Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa
Authors: Mohammed Aliu , Donkoh Irene Esi , Aboagye Richard Gyan , Ahinkorah Bright Opoku , Seidu Abdul-Aziz 
Published: April 2024

Abstract
Background
Improving women’s access to and use of modern contraceptives is a key global strategy for improving the sexual and reproductive health of women. However, the use of modern contraceptives among adolescent girls and young women in sub-Saharan Africa (SSA) remains relatively low, despite the numerous interventions to increase patronage. This study examined adolescent girls and young women’s receipt of quality contraceptive counselling and its associated factors in SSA.

Methods
Data for the study were extracted from the recent Demographic and Health Surveys of 20 countries in SSA, spanning from 2015 to 2021. A sample of 19,398 adolescent girls and young women aged 15 to 24 years was included in the study. We presented the proportion of adolescent girls and young women who received quality contraceptive counselling using a spatial map. Multilevel binary logistic regression analysis was carried out to examine the factors associated with the receipt of quality contraceptive counselling.

Results
Overall, 33.2% of adolescent girls and young women had access to quality contraceptive counselling, ranging from 13.0% in Cameroon to 67.0% in Sierra Leone. The odds of receiving quality contraceptive counselling was higher among adolescent girls and young women aged 20–24 (AOR = 1.48, CI: 1.32–1.67), those with primary (AOR = 1.32, CI: 1.11–1.57) and secondary or higher education (AOR = 1.31, CI: 1.09–1.58), and those married (AOR = 1.32, CI: 1.15–1.52), cohabiting (AOR = 1.47, CI: 1.23–1.76), and previously married (AOR = 1.48, CI: 1.20–1.83) compared to their counterparts in the reference groups. Adolescent girls and young women who were currently working (AOR = 1.22, CI: 1.09–1.37), those who heard of family planning from radio in the last few months (AOR = 1.34, CI:1.21–1.50), those who visited the health facility in the last 12 months (AOR = 1.69, CI: 1.52–1.88), and those residing in the Southern (AOR = 5.01, CI: 3.86–6.51), Eastern (AOR = 2.54, CI: 1.96–3.30), and Western (AOR = 4.09, CI: 3.19–5.25) SSA were more likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. Conversely, adolescent girls and young women who used the internet, those who had problem getting permission to seek medical help, those facing problem in seeking medical help for not wanting to go alone, those from the middle and richest wealth indices, and those from the rural areas were less likely to receive quality contraceptive counselling compared to their counterparts in the reference groups.

Conclusion
Receipt of quality contraceptive counselling among adolescent girls and young women was low. Considering the importance of quality contraceptive counselling on the uptake and continuation of contraception, policymakers need to institute measures that improve adolescent girls and young women’s access to quality contraceptive counselling in SSA, especially in countries like Cameroon, Angola, Madagascar, Mauritania, and Guinea, taking into consideration the factors identified in the study. Increasing adolescent girls and young women’s access to quality contraceptive counselling could greatly minimize the risk of unintended pregnancies and its associated maternal and child health burden in SSA and subsequently contribute to the attainment of the Sustainable Development Goal 3, target 3.7.