What works to improve young people’s sexual and reproductive health

New research published today shows that there are number of interventions which can help to improve health outcomes in young people (ages 10-24), but there is no single action or intervention which can work for all young people, to address all of their needs. While several high-quality interventions were found, they may only be applicable in specific settings for specific outcomes. More evidence is needed to show whether these interventions can apply to other settings or help to improve additional sexual and reproductive health outcomes for young people.

About the research

The set of reviews, published in a special supplement to the Journal of Adolescent Health, provide a systematic assessment of evidence on high-quality studies (which met criteria assessing the design, implementation, and evaluation) for improving the sexual and reproductive health of young people living in low- and middle-income countries. The reviews focus on three adverse health-related outcomes for young people: unintended and repeat pregnancy; child marriage; and sexually transmitted infections including HIV.

Taking more than four years to complete, the study team reviewed over 57 000 articles from both peer-reviewed articles and grey literature, and report on high-quality studies intended to make changes in young people’s actions or behaviours.

No simple solution

The research team identified a small number of high-quality studies, but none which prove effective in addressing all three targets simultaneously, and few which are effective across settings. As the authors note, high-quality, well-implemented and effectively-evaluated interventions that found success – such as conditional cash-transfer programmes – are also not effective in all country settings or for all three outcomes simultaneously.

Michelle Hindin, Scientist at WHO and an author of the study comments, “There’s no one size fits all solution – and effectiveness often also depends on where and how an intervention is implemented.”

While there is no single approach which works to improve all outcomes, the study found that there are a range of high-quality strategies that have positively impacted young people’s sexual and reproductive health, in that they can help to inform strategic investments in many contexts and across diverse populations and settings.

What works well?

  • Addressing early unintended and repeat pregnancy
    High quality and consistently effective intervention strategies included direct provision of contraception (China, Kenya), peer education (India, Cameroon), and a mass media campaign (India). To reduce unwanted pregnancy, contraceptive use is arguably essential. Interventions with direct provision of contraceptive methods worked to increase contraceptive use in a community (China), increase use and offer more effective methods to contraception seekers (Kenya) and reduce missed opportunities to reach young women following an abortion (China).
  • Preventing sexually transmitted infections and HIV
    Many interventions focus on outcomes related to reducing risky sexual behaviours, such as decreasing the number of sexual partners and encouraging condom use. Half of the high quality interventions that significantly reduced STI diagnosis or STI symptoms were mass media campaigns (South Africa, Malawi and Cameroon). With the advent of relatively low-cost and non-invasive methods for testing, recent interventions have been using laboratory tests to accurately measure STIs diagnosis and provide a better measure of intervention impact. Four interventions tested young people for HIV and/or herpes simplex virus type 2 (which can cause genital herpes) (Kenya, Malawi, South Africa and Zimbabwe).
  • Ending child marriage
    The most common high-quality strategies focused to prevent early marriage focus on interventions to ensure that school attendance is more advantageous for girls’ families than marriage. High-quality interventions and evaluations identified included financial incentives given to families such as cash transfers (Malawi, Mexico) or the provision of school uniforms which are part of the expenses of sending children to school (Kenya, Zimbabwe). While the majority of these programs were successful in decreasing the proportion of girls marrying early, or increasing the age at marriage, some had mixed success or were unsuccessful. Although financial incentives can be effective in preventing child marriage, they are difficult to finance, maintain and scale-up.

Doing things well

The authors call attention to the need for efforts to be made to improve reporting and data. This includes a greater focus on what interventions work, and also how they are designed, how they are carried out, and how they are evaluated.

Michelle Hindin comments “When we have better data, we have a better understanding of what works, where, and how. Programme managers and funders need this information to take action that can make a sustainable difference”.

The study also shows the need for high-quality interventions to be implemented well, designed well and evaluated well in order to be successful, sustainable, and potentially scalable.