LONG ACTING REVERSIBLE CONTRACEPTION FOR ADOLESCENTS IN KENYA AND RWANDA: A review of supply and demand factors affecting uptake

Abstract

Background: Adolescent pregnancy can pose a multitude of problems in a young girl’s life, affecting her access to education, her health, and relations with others. Long-acting reversible contraceptives (LARCs) can provide an extremely effective type of protection against unwanted or unintended pregnancies that require little to no interference from the user. Despite the effectiveness of these contraceptives, structural and cultural barriers prevent the supply of these contraceptives to adolescents. Understanding supply and demand factors in Kenya and Rwanda can assist in creating new interventions to increase LARC uptake among the target group of sexually active unmarried adolescent females. Aim: To understand contextual factors leading to the use or non-use of LARC among adolescents in Kenya and Rwanda Study Design: A desk review of literature from Medline, SCOPUS, CINAHL, and PubMed and policy documents Review Methods: The 16 selected studies were published from 2002 to 2019 and focused on LARC usage, availability, and accessibility for adolescents in Kenya and Rwanda. A modified version of the conceptual framework from Kinaro et al. (2015) was used. Results/Findings: An initial search led to 955 studies, with 16 making the final selection. The studies showed a multitude of supply and demand factors affecting uptake, including bias and misconceptions from the healthcare provider’s perspective, as well as a large amount of incorrect information regarding methods for adolescents. A lack of time and skills on the providers’ part, coupled with frequent drug stock-outs, added to effects on the supply side. Conclusion and Recommendations: To increase the uptake of LARC methods, age-appropriate comprehensive sexuality education must be installed in schools and delivered in a non-judgmental environment. Additionally, training must be given to providers both during schooling and on the job regarding the provision of youth-friendly services and LARC applicability for youth. Keywords: LARC, Contraceptive Use, Adolescents, Kenya, Rwanda