Most pregnancies among adolescent girls and young women aged
15–24 years occur in low- and middle-income countries (LMICs), and do so
within marriage. The mortality rates and pregnancy-related morbidities are
significantly higher among the women of younger age group in many South Asian
and Sub-Saharan African countries. This paper presents a review of the
available evidence on the effectiveness of community-based health interventions
to improve the reproductive health status of young married couples in LMICs.
We carried out a systematic review of research studies and
evaluation reports of different community-level initiatives in improving access
to contraception, pregnancy care and safe abortion services by young married
couples, where women were in the age-group of 15–24 years.
Of the 14 projects, which met inclusion criteria, eight met
the quality criteria and were included in the review (five from India, two from
Nepal and one from Malawi). Our analysis shows that community-based
interventions consisting of counseling of young married women, and their
husbands, family and community members, as well as capacity building of health
workers were some of the effective measures in increasing contraceptive use,
delaying pregnancy and improving pregnancy care. Stratifying young women in
line with their specific reproductive health needs (newly married woman,
pregnant woman, mother of one/more children) was found to be a successful
innovative strategy. None of these projects explicitly addressed improving access
to safe abortion care.
Our review suggests that multi-layered community-based
interventions, targeting young married women, their families and the health
system can improve utilization of reproductive health services among young
couples in resource-constrained settings. There is less focus on strategies to
delay first pregnancy as compared to spacing among young women. Further, family
and community level barriers in most of the project settings restricted its
effective implementation. The paper emphasizes the need for further research to
fill the knowledge gaps that exist about improving utilization of reproductive
healthcare services, especially safe abortion care among young married women in
LMICs.
Below: Schematic representation of multi-layered intervention to improve reproductive health access among young married women
Full article
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By:
1Monitoring, Evaluation & Research
Division, MAMTA Health Institute for Mother & Child, B-5, Greater Kailash
Enclave-II, New Delhi 110048, India
2Department of Reproductive Health and
Research, World Health Organization, Geneva, Switzerland
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