What is this ‘never-before’ opportunity?
First, there is a growing recognition of the widespread unmet contraceptive needs of sexually active adolescents (both in and out of union), and the enormous health, social, and economic consequences of low levels of use. Millions of adolescents who wish to postpone or space childbearing are currently not using an effective method of contraception. The Guttmacher Institute estimates that 38 of the 252 million adolescent women aged 15 to 19 living in developing regions are sexually active, and do not wish to have a child in the next two years . Among these adolescents, 23 million have an unmet need for modern contraception. This has enormous individual and social repercussions. The data modeled by Darroch et al. clearly underlines the potential demographic and public health gains of ensuring access and uptake of modern contraception by adolescents. “Meeting the unmet need for modern contraception of women aged 15-19 would reduce unintended pregnancies among this group by 6 million annually. That would mean averting 2.1 million unplanned births, 3.2 million abortions and 5,600 maternal deaths… The dramatic reduction in unintended pregnancies would spare women and their families the adverse consequences of early childbearing, reap savings in maternal and child health care, and boost women’s education and economic prospects” .
Secondly, there is a stronger awareness that simply increasing the overall availability of contraception does not necessarily result in increased uptake of contraceptives by adolescents. Even where contraceptive use increases, adolescent use does not increase as much as among other age groups. Data from Bangladesh and Egypt illustrate this. In Bangladesh, adolescents aged 15 to 19 exhibit the lowest contraception utilization rates compared to older women [DHS, Bangladesh], while in Egypt, the youngest adolescents, aged 15 to 19, have the lowest levels of contraceptive use compared to older women [DHS, Egypt]. Among married 15 to 19 year olds in Egypt, 74% do not use any contraceptives [DHS, Egypt].2
Why are adolescents still unable to obtain and use contraceptives?
What do we need to do – or do differently – to increase correct and consistent contraceptive use by adolescents?
Successful programme approaches
Demand for contraception
Desire to avoid, delay, space or limit child bearing
Gendered roles (expectations to be a mother, wife), need to prove fertility, religious values, path to adulthood
Enhance the acceptability of avoiding, delaying, spacing, and limiting childbearing
Desire to use contraception
Stigma, taboos (communication and cultural), lack of understanding (fear of side effects)
Improve the understanding of contraceptive methods and sexual and reproductive health (SRH)
Life skills education and vocational training programmes in Uganda and India have been shown to increase contraceptive use [61, 62]
Working with influential family members in India helped build support and overcome resistance 
Agency to use contraception
Early marriage, family pressure, sexual coercion/violence, limited decision-making autonomy and power
Increase agency for girls and women to exert agency and make their own decisions
Supply of contraception
Access to contraceptive services
Lack of awareness of services, inaccessible location, inconvenient operating hours, costs, wait times
Expand access to contraceptive services through various channels
Community-based outreach involving provision of information and services through the national Health Extension Programme (HEP) led to remarkable improvements in uptake of modern contraception among adolescents in Ethiopia 
Provision of adolescent-friendly services
Lack of provider sensitivity, provider reluctance to offer contraceptives to adolescents/bias, gender biases, lack of privacy/confidentiality, contraceptives unavailable or out of stock
Increase provision of high-quality, youth-friendly services for adolescents, tailored to meet adolescents’ needs
Expanding access to quality contraceptive services to adolescents with equity: What do we want to see in countries?
Interventions to address the determinants
Factors that contribute to the adolescent behaviours
Adolescent behaviours most directly related to these health outcomes
Unprotected sexual activity
Early initiation of sexual activity
Sexually transmitted infections, including HIV
1. Improve community awareness about adolescent sexuality andsupport for protecting adolescents with sexuality education and sexual and reproductive health services, notably contraception and HIV testing and counselling.
2. Improve access the contraceptive information and services and HIV testing and counselling services to all segments of the population.
Adolescents have many knowledge gaps about sexuality and reproduction and how to avoid problems. They have many misconceptions about contraceptives.
Adolescents are not able to get sexuality education at home, school or elsewhere in the community. Adolescents are not able to obtain contraceptives from government facilities and cannot afford them from private providers. They are under pressure to have sex early from peers and from adults
1.Educate boys and girls about sexuality and reproduction.
2.Build individual and social assets of adolescent girls to avoid from choosing child marriage/to being forced into child marriage.
3.Improve access and uptake of contraception through government clinics and through complementary approaches community outreach, social marketing and commercialsales.
4.Improve access to HIV testing and counselling and links to HIV-related care.
Social norms do not acknowledge adolescent sexuality and are not supportive of providing adolescents with sexuality education and contraception. There are few educational and employment opportunities especially for girls. Traditions and economic constraints pressure families to have their daughters married early.
Indicators and means of verification
Quality and coverage of school and community based education and health service provision (Source: Implementation reports and assessments)
Proportion of adolescent boys and girls who are knowledgeable about contraception and know where they can get them (Source: Surveys)
Proportions of adolescent girls who report using modern contraception and boys who report using condoms (Source: Surveys)
Data on adolescent fertility, and prevalence of STI/HIV disaggregated by age and sex (Source: Surveys)
• In settings with high rates of pregnancy in adolescence, what factors protect adolescents from unwanted and/or unsafe pregnancy?
• What strategies can delay first births among married adolescents?
• What strategies can increase consistent and effective condom use among both male and female adolescents?
• What barriers do health-care providers face when trying to offer contraception services to unmarried adolescents?
• Through what mechanisms can the provision of regular and emergency contraceptives to adolescents be financed or subsidized?