This week, the Family Planning 2020 (FP2020) movement will turn four. With only four years left to accomplish its ambitious goal of reaching an additional 120 million with access to lifesaving contraceptives, this is a pivotal moment to appreciate progress and acknowledge the challenges that line the path to 2020.

One such challenge is accelerating efforts to meet the sexual and reproductive health and rights (SRHR) of young people. As FP2020’s Youth Engagement Manager and a youth advocate, I see that while our community and global partnership are working to address the reality of youth SRHR needs, we aren’t there yet. All too often married young people are told they should be having children, while unmarried young people hear they shouldn’t be having sex. The rights of these young people are not being taken into account.

During the global Women Deliver conference in Copenhagen, Denmark this past spring, youth advisors and advocates gathered at an event to highlight the barriers that young people continue to face in accessing a full range of contraceptive methods, including long-acting reversible contraception (LARCs).

Experiences highlighted at the event included:

• An advocate from China noting that only married couples could legally obtain LARCs.
• A high school student from the U.S., who thought she had received comprehensive sexuality education, was surprised to learn it was safe for her to use a LARC.
• A young health care provider from Tanzania explaining that he did not learn about LARCs in medical school.

From the discussion at “Action for Access: Using the Global Consensus Statement to Accelerate Voluntary Contraceptive Method Choice for Youth“—an event co-sponsored by Family Health International (FHI 360), Family Planning 2020 (FP2020), the Evidence to Action Project (E2A), Marie Stopes International, Pathfinder International, Population Services International (PSI), and United States Agency for International Development (USAID)—it was evident that the challenges to ensuring full access and choice for adolescents and young people are significant but that the SRHR community is committed to meeting these challenges.

For young people, pregnancy, childbirth, and unsafe abortion are all more dangerous than using contraception–including LARCs. We know that pregnancy can be unsafe—or even deadly, especially for girls. In fact, according to statistics gathered by WHO, maternal causes (complications during pregnancy, childbirth, and unsafe abortion) are the second leading cause of death globally among adolescent girls aged 15-19.

Recently released research from the Guttmacher Institute tells us that of the 252 million adolescent girls between ages 15-19 living in developing regions in 2016, an estimated 38 million are sexually active and do not want a child in the next two years.  The majority of these adolescents, (more than 60% or 23 million), have an unmet need for modern contraception

Adolescents and young people everywhere deserve the option to delay childbearing in order to complete their education, and meet their life goals. They deserve to have the option of choosing a reliable long-term contraceptive method or any method of that meets their needs. With the largest-ever generation of adolescents in history entering their reproductive years right now, the growing generational divide has massive implications for sustainable development—particularly in developing countries where the median age typically skews much younger.

As a community, we have the evidence, the commitment, the action, and the roadmap to guide us forward. Now is the time that we must take action for access if countries are to be successful in attaining our FP2020 goals, and ultimately if we are all to be successful in reaching the Sustainable Development Goals.

The Evidence

Through sound medical evidence, we know LARCs are a safe and appropriate option for adolescents and young people. The World Health Organization’s Medical Eligibility Criteria for Contraceptive Use states, “Age alone does not constitute a medical reason for denying any method to adolescents.” Furthermore, both the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM) “fully support action to reduce provider bias that may prevent LARCs from being offered in a non-discriminatory manner to young people.”

In addition, research suggests that, compared with adults, adolescents often have higher discontinuation rates when using short-acting methods. In the United States, the CHOICE Project showed that continuation rates for LARCs among women of reproductive age, including adolescents and youth, are significantly higher than for those using short-acting methods. These higher continuation rates are due to satisfaction with the method, acceptance of side effects, and the lack of a need for daily or precoitally adherence. A 2012 study found that when young (15-24 year old) Kenyan women, who were initially seeking short acting contraceptives, were offered the option on an implant, 1 in 4 selected the implant and had high continuation rates (80% in 18 months).

The Commitment

Launched in November 2015, the Global Consensus Statement for Expanding Contraceptive Choice for Adolescents and Youth to Include Long-acting Reversible Contraception (LARCs) is a call to action to generate awareness about the right of all young people to access a full range of contraceptive methods. Hosted by FP2020 and developed by Pathfinder International, E2A project, PSI, Marie Stopes International, and FHI 360, the statement has been endorsed by 50 organizations, including government agencies, youth networks, service delivery organizations, research institutes, and foundations. Through their endorsement, organizations are committing to creating lasting change in the lives of history’s largest generation of young people.

The Action

Through technical consensus and youth engagement, members of the SRHR community have charted a course forward that recommends research, programming, and policy actions related to:

• Providing client-centered, contraceptive counseling that highlights effectiveness and includes the benefits of LARCs, to expand choice for all adolescent girls and young women;
• Ensuring health providers are able to deliver services through capacity-building opportunities that address provider bias, improve skills, provide support, and integrate service provision;
• Making sure young people have the information and counselling that will enable them to voluntarily access LARCs or short-term or permanent methods as part of a range of contraceptive methods, including follow up visits that show that the client is satisfied with his or her method choice and can have their method removed if and when they want to; and
• Developing behavior change communication messages that balance life planning with short-term decision-making, while normalizing voluntary usage of LARCs.

We, as a community, are poised to secure the widest possible range of contraceptive method choice for all people and to reduce the barriers faced by youth. As the hosts of the Global Consensus Statement, FP2020 calls upon all endorsing organizations to carry out their commitment to expanding LARCs access and for others to join the effort.

As a global community, we must create a new paradigm for all youth. We must examine how we are serving young people and then make the required adjustments to meet their diverse needs.

The Roadmap – Getting Involved:

• Review—and use—the evidence by visiting K4Health’s LARCs topic page
• Endorse the statement and share your support let us know what your organization is doing to turn your endorsement into action
• Stay abreast of FP2020 youth activities by signing up to the FP2020 newsletter and reach out to me at esullivan@familyplanning2020.org.

The largest generation of youth the world has ever seen is entering its reproductive years, and it has high unmet needs for family planning services. We need to make these services open and accessible so that all people, young or old, married or not, can decide freely and for themselves, whether, when, and how many children they want to have. Their future, and indeed ours, depends on it.

July 11 marked the midpoint of Family Planning 2020 (FP2020), the global partnership that supports the rights of women and girls to decide, freely and for themselves, whether, when, and how many children they want to have. This blog is part of a series that looks at a key intervention to accelerate progress on our goal to enable an additional 120 million women and girls to use modern family planning methods: ensuring young people have the right to plan their families and their futures. We know that the ability to reach more young people with contraception in ways that speak to their own needs and desires is essential to achieving our goal by 2020, which is a critical milestone on the road to 2030 and providing universal access to family planning under the Sustainable Development Goals. For more information, visit www.familyplanning2020.org/midpoint.

Image: Family Planning 2020.