Posted by Lauren J Montgomery-Rinehart on octobre 21, 2016 at 7:42
Commissioned by the Reproductive Health Supplies Coalition (RHSC), this report aims to help its members better understand young people’s needs for reproductive health supplies with a view towards framing future actions to ensure optimal and equitable access. It explores the supply-related barriers that impede access to the contraceptive services young people desire and need. The evidence presented here makes it possible to identify these barriers, understand better the variables that contribute to them, and target future youth-focused initiatives.
As key components of its Strategy 2015-2025, the RHSC emphasises the importance of four key pillars: availability, equity, quality and choice. In this report, specific emphasis is placed upon the pillar of equity, and in particular on the financial and product barriers that impede access to reproductive health supplies. The findings in this report lay out a comprehensive set of interventions which are themselves derived from best practices in the field. These hold out the potential to help young people demand and monitor the services and supplies that meet their needs.
Young people’s access to commodities is hampered by a number of factors including restrictive policies, provider attitudes, cultural barriers, and/or social and financial vulnerability, the relative importance of which often depends on the local or national context. In some cases, the key obstacles may be enshrined in law. In others, the greatest obstacles may be the way laws are interpreted.
Common wisdom holds that young people’s sexual activity is largely sporadic and unplanned. They often prefer short term methods (pills, injectables, condoms) which can be cheaper. Nevertheless, Long-Acting Reversible Contraception (LARCs) can be appropriate for this group and yield cost savings through fewer visits and follow-up. If used routinely over time, short terms methods work out to be more expensive as evidenced in the higher cost per Couple Years of Protection.
Although many programmes focus upon unmarried youth, young married women may also benefit from increased use of LARCs to postpone their first birth and space their second and subsequent births. Family disapproval, however, may make it hard for them to access services; so integrating family planning with postpartum care or childhood immunisation services may serve as effective strategies to increase access.
Other underserved groups include marginalized and vulnerable youth who are often difficult to reach. Young people living with HIV, for example, often experience discrimination at health centres because of their HIV status. And youth in emergency or humanitarian crisis situations must often deal with the effects of uncertain supply chains. Even if young people manage to access services, societal disapproval, provider bias or supply chain disruptions prevent them from getting the method they need or want. Stockouts may have an especially pernicious effect on young people as they often do not have the time, cash or autonomy to seek alternative supply sources and therefore quickly become discouraged.
Policymakers, providers, and both community and religious leaders have expressed reservations about the suitability of Emergency Contraception (EC) for youth. EC is not widely available in many settings and is not on the National Essential Medicines List of most developing countries; and yet it holds out unique benefits for young victims of sexual assault and can decrease unsafe abortion and reproductive morbidity and mortality. It is, therefore, crucial that EC be included in political agendas that address both commodities and reproductive rights.
With regard to service provision and delivery channels, many young people seem to prefer to access their family planning methods via the private sector. They perceive it to be more discreet and to provide a better quality of care. A Total Market Approach (TMA) can support private sector provision whilst building up a public sector that is youth friendly. Voucher systems and social marketing can make commodities more affordable via franchises and other outlets where quality is assured. In addition, peer education and community outreach can bring supplies to specific groups who may be marginal or vulnerable. All of that, coupled with rights-based life-skills training could increase uptake.
Young people’s needs and preferences should be considered in the design and implementation of their services and the development of new technologies. Making sure these services include life skills training can also enhance the likelihood young people will apply the reproductive health information they acquire even when society disapproves.
Evidence-based advocacy, carried out collectively by engaging multiple partners, is the best tool for mobilising the resources needed to improve contraceptive availability and service provision.
The interface between youth and reproductive supplies is complex. It encompasses a list of barriers ranging from policies, service delivery protocols, to cultural and legal obstacles. Enhancing young people’s access to commodities should be a priority within countries’ health and development agendas. In addition, youth involvement in the design, implementation and evaluation of relevant policies and
services will be crucial in ensuring ownership and optimal impact.
Specific recommendations on the way forward are given at the end of this report. They include the need for task-shifting and the inclusion of emergency contraception in national Essential Medicines Lists. They also include recommendations for national policies to provide youth-friendly services, including to those under the age of 16. They recommend that young people actively participate in the design of service provision programmes at all levels (through family planning associations, health facilities, and community organizations) to ensure their needs are represented. And lastly, this report highlights the need for appropriate pre- and in-service training to overcome provider biases, and to ensure that providers have the necessary skill sets to adequate stocks of a broad range of contraceptive commodities.
Read the full report here…