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Barriers to contraceptive use

Despite the fact that adolescent fertility rates are falling on a global level, approximately 18 million girls under the age of 20 give birth each year. Sixteen million of these teens are aged fifteen to nineteen and another two million are children under the age of fifteen. Nearly all adolescent mothers, 95%, live in the developing world and the vast majority of them, nine in ten, are married. Adolescent pregnancy is dangerous. Impacting, on average, the poorest girls in the poorest countries, it has serious long-term and wide-ranging negative ramifications—ranging from the health of young mothers and their babies to broader economic concerns.

The project aims to address eight key barriers, both demand- and supply-side, that may limit adolescents’ contraceptive uptake. It recognizes that individuals, families and communities each play key roles in generating that demand—and that supply is shaped by economics, policies and politics, as well as  service access and quality. These barriers are as follows:

  1. Individual attitudinal barriers: research suggests that most adolescent girls—having internalised powerful socio-cultural values-- desire to become pregnant.
  2. Emotional and interpersonal barriers to the uptake of family planning services also stem from the attitudes and desires of husbands/partners and other family members regarding girls’ fertility.
  3. Broader socio-cultural and religious norms and practices impact the use of contraception in so far as the social value they ascribe to girls versus boys and appropriate gender roles for each.
  4. Teens also face important cognitive barriers in that they lack knowledge and understanding of conception and contraception.
  5. Geographic barriers are particularly significant for rural teens and those with restricted mobility.
  6. The cost of contraception can pose an economic barrier for adolescents.
  7. Administrative barriers can limit the access of unmarried teens.
  8. Where teens are stigmatised for their sexuality, barriers relating to quality of care, especially the attitudes of providers, are significant.

This project also addresses the five key empowerment dimensions that need to be tackled if adolescents’ contraceptive needs are to be given the strategic, multi-pronged policy attention that they merit. Those dimensions are as follows:

  1. Socio-cultural: To empower girls to make their own reproductive decisions there is a need for fundamental socio-cultural shifts. The gender stereotypes that drive child marriage, dowry and domestic violence need to be eliminated.
  2. Educational: In order for girls and women to be seen as actors beyond their reproductive capacities they need education through secondary school and access to economic opportunities.
  3. Interpersonal: Girls need to have voice in their interpersonal relationships, with space to be heard in both their natal and marital families.
  4. Legal: Girls’ rights need to have full legal protection—de jure and de facto.
  5. Practical: Girls need to be empowered with practical knowledge--beginning with age-appropriate, school-based sex education in late primary school--and including full access to family planning information and affordable contraception in the community.


Elizabeth Presler-Marshall, Hanna Alder

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