Community based reproductive health interventions for young married couples in resource-constrained settings: a systematic review

Abstract

BackgroundMost pregnancies among adolescent girls and young women aged 15–24 years occur in low- and middle-income countries (LMICs), and do so within marriage. The mortality rates and pregnancy-related morbidities are significantly higher among the women of younger age group in many South Asian and Sub-Saharan African countries. This paper presents a review of the available evidence on the effectiveness of community-based health interventions to improve the reproductive health status of young married couples in LMICs.MethodWe carried out a systematic review of research studies and evaluation reports of different community-level initiatives in improving access to contraception, pregnancy care and safe abortion services by young married couples, where women were in the age-group of 15–24 years.ResultsOf the 14 projects, which met inclusion criteria, eight met the quality criteria and were included in the review (five from India, two from Nepal and one from Malawi). Our analysis shows that community-based interventions consisting of counseling of young married women, and their husbands, family and community members, as well as capacity building of health workers were some of the effective measures in increasing contraceptive use, delaying pregnancy and improving pregnancy care. Stratifying young women in line with their specific reproductive health needs (newly married woman, pregnant woman, mother of one/more children) was found to be a successful innovative strategy. None of these projects explicitly addressed improving access to safe abortion care.ConclusionOur review suggests that multi-layered community-based interventions, targeting young married women, their families and the health system can improve utilization of reproductive health services among young couples in resource-constrained settings. There is less focus on strategies to delay first pregnancy as compared to spacing among young women. Further, family and community level barriers in most of the project settings restricted its effective implementation. The paper emphasizes the need for further research to fill the knowledge gaps that exist about improving utilization of reproductive healthcare services, especially safe abortion care among young married women in LMICs.

Increasing Contraceptive Use Among Young Married Couples in Bihar, India: Evidence From a Decade of Implementation of the PRACHAR Project

“…By age 18, 28% of young women living in developing regions are married or in union, and 90% of the approximately 12 million annual adolescent births in developing regions occur in the context of marriage 4 , 5 . Early and rapid repeat pregnancies and births among young married women (under age 24) are driven by a number of factors, including gendered social norms that require women to demonstrate fertility to prove their value, young women's lack of agency to seek health care, and limited access to contraceptive information and a full range of methods 3 , 6 , 7 …”

“…In response to persistently low use of contraception and high rates of early and rapid repeat childbearing among young married women, there is a growing call to address the drivers of low contraceptive use and to increase young married couples' access to contraception 7 – 9 . Doing so would address critical unmet need for family planning and contribute to achievement of national and global goals and priorities, such as Family Planning 2020 (FP2020) and the Sustainable Development Goals 10 , 11 .…”

“…Doing so would address critical unmet need for family planning and contribute to achievement of national and global goals and priorities, such as Family Planning 2020 (FP2020) and the Sustainable Development Goals 10 , 11 . Some efforts have been made to increase contraceptive use among married adolescents and youth and to prevent rapid repeat pregnancies, and recent papers have synthesized the primary strategies used in these programs 7 , 8 , 12 . However, there remains little published evidence from low- and middle-income countries to inform critical program design decisions related to intervention intensity and duration, effective combinations of interventions, and scale up.…”

Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys

“…Whatever the case, since the public sector is accessed more by adolescents in West Africa, policies and programs should focus on eliminating existing barriers to care within this sector, and tailoring services to the needs of this age group (36).…”

Why are abortions the answer? Prevalence, knowledge and attitude towards induced abortions among women attending a secondary level health care facility in Tamil Nadu, Southern India

“…Many pregnancies are ill timed and unwanted and lead to high rated of unsafe abortions. 5 India has the highest number of women with the unmet need of contraception with only 56.3% of women practicing some form of contraception. 6,7 Though there is high acceptance of permanent sterilisation method for family planning, most birth spacing methods are not opted for by Indian women.…”