Reproductive Health

Adolescent First Birth

Sexually active adolescents use a modern contraceptive method to delay first birth until after age 18

Use of a modern method of family planning to delay a woman’s first birth until after the age of 18 can prevent up to 15% of newborn deaths.1Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study
International Journal of Epidemiology
Xi-Kuan Chen, Shi Wu Wen, Nathalie Fleming, Kitaw Demissie, George G Rhoads and Mark Walker   This is a preventive behavior that can be successfully carried out using a number of different modern contraceptive methods.

Key Points from Global Research

  • Ensuring social support, confidentiality and a relatable, non-judgmental provider can ensure that adolescents will seek modern contraceptives.
  • Addressing different standards of morality and levels of self-efficacy related to sexuality for boys and girls can encourage adolescents to seek and use modern contraceptives.
  • Reducing early marriages, and thus the social expectation of early pregnancy, can encourage adolescents to delay pregnancy.

Behavior Profile Sample: Adolescent First Birth

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating Behavior Profiles. 

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Improve maternal and child survival
Sexually active adolescents use a modern contraceptive method to delay first birth until after age 18
Indicator: Percentage of sexually active unmarried women age 15-19 currently using any modern method of contraception

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Decide to use a modern contraceptive method
  2. Obtain family planning counseling from a qualified provider
  3. Select appropriate modern contraceptive method
  4. Obtain chosen method
  5. Use chosen method as instructed

Click on any box
        to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.  
        of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
Structural
Accessibility: Adolescents cannot easily access family planning services because the hours and location of the health facilities are inconvenient
Service Experience: Adolescents often do not have a positive experience when seeking family planning at health facilities because policies around adolescent sexual and reproductive health are not always clear, including clinic guidelines on parental permission, rights to privacy, and requirements for physical exams
Service Provider Competencies: Adolescents do not feel comfortable seeking family planning because clinics do not always maintain privacy, and providers are often judgmental or may deny them care
Social
Family and Community Support: Adolescents, especially girls, do not access family planning because they do not have social support and suffer stigma and social exclusion if they are known to access family planning
Gender: Adolescents, especially girls, do not discuss or pursue family planning services because traditional concepts of masculinity drive sexual decision making
Norms: Adolescents do not discuss or pursue family planning services because adolescent sexuality is often highly moralized in communities and can be especially taboo for girls
Internal
Self-Efficacy: Adolescents, especially girls, do not discuss family planning with sexual partners or service providers because they lack confidence to do so
Knowledge: Adolescents do not obtain or use modern contraceptives because they have limited information on sexuality, reproduction, and contraceptive methods

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Create and enforce clear policies establishing adolescents' rights to access a wide variety of modern contraception methods without judgement and with the expectation of privacy
Providers: Offer adolescent-friendly contraception services, including assurance of privacy and acceptance, counseling on appropriate methods and continuous care
Community
Community Leaders: Provide forums for the broader community to discuss the issue of girls' safety, support to girls' future planning, and adolescent reproductive health service utilization
Household
Family Members: Support and actively engage in all aspects of adolescents' life including relationships and sexuality
Male Partners: Discuss and mutually agree on when and how to plan for the future

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Financing: Ensure sexual reproductive health services are provided to adolescents at no-cost or highly subsidized (via vouchers, social franchising or other financing models)
Partnerships and Networks: Use variety of service delivery mechanisms (outreach, posts, social franchising, etc.) and innovative partners to reach a wide range of adolescents and create confidence in accessing services
Policies and Governance: Ensure and enforce clear policy around adolescents' right to access contraception services confidentially, respectfully and without a physical exam
Systems, Products and Services
Products and Technology: Offer a full range of contraceptive options to adolescents including long-acting reversible contraceptives
Quality Improvement: Train providers to offer adolescent-friendly services including providing confidential, nonjudgmental information and services, accurate information on medical eligibility criteria for adolescent contraceptive use, etc.
Demand and Use
Communication: Use adolescent-appropriate media to reinforce messages and normalize both adolescent access and use of modern contraception, and create opportunities for community-wide reflection on gender norms, and other issues and concerns
Communication: Create peer-to-peer clubs and other opportunities to work with male and female adolescents on masculinity, healthy relationships and communication
Skills Building: Ensure schools adopt comprehensive sexual and reproductive health curriculum covering family planning options and deliver it by age rather than grade
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Global Status of Accelerator Behavior

Indicator: Percentage of sexually active unmarried women age 15-19 currently using any modern method of contraception

Demographic and Health Survey, The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program