Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis

Zohra S Lassi; Komal Abdul Rahim; Alexandra Maria Stavropoulos; Lareesa Marie Ryan; Jyoti Tyagi; Bisi Adewale; Jaameeta Kurji; Soumyadeep Bhaumik; Salima Meherali; Moazzam Ali

doi:10.1136/bmjsrh-2023-202151

Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis

BMJ Sex Reprod Health. 2024 Mar 13:bmjsrh-2023-202151. doi: 10.1136/bmjsrh-2023-202151. Online ahead of print.

Authors

Zohra S Lassi^{1

2}, Komal Abdul Rahim^{3

4}, Alexandra Maria Stavropoulos², Lareesa Marie Ryan², Jyoti Tyagi⁵, Bisi Adewale⁶, Jaameeta Kurji⁷, Soumyadeep Bhaumik^{8

9}, Salima Meherali⁶, Moazzam Ali¹⁰

Affiliations

¹ School of public health, Faculty of health and medical sciences, The University of Adelaide, Adelaide, South Australia, Australia.
² Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
³ Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan.
⁴ Center of Excellence in Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.
⁵ George Institute of Global Health, New Delhi, India.
⁶ University of Alberta, Edmonton, Alberta, Canada.
⁷ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Meta-Research and Evidence Synthesis Unit, Health Systems Science, George Institute of Global Health, New Delhi, India.
⁹ George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.
¹⁰ Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland alimoa@who.int.

PMID: 38479786
DOI: 10.1136/bmjsrh-2023-202151

Abstract

Introduction: The evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women.

Methods: We ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4.

Results: Forty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment.

Conclusions: Empowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.

Keywords: Contraceptive Agents, Female; Reproductive Health; Reproductive Health Services; adolescent; contraception behavior; family planning services.

Grants and funding

001/WHO_/World Health Organization/International