Lauren Mitchell, Implementation Science Fellow, FHI 360
In Nepal and Uganda, as in many low- and middle-income countries, youth remain a hidden population in family planning (FP) programs, as cultural, religious, and legal issues may hinder their access to contraceptive information and services. However, demographic survey data shows that youth are sexually active. By age 18, 48% and 62% of women have experienced sexual debut in Nepal1 and Uganda,2 respectively. Self-care strategies may be especially appealing to young populations, as they offer individuals greater autonomy, privacy, and engagement in their health care.
Information on adolescent self-care attitudes and preferences for health services is lacking. With technical assistance from the R4S project, questions on interest in and preferences for self-care were added to two existing youth surveys—the Healthy Transitions for Nepali Youth Project (HTNYP) for girls aged 15-24 in Nepal (implemented by Save the Children and funded by Margaret A. Cargill Philanthropies), and the Adolescent Girls and Young Women (AGYW) survey for girls aged 10-24 in Uganda (implemented by Makerere University School of Public Health and funded by The Global Fund). The two countries are at different stages of introducing FP self-care practices; however, findings from both countries show high interest in accessing information on FP methods, side effects, and bleeding changes without seeing a provider.
The R4S project has developed country-specific infographics for both Nepal and Uganda to highlight survey results. Makerere University School of Public Health is working with implementers of local AGYW programs and behavior change campaigns and Save the Children is collaborating with diverse stakeholder groups (e.g., Family Welfare Division, donors, NGOs, CSOs, etc.) to share results locally and discuss program implications. Here are some highlights.
In Nepal, most surveyed youth were receptive to accessing information on condoms (70%), pregnancy tests (67%), injectables (63%) and pills (59%) on their own. When disaggregated by marital status, more never-married youth were interested in accessing information on two methods—condoms and self-injectables—than married youth. Questions also explored respondents’ comfort level with receiving information and family planning methods from various sources, including phones and digital platforms, community health workers and female community health volunteers, pharmacies, and health facilities. Although youth indicated a high level of comfort with receiving both information and FP methods from all sources, more youth felt comfortable with community health workers and female community health volunteers (96-97%) than any other source. The high level of comfort with community health workers highlights a promising opportunity for leveraging this cadre for self-care introduction. One notable difference by demographic group–88% of never-married youth were comfortable with receiving information via phone though only 51% owned a phone compared to 79% of married youth though 89% owned a phone.
In Uganda, questions examined results by schooling status, finding that a higher proportion of in-school youth were interested in accessing information about FP methods without seeing a provider than out-of-school youth. Of youth interested in accessing information on a range of methods, more youth were interested in accessing information on the Standard Days Method (89-90%) and withdrawal (86-89%) than on other methods. Willingness to self-administer injectables was relatively low and ranged from 21% of out-of-school youth to 29% of in-school youth.
In sum, interest in accessing FP method information ranged from 78% to 90% among youth in Uganda. In Nepal, interest ranged from 59% to 70%. Additionally, over 90% of Ugandan youth and approximately two thirds of Nepali youth were interested in receiving information on bleeding changes and side effects. These findings of the HTNYP and AGYW surveys contribute to the field’s current understanding of the self-care preferences of young users and can be applied to support development of future evidence-based FP self-care programming.
- Ministry of Health – MOH/Nepal, New ERA/Nepal, and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: MOH/Nepal, New ERA/Nepal, and ICF.
- Uganda Bureau of Statistics – UBOS and ICF. 2018. Uganda Demographic and Health Survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF.