When it Comes to Continuation, We are Losing Girls

As a global community, we’ve helped 258 million girls and women in the world’s 69 poorest countries get modern contraception.*

As many as 49 million of them could stop using it even while still in need of protection from unintended pregnancy.**

Contraceptive discontinuation is the field’s “leaking bucket.” And A360 is not immune to the problem. Fully meeting contraceptive needs for all women of reproductive age is estimated to cost $9.4 billion.***

The stakes are high; we can’t afford to lose girls.


* Population Council. Contraceptive Discontinuation: Reasons, Challenges, and Solutions. 2015.
** Idem.
*** Darroch et al. “Costs and Beneficits of Meeting the Contraceptive Needs of Adolescents.” Guttmacher. 2016.

Getting someone to take up a behavior is usually way easier than getting them to stick with it.

But the reality is clear: in sub-Saharan Africa, 1 in 2 women who start using contraception stop using it within the first two years, despite not wanting to get pregnant.*

Young girls are most likely to discontinue a method within the first year of starting on contraception.**

**Blanc et al. “Patterns and Trends in Adolescents’ Contraceptive Use and Discontinuation in Developing Countries and Comparisons with Adult Women.” International Perspectives on Sexual and Reproductive Health, 2009, 35(2):63-71.

We’re facing a multi-part challenge.

1) Most programs, including A360, aren’t built to stay with girls throughout their contraceptive user journey.

A key ingredient to girls’ contraceptive continuation is their trust that the health system and their support networks are there for them —within and beyond the clinic walls. But most programs, including A360, are incentivized to go for breadth of reach (think number of girls served) rather than depth (think number of girls who continue using). It’s important —& also hard to do!

2) Health systems have a (big) blind spot.

Data on continuation rates is often only available through research, and therefore invisible to managers in their day-to-day work. As a result, managers lack the key first step to addressing this critical sexual and reproductive health challenge in real-time.

3) Health systems lack ways to find and re-engage girls who’ve been lost to the system.

In-person follow up is costly. Reaching girls via mobile is an option, but girls often don’t own their phones and so can’t be sure that their privacy will be protected. Plus, many girls have no phones at all.

How can we strengthen the health system to address the multi-part challenges—and in doing so, how might we stay with girls once we’ve reached them with sexual and reproductive health services?

Keep exploring

During insight gathering, young people told A360 they contraception wasn’t relevant to their lives. If anything they see it as a threat to their dreams of motherhood, something they view as desirable and achievable no matter the unpredictability within their lives.

Interventions that lead with supporting girls’ self-identified dreams delivers an entry point to reaching, and resonating with, our target consumers.

We’re helping girls set plans for their goals, and then helping them see contraception as a tool to get one step closer to achieving those dreams.

These insights offer guidance into how you, alongside young people, can change the conversation around contraception.

Looking for more?

When it comes contraceptive counseling for young people, we know: choice is key, and leading with what matters to young people is integral to making contraception relevant, valuable and accessible to girls’ lives.

That’s why A360’s 9ja Girls embeds, youth-friendly providers to lead private contraceptive counseling. All contraceptive counseling addresses girls’ expressed concerns, including the potential for side effects and the assurance that all contraceptive methods are safe and reversible.

What have we learned – and what can you apply – about training youth-friendly providers? Explore here.