Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

TitleFacilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.
Publication TypeJournal Article
Year of Publication2021
AuthorsHenry D, Wood S, Moshashane N, Ramontshonyana K, Amutah C, Maleki P, Howlett C, Brooks MJ, Mussa A, Joel D, Steenhoff AP, Akers AY, Morroni C
JournalJ Pediatr Adolesc Gynecol
Date Published2021 Mar 22
ISSN1873-4332
Abstract

STUDY OBJECTIVE: Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.

DESIGN: Cross-sectional mixed methods.

SETTING: Gaborone, Botswana.

PARTICIPANTS: 20 sexually active AGYW ages 18-24; 20 health system stakeholders.

INTERVENTIONS: Surveys and semi-structured interviews grounded in the Consolidated Framework for Implementation Research (CFIR).

MAIN OUTCOME MEASURES: Themes reflecting barriers and facilitators of LARC implementation.

RESULTS: The median age for AGYW was 22 (IQR 21-23). Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators to LARC implementation spanned factors at each CFIR domain: 1) LARC characteristics like side effects; 2) the clinics' inner settings, including availability of youth-friendly services; 3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes and beliefs about LARCs; 4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and 5) the implementation process level such as the availability of free or low-cost LARCs.

CONCLUSIONS: We identified multi-level, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.

DOI10.1016/j.jpag.2021.03.005
Alternate JournalJ Pediatr Adolesc Gynecol
PubMed ID33766793