Evidence suggests youth aged 15-24 across many countries struggle to continue contraceptive use, with contraceptive discontinuation rates 25% higher than that of older women. Method-related side effects have been identified as the leading cause of discontinuation for adolescents, but other drivers include changing reproductive needs (i.e. period of abstinence), evolving reproductive intentions (i.e. a desire to become pregnant), and the reluctance to seek contraceptives due to a negative experience with a healthcare provider, quality of contraceptive counseling, inconvenience, access, cost, and stigma. Despite growing evidence on what works to support contraceptive continuation among adolescents, there’s little indication on what approaches are scalable and can be sustained within existing health structures.
In its second investment phase (2021 -2025), A360’s global project strategy aligned its objectives to focus on contraceptive uptake and to drill down on contraceptive continuation to achieve impact. The project aimed to shape a clear, effective strategy to support continuation, informed by the evidence base and refined through implementation and testing. A continuation strategy was developed to guide implementation, and evidence generation has been ongoing to provide insights into the approaches used and adolescents’ unique patterns of use and drivers of discontinuation. Using results from continuation cohort studies
coupled with provider record reviews, client record reviews, and quality of care evaluation reports, A360 reviewed components of the continuation strategy to identify efficacious approaches to support adolescents in continuing the use of contraceptives when in need and can also be integrated within the different Government systems for sustainability.
This technical brief highlights the results of the review process and the approaches within the refined continuation strategy that can be integrated within different country contexts and Government systems. It further provides details of A360’s contraceptive continuation strategy development, the contextualisation process, testing and evidence generation, strategy refinement, key learnings, and the next steps based on the insights generated.
By Winnie Musubika, Senior Technical Advisor AYSRH for the A360 project at PSI
