How can you increase LARC access for youth while ensuring choice? Jen Tuddenham USAID Program Advisor Marie Stopes International

What do we mean by choice?

Lack of access to information on some methods LARCs are more expensive… Lack of access to facilities with LARCs Lack of trained providers able to provide LARCs Think about how much bigger the barriers are for some methods than other methods – here are just a few of those barriers for LARCs It’s easier for providers to just give a short term method.....

What does method mix look like when these barriers are reduced? 5 years ago, we only had anecotal and small scale study evidence about who we were reaching with FP services – we didn’t really know who our clients were across the board Example of how we’ve been thinking about this at MSI: program in terms of reducing barriers – which can mean additional information on LARCs, specific training, more time spent during counselling, specific interventions to reduce financial barriers to LARC access

Private health provider, Madagascar Madagascar program – work with private providers – train and support them to provide a range of FP services. But they are private providers, charging for services, and weren’t seeing many adolescents. So, tried a combined demand/supply side initiative – gave them youth-friendly training, and started a voucher scheme for adolescents.

3,000 adolescents in Madagascar using e-voucher for services every month 2/3 chose a LARC 1/2 had STI service Madagascar SMS-based voucher activity has seen rapid take-up – over 3,000 under 20 year olds now taking up a package of SRH services (including STI services) from franchisees every month. Voucher is free – high LARC uptake with voucher suggests cost was previously a barrier

How can we support contraceptive choice during provider counselling? Talk about some of the approaches MSI and others are taking around counselling. Counselling training for providers and CHWs – helping the client to find the right method for her, rather than focusing on one set of methods as ‘better’.

Compare the method mix…. Madagascar adolescent method mix (2011 DHS) Methods chosen by e-voucher clients, 2014

Questions for discussion When does ‘reducing barriers’ become ‘promoting’ one method over another’? How do we ensure voluntary choice for youth when also trying to increase awareness of and interest in LARCs?  

Thank you!