This study evaluates the family planning (FP) programme implemented by the Government of Uganda. The intervention provides sexual reproductive health services such as contraceptive products, information and counselling to youth aged between 15 and 24 years.
Uganda’s population growth rate stands at three per cent and is one of the highest in the world. Reproductive health indicators for young people remain very poor. Moreover, the teenage pregnancy rate in Uganda is very high at 25 per cent and is a major cause of school dropout. There is also limited cultural acceptance for discussing sex and sexuality between parents/guardians and the youth. Young people are therefore limited in their exposure to family planning means, including contraceptive information and services, resulting in unwanted teenage pregnancy and maternal deaths.
- What is the impact of utilisation of youth-friendly family planning services on contraceptive utilisation, abstinence, and unintended pregnancy among young people aged between 15 and 24 years in Uganda?
- Is there any evidence of heterogeneous effects, in which the benefits are particularly large for young people already engaged in risky behaviours ex ante?
- Are the effects of youth-friendly FP/sexual reproductive health services different for young men and women, and in urban and rural areas?
The family planning intervention provides youth-friendly services through Youth Corners. The youth-friendly sexual reproductive services include information, education and communication, socio-behaviour change communication, counselling, FP product distribution, testing, and treatment for HIV and other sexually transmitted infections. These services are also provided through visits to communities and health camps.
Theory of change
Establishing youth corners within existing health facilities and equipping them with materials and FP products to serve the sexual and reproductive health needs of young people is believed to increase the product and services uptake and reduce risky sexual behaviour among the youth. This will in turn reduce the rate of sexually transmitted diseases, unsafe abortion rates, unintended pregnancies, school dropout due to teenage pregnancy, and delay childbearing.
The sample includes about 5,012 males and females aged between 15 and 24 years drawn from 16 districts across Uganda representing the northern, west Nile, eastern, western, central and Karamoja regions. The evaluation set out to estimate the impact of utilisation of youth-friendly FP services on health outcomes of interest using a randomised “encouragement design” as the identification strategy, which was assumed to motivate the youth to utilise FP/sexual reproductive health services. Encouragement activities included distribution of information fliers, dissemination of video clips and circulation of informative SMSs.
The encouragement design was not effective in stimulating differential take-up of youth-friendly FP services, and hence the identification method failed. Hence, there is no evidence from this study to support the assumption that utilisation of youth-friendly FP services leads to increased contraceptive utilisation, abstinence, knowledge or self-efficacy in treatment communities. However, knowledge and utilisation of youth-friendly FP services for both treatment and control communities has gone up over the assessment period.
As young people are showing growing interest in FP in general, service providers should pay attention to challenges related to the availability of FP products and institutional capacity issues at public and community-based service delivery points.