Increasing the Uptake of Long-Acting Reversible Contraceptives (LARCs) Among Adolescent Females and Young Women in Cameroon

Prof. Berk Özler, Lead Economist, Development Research Group, The World Bank

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In sub-Saharan Africa, 25% of teenagers have started childbearing (ICF, 2015). While young women describe many of these births as planned and intentional, women under the age of 20 also have the greatest percentage of mistimed/unintended pregnancies compared to all other age groups. For example, in Cameroon, more than 30% of the births to this group were unwanted or wanted later (DHS 2011). Low age at first birth has a significant impact on the spacing of births and timing of future pregnancies. It may also reduce accumulation of human capital for both the mother and the child. Despite the desire to delay childbearing, only a minority of sexually active unmarried women in most low-income countries uses any modern method of contraception (ICF, 2015). The shares of women using reliable short-acting methods of contraception (injectables and pills) are even smaller, with very few unmarried or nulliparous women using LARCs (IUDs or implants). For example, 41% of sexually active unmarried women in Cameroon report using male condoms, with 6% using SARCs and less than 1% using LARCs (DHS 2011). Given meaningful differences in the typical-use effectiveness of these different methods, it is important to understand why most women don’t use any modern methods of contraceptives, and why, among users, women favor the short-acting (but, less reliable) methods over the long-acting (but almost 100% effective) ones. In this talk, Berk Özler will describe their multi-disciplinary team’s ongoing work in Cameroon that is attempting to identify the barriers to the uptake of LARCs and testing interventions to overcome them. They will briefly summarize the formative qualitative work to identify the supply- and demand-side barriers; describe a tablet-based decision-support tool they developed for nurses to counsel young women on modern contraceptive methods, and describe the design of two randomized-controlled trials that test some of the interventions designed with the government of Cameroon.