Contraception

Fact Sheet on Youth Reproductive Health Policy

More couples have access to effective, modern methods of contraception than ever before. The proportion of women using contraception has increased steadily over the past several decades, to the point where about half of women of reproductive age in the developing world now use a modern method of family planning. Nonetheless, some 350 million women still lack access to the full range of contraceptive methods. And making newer, better contraceptives available to women in developing countries remains a challenge.

Its Importance as a Youth Reproductive Health Issue

• With decreasing age of menarche and increasing age at marriage, the risk of a young person experiencing an unintended pregnancy is greater than ever.
   
• Young people have the highest levels of unmet need for contraception.
   
• Early and unwanted pregnancy is detrimental to the health and socioeconomic status of young people and their children.
   
• Helping youth prevent unwanted pregnancy is the best way to prevent unsafe abortions
   
• Many of the same factors that increase exposure to unwanted pregnancy also increase the risk that young people will contract HIV and other sexually transmitted infections.
   

Key Areas for Policy Action

Many of the same policy actions that would help to make contraception available to women and men more generally also apply to contraceptive access for young people. In addition, countries should undertake the following key policy actions that are especially important in improving access for young people:

• Promote abstinence while recognizing the contraceptive needs of sexually active youth. Abstinence is a primary means of preventing unwanted pregnancy. However, policy should acknowledge that sexually active youth need increased contraceptive access and options.
   
• Ensure that youth have access to a wide range of contraception. Nearly all contraceptive methods are appropriate for adolescents. Law, policy, and clinical guidelines should reflect international consensus on the safety and appropriateness of contraceptive methods, so that health workers have clear guidance to advise and prescribe appropriately to young people based on sound medical criteria.
   
• Eliminate restrictions based on social status (e.g. denying contraceptives to unmarried adolescents) or based on unfounded medical criteria.
   
• Allow minors to consent to use of contraception without adult approval or notification. Policies requiring adult consent unnecessarily restrict access to contraception.
   
• Ensure that young people have access to comprehensive information about contraceptive options, through schools and other channels.
   
• Promote dual protection against unintended pregnancy and STIs.
   
• Address the role of emergency contraceptive pills as a backup to failure of condoms and other contraceptives.
   
• Support youth-friendly services that train health workers to address the special concerns of young people, that maintain confidentiality and privacy, and that are accessible and affordable to young people.
   
• Emphasize open discussion and promotion of condoms and allow schools to provide condoms and other contraceptives, as appropriate.
   

The State of Policy Making

A growing number of policies promote access to contraception for young people. Still, in several countries, formal and informal policy barriers limit such access. Often such policy language regarding young people can be found within national population policies, Ministry of Health policies, and guidelines and the policies and guidelines of nongovernmental organizations.

Here are some examples from the policy database of youth-specific policies that address contraception:

• Ghana ARH Policy (pdf 524 kb)

Research Findings to Support Policy Development

New Survey Findings: the Reproductive Revolution Continues. This 2003 edition of Population Reports includes a special section on contraceptive use by youth.

From Rhetoric to Reality: Implementation Tips

Good planning is key to successful youth-friendly services. Important steps towards planning and implementing a youth-friendly health services strategy begin with achieving a national consensus for action. A policy initiative to raise the profile of adolescent health services identifies departments and individuals to start the process of change, and sets up structures through which change is brought about. Political support is important to start the process and to ensure that all government departments collaborate, bearing in mind that health and development needs cannot be met by health services alone. Political backing is critical for winning community support and developing a national sense of urgency. Additional steps include:

• discovering the health status of adolescents, and what they do when they seek help;
   
• developing a strategy to decide what services will be delivered, where and by whom;
   
• identifying an essential services package, core values, quality standards and a process for quality improvement;
   
• linking with other services for young people;
   
• involving youth in the design and implementation of services; and
   
• garnering community support to ensure that services are acceptable and used.
   

Related Links and Resources

Expanding Contraceptive Options and Access for Youth (148kb). FHI, 2004. This YouthLens publication discusses how education, services, and products can help protect youth against unintended pregnancy and sexually transmitted infections, including HIV.

FAQs

Q. What contraceptives are medically appropriate for adolescents?
According to the Medical Eligibility Criteria of the World Health Organization (WHO), no medical condition would absolutely restrict an adolescent's eligibility for any method based only on age. However, for young women, WHO places two methods - IUDs (for women under 20) and progestin-only injectables (for women under 18) - in what it calls category 2, a "condition where the advantages of using the method generally outweigh the theoretical or proven risks." In this category, young women can generally use the method but health workers may need to provide careful follow-up and counseling to make the young client aware that a better option may exist. For youth, no method falls in category 3 or 4 (contraindicated for use). (Adapted from YouthLens #12, 2004 Expanding Contraceptive Options and Access for Youth (148kb).)