Background Despite the existence of preventive policies across sub-Saharan Africa, countries within the sub-region lead global rankings for rates of adolescent pregnancy. The aim of this scoping review was to identify and review national policies on the prevention of adolescent pregnancy in Anglophone sub-Saharan Africa.
Methods Relevant policies were identified from searches of national government websites and the search engine Google. Recognised screening and data extraction processes were used; data were subjected to content analysis using a published Framework for Evaluating Program and Policy Design on Adolescent Reproductive Health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews guidelines was used in reporting the review.
Results In line with the inclusion criteria that guided the selection of relevant policies in this study, 17 of 75 national policies were suitable for the analysis. All were backed by political recognition, were government and public initiatives, acknowledged a range of determinants of adolescent pregnancy and allocated human resources to policy activities. Few specified financial resourcing. Most policies acknowledged the importance of coordination and collaboration among public and private actors. All policies had objectives that addressed adolescent pregnancy but none were measurable or included timeframes. Provision of comprehensive sexuality education and adolescent reproductive health services were the most common recommendations. Monitoring and evaluation plans were present in all the policies. However, youth involvement in policy formulation, and plans for implementation, monitoring and evaluation was scarce.
Conclusion Overall, national policy strengths were seen in relation to their political recognition, and all aspects of policy formulation. Policy implementation strengths and weaknesses were identified, the latter in relation to clear descriptions of financial resources. Importantly, the absence of measurable and time-bound objectives or formal evaluation of policy effectiveness confounds demonstration of what has been delivered and achieved. Youth involvement was notably absent in many policies. For future policy-setting, governments and policy-makers should make efforts to engage young people in policy development and to be transparent, realistic and address the necessary financial resourcing. They should set quantifiable policy objectives that provide a basis for assessing the adoption, uptake and effectiveness of policies in relation to measurable objectives.
United Nations. United Nations International Conference on Population and Development, Cairo 5-13 September, 1994. Programme of Action. New York: United Nations, Department for Economic and Social Information and Policy Analysis; 1995.
World Health Organization (WHO). The World Health Report. Geneva: WHO; 1998.
UNICEF. The State of the World's Children 2011: Adolescence an Age of Opportunity. New York: UNICEF; 2013.
WHO. The Global Strategy for Women's, Children's and Adolescent's Health (2016-2030). WHO; 2015.
Das JK, Salam RA, Thornburg KL, et al. Nutrition in adolescents: physiology, metabolism, and nutritional needs. Ann N Y Acad Sci. 2017;1393(1):21-33. doi:10.1111/nyas.13330
World Health Organization (WHO). WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries. Geneva: WHO; 2011.
United Nations. Sustainable Development Goals. New York: United Nations; 2015.
Asnong C, Fellmeth G, Plugge E, et al. Adolescents' perceptions and experiences of pregnancy in refugee and migrant communities on the Thailand-Myanmar border: a qualitative study. Reprod Health. 2018;15(1):83. doi:10.1186/s12978-018-0522-7
Nguyen H, Shiu C, Farber N. Prevalence and factors associated with teen pregnancy in Vietnam: results from two national surveys. Societies. 2016;6(2):17. doi:10.3390/soc6020017
Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19(1):59. doi:10.1186/s12884-019-2204-z
Vogel JP, Pileggi-Castro C, Chandra-Mouli V, et al. Millennium Development Goal 5 and adolescents: looking back, moving forward. Arch Dis Child. 2015;100(Suppl 1):S43-47. doi:10.1136/archdischild-2013-305514
World Health Organization (WHO). Global Health Estimates 2013 Summary Tables: DALYs, YLLs and YLDs by Cause, Age and Sex by WHO Regional Group and World Bank Income Classification, 2000-2012 (provisional estimates). Geneva: WHO; 2014.
Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121 Suppl 1:40-48. doi:10.1111/1471-0528.12630
Neal S, Channon AA, Chintsanya J. The impact of young maternal age at birth on neonatal mortality: evidence from 45 low and middle income countries. PLoS One. 2018;13(5):e0195731. doi:10.1371/journal.pone.0195731
Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics. 2014;133(1):114-122. doi:10.1542/peds.2013-0927
Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review. Reprod Health. 2018;15(1):15. doi:10.1186/s12978-018-0460-4
United Nations Educational, Scientific and Cultural Organization (UNESCO). Early and Unintended Pregnancy & The Education Sector: Evidence Review and Recommendations. Paris: UNESCO; 2017.
Ayanaw Habitu Y, Yalew A, Azale Bisetegn T. Prevalence and factors associated with teenage pregnancy, Northeast Ethiopia, 2017: a cross-sectional study. J Pregnancy. 2018;2018:1714527. doi:10.1155/2018/1714527
Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and meta-analysis. Reprod Health. 2018;15(1):195. doi:10.1186/s12978-018-0640-2
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/1364557032000119616
Calvès AE. Assessing Adolescent Reproductive Health Policies and Programs: Case Studies from Burkina Faso, Cameroon, And Togo. Policy Working Paper Series. 2002(8):1-33.
Makoba JW. Rethinking current explanations of political changes in sub-Saharan Africa. J Third World Stud. 1999;16(2):61-73.
Tordoff W. Introduction: African politics since independence. In: Government and Politics in Africa. London: Palgrave Macmillan; 1993.
Basedau M, Stroh A. Ethnicity and Party Systems in Francophone Sub-Saharan Africa. Hamburg: German Institute of Global and Area Studies; 2009.
Ali M, Fjeldstad OH, Jiang B, Shifa AB. Colonial legacy, state-building and the salience of ethnicity in sub-Saharan Africa. Econ J. 2019;129(619):1048-1081. doi:10.1111/ecoj.12595
Nabyonga-Orem J, Ousman K, Estrelli Y, et al. Perspectives on health policy dialogue: definition, perceived importance and coordination. BMC Health Serv Res. 2016;16(Suppl 4):218. doi:10.1186/s12913-016-1451-1
Mwisongo A, Nabyonga-Orem J, Yao T, Dovlo D. The role of power in health policy dialogues: lessons from African countries. BMC Health Serv Res. 2016;16(Suppl 4):213. doi:10.1186/s12913-016-1456-9
Defor S, Kwamie A, Agyepong IA. Understanding the state of health policy and systems research in West Africa and capacity strengthening needs: scoping of peer-reviewed publications trends and patterns 1990-2015. Health Res Policy Syst. 2017;15(Suppl 1):55. doi:10.1186/s12961-017-0215-7
Hughes KM, Kaiser MJ, Jennings S, et al. Investigating the effects of mobile bottom fishing on benthic biota: a systematic review protocol. Environ Evid. 2014;3(1):23. doi:10.1186/2047-2382-3-23
Reed J, Deakin L, Sunderland T. What are ‘Integrated Landscape Approaches’ and how effectively have they been implemented in the tropics: a systematic map protocol. Environ Evid. 2015;4(1):2. doi:10.1186/2047-2382-4-2
Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/m18-0850
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398-405. doi:10.1111/nhs.12048
Mayring P. Qualitative content analysis: theoretical background and procedures. In: Bikner-Ahsbahs A, Knipping C, Presmeg N, eds. Approaches to Qualitative Research in Mathematics Education. Dordrecht: Springer; 2015:365-380. doi:10.1007/978-94-017-9181-6_13
United Republic of Tanzania. The National Health Policy 2017. In: Gender, Elderly and Children. 6th ed. United Republic of Tanzania: Ministry of Health; 2017.
Sudan RoS. National Family Planning Policy. South Sudan: Government of the Republic of South Sudan; 2013. https://www.moh-rss.org/. Accessed February 20, 2019.
Dye T. Understanding Public Policy. Toronto: Prentice Hall; 1998.
Stover J, Johnston A. The Art of Policy Formulation: Experiences from Africa in Developing National HIV/AIDS Policies. Washington, DC: The Futures Group International, POLICY Project; 1999.
Birdthistle I, Vince-Whitman C. Reproductive Health Programs for Young Adults: School-based Programs. Washington, DC: Pathfinder International, Focus on Young Adults Project, 1997.
Gunawardena N, Fantaye AW, Yaya S. Predictors of pregnancy among young people in sub-Saharan Africa: a systematic review and narrative synthesis. BMJ Glob Health. 2019;4(3):e001499. doi:10.1136/bmjgh-2019-001499
Mkwananzi S, Odimegwu C. Teen Pregnancy in Sub-Saharan Africa: The Application of Social Disorganisation Theory. San Diego, California: Population Association of America; 2015.
Breuner CC, Mattson G. Sexuality education for children and adolescents. Pediatrics. 2016;138(2). doi:10.1542/peds.2016-1348
LeBrun S, Omar HA. The importance of comprehensive sexuality education in adolescents. Dynamics of Human Health. 2015;2(4):1-4.
Panchaud C, Keogh SC, Stillman M, et al. Towards comprehensive sexuality education: a comparative analysis of the policy environment surrounding school-based sexuality education in Ghana, Peru, Kenya and Guatemala. Sex Educ. 2019;19(3):277-296. doi:10.1080/14681811.2018.1533460
Senderowitz J. Health Facility Programs on Reproductive Health for Young Adults. Washington, DC: Pathfinder International; 1997.
Hughes J, McCauley AP. Improving the fit: adolescents' needs and future programs for sexual and reproductive health in developing countries. Stud Fam Plann. 1998;29(2):233-245.
O’Neill K, Viswanathan K, Celades E, Boerma T. Monitoring, Evaluation and Review of National Health Policies, Strategies and Plans. Geneva: WHO; 2016.
Adamchak S, Bond K, MacLaren L, Magnani R, Nelson K. A Guide to Monitoring and Evaluating Adolescent Reproductive Health Programs. Princeton, New Jersey: Citeseer; 2000.
Chandra-Mouli V, Ferguson BJ, Plesons M, et al. The political, research, programmatic, and social responses to adolescent sexual and reproductive health and rights in the 25 years since the International Conference on Population and Development. J Adolesc Health. 2019;65(6S):S16-S40. doi:10.1016/j.jadohealth.2019.09.011
Ahinkorah, B. O., Kang, M., Perry, L., & Brooks, F. (2022). Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies. International Journal of Health Policy and Management, 11(6), 726-739. doi: 10.34172/ijhpm.2020.185
MLA
Bright Opoku Ahinkorah; Melissa Kang; Lin Perry; Fiona Brooks. "Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies". International Journal of Health Policy and Management, 11, 6, 2022, 726-739. doi: 10.34172/ijhpm.2020.185
HARVARD
Ahinkorah, B. O., Kang, M., Perry, L., Brooks, F. (2022). 'Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies', International Journal of Health Policy and Management, 11(6), pp. 726-739. doi: 10.34172/ijhpm.2020.185
VANCOUVER
Ahinkorah, B. O., Kang, M., Perry, L., Brooks, F. Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies. International Journal of Health Policy and Management, 2022; 11(6): 726-739. doi: 10.34172/ijhpm.2020.185