l’Adolescent et des Jeunes 2016-2020” includes activities to strengthen the capacity of YF service providers and to combat the stigmatization that youth face when accessing services:

6.5: Santé reproductive et sexuelle des adolescents et jeunes : Amélioration de l’accès des adolescents et jeunes à des services adaptés à leurs besoins du point de vue santé, éducation, emploi et information

…Interventions :
Renforcement des capacités des prestataires en santé et développement des adolescents et jeunes y compris la lutte contre la stigmatisation des ado/jeunes dans les structures

The “Standards de Services” include a guiding principle on respect for the confidentiality and privacy of youth. However, Guinea’s policies do not adequately address the provision of no-cost or subsidized services. The “Standards de Services” include an activity to make health products affordable to adolescents, but do not specifically address the cost of FP services.

Guinea is placed in the green category for this indicator because its policies reference YF contraceptive services and include plans to address all three elements.

One of the five overarching standards described in the “Standards de Services de Santé Adaptés aux Adolescents et aux Jeunes 2013” includes planned activities for mobilizing communities around youth-friendly services, which include contraceptive services:

Standard 4 : La communauté - y compris les adolescents et les jeunes - facilite la mise en place et l’utilisation des services de santé adaptés aux adolescents et aux jeunes.

1. Les organisations à base communautaire les leaders communautaires, les enseignants, les agents communautaires/Assistants sociaux et les associations de jeunes sont mobilisées autour des PPS [points de prestation de services] pour faciliter l’utilisation des services de santé par les adolescents et les jeunes

6.  Les organisations à base communautaire, les leaders communautaires et les enseignants, les agents communautaires/Assistants sociaux et les associations de jeunes, sont orientés en vue de faciliter l’utilisation des PPS par les A&J [les adolescents et les jeunes]

7. Les leaders communautaires/parents encouragent les A&J à utiliser les SSAAJ

The “Plan Stratégique en Santé et Développement des Adolescents et des Jeunes en Guinée 2015-2019” discusses building support in communities and addressing gender norms. However, this document is not specific to youth sexual and reproductive health services, and it does not describe youth access to contraception, rather referring to youth health services in general. The “Standards de Services” make brief mention of gender mainstreaming, though not in any detail.

Because Guinea’s policies outline a detailed strategy to build community support but do not have a detailed strategy for addressing gender norms in youth access to family planning, the country is placed in the yellow category for this indicator.

Despite Kenya’s strong policy environment supporting sexual and reproductive health (SRH) services for adolescents and youth, the legal stance on parental and spousal consent for youth accessing family planning (FP) services remains noticeably weak. The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya, 2016” outline a clear strategy to improve adolescents’ access to and use of SRH services. While this document identifies laws and policies requiring parental and partner approval as a structural barrier to youth accessing SRH services, it does not make any definitive statement on the right of adolescents to access services without parental and spousal consent.

A “Reproductive Health Care Bill,” introduced in the Kenyan Senate in 2014, would have explicitly allowed for youth to freely access SRH services without parental consent. The draft of this bill states:

33.2: In the provision of reproductive health services to adolescents, parental consent is not mandatory.

If enacted, the “Reproductive Health Care Bill” would likely heighten the impact and reach of the “National Adolescent Sexual and Reproductive Health Policy, 2015” by providing the necessary legal justification for youth in Kenya to access contraceptive services as outlined in the national policy’s program strategies. In the absence of this legal recognition of youth’s rights, youth will continue to face barriers at facilities when attempting to access the contraceptive services they desire.

Kenya is placed in the gray category for parental or spousal consent. The country could move into the green category if policymakers enact the “Reproductive Health Care Bill” or another policy with a provision that recognizes youth’s right to access FP services without parental or spousal consent.

Explicit policy language directs providers to offer nondiscriminatory, unbiased care to adolescents based on medical eligibility criteria. The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya” promote five characteristics of adolescent service provision that follow the World Health Organization’s Quality of Care framework for adolescent service provision: accessible, acceptable, appropriate, equitable, and effective. The guidelines specifically address the role of the provider to offer adolescent-friendly health services, including the provision of contraception, in a manner that respects the five quality of care characteristics:

The service providers should be non-judgmental and considerate in their dealings with adolescents and youth and deliver the services in the right way.

Kenya is placed in the green category for Provider Authorization as policies direct providers to deliver nonjudgmental FP services.

The right to health services, including reproductive health (RH) services, is recognized at the highest policy level in Kenya. The 2010 Constitution of Kenya recognizes the right of all people to access RH care:

Article 43: (1) Every person has the right—(a) to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.

The “Health Act, 2017” includes the right of people of reproductive age to access family planning (FP) services:

Article 6: (1) Every person has a right to reproductive health care which includes—(a) the right of men and women of reproductive age to be informed about, and to have access to reproductive health services including to safe, effective, affordable and acceptable family planning services.

This strong declaration in favor of all people accessing health care sets the stage for equal access to health care services.

The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya, 2016” recognize adolescents’ right to access services independent of their age or marital status, including FP and contraceptive services as a subset of services under the “Minimum Initial Service Package (MISP) for Reproductive Health.” Under the MISP operational guidelines, health providers are directed as follows:

Health staff should be aware that adolescents requesting contraceptives have a right to receive these services, regardless of age or marital status.

This explicit recognition of adolescents’ right to contraception regardless of age is a critical step toward addressing the barriers many youth encounter when trying to access these services. As such, Kenya is placed in the green category for Restrictions Based on Age.

The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya, 2016” recognize adolescents’ right to access services independent of their age or marital status, including access to family planning (FP) services and contraception. FP and contraceptive services are included in these guidelines as a subset of services under the “Minimum Initial Service Package (MISP) for Reproductive Health.” Under the MISP operational guidelines, health providers are directed as follows:

Health staff should be aware that adolescents requesting contraceptives have a right to receive these services, regardless of age or marital status.

Kenya is placed in the green category for this indicator because the “National Guidelines for Provision of Adolescent and Youth Friendly Services, 2016” make a clear provision for youth to access family planning services regardless of marital status.

Adolescents and youth in Kenya can access a full range of contraception under existing policies. The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya” include contraception as a component in the essential package of service offerings for adolescents:

Contraception counselling and provision of full range of contraceptive methods, including long-acting reversible methods.

The “National Family Planning Guidelines for Service Providers 2010” state that women of reproductive age and any parity are eligible to receive contraceptive pills with no extra caution and are eligible to receive an intrauterine device, implant, or injectable with extra precaution and monitoring:

Generally provide after careful counselling on range of methods available. 

The “National Family Planning Guidelines for Service Providers 2010 align with the World Health Organization’s medical eligibility criteria guidelines. Therefore, Kenya is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that under these guidelines, all women are eligible to receive EC:

ECPs are safe and appropriate for all women.

The Cabinet Secretaries of the Ministries of Education and Health have jointly signed a new “Kenya School Health Policy, 2018,” but as of April 2019, it had not been launched. Until its launch, Kenya is governed by the “National School Health Policy, 2009,” which seeks to “address the health and education needs of learners, teachers, and their families.” The policy does not include a standalone comphrehensive sexuality education (CSE) program but rather integrates components of CSE in the Gender Issues strategy (Section 4.2). The 2009 policy includes two guiding principles, “Safety in Learning Institutions” and “Gender Responsiveness,” that recognize the importance of a safe and healthy physical and psychosocial learning environment for children and integrate a focus on gender—two of the nine United Nations Population Fund (UNFPA) essential components of CSE. Further, the Gender Issues strategy recognizes the effects of gender inequity in education and includes steps that apply cultural relevance in tackling human rights violations and gender inequality—another UNFPA essential component of CSE:

There are several gender related issues that affect learning. Girls may fail to attend school or fail to concentrate in school if not supported during their menses. Furthermore, cultural responsibilities for boys and girls may lead to school drop-out.

References to sexuality education are vague in the 2009 policy. The most relevant section, “Early/Unprotected sexual activity” alludes to protectionist educational opportunities, such as abstinence, to learn about avoiding sexual situations but does not explicitly mention enabling educational practices, such as linking youth to sexual and reproductive health (SRH) services or informing youth about contraception. The activities included in this section are:

The design and production of educational materials shall be done in collaboration with Ministry of Education—KIE and Ministry of Public Health and Sanitation (MOPHS).

The adolescent reproductive health materials developed through MOPHS shall be reviewed for relevance in the various school classes’ grades.

Schools shall equip students with adequate skills to avoid situations that would lead to teenage pregnancy, rape and sodomy.

All children, including those with special needs and disability, shall be protected from sexual violence and abuse.

Students shall be taught and instilled with skills to avoid health risks, including rape.

Students shall be taught about the consequences of involving themselves in sexual activities as these may lead to pregnancy, disease, infertility etc.

A more recent policy, the “National Adolescent Sexual and Reproductive Health Policy, 2015” includes more direct CSE guidance for educating youth. CSE is defined as:

Age-Appropriate Comprehensive Sexuality Education is an age-appropriate, culturally relevant approach to teaching about sexuality and relationships by providing scientifically accurate, realistic and non-judgmental information. Sexuality education provides opportunities to explore one’s own values and attitudes as well as build decision-making communication and risk reduction skills about many aspects of sexuality.

The guidelines in the “National Adolescent Sexual and Reproductive Health Policy, 2015” and the "National Adolescent Sexual Reproductive Health Policy Framework, 2017-2021" lay out a vision for sexuality education in the country, including elements such as reaching in-school and out-of-school youth, using medically accurate information, and training health care providers to provide SRH information. Further, the “National Guidelines for Provision of Adolescent Youth Friendly Services in Kenya, 2016” present a framework for youth-friendly service delivery based at schools. Included in this framework are components such as life skills education on decisionmaking, negotiation, self-assurance, and communication, as well as an emphasis on school discussions surrounding the topic of sexual assault. None of these guidelines, however, covers all nine essential components of CSE.

The finalized version of the “Kenya School Health Policy, 2018,” which cannot be considered binding until its launch, addresses several of the UNFPA essential components for CSE: recognition of international and national equal rights to health, including RH; an integrated focus on gender; access and links to SRH information and services; a safe and healthy learning environment; and cultural relevance. However, the remaining four essential CSE elements are not clearly addressed in the policy: scientifically accurate information; participatory teaching methods; youth advocacy and civic engagement; and connections to the informal sector. Given that the "Kenya School Health Policy, 2018" is not likely to incorporate new language addressing these elements before it's launch, the policy environment surrounding CSE in Kenya is considered promising but incomplete, and the country has been placed in the yellow category.

Kenya has an inclusive and supportive policy environment for the provision of sexual and reproductive health (SRH) services to both youth and adolescents, incorporating the three service-delivery core elements of adolescent-friendly contraceptive services discussed in the HIPs "Adolescent Friendly Contraceptive Services" review. The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya, 2016” recognize the health and human rights of young people. The guidelines explicitly address the high cost of services as a barrier to youth seeking family planning services:

All adolescents and youth should be able to receive health services free of charge or are able to afford any charges that might be in place.

The “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya” recognize and address the challenges providers face when balancing personal beliefs with the provision of SRH care to youth:

Health service providers report being torn between personal feelings, cultural and religious values and beliefs and their wish to respect young people’s rights to accessing and obtaining SRH services. Training of service providers should address service provider attitudes and beliefs, and improve provider knowledge of normal adolescent development and special characteristics of adolescent clients and skills—both clinical and counselling.

The guidelines for health provider training further reference offering nonjudgmental and private contraceptive services:

Health service providers should receive both pre- and in-service training on but not limited to:

  • Essential package for AYFS
  • Value clarification and attitude transformation (VCAT) training on adolescent and youth sexuality and provision of services such as contraception
  • Characteristics of adolescent growth and development (including neurobiological, developmental and physical) which impact health
  • Privacy and confidentiality

The “National Adolescent Sexual Reproductive Health Policy Framework, 2017-2021” also outlines several planned activities to expand and improve provider training on adolescent and youth friendly services. Since the policy environment addresses the three core elements of youth-friendly service provision, as outlined in the HIPs recommendation, Kenya is placed in the green category.

Thematic Area 5 of Kenya’s “National Family Planning Costed Implementation Plan, 2017-2020” outlines several activities to promote family planning (FP) within the community, one of which targets support for adolescent sexual and reproductive health:

Activity DC 2. Adaptation of a multisectoral/stakeholder approach in provision of accurate and consistent information on FP to communities.

DC 2.1.3. FP coordinators to support adolescents and youth to promote FP among peers.

The “National Adolescent Sexual and Reproductive Health Policy 2015” states an objective to “promote adolescent sexual and reproductive health and rights” and includes specific actions relevant to building community support and addressing gender norms:

Promote education of parents and the community on Sexual and Reproductive Health and Rights of adolescents

Mainstream gender and address its concerns in all ASRH programs.

Both of these actions are further detailed in “The “National Adolescent Sexual Reproductive Health Policy Framework, 2017-2021.” Additionally, the “National Guidelines for Provision of Adolescent and Youth Friendly Services in Kenya” recognize the compounding impact of gender norms for youth accessing FP:

Gender inequities and differences that characterize the social, cultural and economic lives of the young people influence their health and development. Thus, adolescents and youth friendly reproductive and sexual health services must promote gender equality

All three policies seek to create an enabling social environment for youth FP, placing Kenya in the green category for this indicator.

The “Loi n° 2011-087 du 30 décembre 2011 Portant Code des Personnes et de la Famille” states that wives must obey their husbands and that husbands are the head of the family.

Article 316 : Dans la limite des droits et devoirs respectifs des époux consacrés par le présent Code, la femme doit obéissance à son mari, et le mari, protection à sa femme.

Article 319 : Le mari est le chef de famille. Il perd cette qualité au profit de la femme en cas :

  • d'absence prolongée et injustifiée ;
  • de disparition ;
  • d'interdiction ;
  • d'impossibilité de manifester sa volonté.

Le choix de la résidence de la famille appartient au mari. La femme est tenue d’habiter avec lui et il est tenu de la recevoir.

Ce choix doit se faire dans l’intérêt exclusif du ménage.

Les charges du ménage pèsent sur le mari. La femme mariée qui dispose de revenus peut contribuer aux charges du ménage.

However, the “Politique et Normes des Services de Santé de la Reproduction 2005” state that contraceptive users, including adolescents, should not be required to seek parental or partner consent:

Les bénéficiaires des services de contraception sont les hommes, les femmes en âge de procréation et en particulier les femmes jeunes sans enfant, les grandes multipares, les personnes à comportement à risque de IST-VIH/SIDA, les malades mentaux et les jeunes adultes. Les méthodes de contraception devront être offertes à tous les bénéficiaires qui en feront le choix, sans exiger l'autorisation ou le consentement parental ou marital.

Due to conflicting policy documents surrounding spousal consent, Mali is placed in the yellow category for this indicator. The discrepancy in the policies adds a barrier to youth attempting to access family planning without parental and spousal consent. To improve the policy environment, policymakers should include specific provisions for youth to access family planning services without consent from a parent or spouse.

The “Plan d’Action National de Planification Familiale du Mali 2014-2018” acknowledges that provider attitudes are a critical barrier to youth seeking contraceptive services, particularly young women and unmarried women. However, the “Plan d’Action” does not say explicitly that providers must avoid exercising bias and discrimination toward youth. Mali is placed in the gray category for this indicator.

The “Politique et Normes des Services de Santé de la Reproduction 2005” states that young women are primary beneficiaries of contraceptive services:

Les bénéficiaires des services de contraception sont les hommes, les femmes en âge de procréation et en particulier les femmes jeunes sans enfant, les grandes multipares, les personnes à comportement à risque de IST-VIH/SIDA, les malades mentaux et les jeunes adultes. Les méthodes de contraception devront être offertes à tous les bénéficiaires qui en feront le choix, sans exiger l'autorisation ou le consentement parental ou marital.

Therefore, Mali is placed in the green category for this indicator.

The “Loi n° 02-044 Relative à la Santé de la Reproduction 2002” states that all individuals and all couples are guaranteed access to reproductive health:

Article 3 : Les hommes et les femmes ont le droit égal de liberté, de responsabilité, d'être informés et d'utiliser la méthode de planification ou de régulation des naissances de leur choix, qui ne sont pas contraires à la loi.

Article 4 : Tout individu, tout couple a le droit d'accéder librement à des services de santé de reproduction et de bénéficier des soins de la meilleure qualité possible.

The “Plan d’Action National de Planification Familiale du Mali 2014-2018” discusses the stigma that unmarried adolescents face when seeking contraceptive services:

Quant aux adolescents et jeunes non en union, ils craignent de rencontrer leurs parents et les autres adultes au niveau des points d’accès de la PF et jugent que leur utilisation de la PF est mal perçue par les prestataires qui préfèrent offrir les méthodes uniquement aux femmes en union.

The “Plan d’Action” interprets the “Loi” as a guarantee for access to contraceptives by unmarried women and adolescent women:

L’accès libre aux contraceptifs pour les femmes non en union et les adolescentes garanti par la loi sur la santé de la reproduction.

Because Mali’s policies support access to contraceptives for unmarried youth, Mali is placed in the green category for this indicator.

The “Programme de Développement Socio-Sanitaire 2014-2018” affirms the need to make all methods available to youth:

Extrant 1-3-2. Développement d’interventions spécifiques pour renforcer la continuité de l’offre de services PF de qualité notamment l’utilisation des méthodes de longue durée, l’augmentation de la demande des services de la PF et la facilitation de l’accès des femmes, des hommes, des jeunes et adolescents aux services de PF.

The “Politique et Normes des Services de Santé de la Reproduction 2005” describe the reproductive services that are required to be available to adolescents, which include a full range of short- and long-acting contraceptive options.

These policies support youth access to contraception, including long-acting and reversible contraceptives, regardless of age. Therefore, Mali is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that the “Politique et Normes” includes EC in the general list of contraceptive methods, but not in the adolescent-specific sexual and reproductive health section. Thus, it is not clear whether the policy intends for EC to be accessible to youth.

The “Loi n° 02-044 Relative à la Santé de la Reproduction 2002” guarantees information and education on contraception:

Article 12 : Sont également autorisées, l’information et l'éducation concernant la contraception dans le respect de l'ordre public sanitaire et de la morale familiale.

The “Plan d’Action National de Planification Familiale du Mali 2014-2018” includes activities to reach in-school and out-of-school youth with sexuality education, one of the essential components of comprehensive sexuality education (CSE):

Activité D3a.2: Sensibilisation sur la santé sexuelle et reproductive et la planification familiale en milieu scolaire en synergie avec le ministère de l’éducation nationale

Activité D3a.3: Développement d’une synergie avec les associations culturelles et sportives de jeunes du secteur informel et du milieu rural pour la sensibilisation sur les questions de Santé Sexuelle Reproductive et la Planification Familiale (SSR/PF)

Similarly, the “Guide for Constructive Men’s Engagement in Reproductive Health 2008” describes strategies for educating youth in sexual and reproductive health in informal and formal settings:

Objective:
To increase the number of adolescents and young adults trained and sensitized in sexual and reproductive health who adopt positive behaviors within the community.

Strategies:
…Develop innovative initiatives that promote RH within formal and informal education systems
…Encourage sex education dialogue within the family

The “Politique et Normes des Services de Santé de la Reproduction 2005” include activities for family life education and population education in schools and in neighborhoods.

The “Plan d’Action” describes a specific activity to improve youth advocacy, one of the nine essential components of CSE, by strengthening partnerships with youth groups working in family planning. However, this is not described as a component of a CSE program.

Mali is placed in the yellow category because its policy environment supports the provision of sexuality education, but it does not describe the components that should be included in a CSE program.

The “Plan d’Action National de Planification Familiale du Mali 2014-2018” notes the importance of youth-friendly (YF) services:

Stratégie O3 : Renforcement des services PF destinés aux adolescent(e)s et jeunes

Le diagnostic a permis de remarquer que dans la majorité des services de PF, les spécificités des jeunes ne sont pas prises en compte. Il s’agit de mieux les intégrer à travers des interventions mieux adaptées à leurs besoins en matière de SSR/PF.

The “Plan d’Action” includes a specific activity to train providers in YF services:

Activité O3.1 : Formation des prestataires de 25% des FS [Formations Sanitaires] pour offrir des services de PF adaptés aux adolescents et aux jeunes

While the “Plan d’Action” briefly describes provider judgment as a barrier, it does not connect the training of providers to the issue of judgment. Therefore, it is not clear whether the training would include changing providers’ attitudes and preventing judgment toward youth. The “Plan d’Action” discusses cost as a barrier to youth access to contraceptives and includes an activity to seek funding to cover the cost of services for adolescent girls and poor women:

Stratégie E3 : Plaidoyer pour l’adoption d’une politique de tiers payant au cours de l’offre des services de PF aux adolescentes et aux femmes démunies

The “Plan d’Action” describes the barrier that lack of confidentiality poses for women seeking contraception, but it does not describe plans to improve confidentiality and privacy among youth seeking contraceptive services. The “Guide for Constructive Men’s Engagement in Reproductive Health 2008” does discuss confidentiality:

Objective:
To increase the number of adolescents and young adults trained and sensitized in sexual and reproductive health who adopt positive behaviors within the community.

Strategies:
…Reinforce a climate of trust and confidentiality with teenagers and youth when they access RH services.

Mali is placed in the yellow category because its policies reference YF family planning services but do not adequately address all three service delivery elements.

The “Programme de Développement Socio-Sanitaire 2014-2018” includes a plan to engage parents through developing a training curriculum on communicating with adolescents about sexual and reproductive health:

Afin de promouvoir la planification familiale au Mali, le MPFFE [Ministère de la Promotion de la Femme, la Famille et l’Enfant] se propose de sensibiliser les membres des communautés sur la santé de la reproduction et la planification familiale ainsi que de diffuser la politique de la législation relative à la SR…Un plan intégré de communication pour le repositionnement de la PF sera élaboré et un curriculum de formation des parents sur la communication avec les enfants et les ados sur la SR développé.

The “Plan d’Action National de Planification Familiale du Mali 2014-2018” describes engaging the community to promote FP in youth centers:

Activité D3a.4: Développement d’un partenariat avec les communes pour la promotion de la SR et la Planification Familiale chez les adolescentes et jeunes dans les centres d’encadrement des jeunes

…Plaidoyer en direction des responsables des communes chargés d’encadrer les jeunes,
…Organisation des ateliers régionaux de 2 jours pour le renforcement des capacités de 200 encadreurs de jeunes dans les communes.

However, the existing evidence on youth centers shows that, as an intervention, it is not particularly effective in increasing youth contraceptive use. The “Plan d’Action” includes detailed activities for engaging community leaders on family planning (FP) but those activities are not specific to youth FP access. The “Plan d’Action” and the “Guide for Constructive Men’s Engagement in Reproductive Health 2008” discuss detailed activities for reaching youth in their communities with services and information; however, these policies do not discuss building support among other members of the community.

The “Plan d’Action” includes activities to address some of the gender norms that act as a barrier to women accessing contraception, such as financial dependence:

Activité D3a.5: Mise en place des interventions permettant de renforcer le pouvoir économique et décisionnel des adolescentes et jeunes

Les questions de prise de décision en matière de santé de la reproduction étant influencées par le pouvoir économique de la femme et leur capacité à prendre une décision éclairée, il est important d’aider les adolescentes et les jeunes filles à s’instruire mais aussi à avoir des sources de revenus financiers pouvant leur permettre d’être autonomes financièrement.

Mali’s policy environment adequately addresses gender norms. However, Mali does not include detailed activities for engaging the community to support youth access to FP. Therefore, Mali is placed in the yellow category for this indicator.

The “Plan d’Action en Faveur de l’Espacement des Naissances 2014-2018” acknowledges the parental and provider stigma that youth, especially unmarried young women, face when seeking family planning (FP) services:

S’agissant des adolescents et jeunes, ils craignent de rencontrer leurs parents et les autres adultes dans les points d’accès à la PF, jugent que leur utilisation de la PF est mal perçue par les prestataires qui préfèrent offrir les méthodes uniquement aux femmes en union.

However, no law or policy exists that prohibits parental or spousal consent for youth access to FP services. Mauritania is placed in the gray category for this indicator.

Although the “Plan d’Action en Faveur de l’Espacement des Naissances 2014-2018” acknowledges the issue of parental and provider stigma toward youth seeking family planning services (see Parental and Spousal Consent), no law or policy exists explicitly stating that providers must avoid discrimination or bias towards youth. Mauritania is placed in the gray category for this indicator.

The “Projet de Loi Relative à la Santé de la Reproduction 2017” states that all individuals, including adolescents, are equal in dignity and rights related to reproductive health; it also prohibits discrimination based on age:

Article 7

Tous les individus, y compris les adolescents et les enfants, tous les couples sont égaux en droit et en dignité en matière de santé de la reproduction.

Le droit à la santé de la reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie.

Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l’âge, le sexe, la fortune, la couleur, la religion, l’ethnie, la situation matrimoniale ou sur toute autre situation.

Mauritania is placed in the green category for this indicator.

The new “Projet de Loi Relative à la Santé de la Reproduction 2017” states that all individuals, including adolescents, are equal indignity and rights related to reproductive health and prohibits discrimination based on marital status:

Article 7

Tous les individus, y compris les adolescents et les enfants, tous les couples sont égaux en droit et en dignité en matière de santé de la reproduction.

Le droit à la santé de la reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie.

Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l’âge, le sexe, la fortune, la couleur, la religion, l’ethnie, la situation matrimoniale ou sur toute autre situation.

Mauritania is placed in the green category for this indicator.

The “Projet de Loi Relative à la Santé de la Reproduction 2017” includes “family planning/birth spacing” among reproductive health care services. The “Projet de Loi” states that all people, including adolescents, must receive information and education on all methods of birth spacing:

Article 9
Tout couple, toute personne y compris les adolescents et les enfants, a droit à l’information, à l’éducation concernant les avantages, les risques et l’efficacité de toutes les méthodes d’espacement des naissances.

While the law guarantees information and education on all methods of birth spacing, it does not guarantee youth access to a range of contraceptive methods, including long-acting and reversible contraceptives.

Further, the “Guide de Planification Familiale – Espacement des Naissances, Edition révisée en avril 2008,” which includes protocols for providing each contraceptive method, states that oral contraceptives are the best method for adolescents and that the intrauterine device (IUD) should be avoided:

4. AUTRES FEMMES A RISQUE
…Adolescente : la contraception orale constitue la meilleure méthode ; conseiller également l'utilisation du préservatifs si partenaires multiples et éviter surtout le DIU.

Future updates to the document should align with the World Health Organization’s medical eligibility criteria for contraceptive use. A more recent document, “Guide de la Pratique Sage-Femme en Mauritanie 1ére Edition 2014,” states that IUDs and implants are acceptable for young women, and that IUDs are acceptable for nulliparous women:

Plusieurs études ont démontré que les méthodes contraceptives de longue durée sont plus efficaces que celles de courte durée.

Le DIU et l’implant sont donc des méthodes contraceptives intéressantes, même pour les jeunes femmes. Contrairement à une certaine idée reçue, le DIU n’est pas uniquement indiqué chez les femmes ayant eu un enfant.

The “Plan d’Action en Faveur de l’Espacement des Naissances 2014-2018” notes that decisionmakers in Mauritania prefer to use the concept of birth spacing rather than family planning because of cultural and religious beliefs that contraception should only be available to married women. The policy notes that these beliefs lead to the stigmatization of family planning for unmarried youth:

Certains décideurs estiment que les méthodes modernes ou la PF en général va contre les préceptes religieux ou que la PF est dictée par la société occidentale. Le concept planification familiale n’est pas officiellement utilisé en Mauritanie. Les politiques et les acteurs clés lui préfèrent l’expression espacement des naissances. Un grand nombre de décideurs estiment que les méthodes contraceptives sont réservées uniquement aux femmes en union et pas aux adolescentes et jeunes non mariées. Ces perceptions conduisent à des attitudes de négligence ou de propagation des messages contre l’adoption de la PF ou incitent certaines couches de la population à utiliser des méthodes contraceptives dans la clandestinité.

Because the policy environment does not consistently guarantee access to a full range of methods for youth, Mauritania is placed in the red category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that EC is included in the “Guide de Planification Familiale – Espacement des Naissances, Edition révisée en avril 2008,” but it is not included in the recommended methods for youth. The “Guide de la Pratique Sage-Femme en Mauritanie 1ére Edition 2014” does not include EC because it is focused on LARC methods.

Mauritania’s policies support the provision of sexuality education for youth. The “Plan d’Action en Faveur de l’Espacement des Naissances 2014-2018” includes activities to reach youth in and out of school with SRH education and information:

Activité D3.2 : Sensibilisation sur la SSR en milieu scolaire en synergie avec le ministère de l’éducation nationale.

L’introduction de l’enseignement de la SSR dans les écoles à travers l’élaboration d’un module SSR en français et en arabe et la formation des enseignants a été envisagée.

Activité D3.4 : Développement d’une synergie avec les associations culturelles et sportives de jeunes du secteur informel et du milieu rural sur les questions de SSR.

Les associations culturelles et sportives ont sous leurs influences un grand nombre de jeunes non scolarisés. Elles pourraient alors servir de canal pour faire passer des messages spécifiques de SSR/PF en faveur de ces jeunes.

Mauritania is placed in the yellow category because its policy environment supports sexuality education but does not reference all nine of the United Nations Population Fund essential components of comprehensive sexuality education.

Mauritania’s policy environment acknowledges the importance of youth-friendly (YF) sexual and reproductive health (SRH) services. The “Programme National de Santé de la Reproduction: Projet de Plan d’Action 2007” includes specific activities to pilot and study the feasibility of YF SRH services. The “Programme National de Santé de la Reproduction: Plan Stratégique SR 2008-2012” aims to increase the supply of YF SRH services. It addresses training providers on specific communication techniques with youth and offering youth certain family planning methods (condoms, pills, and emergency contraception):

RESULTAT ATTENDU 2: L´offre et l´utilisation des services de SSRAJ est augmenté

ACTIONS 2

  • Former les prestataires en techniques spécifiques de communication avec les A et J.
  • …Faciliter l’accès des AJ à la contraception (méthodes adaptées (préservatif, pilule, contraception d’urgence…)

The “Plan d’Action en Faveur de l’Espacement des Naissances 2014-2018” includes a specific activity to train providers to offer YF services:

Activité O5.1 : Renforcement des capacités des prestataires de 25% des FS pour offrir les services de PF adaptés aux adolescents et aux jeunes.

However, because the policies do not address confidentiality and privacy or cost and therefore do not cover all three of the service delivery elements of YF family planning services, Mauritania is placed in the yellow category for this indicator.

The “Programme National de Santé de la Reproduction: Projet de Plan d’Action 2007” includes among its sexual and reproductive health (SRH) goals for youth a briefly described activity to reach out leaders and to mobilize the community:

2.4 Développer des actions de plaidoyer auprès des autorités et des leaders et de mobilisation sociale au niveau de la communauté

The “Programme National de Santé de la Reproduction: Plan Stratégique SR 2008-2012” aims to promote adolescent SRH among political, religious, and traditional leaders:

Plaidoyer auprès des leaders politiques, religieux, traditionnels pour la promotion de la SR des A et J

The adolescent SRH goals within the “Programme National” include an action to address age at first marriage and harmful traditional practices. However, detail is not provided beyond that action.

The “Plan d’Action en Faveur de l’Espacement des Naissances 2014-2018” includes a detailed activity to mobilize community members around FP; however, it is not specific to youth.

Because a detailed strategy for building an enabling social environment for youth family planning services, including addressing gender norms, is not described, Mauritania is placed in the yellow category for this indicator.

None of the policy documents reviewed for Niger include language addressing parental or spousal consent. The lack of policy language supporting youth access to family planning (FP) services without these authorizations creates a potential barrier for youth in Niger interested in accessing contraception. To improve the policy environment, policymakers should consider including specific provisions for youth to access FP services without consent from a parent or spouse. Niger is placed in the gray category for this indicator.

Niger’s policy environment does not address provider authorization. Niger is placed in the gray category for this indicator.

Nigerien law recognizes the rights of all people to receive SRH care broadly. Article 2 of the 2006 law on reproductive health (RH), “Loi Sur la Santé de la Reproduction au Niger, 2006” acknowledges that RH is a universal human right and should be free from discrimination, including discrimination based on age or marital status:

Article 2 - Caractère universel du droit à la santé de la reproduction. Tous les individus sont égaux en droit et en dignité en matière de santé de la reproduction. Le droit à la santé de la reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l'âge, le sexe, la fortune, la religion, l'ethnie, la situation matrimoniale ou sur toute autre situation.

Niger is placed in the green category for this indicator.

While the “Loi Sur la Santé de la Reproduction au Niger, 2006” makes a declarative statement supporting the rights of all people, regardless of age or marital status, to receive reproductive health (RH) care, the following article emphasizes the right of legally married couples to RH:

Article 3 – Autodétermination
Les couples et les individus ont le droit de décider librement et avec discernement des questions ayant trait à la santé de la reproduction dans le respect des lois en vigueur, de l'ordre public et des bonnes mœurs. Les couples légalement mariés peuvent décider librement et avec discernement de l'espacement de leurs naissances et de disposer des informations nécessaires pour ce faire, et du droit d'accéder à la meilleure santé en matière de reproduction.

Additionally, while the “Planification Familiale au Niger: Plan Operationnel 2018” acknowledges that the use of contraceptive methods by young unmarried women is negatively perceived by the public, it states that such a perception does not align with the country’s adolescent and youth sexual and reproductive health (SRH) vision. However, the Plan does not offer any further details:

La jeune femme célibataire utilisant une méthode contraceptive est mal vue par la population ce qui est contraire à la vision SSRAJ (Santé sexuelle et reproductive des adolescents et des jeunes);

This emphasis on legally married couples stands in contrast to the rest of the law, which extends reproductive rights, including family planning (FP), to all individuals. To address this discrepancy, the government should clarify policy language supporting access to FP services by married and unmarried couples and individuals, including youth. Furthermore, the government should provide specific policy language regarding its adolescent and youth SRH vision, and particularly the right of young unmarried women to access and use contraceptive methods. Thus, Niger is placed in the yellow category for this indicator.

Niger’s policy environment does not discuss extending access to a full range of family planning methods to youth. Niger is placed in the gray category for this indicator.

Activity 1.1.19 of the “Planification Familiale au Niger: Plan d’action, 2012-2020” briefly references strengthening FP education for high school students through the home economics curriculum.

Renforcer l'enseignement de la PF au cours d'économie Familiale dans les CES

Recognizing the need for family planning education demonstrates a level of policy commitment on this issue. However, the policy fails to include specific guidelines on the content of the material and how the lessons should be instructed, nor coverage for young people outside of this specific course. FP demand-generation objective 3 of the “Planification Familiale au Niger: Plan Operationnel 2018” aims to reinforce the adolescent and youth FLE program.

Objectif CD 3 : Renforcer le programme d'éducation à la vie familiale des adolescents et jeunes

Définition de l’Objectif : La majorité des adolescents et jeunes n’ont pas d’informations précises et approfondies sur les questions de procréation et de préparation à la gestion future de la vie familiale. Le MSP va travailler à préparer les adolescents et jeunes à la parenté responsable. Il formera les adolescents et jeunes à travers les canaux propices (mise à échelle de la formation sur les curricula en milieu scolaire, etc.). Il les sensibilisera dans les villages, au niveau des centres de promotion des jeunes, les ‘’Makarantas’’, ‘’les Fada’’, les centres de formation des jeunes pour apprendre et discuter de la PF.

The 2018 Plan offers more details about program approach compared to the 2012-2020 Plan. Examples of such details include a focus on preparing adolescents and youth for responsible parenting and a mention of implementation of activities in settings outside of schools (villages, youth promotion centers, youth training centers, etc.). However, the policy lacks content specificity and directives for instruction. It also does not reference all nine of the UNFPA essential components of CSE. Given this omission and limited details, the country is placed in the yellow category for this indicator.

The “Planification Familiale au Niger: Plan Operationnel 2018” identifies youth as a priority population and includes a service access objective targeting youth.

Objectif AS 2 : Augmenter les points d’accès aux services de SR/PF pour les adolescents et jeunes en milieux scolaire et extrascolaire.

Définition de l’Objectif : Les jeunes ont des besoins spécifiques en matière de planification familiale qui ne sont pas suffisamment pris en compte alors qu’ils sont plus exposés à des pratiques à risque en matière de santé sexuelle et de reproduction. Le MSP cherche à accroître la disponibilité de points d’accès aux services de planification familiale adaptés à leurs besoins. Il renforcera davantage les capacités des prestataires en approche jeunes à tous les niveaux pour offrir aux jeunes et aux adolescents, des services de planification familiale et des soins de santé de la reproduction de qualité.

The objective highlights the government’s commitment to increasing the availability of family planning (FP) service access points tailored to the needs of youth and indicates that building the capacity of service providers in a “youth approach” will be prioritized. The policy does not mention enforcing confidentiality and audio/visual privacy, nor does it suggest an intention on the government’s part to offer free or subsidized services.

Because the policies do not cover all three of the service-delivery elements of youth-friendly FP services, Niger is placed in the yellow category for this indicator.

The “Planification Familiale au Niger: Plan d’Action, 2012-2020” includes a family planning (FP) communications intervention, Activity 2.1.2, that targets multiple stakeholder groups, including youth:

Renforcer la communication à travers le marketing social et le partenariat avec les leaders religieux et traditionnels, les élus locaux, les ONG et associations, les groupements féminins et les jeunes chaque année dans les huit régions du pays.

However, no further details exist regarding the purpose of the communication materials or activities within the intervention. It is unclear if the activity will contribute to building community support for youth access to FP services.

The “Planification Familiale au Niger: Plan Operationnel 2018” includes a demand-generation objective to increase the number of opinion leaders and champions in support of FP:

Objectif CD 1 : Augmenter le nombre de leaders d'opinion Champions de la PF

Définition de l’Objectif : Les leaders d'opinion sont des modèles pour la société. Ils pourront contribuer à la promotion de la PF en parlant publiquement de ses bénéfices pour le bien-être des communautés. Le MSP va identifier plus de leaders d'opinion afin qu'ils soutiennent activement et plaident pour les programmes de PF. Il va former les leaders et les outiller avec des données probantes sur la valeur de la PF pour en faire des Champions.

The Plan outlines a priority action that focuses on creating FP champions within several community groups:

Identifier et former en plaidoyer et IEC/CCC des champions PF au niveau des institutions, religieux, sociétés civiles, secteurs privés, jeunes

However, while both the objective and priority action described above suggest an intention to increase community support for FP services, it is not evident that the focus is on increasing community support for youth access to FP services in particular.

In the absence of this information and mention of addressing gender norms, the country is placed in the gray category, subject to updating if further policy documents provide additional information regarding the content of this intervention.

There is no mention of parental or spousal consent in available policies. The absence of this topic in the policies reviewed suggests that either guidelines exist in policies not available to reviewers or that Nigeria has not taken an official stance on the matter. The ambivalence of the legal framework on youth’s right to freely and independently access family planning services creates a barrier for youth accessing such services. Nigeria is placed in the gray category for this indicator.

The “National Guidelines on Promoting Access of Young People to Adolescent and Youth-Friendly Services in Primary Health Care Facilities in Nigeria, 2013” promote the right of young people to access general health services without provider discrimination:

This document recognizes the rights of all young people, irrespective of gender, social class, ethnicity, religion, political belief, health status, sexual orientation, and other social and related factors to quality health services. As such, it recognizes that duty bearers have a responsibility to offer health services that are relevant to all young people without any discrimination.

While the document underscores health providers’ obligation to serve youth without discrimination, it does not explicitly mention family planning (FP) services. Further acknowledgment of providers’ duty to offer FP services to youth without discrimination or bias is necessary to ensure a comprehensive policy environment that supports youth access to contraception. Nigeria is placed in the gray category for this indicator.

Several key policies acknowledge clients’ rights to access sexual and reproductive health (SRH) services regardless of age. The “National Reproductive Health Policy, 2017” states:

All Nigerians, irrespective of their gender and age including adolescents from age 10 years and older population, have sexual and reproductive rights, and are equally entitled to sexual and reproductive health development and care.

The “National Family Planning/Reproductive Health Service Protocols, Revised Edition, 2010” directs service providers to inform every client of his or her right to:

Access—obtain services regardless of age, sex, creed, colour, marital status, or location.

This recognition of the rights of all people to access family planning services is critical to address the barriers women of all ages frequently face when attempting to access contraception. Nigeria is placed in the green category for this indicator.

Although a final copy of the approved policy could not be located, a draft version of the “National Health Policy, 2016” took an expansive approach to SRH services for youth:

The Goal: To reduce maternal, neonatal, child and adolescent morbidity and mortality in Nigeria, and promote universal access to comprehensive sexual and reproductive health services for adolescents and adults throughout their life cycle.

However, another Nigerian policy document includes an age definition that may constrain access to services among adolescents. The “Second National Youth Policy Document of the Federal Republic of Nigeria, 2009” confirms the right of youth to access reproductive health, but defines youth as ages 18 to 35, noting that the age range of 15 to 24 “is too narrow for countries like Nigeria.”

The “National Family Planning/Reproductive Health Service Protocols, Revised Edition, 2010” acknowledge clients’ rights, including the right to access services. Service providers are directed to inform every client of his or her right to:

Access—obtain services regardless of age, sex, creed, colour, marital status, or location.

This recognition of the rights of all people to access family planning services, regardless of marital status, is critical to address the barriers women frequently face when attempting to access contraception. Nigeria is placed in the green category for this indicator.

The “National Training Manual for the Health and Development of Adolescent and Young People in Nigeria 2011” discourages providers from recommending certain nonpermanent method options, even though they have been deemed safe for general use by the World Health Organization:

Other methods of contraception are available, but they are often not recommended for youths who have never had children. These methods include Intra-Uterine Devices (IUD), Injectables (Depo-Provera and Noristerat), Tubal ligation, Vasectomy.

The same document further lists three methods deemed most appropriate for youth in the instructions for providers on contraceptive method counseling:

Present a brief lecture covering the three methods of contraception, which are most appropriate for young people – pills, condoms and spermicide e.g. foaming tablets.

The “National Guidelines for the Integration of Adolescent and Youth Friendly Services into Primary Health Care Facilities in Nigeria, 2013” include specific directives to provide contraceptive counseling and services as a part of all clinical preventive services targeting adolescents and youth in primary health care facilities. The list of essential drugs, however, limits contraceptive offerings to barrier methods, oral contraceptives, and emergency contraception (EC). While an IUD kit is listed in the medical equipment addendum, this contraceptive offering is absent in the essential drug list.

Providers are discouraged from providing long-acting and reversible contraceptives (LARCs) to youth under these policies. Furthermore, a national strategy to increase access to LARCs, “Increasing Access to Long-Acting Reversible Contraceptives in Nigeria: National Strategy and Implementation Plan, 2013-2015,” does not include a targeted strategy to increase uptake of LARCs among youth.

However, an earlier document, “National Family Planning/Reproductive Health Service Protocols, Revised Edition, 2010” includes youth and nulliparous women in the eligibility criteria for short-acting and long-acting reversible contraceptive methods. The document outlines no restrictions on the provision of oral contraceptives and implants to women between menarche and less than 18 years old and advises providers that the advantages outweigh the risks for the provision of injectables and IUDs to women who are younger than age 18 and nulliparous.

The inconsistency between the adolescent policies and general family planning (FP) service protocols creates an opportunity for providers to differentially interpret the directives. The discordance in the policies adds a barrier to youth attempting to access a full range of methods. Nigeria is placed in the red category for this indicator. Adding a provision that explicitly supports youth access to all medically eligible contraceptive methods would strengthen Nigeria's policies regarding youth FP and support full implementation of the “Nigeria Family Planning Blueprint (Scale-Up Plan),” which promotes the provision of LARCs to youth.   

Although the availability of EC is not factored into the categorization of this indicator, note that the “National Family Planning/Reproductive Health Service Protocols, Revised Edition, 2010,” as well as the “Clinical Protocol for the Health and Development of Adolescent and Young People in Nigeria, 2011,” include EC as a possible contraceptive method for youth. 

Nigeria’s policy environment surrounding sexuality education is weak. The leading guidance on provision of sexuality education in the country is the “National Family Life and HIV Education (FLHE) Curriculum for Junior Secondary School in Nigeria, 2003.” This document provides a substantial overview of the FLHE curriculum for junior secondary schools, primarily focused on human development and life skills. The component of the curriculum most relevant to contraceptive provision is human immunodeficiency virus (HIV) education. While the curriculum presents comprehensive information on sexually transmitted infections (STI)/HIV definitions, modes of transmission, and signs and symptoms, it falls short of informing youth on how to prevent these infections through safe sexual behavior and condom and contraceptive use. Further, there is no discussion of where or how to access sexual and reproductive health (SRH) services. Rather, the guidance for preventing STI/HIV is:

  • Abstain from sexual behavior.
  • Avoid sharing sharp objects (such as needles, razor, clippers).
  • Insist on screened blood.

Nigeria is placed in the red category for comprehensive sexuality education (CSE) since the country’s current guidance on sexuality education refers only to abstinence. However, the “National Guidelines on Promoting Access of Young People to Adolescent and Youth-Friendly Services in Primary Health Care Facilities in Nigeria, 2013” does reference peer education as a strategy to supplement in-school SRH instruction to reach in-school and out-of-school youth, as well as parents and guardians. Among its strategic interventions in the education sector, the “Second National Youth Policy Document of the Federal Republic of Nigeria, 2009” identifies:

Promotion of health education and family planning techniques.

However, this policy also makes multiple references to promoting abstinence until marriage. The “Nigeria Family Planning Blueprint (Scale-Up Plan), October 2014” includes an activity to improve the FLHE curriculum:

DBC3. Fully Integrate family planning into school health programs: The Family Life and HIV Education (FLHE) curriculum will be updated to support the goal of increasing appropriate FP messaging to adolescents and youth.

To improve the policy environment surrounding sexuality education, policymakers in Nigeria should consider including the nine United Nations Population Fund essential components of CSE when updating the FLHE curriculum.

Nigeria’s “National Reproductive Health Policy, 2017” emphasizes YF service provision, although such services are not defined:

Objective 4: To increase access to quality reproductive health information and services for adolescents and young persons. Target 1: Achieve at least 50% coverage of young people who have access to comprehensive SRH information and services by 2021. Target 2: Achieve at least 50% coverage of young people who have access to comprehensive youth friendly health services by 2021.

The “Nigeria Family Planning Blueprint (Scale-Up Plan), October 2014” includes a specific service delivery activity addressing privacy and confidentiality in the provision of youth-friendly (YF) family planning (FP) services:

SD16. Make PHCs [primary health care centers] youth-friendly. FP providers will be given adequate orientation to enable them to provide youth-friendly FP services. Part of making FP youth-friendly requires providing places where youths can have adequate privacy to receive FP services. When possible, private, youth-friendly service points will be established in existing PHCs. These rooms will be closed off so that the identity of the person inside cannot be viewed from the rest of the facility. The rooms will be furnished with FP materials and necessary supplies. Peer educators trained to dispense pills and condoms will staff the service points.

This activity directs YF centers to provide private spaces for young clients, which aligns with one of the three service-delivery core elements identified in the High-Impact Practices in Family Planning (HIPs) “Adolescent-Friendly Contraceptive Services” review.

Other policies, including the "Second National Youth Policy Document of the Federal Republic of Nigeria, 2009," outline steps to train providers on YF service delivery, an additional HIPs core element of service delivery.

The “National Training Manual for the Health and Development of Adolescent and Young People in Nigeria 2011” lists eight competencies of a youth-centered counselor, one of which guides counselors to be aware of their own judgments:

Self awareness and self-knowledge: Develop a keen knowledge and awareness of self in terms of one’s own limitations, biases, prejudices religious and cultural beliefs and internal conflicts.

However, the same document emphasizes abstinence-only values, likely affirming some providers’ preconceived notions regarding youth’s right to access contraception. The section describing factors affecting adolescent development mentions abstinence as a positive traditional practice:

Our traditional, cultural and religious beliefs, attitudes and norms affect the health and development of adolescents. While some of these traditions are positive, for example, sexual abstinence till marriage and respect for more elderly people, others are negative and have tendencies to impact on the health and well-being of adolescents negatively.

A later section, describing pregnancy prevention methods, emphasizes abstinence as the norm:

Sexual abstinence is the surest way of preventing STIs and unwanted pregnancies. In our society where the norm is sexual abstinence, young people practising abstinence are free of guilt of being found to have violated the norm, and fear of the consequences of sexual intercourse. Sexual abstinence could also add to the sense of self-esteem and self-worth.

Similarly, conflicting guidance exists in the “Clinical Protocol for the Health and Development of Adolescents and Young People in Nigeria, 2011,” which guides providers on how to counsel youth regarding contraception, emphasizing youth’s choice:

Discuss all temporary forms of contraceptives available in the clinic with the client. Show all the methods to the client. Discuss the advantages and disadvantages of each method. Allow the client to make a choice. Discuss the method chosen by the client with him/her.

While supportive of contraceptive provision to youth, this protocol emphasizes youth abstinence. Under the counseling guidelines for abstinence, providers are instructed to:

Provide information on the need to continue with abstinence for as long as possible.

Avoid situations that can provoke sexual stimulations.

Multiple external documents report the existence of Nigeria’s “Free Family Planning Commodity Policy” of 2011, which states that family planning commodities should be provided free of charge to all clients in the public sector. However, a copy of this policy could not be obtained, and stakeholders note that out-of-pocket costs often offset its effectiveness.

Nigeria is placed in the yellow category for YF FP service provision. The country has the potential to move to a green categorization if updated manuals train providers to offer nonbiased, nondiscriminatory services that do not prioritize abstinence and include provisions to offer free or subsidized FP services to youth.

The “National Policy on Health and Development of Adolescents and Young People in Nigeria, 2007” briefly addresses the sexual and reproductive health (SRH) needs of young people. The policy acknowledges that youth face sociocultural barriers to access SRH services:

Negative perception about adolescent sexual and reproductive health issues and related services.

To address this barrier, the policy includes activities to link service delivery with community sensitization efforts targeting parents and mass media activities to shift social norms. 

The “National Strategic Framework on the Health and Development of Adolescents and Young People in Nigeria, 2007-2011” includes two relevant objectives:

Promote awareness of reproductive health issues of young people amongst all stakeholders.

Strengthen the capacity of parents, guardians and significant others to respond positively to the needs of young people through effective IEC [information, education, and communication] approaches.

Specific activities are outlined under these objectives to engage the community through advocacy and community mobilization, and promote reproductive health behaviors through information, education, and communication. Existing policies, however, do not include specific activities to address gender norms related to youth access to or use of family planning services. Nigeria is placed in the yellow category for this indicator.

The policy documents reviewed for Senegal contain no references to parental or spousal consent. Senegal is placed in the gray category for this indicator. 

The “Plan Stratégique de Santé Sexuelle et de la Reproduction des Adolescent(e)s/Jeunes au Sénégal, 2014-2018” states that services must be provided to youth by providers who are nonjudgmental:

Ces services doivent être :

…• efficaces : ils sont assurés par des prestataires disponibles, compétents, accueillants qui savent communiquer avec les jeunes sans porter de jugement de valeur.

Therefore, Senegal is placed in the green category for this indicator.

The right of youth to receive sexual and reproductive health care is written into Senegalese law. The 2005 RH law, “Loi n° 2005-18 du 5 Août 2005 Relative à la Santé de la Reproduction,” includes a clear declaration allowing all people to access reproductive health (RH) services without discrimination, including discrimination based on marital status or age. Under Articles 3 and 10, the right to RH is acknowledged as a fundamental health and human right for all people. The law further promotes access to RH for adolescents under Article 4.

Article 3 : Le droit à la Santé de la Reproduction est un droit fondamental et universel garanti à tout être humain sans discrimination fondée sur l’âge, le sexe, la fortune, la religion, la race, l’éthnie, la situation matrimoniale ou sur toute autre situation.

Article 4 : Les Soins et services de Santé de la Reproduction recouvrent : …la promotion de la santé de la reproduction des adolescents ;

Article 10 : Toute personne est en droit de recevoir tous les soins de santé de la reproduction sans discrimination fondée sur l’âge, le sexe, le statut matrimonial, l’appartenance à un groupe ethnique ou religieux.

Senegal is placed in the green category for this indicator since national laws and policy guidelines support adolescents’ access to contraception regardless of age.

The right of youth to receive sexual and reproductive health care is written into Senegalese law. The 2005 RH law, “Loi n° 2005-18 du 5 Août 2005 Relative à la Santé de la Reproduction,” includes a clear declaration allowing all people to access reproductive health (RH) services without discrimination, including discrimination based on marital status or age. Under Articles 3 and 10, the right to RH is acknowledged as a fundamental health and human right for all people. The law further promotes access to RH for adolescents under Article 4.

Article 3 : Le droit à la Santé de la Reproduction est un droit fondamental et universel garanti à tout être humain sans discrimination fondée sur l’âge, le sexe, la fortune, la religion, la race, l’éthnie, la situation matrimoniale ou sur toute autre situation.

Article 4 : Les Soins et services de Santé de la Reproduction recouvrent: …la promotion de la santé de la reproduction des adolescents ;

Article 10 : Toute personne est en droit de recevoir tous les soins de santé de la reproduction sans discrimination fondée sur l’âge, le sexe, le statut matrimonial, l’appartenance à un groupe ethnique ou religieux.

Senegal is placed in the green category for this indicator since national laws and policy guidelines support adolescents’ access to contraception regardless of marital status.

The right to a full range of contraceptive options is explicitly outlined in the “Protocoles de Services de Santé de la Reproduction au Sénégal (no date).” The service protocols recognize the unique sexual and reproductive health needs and interests of youth and instruct providers to offer medically-appropriate contraception to adolescents, regardless of age:

En ce qui concerne la planification familiale, les adolescents peuvent utiliser n’importe quelle méthode de contraception et doivent avoir accès à un choix étendu. L’âge ne constitue pas à lui seul une raison médicale permettant de refuser une méthode à une adolescente. Si certaines inquiétudes ont été exprimées concernant l’utilisation de certaines méthodes contraceptives chez l’adolescente (par ex. l’emploi des progestatifs injectables seuls pour les moins de 18 ans), elles doivent être pesées en regard des avantages présentés par le fait d’éviter une grossesse.

Additionally, the “Protocoles” include long-acting contraception in the list of available methods. Therefore, Senegal is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, EC is also included in the list of available methods in “Protocoles.”

In the early 1990s, two family life education (FLE) programs were piloted in Senegal. In 1990, the Ministry of Education (MoE) piloted a population education curriculum in primary schools. In 1994, the MoE appointed le Groupe pour l’Étude et l’Enseignement de la Population, a Senegalese nongovernmental organization, to pilot an FLE program in secondary schools. In 2010, the MoE incorporated aspects of the FLE pilot programs into the national basic education curriculum; however, critical elements of comprehensive sexuality education (CSE) were omitted, including “rights, gender, personal values, interpersonal relationships, gender-based violence, skills-building related to SRH (for example, negotiating condom use), and critical thinking skills to assess social norms.” The MoE has facilitated efforts to refresh the national curriculum. In doing so, the policy revision should consider the nine United Nations Population Fund essential components of CSE.

The “Plan Stratégique de Santé Sexuelle et de la Reproduction des Adolescent(e)s/Jeunes au Senegal, 2014-2018” describes the aims of a proposed sexual health education program, including some of the essential components of CSE programs. It describes strengthening skills in critical thinking, personalization of information, and reaching across formal and informal sectors and across age groups. For example:

L'éducation à la santé sexuelle consiste à informer sur la sexualité en transmettant un certain nombre de valeurs et de recommandations aux adolescent(e)s/jeunes. En effet elle vise à… développer l'exercice de l'esprit critique, notamment par l'analyse des modèles et des rôles sociaux véhiculés par les médias.

Elsewhere, the plan describes educating youth on human rights and gender inequalities:

Dans le cadre de l'éducation de ces derniers, les questions de genre et les conséquences néfastes de la violence basée sur le genre seront abordées afin que toute forme de violence soit prévenue. Les jeunes seront informés et sensibilisés sur les Droits Humains (le genre faisant partie intégrante des questions de droit de l'homme).

This component, however, is not included as an aim of the previously described sexual health education program. Additional components, such as providing accurate information, linking sexual and reproductive health (SRH) services and other initiatives for young people, providing youth-friendly spaces, and strengthening youth input into SRH programming, are also acknowledged in the “Plan Stratégique de Santé Sexuelle et de la Reproduction des Adolescent(e)s/Jeunes au Senegal, 2014-2018,” but often in the context of service delivery rather than CSE.

The “Cadre Stratégique National de Planification Familiale, 2016-2020” includes interventions for the promotion of large-scale communication on birth spacing. In reference to communication to young people, the National Strategy outlines the integration of new family planning protocols into current home economics and life and earth sciences curricula and the support of peer educators within FLE clubs as interventions.

Renforcement de la communication visant les jeunes :

En matière de renforcement de la communication visant les jeunes, la DSRSE mettra l’accent sur des initiatives visant à adapter davantage le dispositif de formation existant en formant les professeurs relais technique (PRT) et les professeurs d'économie familiale sur la PF, en appuyant l’intégration des nouveaux protocoles PF dans les curricula des professeurs d'économie familiale et de Sciences de la Vie et de la Terre en formant les leaders Elèves Animateurs (LEA), les gouvernements scolaires et autres pairs éducateurs sur les techniques de communication. Enfin, le présent plan prévoit de réaliser des investissements substantiels visant à doter les LEA de supports de communication, contractualiser avec les clubs EVF dans les écoles pour la mise en oeuvre d'un paquet d'activités et soutenir la réalisation d’activités périodiques de suivi /coordination.

While these policies acknowledge CSE broadly, they fall short of including all nine essential components together in a clear operational policy for CSE. Senegal has a promising policy environment for CSE, but until these policies are revised, the country will remain in the yellow category.

The “Plan Stratégique de Santé Sexuelle et de la Reproduction des Adolescent(e)s/Jeunes au Sénégal, 2014-2018” includes plans to train providers to offer youth-friendly (YF) contraceptive services, with particular emphasis on good communication skills:

Pour le professionnel de santé, le dialogue et la relation de confiance noués avec l'adolescent(e)/ jeune sont des déterminants fondamentaux de la qualité de la prise en charge, qu'il s'agisse de diagnostiquer, de dépister et d'informer. En effet, il doit avoir des compétences nécessaires pour communiquer avec les adolescent(e)s/jeunes, détecter leurs problèmes de santé de façon précoce et fournir des conseils et des traitements. Il doit placer les besoins, les problèmes, les pensées, les sentiments, les points de vue et les perspectives des adolescent(e)s/jeunes, au cœur de ses activités... L'accent sera mis sur l'apprentissage et la formation continue.

Additionally, the “Plan Stratégique” outlines the necessary criteria for YF services in line with the World Health Organization’s Quality of Care framework for adolescent service provision, including that services must be accessible (and affordable), acceptable, equitable, effective (and without any value judgments), appropriate, efficient, and comprehensive:

Ces services doivent être :

  • accessibles : ils sont disponibles au bon endroit, au bon moment, à un bon prix (gratuit si nécessaire).
  • acceptables : ils répondent à leurs attentes et garantissent la confidentialité.
  • équitables : ils sont offerts à tous sans distinction de sexe, d'âge, de religion, d'appartenance ethnique, de handicap, de statut social ou de toute autre nature.
  • efficaces : ils sont assurés par des prestataires disponibles, compétents, accueillants qui savent communiquer avec les jeunes sans porter de jugement de valeur.
  • appropriés : les soins essentiels sont fournis d'une manière idéale et acceptable dans un environnement sécurisé.
  • efficients : les soins de qualité sont dispensés au coût le plus faible possible.
  • complets : la prestation de soins couvre tous les aspects de la prise en charge et la référence est assurée en cas de besoin.

The “Plan d’Action National de Planification Familiale, 2012-2015” further references the provision of family planning (FP) services to youth and identifies the need for discretion, confidentiality, and tailored service provision:

L’accent sera mis sur la qualité du service et du counseling tout en assurant la disponibilité du matériel et des consommables. Un focus particulier sera mis sur l’amélioration de l’accès aux services de Planification Familiale pour les jeunes en leur assurant la discrétion, la confidentialité et un service adapté.

Similarly, the “Protocoles de Services de Santé de la Reproduction au Sénégal” include a direct reference to the provision of FP services for youth and recognize the rights of youth to receive services, including their right to information, access, privacy, and dignity.

Les protocoles définis doivent être respectés pour les différents services. Cependant du fait de la spécificité et de la vulnérabilité de cette cible, une attention particulière doit être apportée aux droits à l’information, à l’accès, à l’intimité et à la dignité de ces adolescent(e)s et jeunes.

Across these policies, all three service delivery elements of adolescent-friendly contraceptive service provision are addressed. Therefore, Senegal is placed in the green category for this indicator.

The “Plan d’Action National de Planification Familiale, 2012-2015” highlights the need to inform youth and their communities regarding family planning (FP). One of the strategic actions under the communication plan is to roll out a mass media campaign aimed at young people. This strategic action has three main activities:

[Bâtir] une campagne participative pour les jeunes.

Renforcer les centres d'écoute pour les jeunes et centres d'informations.

Utilisation des [réseaux] sociaux et [nouvelles techniques pour] informer les jeunes sur la PF (facebook, sms, blogs).

The “Plan Stratégique de Santé Sexuelle et de la Reproduction des Adolescent(e)s/Jeunes au Sénégal, 2014-2018” includes plans to use information and communications technology and media to reach youth and the broader community.

Une campagne nationale médiatique de sensibilisation sur la SRAJ sera également menée. De même il serait judicieux d'utiliser des radios communautaires qui représentent un moyen de mobilisation important, pour garantir la participation de la communauté.

The “Plan Stratégique” also discusses how gender will be addressed in youth reproductive health programs:

6.4.2.1 Sur le plan social et organisationnel

Des actions à mener pour l'amélioration de l'environnement social/organisationnel sont indispensables pour l'atteinte des objectifs de la SRAJ.

• Prise en compte des questions de Genre

La dimension genre sera prise en compte dans l'élaboration des projets et programmes de SRAJ ainsi que dans 1'éducation et la formation des adolescent(e)s/jeunes. Dans le cadre de l'éducation de ces derniers, les questions de genre et les conséquences néfastes dela violence basée sur le genre seront abordées afin que toute forme de violence soit prévenue.

Les jeunes seront informés et sensibilisés sur les Droits Humains (le genre faisant partie intégrante des questions de droit de l'homme).

Since these plans include detailed steps to build an enabling social environment among youth and communities for FP services, the country is placed in the green category for this indicator.

The “Reproductive and Healthcare Rights Act, 2013,” a law applicable across Pakistan, signals increased political acknowledgment of the reproductive rights of women, in an effort to curtail maternal mortality and morbidity. While the act provides increased legal protection for women overall, it ignores the particular reproductive health (RH) rights of young women.

The act does not include any provision for youth. Further, under Line B, Article 4, the right of parents to educate their children is prioritized as a means of promoting RH care information. The acknowledgment of parental responsibility without subsequent recognition of youth’s rights to family planning (FP) services creates an opportunity for interpretation that favors parental rights over their children’s RH decisions.

Article 4: Promotion of reproductive healthcare rights:

1. The right to reproductive healthcare information can be promoted,

....

(b) through the exercise of parental responsibility which assures the right of parents as educators.

The Sindh policies reviewed do not provide further guidance on youth’s right to access family planning services without parental consent, leaving ambiguity in the requirement of parental consent for FP services.

The “Manual of National Standards for Family Planning, 2009” and the “Manual of Standards for Family Planning Services, Sindh: Revised 2017” include identical guidance to providers on preventing barriers to contraceptive use, including discouragement of requiring spousal consent:

Eligibility requirements that needlessly limit the use of certain methods based on a woman’s age, parity, or lack of spousal consent.

The national and provincial standards advise providers to follow the World Health Organization’s medical eligibility criteria when offering contraception to women. While the policies address spousal consent, they fail to sufficiently address parental consent for youth to access FP services. The province is placed in the yellow category for this indicator.

The “Manual of National Standards for Family Planning, 2009” and the "Manual of Standards for Family Planning Services, Sindh: Revised 2017" identify unjustified medical barriers, including provider bias:

What Are Unjustified Medical Barriers?

  • Practices derived (at least partly) from a medical rationale.
  • Non-evidence-based barriers that result in denial of contraception.
  • Eligibility restrictions, based on providers’ limitations/personal biases.

These policies urge providers to follow the medical eligibility criteria to discern eligibility for contraceptive services. Sindh is placed in the green category for this indicator.

The “Costed Implementation Plan on Family Planning for Sindh, 2015” includes the “Family Planning 2020: Rights and Empowerment Principles of Family Planning” as an annex to the document. This list states that age and marital status should not determine access to family planning services:

Quality, accessibility, and availability of information and services should not vary by non-medically indicated characteristics i.e. age, location, language, ethnicity, disability, HIV status, sexual orientation, wealth, marital or other status.

This declaration references the right of all people to access services regardless of age, placing Sindh in the green category for this indicator.

Sindh policy documents are contradictory regarding the right to access FP services regardless of marital status. The “Costed Implementation Plan on Family Planning for Sindh, 2015” references the right of all women, regardless of marital status, to access family planning (FP) information and services, , as does the “Manual of Standards for Family Planning Services, Sindh: Revised 2017”:

Right to Access: All individuals in the community have a right to receive services from FP programmes, regardless of their social status, economic situation, religion, political belief, ethnic origin, marital status, geographical location, or any other group identity.

However, the “Sindh Population Policy, 2016” narrows the scope of access to FP services to married young people:

The Population Welfare Department will provide information, education and counseling on population issues and make available services for birth spacing to young married couples to minimize high risk fertility behaviours.

The latter policy references sociocultural beliefs surrounding young people’s reproductive health behaviors as justification for the focus on married youth. As such, the “Sindh Population Policy, 2016” overlooks the FP needs of unmarried youth, creating a barrier to access to services. Further, the “Manual of Standards for Family Planning Services, Sindh: Revised 2017” contradicts its own language on marital status cited above by stating:

Adolescents who are married need access to safe and effective contraception.

Because of the language limiting the perceived need for contraception to married youth, the province is placed in the red category for this indicator.

The “Manual of National Standards for Family Planning, 2009” and the “Manual of Standards for Family Planning Services, Sindh: Revised 2017” discuss the special contraceptive and counseling needs of adolescents, ultimately encouraging providers to offer a full range of methods to youth:

Adolescents who are married need access to safe and effective contraception. Many adolescents use no contraception or use a method irregularly, so they are at high risk of unwanted pregnancy, unsafe abortion, and STIs. In general, adolescents are eligible to use any method of contraception. Services should avoid unnecessary procedures that might discourage or frighten teenagers, such as requiring a pelvic examination when they request contraceptives.

These policies align with the World Health Organization’s medical eligibility criteria and classify all short- and long-acting reversible methods as “use method in any circumstance” or “generally use method” for post-menarche women under age 18 and nulliparous women. The province is placed in the green category for this indicator. 

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, it is worth noting that the “Manual of National Standards for Family Planning, 2009” includes women of reproductive age in the eligibility requirement for EC and acknowledge youth vulnerability to sexual assault, which warrants the provision of this method: 

While all women in situations of conflict are vulnerable to sexual assault, young female adolescents may be the group most in need of EC services. Adolescent refugees are often targeted for sexual exploitation and rape, yet there are relatively few programmes that address the specific reproductive health needs of young people, and even fewer that provide EC.

The “Sindh Population Policy, 2016” limits the provision of sexuality education to married couples, using sociocultural beliefs as a justification. Under the “Focusing on Youth and Adolescents” section, the policy emphasizes marriage as a precursor to parenthood, suggesting an abstinence-only educational approach:

Similar move would be initiated to support education of adolescents as their reproductive health issues are significant in urban and rural areas. However, this will be approached within the acceptable socio-cultural framework of the province and in conductive settings. As such, the Policy endorses that adolescents and youth may be equipped with knowledge about healthy and happy marital life leading to responsible parenthood.

Sindh is placed in the red category for this indicator because of the limited scope of sexuality education targeting unmarried youth. Additional activities support educating older youth regarding life skills. Sindh addressed family planning education for youth at the university level, under Activity 5.4.1 of the “Costed Implementation Plan on Family Planning for Sindh, 2015”:

Consultations held with Department of Education, Health Education Commission, professional colleges to include life skills into the curriculum

Although this policy recognizes the provision of sexuality education, the scope is limited to college-age students.

The provision of contraception to youth is highlighted as a special area of focus in the “Sindh Health Sector Strategy, 2012-2020”:

Strategy 3.4: Re-defining links with DoPW (Department of Population Welfare) with shift of contraceptive services through district and urban PHC [primary health care] systems and aimed at birth spacing in younger couples

The strategy includes an activity to integrate family planning (FP) service provision with maternal care, which states that contraceptives should be provided at no cost to younger couples:

Integrating contraception provision: Provision of free contraceptives and training by DOPW to all DOH facilities for birth spacing. Integration of services with pregnancy care to reach out to couples and supported by community based BCC.

The “Manual of Standards for Family Planning Services, Sindh: Revised 2017” defines youth-friendly (YF) services and provides a checklist for facility observation that includes whether services are free or affordable to young people and whether several provisions to ensure privacy and confidentiality are in place.

The “Costed Implementation Plan on Family Planning for Sindh, 2015” identifies youth as a vulnerable segment of the population and includes activities to train health providers in YF service provision:

During the training of providers and community-based workers on FP, youth-friendly services and engagement will be added as a compulsory element of training (in-service and pre-service). Such an orientation of providers to the principles of youth-friendly services will allow existing facilities and community-based workers to incorporate ownership of providing services to meet the needs of young people.

Because these policies emphasize YF FP services and include the three service-delivery elements of the HIPs recommendations—cost, privacy and confidentiality, and provider training—Sindh is placed in the green category for this indicator.

The “Costed Implementation Plan on Family Planning for Sindh, 2015” highlights reaching youth as a key concern and priority area. As a part of the discussion for reaching youth, the plan recognizes the importance of engaging the community to support youth access to family planning:

Engagement with key gatekeepers and community leaders to foster an enabling environment for service uptake.

However, additional guidance on how this activity will be implemented, as well as discussion of approaches to address gender norms, are missing, placing the province in the yellow category for this indicator.

The right of young people and adolescents to freely access family planning services without requiring consent from a parent or spouse is situated prominently in the Tanzania “National Family Planning Guidelines and Standards, 2013”:

Decisions about contraceptive use should only be made by the individual client. No parental or spousal consent is needed for an individual to be given family planning information and services, regardless of age or marital status.

Given this clear declaration protecting youth autonomy in sexual and reproductive health decisionmaking, Tanzania is placed in the green category for this indicator.

The “National Family Planning Guidelines and Standards, 2013” provide specific guidance to providers to deliver respectful, competent, and nonjudgmental services to youth:

Standard 5.4: Service providers in all delivery points have the required knowledge, skills, and positive attitudes to effectively provide sexual and reproductive health services to young people in a friendly manner.

The service providers exhibits the following characteristics:

  • Has technical competence in adolescent-specific areas.
  • Respects young people.
  • Keeps privacy and confidentiality.
  • Allows adequate time for client/provider interaction.
  • Is non-judgmental and considerate.
  • Observes adolescent reproductive health rights.

The recent “National Adolescent Health and Development Strategy, 2018-2022” highlights provider bias and attitude as key barriers to youth access to family planning (FP) services, defining adolescent-friendly services as those that include:

Providers who are non-judgmental and considerate, easy to relate to and trustworthy [;] provide information and support to enable each adolescent to make the right free choices for his or her unique needs.

The much earlier “National Standards for Adolescent Friendly Reproductive Health Services, December 2004” affirm the rights of youth to access FP services and providers’ obligation to adhere to youth rights:

All adolescents are informed of their rights on sexual and reproductive health information and services whereby these rights are observed by all service providers and significant others.

Taken together, these statements supporting youth access to sexual and reproductive health services free from provider judgment or bias indicate a supportive and favorable policy environment. Therefore, the country is placed in the green category for this indicator.

The right of young people and adolescents to freely access family planning (FP) services regardless of age is situated prominently in Tanzania’s “National Family Planning Guidelines and Standards, 2013”:

Decisions about contraceptive use should only be made by the individual client. No parental or spousal consent is needed for an individual to be given family planning information and services, regardless of age or marital status.

The “National Family Planning Guidelines and Standards, 2013” also directly mentions the right of youth to receive FP services:

Like persons of other age groups, young people have the rights to decide if and when they want to have children, be informed and obtain information about family planning services, and access a full range of contraceptives methods.

Tanzania is placed in the green category because its policies explicitly acknowledge young people’s right to FP services.

Standard 5.3 of the “National Family Planning Guidelines and Standards, 2013” recognizes the right of all young people to receive family planning (FP) services, regardless of marital status:

Young people are able to obtain family planning services without any restrictions, regardless of their marital status.

This clear recognition of married and unmarried youth’s right to FP services warrants a green categorization for this indicator.

The “National Family Planning Guidelines and Standards, 2013” affirm the right of young people to access a full range of family planning (FP) methods:

Like persons of other age groups, young people have the rights to decide if and when they want to have children, be informed and obtain information about family planning services, and access a full range of contraceptives methods.

The “National Standards for Adolescent Friendly Reproductive Health Services” further directs providers to offer FP services in accordance with the World Health Organization’s medical eligibility criteria:

Contraceptives should be provided to clients in accordance with nationally approved method-specific guidelines, as defined by the World Health Organization (WHO) Medical Eligibility Criteria (MEC).

Tanzania recognizes young people’s right to access a full range of contraception, including long-acting and reversible contraceptives, and is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that EC is included in the package of contraceptive offerings listed in the “National Adolescent Reproductive Health Strategy 2011-2015.”

The Ministry of Education and Culture in Tanzania has taken a broad stance on the form of sexuality education to offer to youth. The Ministry developed the “Guidelines for Implementing HIV/AIDS/STDs and Life Skills Education in Schools and Teachers’ Colleges, 2002” as a response to increased transmission of human immunodeficiency virus (HIV) among youth. As a result, the directives focus primarily on the prevention of HIV and sexually transmitted diseases (STDs). Comprehensive sexuality education (CSE), specifically, is not referenced and accordingly not defined.

The “Guidelines for Implementing HIV/AIDS/STDs and Life Skill Education in Schools and Teachers’ Colleges, 2002” describe the national approach to sexual education as:

The content of HIV/AIDS/STIs control education shall aim at developing and promoting knowledge, skills positive and responsible attitudes such as assertiveness, effective communication, negotiation, informed decision making and provide motivational support as a means to responsible sexual behaviour.

These guidelines were developed in 2002, prior to the publication of international guidance on CSE. This framing is not comprehensive and limits the provision of information on sexuality, safe sexual behaviors, sexual and reproductive health care, and gender.

Newer policies implicitly acknowledge the limitations of the current policy environment for CSE. The “National Adolescent Health and Development Strategy, 2018-2022,” which replaces the previous National Adolescent Reproductive Health Strategy, recommends:

Promote a comprehensive curriculum which makes sexual and reproductive health, nutrition, life skills and empowerment compulsory topics to be included in secondary school and non-formal education packages.

Tanzania is placed in the yellow category for youth access to CSE. To improve upon existing guidelines, the Ministry of Education and Culture should consider publishing additional directives based on the nine essential components for CSE.

The “National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child, and Adolescent Health in Tanzania, 2016-2020 (One Plan II)” prioritizes adolescent and youth-friendly (YF) family planning (FP) services,  setting a target to increase the proportion of adolescent- and youth-friendly health services from 30 percent to 80 percent by 2020. The “Health Sector Strategic Plan IV, 2015-2020” also emphasizes YF services:

Adolescent Friendly Sexual and Reproductive Health Services (AFSRHS) will be expanded. Focusing on adaptation and use of adolescent friendly guidelines and standards, demand creation and utilization of AFSRHS, adolescents and youth will be encouraged to access… condoms and other contraceptives… through age-appropriate IEC, peer education, and mobilization of young people.

The Tanzania “National Family Planning Guidelines and Standards, 2013” recognize the unique FP needs of young people as a group deserving special consideration:

All family planning service-delivery points—whether in a facility, community, or outreach setting—should incorporate youth-friendly services, as further described in Section II: Standards. Services are youth-friendly if they have policies and attributes that attract youth to the services, provide a comfortable and appropriate setting for serving youth, meet the needs of young people, and are able to retain their young clients for follow-up and repeat visits.

This document further details specific directives for the provision of YF services (Standard 5.1.-5.6.), provider training, and free contraceptives for all FP clients in the public sector.

Together, these policies address each of the three service delivery core elements identified in the High-Impact Practices in Family Planning “Adolescent-Friendly Contraceptive Services” review to improve adolescent and youth uptake of contraception. Therefore, Tanzania is considered to have a supportive and favorable policy environment surrounding service provision and is placed in the green category for this indicator.

The “National Adolescent Health and Development Strategy, 2018-2022” emphasizes community engagement and efforts to overcome gender norms:

Misinformation among gatekeepers is a potential drawback to adolescents’ access to health services as parents, guardians and local leaders are critical information channels for adolescents… By empowering families and the community in general, demand for adolescent friendly health services can be significantly improved.

Among its top priorities and recommendations, the strategy includes:

Create strong linkages with community groups, community-based organizations [CBOs] and faith-based organizations [FBOs] to promote positive socio-cultural norms.

The “National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn, and Child Deaths in Tanzania, 2016-2020 (One Plan II)” includes several activities to build community support for adolescent and youth sexual and reproductive health (SRH), including:

Activity 5.5: Support utilization of existing community structures (religious leaders, parents, community and government leaders) to reach young people with age-appropriate sexual and reproductive health information and link them to services.

The “National Adolescent Health and Development Strategy, 2018-2022” also notes the importance of gender norms:

Gender norms have an influence on the health of adolescents, which manifests through discrimination of both male and female adolescents, leading to marginalization… Contradictory gender norms from family and society can shape sexual expectations with implications on engagement in unsafe sexual behaviors.

Gender norms are briefly referenced within the strategy’s strategic recommendations, which include a call to raise the minimum age at marriage for women to age 18:

CBOs and FBOs should also address gender norms, roles and relationships that may be harmful… Cash transfer interventions can particularly help adolescent girls take fewer risks in their sexual relationships.

The “National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn, and Child Deaths in Tanzania, 2016-2020 (One Plan II)” outlines several activities related to gender norms, although most focus on strengthening policy language and resource mobilization and target gender-based violence rather than access to contraceptive services.

The country is placed in the green category for this indicator since its strategies not only acknowledges the importance of engaging the community in the provision of family planning (FP) services to youth, but also identifies interventions to build community support for youth-friendly FP services and address gender norms.

The “Plan d’Action pour le Repositionnement de la Planification Familiale au Togo 2013-2017” acknowledges that parental and provider bias is a barrier to youth seeking family planning services.

Diagnostic : Les adolescents et jeunes :

  • craignent de rencontrer leurs parents et les autres adultes dans les centres.
  • jugent que leur utilisation de la PF est mal perçue par les prestataires.

However, the policy environment does not go further to prohibit parental or spousal consent. Togo is placed in the gray category for this indicator.

The “Protocoles de Santé de la Reproduction; Santé de la Mère, Santé de l’Enfant, Santé des Jeunes et Adolescents(es), Santé des Hommes. TOME I. 2ème Édition 2009” make clear that providers should be nonjudgmental of youth:

Comment les adolescents et jeunes aimeraient être traités ?

  • Les acceptez tels qu’ils sont, ne pas leur faire de la morale et ne pas les démoraliser.
  • … Ne pas les juger.

The “Loi n° 2007-005 Sur la Santé de la Reproduction 2007” guarantees the right of reproductive health to adolescents without discrimination. Similarly, the “Politique et Normes en Santé de la Reproduction, Planification Familiale et Infections Sexuellement Transmissibles de Togo 2009” state that youth have the right to health services without discrimination:

Le respect des droits humains et en particulier le droit des adolescents/jeunes à l’accès aux services de santé de qualité sans discrimination aucune liée à leur âge, leur sexe, leur religion ou condition sociale

Because Togo’s policies explicitly state that providers must avoid judgment of youth, Togo is placed in the green category for this indicator.

The “Loi n° 2007-005 Sur la Santé de la Reproduction 2007” states that reproductive health (RH) services should be available to all individuals regardless of age or marital status and further guarantees the adolescents' right to RH without discrimination:

Art. 7 - En matière de santé de la reproduction, tous les individus sont égaux en droit et en dignité sans discrimination aucune fondée sur l'âge, le sexe, le revenu, la religion, l'ethnie, la race, la situation matrimoniale ou sur toute autre situation touchant à l'état de la personne.

Art. 9 - Le droit à la santé de la reproduction est reconnu, sans discrimination aucune, à tout individu, personne du troisième âge, adulte, jeune, adolescent et enfant.

Similarly, the “Politique et Normes en Santé de la Reproduction, Planification Familiale et Infections Sexuellement Transmissibles de Togo 2009” state that youth-friendly services are based on the principle that adolescents have the right to health services regardless of age:

Le respect des droits humains et en particulier le droit des adolescents/jeunes à l’accès aux services de santé de qualité sans discrimination aucune liée à leur âge, leur sexe, leur religion ou condition sociale

Togo is placed in the green category for this indicator.

The “Loi n° 2007-005 Sur la Santé de la Reproduction 2007” guarantees the right to reproductive health (RH) services regardless of age or marital status and further guarantees the right of RH to adolescents without discrimination:

Art. 7 - En matière de santé de la reproduction, tous les individus sont égaux en droit et en dignité sans discrimination aucune fondée sur l'âge, le sexe, le revenu, la religion, l'ethnie, la race, la situation matrimoniale ou sur toute autre situation touchant à l'état de la personne.

Art. 9 - Le droit à la santé de la reproduction est reconnu, sans discrimination aucune, à tout individu, personne du troisième âge, adulte, jeune, adolescent et enfant.

The “Programme National de Lutte Contre les Grossesses et Mariages chez les Adolescents en Milieux Scolaire et Extrascolaire au Togo 2015-2019” includes a focus on access to improving sexual and reproductive health services and targets both married and unmarried youth:

Axe stratégique 3 : Accès à l’information et aux services de santé sexuelle et de la reproduction adaptés aux adolescents

Résultat d’effet 3.1
Un plus grand nombre d’adolescentes utilisent de services contraceptifs.

  • % d’adolescentes (15 à 19 ans) mariées utilisant une méthode moderne de contraception
  • % d’adolescentes (15 à 19 ans) non-mariées utilisant une méthode moderne de contraception

Togo is placed in the green category for this indicator because its policy environment protects youth access to family planning regardless of marital status.

The “Standards de Services de Santé Adaptés aux Adolescents et Jeunes de Togo 2009” describe the package of minimum services for adolescents at each level of the health system, which includes all methods of contraception, including long-acting and reversible contraceptives (LARCs). The “Protocoles de Santé de la Reproduction du Togo; Composantes Communes, Composantes d’Appui. TOME II. 2ème Édition 2009” include a full range of contraceptive options for youth in family planning services and acknowledge the importance of providing contraception to sexually active youth. However, the policy states that abstinence should be strongly recommended to adolescents. It includes restrictions for recommending interuterine devices to adolescents based on parity, frequency of sexual activity, and number of partners:

Appliquer la conduite à tenir :  « convient à ou ne convient pas à » en tenant compte des caractéristiques de l’adolescent et de son choix

Caractéristiques Méthode de choix Methode non appropriée
Nulligeste Pilules combinées DIU
Partenaires multiples Préservatifs DIU
Inconscience DIU Pilule
Cycles irréguliers Pilule combine PSP injectiable
Rapports sexuels occasionnels espacés ou irréguliers Préservatifs Spermicides DIU

Because Togo restricts the provision of LARCs to youth, it is placed in the red category. Future protocols for provider provision of LARCs for adolescents should be updated based on the most recent World Health Organization medical eligibility criteria for contraceptive use.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that the “Protocoles” include EC in the general list of contraceptive methods, but not in the adolescent-specific sexual and reproductive health section. Thus, it is not clear whether the policy intends for EC to be accessible to youth.

The “Loi n° 2007-017 Portant Code de l'Enfant 2007” guarantees every child the right to have information on reproductive health:

f. le droit de tout enfant d'avoir des informations sur la santé de la reproduction.

The “Loi n° 2007-005 Sur la Santé de la Reproduction 2007” states that everyone has the right to information and education on sexual and reproductive health (SRH):

Art. 13 - Tout individu a droit à l'information, à l'éducation utile à sa santé sexuelle et reproductive et aux moyens nécessaires lui permettant d'évaluer les avantages et les risques pour un choix judicieux.

The “Plan National de Développement Sanitaire du Togo, 2017-2022” lists comprehensive sexuality education (CSE) and information, advice, and services for SRH, including commodities, as priority interventions for adolescent health and development.

Orientation stratégiques : Promotion de la santé et le développement de l’adolescent

Renforcement du cadre de concertation intersectoriel en matière de promotion de la santé des adolescents ; …

  • Éducation sexuelle complète ;
  • Informations, conseil et services pour une santé sexuelle et génésique complète, contraception incluse ;

The “Plan d’Action pour le Repositionnement de la Planification Familiale au Togo 2013-2017” includes activities to reach youth in formal and informal settings, one of the CSE essential components:

Activité D3.2 : Extension de l’éducation sexuelle complète (SSR) dans l’enseignement primaire et secondaire et dans les écoles de formation de base des enseignants.

Activité D3.4 : Développement d’une synergie avec les associations de métiers sur les questions de SSR ciblant les jeunes du secteur informel et en milieu rural.

Similarly, the “Programme National de Lutte Contre les Grossesses et Mariages chez les Adolescents en Milieux Scolaire et Extrascolaire au Togo 2015-2019” includes specific activities for introducing CSE to youth, particularly girls, in and out of school:

Axe stratégique 2 : Accès et maintien des adolescentes dans le système éducatif et accès à l’éducation sexuelle complète

…Il vise également l’accès à l’éducation sexuelle complète (ESC) pour toutes les adolescentes en milieux scolaire et extrascolaire. L’ESC est reconnue globalement comme une stratégie efficace pour prévenir les grossesses précoces et renforcer l’autonomisation des adolescentes.

Résultats d’effet 2.2 : La qualité et la couverture de l’éducation sexuelle complète sont renforcées dans les établissements scolaires, dans les centres de formations professionnelles et pour les portefaix, les domestiques et les serveuses dans les bars

As part of its gender approach, the “Politique et Normes en Santé de la Reproduction, Planification Familiale et Infections Sexuellement Transmissibles de Togo 2009” includes a plan to incorporate gender into population education for youth, another of the essential components of CSE:

…En matière d'éducation des enfants, des adolescents et des jeunes, il s'agira d'introduire des modules d'approche genre dans l'EPD [éducation en matière d'environnement et de population pour un développement humain durable] / SR.

Togo’s policy environment is supportive of CSE but does not reference all nine of the United Nations Population Fund essential components of CSE. Togo is placed in the yellow category for CSE.

The “Protocoles de Santé de la Reproduction; Santé de la Mère, Santé de l’Enfant, Santé des Jeunes et Adolescents(es), Santé des Hommes. TOME I. 2ème Édition 2009” describe the necessary characteristics of provider interactions with adolescents, such as respecting their moral principles, establishing a climate of trust, and ensuring confidentiality:

Ils ont besoin d’attention et de compréhension, d’où la nécessité de développer une approche amicale avec eux dans le but d’établir un climat de confiance, de dialogue confidentiel et de respect de leurs principes moraux et de créer un service adapté à leur prise en charge.

The “Plan d’Action pour le Repositionnement de la Planification Familiale au Togo 2013-2017” includes plans to train providers in youth-friendly (YF) family planning service provision:

Activité O6.1 : Renforcement des capacités des prestataires de 25% des FS pour offrir les services de PF adaptés aux adolescents et aux jeunes.

The “Standards de Services de Santé Adaptés aux Adolescents et Jeunes de Togo 2009” aim to improve the financial accessibility of YF services, and the “Programme National de Lutte Contre les Grossesses et Mariages chez les Adolescents en Milieux Scolaire et Extrascolaire au Togo 2015-2019” includes an activity to pilot a contraceptive subsidy program for adolescents. The most recent “Plan National de Développement Sanitaire du Togo, 2017-2022” includes the development of FP services specific to young people and adolescents as a priority intervention. 

Togo is placed in the green category for this indicator because all three YF service delivery elements are addressed.

One of the five standards in “Standards de Services de Santé Adaptés aux Adolescents et Jeunes de Togo 2009” seeks community support for health services adapted to youth:

Standard 4 : Les membres de la communauté et les associations communautaires y compris les adolescents et les jeunes sont organisés en vue de faciliter l’utilisation des services de santé par les adolescents et les jeunes

The “Programme National de Lutte Contre les Grossesses et Mariages chez les Adolescents en Milieux Scolaire et Extrascolaire au Togo 2015-2019,” which explicitly aims to extend youth access to contraception, includes activities for building community support for preventing adolescent pregnancies. These activities include engaging community leaders and community-based organizations:

Résultat d’effet 4.2 : Les parents, les communautés et les leaders traditionnels et religieux s’engagent dans la lutte contre les grossesses et mariages des adolescentes

Résultats d’effet 4.3 : Les OSC [Organisation de la Société Civile] / OBC [Organisation de Base Communautaire] sont plus aptes à intervenir efficacement dans la prévention et la prise en charge des grossesses et mariages chez les adolescentes

The “Politique Nationale pour l'Equité et l'Égalité de Genre du Togo 2011” plans to raise awareness of gender issues among health stakeholders and to integrate a gender approach into sexual and reproductive health services for men, women, and adolescents:

Objectif 3.2. Assurer la prise en compte des besoins différenciés en santé de la reproduction des femmes, des adolescent(e)s et des hommes

  • Intégration effective de l’approche genre dans la conception la planification, la budgétisation des interventions en santé et SR
  • Mener des activités de sensibilisation et de plaidoyer des acteurs du secteur santé sur les questions de genre et leurs manifestations sur la santé et la SR des femmes et des hommes et des adolescent(e)s

Togo is placed in the green category because its policies include a detailed strategy for building an enabling social environment.

Uganda’s policy environment supports youth access to family planning (FP) services without authorization by a third party. The “National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, 2006” explicitly affirm the right of all people, including youth, to access FP services without parental or spousal consent:

No verbal or written consent is required from parent, guardian or spouse before a client can be given family planning service except in cases of incapacitation (intellectual disability). Clients should give written consent to long-term and permanent family planning methods.

Uganda is placed in the green category for this indicator.

The “Uganda Clinical Guidelines 2016: National Guidelines for Management of Common Conditions” instructs providers to counsel clients to make voluntary, informed family planning (FP) choices. Providers are directed to explain each method using the medical eligibility criteria:

Help client choose appropriate method using family planning medical eligibility criteria wheel

The medical eligibility criteria for contraception in Uganda specify that youth are eligible for short-term methods and long-acting and reversible contraceptives (discussed further in Access to a Full Range of FP Methods). This provides a promising policy environment for provider authorization of youth FP services, but it would be strengthened with explicit guidance to providers to withhold personal judgment when offering these services. Uganda is placed in the yellow category for this indicator.

The “National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, 2006” explicitly mention the right of all Ugandans, regardless of age, to access family planning services:

Every individual who is sexually active can receive family planning and contraceptive services irrespective of age or mental status.

The acknowledgement of individuals’ right to receive sexual and reproductive health services, regardless of age, signals a strong policy environment and warrants categorization the green category for this indicator.

The “National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, 2006” explicitly mention the right of all Ugandans to access family planning services:

Every individual who is sexually active can receive family planning and contraceptive services irrespective of age or mental status.

While inclusive of all people, the guidelines do not explicitly recognize marital status as a criterion for provision or refusal of family planning services. Providers and clients may differentially interpret this statement, potentially creating a barrier for youth desiring access to contraception. To strengthen the eligibility criteria, the guidelines eligibility statement should specifically recognize segmented parts of the population, such as married and unmarried youth.

The “National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, 2006” state that all sexually active Ugandans are eligible for family planning services:

All sexually active males and females in need of contraception are eligible for family planning services provided that:

They have been educated and counseled on all available family-planning methods and choices;

Attention has been paid to their current medical, obstetric contra-indications and personal preferences.

The eligibility criteria state that women of reproductive age, including adolescents, and nulliparous women can generally use each short-term (contraceptive pill and injectable) and long-acting and reversible contraceptives (intrauterine device and implant) method. The same medical eligibility criteria are reinforced in the “Uganda Clinical Guidelines 2016: National Guidelines for Management of Common Conditions.” Uganda is placed in the green category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that the latter document includes adolescents in the eligibility for EC:

Emergency contraception indications: All women and adolescents at risk of becoming pregnant after unprotected sex.

The “National Sexuality Education Framework, 2018” aims to streamline the delivery of sexuality instruction in formal education settings by providing young people with “age-appropriate values and skills-based information about their sexuality in accordance with Uganda’s national, religious, and cultural values.”

The Framework promotes sexual abstinence outside of marriage and restricts sexual and reproductive health (SRH) information to students, in part due to religious opposition. The document also avoids any discussion of contraceptive use or family planning methods as a way to prevent unwanted pregnancies.

Strategic Priority Policy Goals and Outcomes for NSEF : 3) To promote health behaviors such as sexual abstinence and health-seeking behaviors.

Since the current Framework does not include the exact messaging that will be provided in schools, an opportunity exists for the National Curriculum Development Center to elaborate on important SRH information as the associated curriculum, textbooks, and messages are developed. However, the exclusion of critical sexuality education material and promotion of abstinence-only practices in this Framework suggests that the policy environment creates a barrier to youth accessing care. Thus, Uganda is placed in the red category for this indicator.

Youth-friendly (YF) family planning (FP) service provision features prominently across Uganda’s policy documents. While none of the policies detail clear action steps aligned with all three service-delivery core elements of adolescent-friendly contraceptive services, each recognizes the need to tailor services to youth.

The “Health Strategic Plan III, 2010/11-2014/15” specifically targets adolescents and youth in the sexual and reproductive health (SRH) services strategy. The strategy proposes the following activities to strengthen adolescent SRH services and the policy environment surrounding SRH:

Strengthen adolescent sexual and reproductive health services:

  • Integrate and implement adolescent sexual and reproductive health in school health programmes; and
  • Increase the number of facilities providing adolescent friendly sexual and reproductive health services.
  • Strengthen the legal and policy environment to promote delivery of SRH services.
  • Review SRH and related policies and address institutional barriers to quality SRH services.
  • Review SRH policies, standards, guidelines and strategies as need arises.

The “Uganda Family Planning Costed Implementation Plan, 2015-2020” includes a FP service delivery activity targeting youth:

SD9. Youth-friendly services are provided in clinics. To increase the availability of youth-friendly services, youth-friendly corners will be established, and health workers will be trained on youth-friendly services. In addition, FP service delivery hours will be increased to include outside school hours to accommodate youth.

The activity mentions providing training to providers on YF services but does not reference training providers to withhold personal beliefs, bias, or judgment when offering contraception to youth.  Altogether, the strategies generally address providing youth-friendly FP services to youth but do not sufficiently incorporate all three service delivery core elements of adolescent-friendly contraceptive services, placing Uganda in a yellow category for this indicator. To bolster the policy environment supporting youth-friendly FP service provision, future guidelines should consider including the remaining service-delivery elements of adolescent-friendly contraceptive provision.

The “Uganda Family Planning Costed Implementation Plan, 2015-2020” includes comprehensive actions to create demand for family planning (FP) services among youth, including elements of building community support:

DC3. Young people, 10-24 years old, are knowledgeable about family planning and are empowered to use FP services: To increase the knowledge and empowerment of young people, peer educators will be engaged and supported; media (print and online) targeting youth will be disseminated; and “edutainment” community events will provide the opportunity for knowledge exchange amongst young people and empower adults to help youth avoid teenage pregnancy.

The proposed steps not only target youth in awareness and mass media campaigns, but also seek to engage gatekeepers in additional community engagement activities:

Empower parents, caregivers, and teachers to help their children to avoid teen pregnancy, including improving parent-child communication on sexual issues.

The inclusion of a detailed strategic initiative to build community support among youth and adults for youth FP services indicates a promising policy environment, placing Uganda in the yellow category for this indicator. Outlining additional activities to address gender norms would strengthen existing policies in favor of youth access to FP.

 

Policy documents could not be located:

  • Stratégie Nationale pour la Sécurisation des Produits de Santé de la Reproduction (SNSPSR) 2011–2016.
  • Plan Stratégique Intégré de la Santé de la Reproduction, de la Mère, du Nouveau-né, de l’Enfant, de l’Adolescent et Jeune 2017 – 2021.
  • Plan National de Développement Sanitaire, 2018-2022.
  • Plan Opérationnel de Reduction de la Mortalité Maternelle et Néonatale au Benin, 2018-2022.

 

Documents in draft, not reviewed:

  • Politique Nationale de la Santé de la Reproduction.

 

Policy documents in draft, not reviewed:

  • Politique Nationale de la Santé de la Reproduction, 2018.

 

Policy documents in draft, not reviewed:

 

Policy documents that could not be located:

  • Politique Nationale de Santé, 2015.

 

Draft policy documents:

  • National Health Policy, 2016.

 

Policy documents that could not be located:

  • Free Family Planning Commodity Policy, 2011.

 

Policy documents in draft, not reviewed:

  • Pakistan National Population Policy, 2017.
  • National Reproductive Health Rights Bill.

 

Policy documents in draft, not reviewed:

  • National Health Policy, 2018.
  • Five-Year Costed Implementation Plan for Family Planning, 2018-2022.

 

Policy documents in draft, not reviewed:

  • Politique Nationale de la Jeunesse, 2019.

 

Policy documents that could not be located:

  • Plan d’Action pour le Passage à Grande Echelle de la Distribution à Base Communautaire des Produits Contraceptifs y Compris les Injectables 2017-2018.

 

Policy documents in draft, not reviewed:

  • National Sexual and Reproductive Health Policy.
  • National Adolescent Health Policy.

 

Policy documents that could not be located:

  • National Condom Programming Strategy, 2017-2021.

LEGEND

GREEN: Strong policy environment.

YELLOW: Promising policy environment but room for improvement.

RED: Policy environment impedes youth from accessing and using contraception.

GRAY: Policy addressing the indicator does not exist.

Select a country or indicator to view results.

Overview

Discussion of Results

Parental and Spousal Consent
Provider Authorization
Age Restrictions
Marital Status Restrictions
Access to a Full Range of FP Methods
Comprehensive Sexuality Education
Youth-Friendly FP Service Provision
Enabling Social Environment
Benin

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from both third-parties (parents and spouses).

Benin

Provider Authorization

No law or policy exists that addresses provider authorization.

Benin

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Benin

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Benin

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include LARC methods.

Benin

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Benin

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Benin

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.
Burkina Faso

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from one but not both third parties.

Burkina Faso

Provider Authorization

No law or policy exists that addresses provider authorization.

Burkina Faso

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Burkina Faso

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Burkina Faso

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Burkina Faso

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Burkina Faso

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Burkina Faso

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.
Côte d’Ivoire

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Côte d’Ivoire

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Côte d’Ivoire

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Côte d’Ivoire

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Côte d’Ivoire

Access to a Full Range of FP Methods

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Côte d’Ivoire

Comprehensive Sexuality Education

Policy supports the provision of sexuality education AND mentions all nine UNFPA essential components of CSE.

Côte d’Ivoire

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Côte d’Ivoire

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.
Democratic Republic of the Congo

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from one but not both third parties.

Democratic Republic of the Congo

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Democratic Republic of the Congo

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Democratic Republic of the Congo

Marital Status Restrictions

No law or policy exists addressing marital status in access to FP services.

Democratic Republic of the Congo

Access to a Full Range of FP Methods

No law or policy exists addressing youth access to a full range of FP methods. 

Democratic Republic of the Congo

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Democratic Republic of the Congo

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Democratic Republic of the Congo

Enabling Social Environment

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both HIPs-recommended elements.

Ethiopia

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Ethiopia

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Ethiopia

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Ethiopia

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Ethiopia

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Ethiopia

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Ethiopia

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Ethiopia

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services:

  • Address gender norms.
  • Build community support.
Guinea

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Guinea

Provider Authorization

No law or policy exists that addresses provider authorization.

Guinea

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Guinea

Marital Status Restrictions

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

Guinea

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include LARC methods.

Guinea

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Guinea

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Guinea

Enabling Social Environment

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Kenya

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Kenya

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Kenya

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age

Kenya

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Kenya

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting and reversible contraceptives (LARCs).

Kenya

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Kenya

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Kenya

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services:

  • Address gender norms.
  • Build community support.
Mali

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from one but not both third parties (parents and spouses).

Mali

Provider Authorization

No law or policy exists that addresses provider authorization.

Mali

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Mali

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Mali

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Mali

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Mali

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Mali

Enabling Social Environment

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Mauritania

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Mauritania

Provider Authorization

No law or policy exists that addresses provider authorization.

Mauritania

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Mauritania

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Mauritania

Access to a Full Range of FP Methods

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Mauritania

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Mauritania

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Mauritania

Enabling Social Environment

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both HIPs-recommended elements.

Niger

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Niger

Provider Authorization

No law or policy exists that addresses provider authorization.

Niger

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Niger

Marital Status Restrictions

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

Niger

Access to a Full Range of FP Methods

No law or policy exists addressing youth access to a full range of FP methods. 

Niger

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Niger

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Niger

Enabling Social Environment

No policy exists to build an enabling social environment for youth FP services. 

Nigeria

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Nigeria

Provider Authorization

No law or policy exists that addresses provider authorization.

Nigeria

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age

Nigeria

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Nigeria

Access to a Full Range of FP Methods

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Nigeria

Comprehensive Sexuality Education

Policy promotes abstinence-only education or discourages sexuality education.

Nigeria

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Nigeria

Enabling Social Environment

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Senegal

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Senegal

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Senegal

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Senegal

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Senegal

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Senegal

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Senegal

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Senegal

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.
Sindh (Pakistan)

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from one but not both third parties.

Sindh (Pakistan)

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Sindh (Pakistan)

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Sindh (Pakistan)

Marital Status Restrictions

Law or policy exists that restricts youth access to FP services based on marital status.

Sindh (Pakistan)

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Sindh (Pakistan)

Comprehensive Sexuality Education

Policy promotes abstinence-only education OR discourages sexuality education.

Sindh (Pakistan)

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services:

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Sindh (Pakistan)

Enabling Social Environment

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both HIPs-recommended elements.

Tanzania

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from both third parties (parents and spouses).

Tanzania

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Tanzania

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Tanzania

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Tanzania

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Tanzania

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Tanzania

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Tanzania

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.
Togo

Parental and Spousal Consent

No law or policy exists that addresses consent from a third party to access FP services.

Togo

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Togo

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Togo

Marital Status Restrictions

Law or policy exists that supports youth access to FP services regardless of marital status.

Togo

Access to a Full Range of FP Methods

Law or policy exists that restricts youth from accessing a full range of FP methods based on age, marital status, and/or parity.

Togo

Comprehensive Sexuality Education

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Togo

Youth-Friendly FP Service Provision

Policy mentions three service-delivery elements of the High-Impact Practices in Family Planning (HIPs) recommendations for adolescent-friendly contraceptive services.

  • Provider training.
  • Confidentiality and privacy.
  • Free or reduced cost.
Togo

Enabling Social Environment

Policy outlines detailed strategy addressing two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

  • Address gender norms.
  • Build community support.
Uganda

Parental and Spousal Consent

Law or policy exists that supports youth access to FP services without consent from both third parties (parents and spouses).

Uganda

Provider Authorization

Law or policy exists that requires providers to authorize medically-advised youth FP services but does not address personal bias or discrimination.

Uganda

Age Restrictions

Law or policy exists that supports youth access to FP services regardless of age.

Uganda

Marital Status Restrictions

No law or policy exists addressing marital status in access to FP services.

Uganda

Access to a Full Range of FP Methods

Law or policy exists that supports youth access to a full range of FP methods, including long-acting and reversible contraceptives (LARCs).

Uganda

Comprehensive Sexuality Education

Policy promotes abstinence-only education or discourages sexuality education.

Uganda

Youth-Friendly FP Service Provision

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements of the HIPs recommendations for adolescent-friendly contraceptive services.

Uganda

Enabling Social Environment

Policy outlines detailed strategy addressing one of the two enabling social environment elements of the HIPs recommendations for adolescent-friendly contraceptive services.

View All Results For

LEGEND

GREEN: Strong policy environment.

YELLOW: Promising policy environment but room for improvement.

RED: Policy environment impedes youth from accessing and using contraception.

GRAY: Policy addressing the indicator does not exist.

POLICY DOCUMENTS

Please select a country to view documents.

 

Policy documents could not be located:

  • Stratégie Nationale pour la Sécurisation des Produits de Santé de la Reproduction (SNSPSR) 2011–2016.
  • Plan Stratégique Intégré de la Santé de la Reproduction, de la Mère, du Nouveau-né, de l’Enfant, de l’Adolescent et Jeune 2017 – 2021.
  • Plan National de Développement Sanitaire, 2018-2022.
  • Plan Opérationnel de Reduction de la Mortalité Maternelle et Néonatale au Benin, 2018-2022.

 

Documents in draft, not reviewed:

  • Politique Nationale de la Santé de la Reproduction.

 

Policy documents in draft, not reviewed:

  • Politique Nationale de la Santé de la Reproduction, 2018.

 

Policy documents in draft, not reviewed:

 

Draft policy documents:

  • National Health Policy, 2016.

 

Policy documents that could not be located:

  • Free Family Planning Commodity Policy, 2011.

 

Policy documents in draft, not reviewed:

  • Politique Nationale de la Jeunesse, 2019.

 

Policy documents that could not be located:

  • Plan d’Action pour le Passage à Grande Echelle de la Distribution à Base Communautaire des Produits Contraceptifs y Compris les Injectables 2017-2018.

 

Policy documents in draft, not reviewed:

  • National Sexual and Reproductive Health Policy.
  • National Adolescent Health Policy.

 

Policy documents that could not be located:

  • National Condom Programming Strategy, 2017-2021.

ACKNOWLEDGEMENTS

The content of this website originates from the 2019 edition of the Youth Family Planning Policy Scorecard, updated by Christine Power and Elizabeth Leahy Madsen of Population Reference Bureau (PRB). The Scorecard was originally developed and refined by Sara Harris, Meredith Pierce, and Elizabeth Leahy Madsen. Support for the development of and updates to the Scorecard and website has been provided by the Bill & Melinda Gates Foundation, particularly Caitlin Feurey, Gwyn Hainsworth, and Ryan Cherlin.

CONTENT

Christine Power, policy analyst
Marissa Falk, policy advisor
Sara Harris, policy analyst
Elizabeth Leahy Madsen, program director
Nancy Matuszak, editor
Meredith Pierce, policy advisor
Heidi Worley, editorial director

DESIGN AND PRODUCTION

Jessica Woodin, senior designer
Automata Studios, web development partners

PHOTOGRAPHY

© Jonathan Torgovnik/Getty Images

References

Parental and Spousal Consent

Kara Apland, Over-Protected and Under-Served: A Multi-Country Study on Legal Barriers to Young People’s Access to Sexual and Reproductive Health Services—El Salvador Case Study, (July 2014), accessed at www.ippf.org/sites/default/files/ippf_coram_el_salvador_report_eng_web.pdf, on Feb. 2, 2018.

UNFPA, “Follow-Up to the Implementation of the Programme of Action of the International Conference on Population and Development Beyond 2014—Bali Global Youth Forum, Bali, Indonesia 4-6 December 2012,” (April 2013), accessed at www.unfpa.org/, on Feb. 2, 2018. 

Provider Authorization

Gorrette Nalwadda et al., “Constraints and Prospects for Contraceptive Service Provision to Young People in Uganda: Providers’ Perspectives,” BMC Health Services Research 11, no. 1 (2011): 220.

“Sexual Rights Database,” Sexual Rights Initiative, accessed at http://sexualrightsdatabase.org/, on Feb. 2, 2018.

Venkatraman Chandra-Mouli et al., “Contraception for Adolescents in Low- and Middle-Income Countries: Needs, Barriers, and Access,” Reproductive Health 11, no. 1 (2014).

Age Restrictions

Paula Tavrow, “Promote or Discourage: How Providers Can Influence Service Use,” in Social Determinants of Sexual and Reproductive Health: Informing Future Research and Programme Implementation, ed. Shawn Malarcher (Geneva: WHO, 2010): 15-36, accessed at www.popline.org/, on Feb. 2, 2018.

UNFPA, “Follow-Up to the Implementation of the Programme of Action of the International Conference on Population and Development Beyond 2014—Bali Global Youth Forum, Bali, Indonesia 4-6 December 2012,” (April 2013), accessed at https://www.unfpa.org/sites/default/files/event-pdf/bali_global_youth_forum_rec.pdf on Feb. 2, 2018. 

Venkatraman Chandra-Mouli, Alma Virginia Camacho, and Pierre-André Michaud, “WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries,” Journal of Adolescent Health 52, no. 5 (2013): 517-22.

Marital Status Restrictions

Venkatraman Chandra-Mouli et al., “Contraception for Adolescents in Low- and Middle-Income Countries: Needs, Barriers, and Access,” Reproductive Health 11, no. 1 (2014).

Access to a Full Range of FP Methods

Akinrinola Bankole and Shawn Malarcher, “Removing Barriers to Adolescents’ Access to Contraceptive Information and Services,” Studies in Family Planning 41, no. 2 (2010): 117-24; and R. Rivera et al., “Contraception for Adolescents: Social, Clinical, and Service-Delivery Considerations,” International Journal of Gynecology & Obstetrics 75, no. 2 (2001): 149-63; and Paula Tavrow, “Promote or Discourage: How Providers Can Influence Service Use,” in Social Determinants of Sexual and Reproductive Health: Informing Future Research and Programme Implementation, ed. Shawn Malarcher (Geneva: WHO, 2010): 15-36, accessed at www.popline.org/, on Feb. 2, 2018.

David Hubacher et al., “Preventing Unintended Pregnancy Among Young Women in Kenya: Prospective Cohort Study to Offer Contraceptive Implants,” Contraception 86, no. 5 (2012): 511-17.

Pathfinder International, Evidence 2 Action (E2A), Population Services International (PSI), Marie Stopes International, FHI 360, Global Consensus Statement: Expanding Contraceptive Choice for Adolescents and Youth to Include Long-Acting Reversible Contraception, (2015), accessed at www.familyplanning2020.org/resources/10631, on Feb. 2, 2017.

WHO, Medical Eligibility for Contraceptive Use, 5th ed. (Geneva: WHO, 2015).

Comprehensive Sexuality Education

Chioma Oringanje et al., “Interventions for Preventing Unintended Pregnancies Among Adolescents,” Cochrane Database Systematic Review 4, no. 4 (2009).

George Patton et al., “Our Future: A Lancet Commission on Adolescent Health and Wellbeing,” Lancet 387, no. 10036 (2016): 2423-78.

Heloísa Helena Siqueira Monteiro Andrade et al., “Changes in Sexual Behavior Following a Sex Education Program in Brazilian Public Schools,” Cadernos de Saúde Pública 25, no. 5 (2009): 1168-76.

K.G. Santhya and Shireen J. Jejeebhoy, “Sexual and Reproductive Health and Rights of Adolescent Girls: Evidence From Low- and Middle-Income Countries,” Global Public Health 10, no. 2 (2015): 189-221.

UNESCO, International Technical Guidance on Sexuality Education: An Evidence-Informed Approach for Schools, Teachers, and Health Educators, vol. 1 (Paris: UNESCO, 2009).

UNFPA, UNFPA Operational Guidance for Comprehensive Sexuality Education: A Focus on Human Rights and Gender, (2014), accessed at www.unfpa.org/publications, on Feb. 2, 2018.

Venkatraman Chandra-Mouli, Alma Virginia Camacho, and Pierre-André Michaud, “WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries,” Journal of Adolescent Health 52, no. 5 (2013): 517-22.

Virginia A. Fonner et al., “School-Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis,” PloS One 9, no. 3 (2014).

Youth-Friendly FP Service Provision

Allison Glinski, Magnolia Sexton, and Suzanne Petroni, Adolescents and Family Planning: What the Evidence Shows (Washington, DC: International Center for Research on Women, 2016).

Jill Gay et al., High-Impact Practices in Family Planning (HIPs), “Adolescent-Friendly Contraceptive Services: Mainstreaming Adolescent-Friendly Elements Into Existing Contraceptive Services,” (Washington, DC: United States Agency for International Development, 2015), accessed at www.fphighimpactpractices.org/afcs, on Feb. 2, 2018.

Lindsey B. Gottschalk and Nuriye Ortayli, “Interventions to Improve Adolescents’ Contraceptive Behaviors in Low- and Middle-Income Countries: A Review of the Evidence Base,” Contraception 90, no. 3 (2014): 211-25.

Michelle J. Hindin et al., “Interventions to Prevent Unintended and Repeat Pregnancy Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature,” Journal of Adolescent Health 59, no. 3 (2016): S8-S15.

Venkatraman Chandra-Mouli, Alma Virginia Camacho, and Pierre-André Michaud, “WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries,” Journal of Adolescent Health 52, no. 5 (2013): 517-22.

Venkatraman Chandra-Mouli, Catherine Lane, and Sylvia Wong, “What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices,” Global Health: Science and Practice 3, no. 3 (2015): 333-40.

Enabling Social Environment

George Patton et al., “Our Future: A Lancet Commission on Adolescent Health and Wellbeing,” Lancet 387, no. 10036 (2016): 2423-78.

Jill Gay et al., High-Impact Practices in Family Planning (HIPs), “Adolescent-Friendly Contraceptive Services: Mainstreaming Adolescent-Friendly Elements Into Existing Contraceptive Services,” (Washington, DC: United States Agency for International Development, 2015), accessed at www.fphighimpactpractices.org/afcs, on Feb. 2, 2018.

Kate Ploude et al., High-Impact Practices in Family Planning (HIPs), “Community Group Engagement: Changing Norms to Improve Sexual and Reproductive Health,” (Washington, DC: United States Agency for International Development, 2016), accessed at www.fphighimpactpractices.org/, on Feb. 2, 2018.

Discussion of COUNTRY Results

Jonathan Cohen and Tony Tate, “The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda,” Reproductive Health Matters 14, no. 28 (2006): 174-78.

Katie Chau et al., “Scaling Up Sexuality Education in Senegal: Integrating Family Life Education Into the National Curriculum,” Sex Education 16, no. 5 (2016): 1-17.

UNESCO Office in Dakar, “Senegal Is Updating Its Curricula by Reinforcing Reproductive Health Education,” (2016), accessed at www.unesco.org/new/en/dakar/about-this-office/single-view/news/senegal_is_updating_its_curricula_by_reinforcing_reproductiv/, on Feb. 2, 2018.

WHO, Medical Eligibility for Contraceptive Use, 5th ed. (Geneva: WHO, 2015).