In June 2012 during the landmark London Family Planning Summit, Malawi committed to raise its contraceptive prevalence rate to 60% by 2020 with a focused increase among those aged 15-24 years. The commitment was launched with a theme of no parenthood before adulthood.
Malawi has a rapidly growing youthful population with a total fertility rate (TFR) of 5.5 and an adolescent fertility rate of 137 per 1000 adolescent girls aged 15 to 19 (ps- this is high). Adolescents have diverse needs and require integrated comprehensive sexual and reproductive health information and services in line with their life cycle.
So why Long Acting Reversible Contraceptives (LARCs) for young people?
1- Young people are advocates for reproductive health and choice as community distribution agents, providing information and short acting contraceptives methods to their peers. They serve as a bridge to static facilities and outreach services that provide LARCs to adolescents, initiating change in provider interactions with young people as they influence adaptation of family planning services and counseling that is best suited for adolescents.
2- There’s a high intention to use contraception: sexually active young people (2 % among males and 74.7 % among females) reported a high intention to use contraceptives at next sexual interaction.
3- It will help address Malawi’s high total fertility rate: The 2015/16 Malawi Demographic and Health Survey Key Indicator report shows that use of modern contraceptive methods among married women aged 15-49 years increased from 42% in 2010 to 58% in 2015/16. Yet, adolescent fertility increased 4% between 2010 and 2015.
A 2015 study by Health Policy Project revealed that high teenage pregnancy rates is a key facilitator in addressing Malawi’s high total fertility rate. This suggests that a shift to focusing on adolescents in the national family planning program to raise awareness for acceptability and uptake of LARCs can prevent over 109,000 teenage pregnancies annually resulting in a significant drop in unintended and repeat pregnancies.
4- LARCs are key in managing development and accelerating economic growth: This growth results from a decline in a country’s mortality and fertility rates by changes in the age structure and the increased ratio between a productive labor force and non-productive dependents. Contraceptive choice allows all women of child bearing age especially adolescents to control their spacing needs, as the number of non-productive dependents within the country decreases, and the economy grows, therefore, improves. A delayed pregnancy provides girls a chance, second chances to teen mothers and married adolescents to advance their education aspirations, for families to better invest in the lives of their children and to explore entrepreneurship as they have added income.
“Adolescents’ contraceptive choice should never be compromised. Comprehensive sex education must be part and parcel of approaches aimed at offering timely same day LARC services to young people.”
It can be done
The Costed Youth Friendly Health Services (YFHS) Strategy 2015-2020 and the YFHS standards (2015) provide a framework for voluntary client-centered approach to the implementation of contraception services. They seek to accelerate access and uptake of LARCs by adolescents through multi-sectoral strategies and collaboration as an integrated program in various sectors such as education, youth and agriculture and gender.
The St. Louis Contraceptive Choice Project, which was a large cohort study, provides strong evidence that comprehensive contraceptive counseling and provision of free wide range short and long acting reversible contraceptives methods to women including adolescents leads them to choose LARCs through informed choice with high 3-year continuation rates. These findings affirm that LARCs are a voluntary cost effective strategy in preventing unintended teenage and repeat rapid pregnancy.
Investing in adolescent reproductive health pays! Why not reap the gains today by expanding access of LARCs for adolescents and make No Parenthood before Adulthood a reality for Malawian adolescents?
Written by: Barwani Msiska
IYAFP Member, Malawi