Adolescent-Responsive Contraceptive Services: Institutionalizing a Systems Approach
Establishing Adolescent-Responsive Contraceptive Services (ARCS) is emerging as a more scalable and sustainable way to meet adolescents’ needs for contraceptive information and services. The term ARCS signals an evolution from traditional stand-alone models of adolescent-friendly services towards a systems approach to making existing contraceptive services adolescent-responsive by incorporating elements with demonstrated effectiveness for increasing adolescent contraceptive use.
The Importance of Targeted Adolescent Care
Adolescence, defined by the World Health Organization (WHO) as ages 10 to 19, is a time of tremendous physical, cognitive, and social change and when many people initiate sexual activity. Adolescents need a range of supports to remain well, to transition safely into adulthood, and to adopt lifelong healthy behaviors; a key support is access to contraceptive information and services. However, this contributes to poor sexual and reproductive health outcomes, with about half of all pregnancies among adolescent females (15 – 19 years) in developing regions being unintended.
Defining the Systems Approach
A systems approach refers to incorporating evidence-based elements throughout all components of the health system, rather than implementing isolated interventions. It implies that policies, procedures, and programs across the entire health system are adapted to respond to the diverse needs and preferences of adolescents. For example, an adolescent-responsive systems approach would include:
- Job descriptions and core competencies for providing technically sound nonjudgmental and confidential services.
- Pre-service and in-service training rather than solely running trainings with service providers.
- Performance reviews that institutionalize service delivery acknowledging adolescents as distinct from other age groups.
Scaling Beyond Traditional Models
Many countries continue to invest in interventions that are ineffective or challenging to sustain. In an attempt to respond to adolescents’ concerns around stigma, privacy, and confidentiality, many programs have implemented adolescent-friendly services using separate space models, such as offering services in a separate room within an existing health facility. However, separate space models have proven difficult to sustain and scale. ARCS is an “enhancement to high-impact practices in family planning” as identified by the HIPs Technical Advisory Group, designed to further intensify the impact of existing practices.
Comparative Effectiveness of Interventions
Health systems must go beyond piecemeal approaches to addresses the barriers that limit adolescents’ access to and use of contraception. The following table summarizes the effectiveness and sustainability of various common interventions based on the draft material:
| Intervention Type | Demonstrated Effectiveness and Sustainability |
|---|---|
| Youth centers | Ineffective at increasing contraceptive use |
| Peer education | Demonstrate mixed effects |
| Separate spaces | Challenging to sustain and bring to scale |
| Systems Approach (ARCS) | More scalable and sustainable; intensifies impact of HIPs |
The Global Context
With 1.25 billion adolescents, increasing to 1.35 billion in 2050, and countries striving to achieve universal health coverage, health systems must institutionalize service delivery that addresses the specific barriers adolescents face. There is evidence that adolescent-friendly services, when well-designed and well-implemented, can help increase access to and use of contraception. ARCS focuses on service delivery aspects to make existing contraceptive services responsive to the needs and preferences of adolescents.