Skibiak, John, Tori Rumbold, and Jill Keesbury. "Expanding adolescent contraceptive choice in Ethiopia."

Abstract

BACKGROUND AND OBJECTIVES: A 1998 nationwide assessment of reproductive health needs in Ethiopia demonstrated a significant discrepancy in young people’s behavior toward family planning. While adolescent knowledge of contraceptives was much higher than health planners thought, utilization of those methods remained surprisingly low. To explain this, young people themselves suggested that there was a lack of contraceptive methods—even at youth-friendly facilities—that reflected the nature of their sexual behavior: irregular, unplanned, hurried, and clandestine.

In 2001, a leading Ethiopian nongovernmental provider of reproductive health services to young people asked the Population Council to explore the impact of expanding access to the methods that young people wanted, such as the male and female condom, vaginal foaming tablets, and emergency contraception. This study, which recently ended, was designed to test the hypothesis that greater access to contraceptive methods that reflect the distinctive nature of young people’s sexual behavior will increase their use of such methods.

FINDINGS: The study highlighted a set of important lessons regarding the feasibility of providing coital-dependent methods to adolescents through youth clinics in Ethiopia.

• Repackaging various methods into a single youth-friendly “brand” significantly increased demand, but such an undertaking could not be scaled up in a cost-effective manner.

• Peer service providers played a key role in increasing utilization overall, although negative attitudes toward vaginal foaming tablets significantly limited uptake of that method.

• Decentralized clinic management complicated efforts to administer the program consistently throughout the country.

Another key finding relates to the study’s design. Because of the significant differences among youth centers in Ethiopia, the effectiveness of similar interventions are best measured by looking longitudinally at changes within individual centers. While the study was originally designed to compare centers cross-sectionally, data analysis was frustrated by the degree and magnitude of variations among youth centers. As a result, the impact of specific changes—not all of which were directly related to the project interventions—could only be clearly ascertained within individual centers.

CONCLUSIONS: This study provided insight into the preferences of adolescent contraceptive users, while at the same time bringing to light the systematic constraints to providing such services. Its findings have important implications for the delivery of post-coital contraceptive services to adolescents, both in terms of method acceptability and the means of delivering the services. Methodologically, the study also presents a cautionary tale of the difficulties involved with cross-sectional measurement in a country as diverse and changing as Ethiopia.

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This page updated 30 May 2006

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