Contraceptive use and method choice among young people in sub-Saharan Africa: Are we meeting their reproductive health needs?

Family planning (FP) has been shown to have numerous health and social benefits for women, men and their families, including reduction of infant and maternal mortality, improved health of children due to birth spacing, and enabling young women to remain in school or pursue income generating activities. Yet, there are gaps in access to and use of voluntary contraception, particularly for adolescents and youth. The Full Access, Full Choice (FAFC) project aims to generate and synthesize evidence on contraceptive method choice among adolescents and youth in sub-Saharan Africa and Asia through the analysis of secondary data and collection of primary data. This thesis explores the influencing factors and barriers to adolescents and youth (ages 15-24) accessing and using the contraceptive method of their choice in Ethiopia, Kenya and Niger. Each of the empirical chapters addresses a different research question. Chapter 2 describes the influence of perceptions of peers’ contraceptive use on contraceptive method choice among male and female youth. In Chapters 3 and 4, qualitative data from a study in Kenya describes contraceptive use trajectories throughout adolescence as well as explores decision-making regarding method choice and where to obtain the method. In Chapter 5, we qualitatively explore what factors influence client satisfaction with FP services in Niger. Finally, the association between receipt of FP information and contraceptive use along the maternal, newborn and child health continuum of care among young women in Ethiopia is explored in Chapter 6. Overall, several implications for programs and policy in Ethiopia, Kenya and Niger emerge from this thesis. Programs in these settings, including demand and supply-side programming, should be tailored to the stage and sub-population given that adolescents and youth are a diverse group, and transition through many key life stages during this time period. This may include expanding access to a full range of methods through pharmacies, a common source of FP for youth. To address knowledge gaps, new avenues to provide FP information should be explored, and efforts should be made to provide this information at facility visits, particularly along the maternal, newborn and child health continuum of care. Future research efforts should include longitudinal studies to understand changes over time in key outcomes, including during pregnancy. In addition, studies should include male youth, as they play an important role in method use and choice. In conclusion, decisions about SRH should be based on what young women and men determine is best for them in each setting. Programs and research should incorporate the ideas, knowledge and experience of youth in order to ensure that barriers are addressed and youth are able to exercise their right to free and voluntary use of contraception.