Background
Adolescent girls face unique reproductive health challenges like early marriage, early age at first birth, and low contraceptive uptake with a higher unmet need for contraceptives among married adolescents compared to older married women. Anecdotal evidence from A360 project show that adolescent girls discontinue contraceptive use due to side effects, myths and misconceptions, and disapproval from critical influencers. Society for Family Health through her A360 Amplify project implemented an optimal package to support contraceptive continuation for women still in need.
Methodology
To reduce method failure related to individual level barriers, A360 developed protocols for provider follow-up calls digitized and linked to DHIS2 for tracking and follow-up cards for girls without access to a phone.
To manage side effects and method related barriers, the counseling for choice (C4C) strategy was introduced targeting woman's unique contraception need. The use of the 3Ws, NORMAL rubric enabled providers to better address girls' concerns around side effects.
In strengthening enabling environment to address relational and environment barriers, A360 designed a key influencer engagement strategy for husbands of married adolescents and mothers of unmarried adolescent girls.
While to support sustainable access, community-based distribution agents called Big Sistas work with providers on a two-way referral for initial uptake and resupply of DMPA-SC.
Results
Provider call log; of the 8,441 adolescent girls called, 7,212 returned to the facility for scheduled visits. Specific to continuation, 539 were called and 510 returned for resupply. For sustainable access using Big Sista strategy, of the 658 girls who initiated FP, 450 continuing users representing 68% returned for continuation. Outcome of combined strategies of provider call log and quality counselling using the C4C and 3Ws yielded 88% and 90% of returning unmarried and married adolescent girls respectively who had previously initiated a contraceptive method returning for re-supply.
