London School of Hygiene & Tropical Medicine

Achieving universal access to such services is a key component of Sustainable Development Goal 3.7, as it not only promotes health but also empowers young girls by giving them control over their fertility, which, in turn, supports their educational and employment opportunities.

Efforts have been made to increase contraceptive use among adolescents, but their effectiveness has been limited. Adolescents 360 (A360) was a four-year initiative spanning from 2016 to 2020, which aimed to increase the voluntary uptake of modern contraceptives among adolescent girls in four distinct settings. A360 employed a human-centered design approach to develop specific interventions tailored to each location through research and prototyping.

The program hypothesized that engaging adolescents in the development process would result in novel and more successful approaches to promoting contraceptive use. It was expected that while this might lead to higher design costs, the effectiveness of the interventions would ultimately make them more cost-effective.

The primary aim of the study published in Plos Global Public Health, was to evaluate the effectiveness and cost-effectiveness of the A360 approach in increasing modern contraceptive use among sexually active girls aged 15–19 years. The primary outcome measured was the proportion of sexually active girls who reported using modern contraception.

The outcome evaluation and cost-effectiveness studies of A360 were conducted in Northern Nigeria, Southern Nigeria, Ethiopia, and Tanzania, drawing on process evaluation findings to interpret the results.

The study design used repeat cross-sectional surveys to assess the impact of A360 on modern contraceptive use. In each setting, eligible girls aged 15 to 19 years were identified at the household level. The study areas were selected based on various criteria, and the same design and primary sampling units were included at baseline and endline when possible.

In Nasarawa, Nigeria, the study found no evidence of an impact of A360 on modern contraceptive use despite an increase in modern contraceptive prevalence rate (mCPR) in intervention areas. Self-reported exposure to 'Matasa Matan Arewa' was low, and the program's impact was limited.

In Ogun, Nigeria, mCPR increased in intervention areas, but again, there was no evidence of an impact of A360. Self-reported exposure to '9ja Girls' also did not show a strong relationship with primary and secondary outcomes.

In Oromia, Ethiopia, mCPR increased, and the study showed that A360 had a positive impact in terms of contraceptive use, with a positive association between self-reported exposure to 'Smart Start' and mCPR.

In Mwanza, Tanzania, mCPR decreased, primarily driven by a decline in male condom use. However, the study found a positive association between self-reported exposure to 'Kuwa Mjanja' and mCPR, indicating some impact.

Aoife Doyle, Associate Professor and senior author of this paper highlighted the significance of this study and wider implications saying, “Improving adolescent access to essential health services is critical. This paper is important as it describes the rigorous evaluation of an innovative approach to improve adolescent health. The findings highlight the need for future interventions to put more emphasis on addressing the contextual drivers of low modern contraceptive use.”

In summary, the A360 initiative had varying success in increasing modern contraceptive use among adolescent girls in different settings. The impact was influenced by factors such as self-reported exposure to the program and the local context. Cost-effectiveness also varied, with better outcomes in areas where the program was more effective in increasing contraceptive use. The findings of this study shed light on the challenges and successes of initiatives aimed at improving sexual and reproductive health outcomes for adolescents in low and middle income countries.

Publication

Catarina Krug, Melissa Neuman, James E. Rosen, Michelle Weinberger, Stefanie Wallach, Mary Lagaay, Melanie Punton, Annapoorna Prakash, Mussa Kelvin Nsanya, Philip Ayieko, Saidi Kapiga, Yewande P. Ajayi, Emily E. Crawford, Eskindir Tenaw, Mohammed Mussa, Som Kumar Shrestha, Christian Bottomley, James R. Hargreaves, Aoife Margaret Doyle. Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies. Plos Global Public Health.

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002347