As the largest cohort of adolescents and young people in history enters its reproductive years, it has among the highest unmet need for contraceptive services.

There is growing consensus that at both the global and national levels, we must invest more than we have and employ more effective approaches than we have to fulfil the unmet need for modern methods of contraception among adolescent girls. Findings from Demographic and Health Surveys (DHS) in three African countries – one each in Eastern, Western and Southern Africa – are useful to reflect on and inform our work in the future.

Firstly, while improving the access and uptake of contraceptives by adult women (i.e. those above 20 years) is important to do, this does not always increase contraceptive access and uptake by adolescents to the same extent. Malawi is a case in point. The just published DHS reports that the contraceptive prevalence in married women aged 25-29 is 62.1% and in those aged 20-24 it is 55.1%, but in those aged 15-19 it is only 38-.1%. Given this, alongside stepped up efforts to reach adult women, adolescents need targeted approaches that respond to their needs and preferences.

Secondly, one size does not fit all.  Adolescents are a diverse group. The life circumstances of a young married woman living in a rural subsistence farming community is very different from that of a young urban-resident, office-employed unmarried sexually active woman.  The data from Ethiopia point to this. Thanks to an impressive rural health extension programme, modern contraceptive prevalence among rural married adolescents increased from below 5% in 2000 to around 40% in 2014. However, unmarried adolescent girls and those living in urban areas did not benefit in the same way. In fact, among unmarried adolescent girls, there was a slight decline in contraceptive prevalence between 2000 and 2011. Given this, a combination of approaches is needed to respond to the different needs and preferences of different groups of adolescents.

Thanks to an impressive rural health extension programme, modern contraceptive prevalence among rural married adolescents increased from below 5% in 2000 to around 40% in 2014.

Thirdly, condoms are the most common contraceptive method used by unmarried, sexually active adolescents. Given the stigma associated with premarital sexuality, private pharmacies and shops rather than government clinics are the main source of contraceptives. Nigeria is a case in point. An estimated 55.1% of sexually active unmarried adolescent girls report using any contraceptive method. Condoms (36.9%) and contraceptive pills (4.8%) are the main modern contraceptive methods used, and nearly one-third of adolescent girls obtain them from pharmacies. Given this, national programs should build stronger bridges with private providers while making government-run health services more responsive to adolescents and better prepared to provide them effective modern contraceptive methods that respond to their needs.

As we enter the final four years of Family Planning 2020 (FP2020) initiative, we welcome the renewed sense of urgency and commitment to meet the special sexual and reproductive health needs of adolescents and young people. We must learn from the valuable experiences of programs and projects in countries, and use these learnings to support countries in their efforts to reach out to young people with comprehensive sexuality education and contraceptive information and services. This includes using a variety of approaches to respond to the differing needs and preferences of this diverse population segment. And finally, we must do this is a way that engages adolescents and young people both as valuable resources and as equal partners

Sources: Malawi Demographic and Health Survey 2015-16, Ethiopia Demographic and Health Surveys 2000, 2011 and 2014, Nigeria Demographic and Health Survey, 2013

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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: UN Photo.