How do We Change Policy and Communities to get Youth Access to Long-Lasting Reversible Contraceptives?

How contraceptives—especially long-acting reversible contraceptives (LARCs)—can improve the health and wellbeing of young women is a topic that presents tough questions. With USAID’s support,  PSI, FHI360, Pathfinder and its Evidence2Action Project, and Marie Stopes International recently held a symposium to tackle those questions head on, and chart a course forward to improve the sexual and reproductive health of young people. Addressing the first of four tough questions, this post discusses how provider bias impacts a young person’s right to information and access to all her contraceptive options, particularly LARCs.

Selam thought carefully about getting a contraceptive implant before walking to the clinic. She debated going for weeks because there were so many unknowns: Would the clinic really supply them? Would her provider tell her parents? Would people see her and think she was promiscuous?

Selam walks toward the clinic and musters the courage to open the door, entering a waiting room teeming with older mothers and their children. Once inside, she is overtaken with panic as they stare at her questionably, whispering to each other about what kind of unmarried woman would be asking for contraceptives.

Embarrassed and afraid, Selam leaves.

In Selam’s community in Ethiopia, like in many countries in Africa, social and gender norms about contraceptives keep many young women and girls from accessing their desired method of family planning. Policies exist, but are often inadequately implemented. Many do not explicitly protect a woman’s right to access contraceptive information or products, particularly if she is unmarried or has not begun childbearing. On many occasions, local leaders and health providers are equally unclear on what the policies say and err on what they assume is the side of caution—limiting long-acting reversible contraceptives (LARCs) to women who are married and/or have begun childbearing.

“Unmarried young women face challenges on a daily basis because of policies that are either ineffective or nonexistent, or community norms that discourage them from accessing long-acting reversible contraceptives.”

At the recent “For Youth, a Healthy Option With LARCs” symposium in Washington, DC, public health professionals from around the world discussed the complexities of how policies and communities affect young people’s access to LARCs. After Kidest Lulu Hagos from Pathfinder Ethiopia presented Selam’s story, she challenged the audience to discuss two important questions:

What approaches can be used to effectively change social and community norms? And, which mechanisms can support the implementation of policies that increase youth access to LARCs?

A few powerful themes emerged. Most agreed that community interventions to address gender norms were necessary, and that choosing the right advocates for specific groups of young people could help build on existing community structures. Furthermore, programs should promote inter-generational dialogue to address barriers, as well as identify ways to overcome cost barriers.

On the research side, case studies for how to track whether policies are implemented successfully would be helpful, as well as learning how providers behave after being more fully informed on LARC and youth policies. Ideally, global, national and regional associations would also actively advocate for policies that make it easier (both logistically and culturally) for young women to access LARCs.

More on this topic and other tough questions related to youth and LARCs will be presented this fall in a meeting report and consensus statement with PSI, Pathfinder International and its Evidence to Action (E2A) Project, MSI and FHI360.