Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation

Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and us...

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Bibliographic Details
Published in:International journal of environmental research and public health 2022-11, Vol.19 (21), p.14414
Main Authors: Burchett, Helen Elizabeth Denise, Griffin, Sally, de Melo, Málica, Picardo, Joelma Joaquim, Kneale, Dylan, French, Rebecca S
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Birth control
Contraception
Contraception - methods
Contraceptive Agents
Contraceptives
Developing Countries
Empowerment
Evaluation
Family planning
Family Planning Services
Female
Fertility
Gender
Girls
Heterogeneity
HIV
Human immunodeficiency virus
Humans
Intervention
Motivation
Norms
Poverty
Pregnancy
Reproductive health
Review
Sexual behavior
Social factors
Social norms
Teenage pregnancy
Teenagers
Womens health
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Summary:Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph192114414