Adolescent-Responsive Contraceptive Services: Institutionalizing adolescent-responsive elements to expand access and choice
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.
The Need for a Systems Approach
With 1.25 billion adolescents, increasing to 1.35 billion in 2050, and countries striving to achieve universal health coverage, health systems must go beyond piecemeal approaches to institutionalize service delivery that acknowledges adolescents as distinct from other age groups and addresses the barriers that limit adolescents’ access to and use of contraception.
However, many countries continue to invest in interventions that are ineffective at increasing contraceptive use (e.g., youth centers), demonstrate mixed effects (e.g., peer education), or are challenging to sustain and bring to scale (e.g., separate spaces for young people within health facilities). This contributes to poor sexual and reproductive health outcomes, for example, about half of all pregnancies among adolescent females (15 – 19 years) in developing regions being unintended.
Defining Adolescent-Responsive Contraceptive Services (ARCS)
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 adolescent-responsive contraceptive services (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.
A systems approach refers to incorporating evidence-based elements throughout all components of the health system, rather than implementing isolated interventions. Apply a systems approach to make existing contraceptive services adolescent-responsive, i.e., responsive to the needs and preferences of adolescents. ARCS is an “enhancement to high-impact practices in family planning” as identified by the HIPs Technical Advisory Group.
Key Elements of the Systems Approach
An adolescent-responsive systems approach would include:
- Job descriptions for health personnel.
- Core competencies for providing technically sound nonjudgmental and confidential services to adolescents.
- Pre-service and in-service training.
- Performance reviews, rather than solely running trainings with service providers.
The following table illustrates the shift from traditional interventions to a comprehensive systems approach:
| Intervention Type | Characteristics |
|---|---|
| Traditional Stand-alone Models | Youth centers, peer education, and separate spaces for young people within health facilities. |
| Systems Approach (ARCS) | Integrating nonjudgmental and confidential services into core health system components like job descriptions and performance reviews. |
Implementation and Scalability
There is evidence that adolescent-friendly services, when well-designed and well-implemented, can help increase access to and use of contraception. However, traditional models of specialized service delivery for adolescents have proven difficult to sustain and scale. In an attempt to respond to adolescents’ concerns around stigma, privacy, and confidentiality, many programs and/or countries have implemented adolescent-friendly services using separate space models (e.g., offering adolescent-friendly services in a separate room within an existing health facility). However, separate space models have proven difficult to sustain.
A systems approach implies that policies, procedures, and programs across the entire health system are adapted to respond to the diverse needs and preferences of adolescents.