Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies

Document Type : Review Article

Authors

1 School of Public Health, University of Technology Sydney, Ultimo, NSW, Australia

2 Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia

Abstract

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.

Keywords

References

  1. 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.
  2. World Health Organization (WHO). The World Health Report. Geneva: WHO; 1998.
  3. UNICEF. The State of the World's Children 2011: Adolescence an Age of Opportunity. New York: UNICEF; 2013.
  4. Adolescent Pregnancy: Factsheet No 364. 2014a. http://www.who.int/mediacentre/factsheets/fs364/en.   Accessed May 2, 2019.
  5. WHO. The Global Strategy for Women's, Children's and Adolescent's Health (2016-2030). WHO; 2015.
  6. 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
  7. World Health Organization (WHO). WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries. Geneva: WHO; 2011.
  8. United Nations. Sustainable Development Goals. New York: United Nations; 2015.
  9. 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
  10. 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
  11. 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
  12. Burton J. Highest Teen Pregnancy Rates Worldwide. World Atlas; 2017. World Atlas. World Facts: Highest Teen Pregnancy Rates Worldwide 2015. http://www.worldatlas.com/articles/highest-teen-pregnancy-rates-worldwide.  Accessed April 3, 2019. Published 2017.
  13. 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
  14. 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.
  15. 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
  16. 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
  17. 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
  18. 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
  19. United Nations Educational, Scientific and Cultural Organization (UNESCO). Early and Unintended Pregnancy & The Education Sector: Evidence Review and Recommendations. Paris: UNESCO; 2017.
  20. 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
  21. 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
  22. 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
  23. 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.
  24. Forsey C. The Top 7 Search Engines, Ranked by Popularity. HubSpot; 2018. https://blog.hubspot.com/marketing/top-search-engines.  Accessed July 15, 2020.
  25. Makoba JW. Rethinking current explanations of political changes in sub-Saharan Africa. J Third World Stud. 1999;16(2):61-73.
  26. Tordoff W. Introduction: African politics since independence. In: Government and Politics in Africa. London: Palgrave Macmillan; 1993.
  27. Basedau M, Stroh A. Ethnicity and Party Systems in Francophone Sub-Saharan Africa. Hamburg: German Institute of Global and Area Studies; 2009.
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. 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
  34. 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
  35. 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
  36. 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
  37. Republic of Ghana. Adolescent Health Service Policy and Strategy (2016-2020). In: Service GH, ed. Accra, Ghana: Republic of Ghana; 2016. https://www.afro.who.int/sites/default/files/2017-10/ADOLESCENT%20HEALTH%20SERVICE%20POLICY%20%20AND%20STRATEGY.pdf.  Accessed February 13, 2019.
  38. United Republic of Tanzania. The National Health Policy 2017. In: Gender, Elderly and Children. 6th ed. United Republic of Tanzania: Ministry of Health; 2017.
  39. Republic of Namibia. Education Sector Policy for the Prevention and Management of Learner Pregnancy. Ministry of Education; 2010. https://www.moe.gov.na/files/downloads/99b_Learner%20Pregnancy%20policy%20final%202010-10-18.pdf.  Accessed February 15, 2019.
  40. Republic of Sierra Leone. Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Policy. Sierra Leone: Ministry of Health and Sanitation; 2017: https://www.afro.who.int/sites/default/files/2017-11/Sierra%20Leone%20Reproductive%2C%20Maternal%2C%20Newborn%2C%20Child%20and%20Adolescent%20Health%20Policy.pdf.  Accessed March 3, 2019.
  41. Republic of Botswana. Revised National Youth Policy 2010. Republic of Botswana: Government of the Republic of Botswana; 2010: https://www.botswanalmo.org.bw/sites/default/files/National%20Youth%20Policy_revised_2010.pdf.  Accessed March 2, 2019.
  42. Republic of Kenya. National Adolescent Sexual and Reproductive Health Policy. Kenya: The Republic of Kenya; 2015. https://www.popcouncil.org/uploads/pdfs/2015STEPUP_KenyaNationalAdolSRHPolicy.pdf.  Accessed February 20, 2019.
  43. Republic of Malawi. National Youth Policy. Malawi: The Republic of Malawi; 2013. https://cepa.rmportal.net/Library/government-publications/National%20Youth%20Policy%202013.pdf/view.  Accessed February 13, 2019.
  44. Republic of Ghana. National Gender Policy. Ghana: The Republic of Ghana; 2015. http://www.mogcsp.gov.gh/index.php/mdocs-posts/national-gender-policy/.  Accessed February 14, 2019.
  45. Republic of The Gambia. Gender and Women Empowerment Policy 2010-2020. The Gambia: The Republic of The Gambia; 2010. http://extwprlegs1.fao.org/docs/pdf/gam170413.pdf.  Accessed February 20, 2019.
  46. Republic of The Gambia. The Gambia National Gender Policy 2010-2020. The Gambia: Government of the Republic of The Gambia; 2010. https://www.ilo.org/dyn/travail/docs/1958/Gambia%20national%20gender%20policy.pdf.  Accessed February 11, 2019.
  47. Republic of South Africa. National Adolescent and Youth Health Policy. Republic of South Africa: Government of the Republic of South Africa; 2017.
  48. Republic of South Africa. Integrated School Health PolicyRepublic of South Africa: Government of the Republic of South Africa; 2012. https://serve.mg.co.za/content/documents/2017/06/14/integratedschoolhealthpolicydbeanddoh.pdf.  Accessed February 20, 2019.
  49. The Kingdom of Swaziland. National Policy on Sexual and Reproductive Health. The Kingdom of Swaziland: Government of the Kingdom of Swaziland; 2013. http://www.integrainitiative.org/blog/wp-content/uploads/2013/10/NATIONAL-POLICY-ON-SEXUAL-AND-.pdf.  Accessed February 11, 2020.
  50. Aliaga A, Ren R. Optimal Sample Sizes for Two-stage Cluster Sampling in Demographic and Health Surveys. Calverton, Maryland: ORC Macro; 2006.
  51. Republic of Seychelles. Reproductive Health Policy. Republic of Seychelles: Government of the Republic of Seychelles; 2012. http://www.health.gov.sc/wp-content/uploads/REPRODUCTIVE-HEALTH-POLICY-2012-last-version.pdf.  Accessed March 4, 2019.
  52. Republic of South Sudan. National Reproductive Health Policy. Republic of South Sudan: Government of the Republic of South Sudan; 2013.
  53. Namibia Ro. National Health Policy Framework (2010-2020). Namibia: Ministry of Health and Social Services; 2010. https://extranet.who.int/countryplanningcycles/sites/default/files/country_docs/Namibia/namibia_national_health_policy_framework_2010-2020.pdf.  Accessed March 9, 2019.
  54. 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.
  55. The National Health Policy 2017. Tanzania: Ministry of Health, Community Development, Gender, Elderly and Children; 2017: http://www.tzdpg.or.tz/fileadmin/documents/dpg_internal/dpg_working_groups_clusters/cluster_2/health/JAHSR_2017/8.The_Nat_Health_Policy_2017_6th__24_October__2017.pdf.  Accessed February 20, 2019.
  56. Dye T. Understanding Public Policy. Toronto: Prentice Hall; 1998.
  57. 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.
  58. Birdthistle I, Vince-Whitman C. Reproductive Health Programs for Young Adults: School-based Programs. Washington, DC: Pathfinder International, Focus on Young Adults Project, 1997.
  59. 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
  60. Mkwananzi S, Odimegwu C. Teen Pregnancy in Sub-Saharan Africa: The Application of Social Disorganisation Theory. San Diego, California: Population Association of America; 2015.
  61. Breuner CC, Mattson G. Sexuality education for children and adolescents. Pediatrics. 2016;138(2). doi:10.1542/peds.2016-1348
  62. LeBrun S, Omar HA. The importance of comprehensive sexuality education in adolescents. Dynamics of Human Health. 2015;2(4):1-4.
  63. 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
  64. Senderowitz J. Health Facility Programs on Reproductive Health for Young Adults. Washington, DC: Pathfinder International; 1997.
  65. 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.
  66. O’Neill K, Viswanathan K, Celades E, Boerma T. Monitoring, Evaluation and Review of National Health Policies, Strategies and Plans. Geneva: WHO; 2016.
  67. 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.
  68. 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
International Journal of Health Policy and Management
Volume 11, Issue 6
June 2022
Pages 726-739

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History

  • Receive Date: 12 March 2020
  • Revise Date: 22 September 2020
  • Accept Date: 22 September 2020
  • First Publish Date: 05 October 2020

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