What is Parental and Spousal Consent?

This indicator assesses the extent to which a country’s policy environment supports youth access to FP services without parental or spousal consent.

What is Provider Authorization?

This indicator assesses the extent to which a country’s policy environment requires providers to deliver FP services to youth without discrimination or bias.

What are Age Restrictions?

This indicator assesses the extent to which a country’s policy environment supports youth access to FP services regardless of age.

What are Marital Status Restrictions?

This indicator assesses the extent to which a country’s policy environment supports youth access to FP services regardless of marital status.

What is Access to a Full Range of FP Methods?

This indicator assesses the extent to which a country’s policy environment supports youth access to a full range of contraceptive methods, including the provision of long-acting reversible contraception.

What is Comprehensive Sexuality Education?

This indicator assesses the extent to which a country’s policy environment supports comprehensive sexuality education (CSE) for all youth, in accordance with the United Nations Population Fund (UNFPA) guidelines on essential components of CSE.

What is Youth-Friendly FP Service Provision?

This indicator assesses the extent to which a country’s policy environment supports youth-friendly FP service delivery, in accordance with three service delivery core elements shown to increase youth uptake of contraception: provider training, confidentiality and privacy, and free or subsidized services.

What is Enabling Social Environment?

This indicator assesses the extent to which a country addresses the two enabling environment elements of youth-friendly contraceptive service provision: build community support and address gender norms.

Many countries have taken a protectionist approach to legislating youth access to FP services, based on a belief that young people need to be protected from harm and that parents or spouses should be able to overrule their reproductive health (RH) decisions. In practice, these laws serve as barriers that inhibit youth access to a full range of sexual and reproductive health (SRH) services, including FP. For example, an International Planned Parenthood Federation study in El Salvador reported that laws requiring parental consent for minors to access medical treatment create a direct barrier for youth to access FP. The study recommended: “Primary legislation should clearly establish young people’s right to access SRH services, independent of parental or other consent; to avoid ambiguity and the risk that informal restrictions will be applied at the discretion of service providers.”

Global health and human rights bodies stress the importance of recognizing young people’s right to freely and responsibly make decisions about their own RH and desires. The 2012 International Conference on Population and Development’s Global Youth Forum recommended that “governments must ensure that international and national laws, regulations, and policies remove obstacles and barriers—including requirements for parental & spousal notification and consent; and age of consent for sexual and reproductive services—that infringe on the sexual and reproductive health and rights of adolescents and youth.”

Laws around consent to FP services are often unclear or contradictory. The Scorecard intends to recognize countries that explicitly affirm youth’s freedom to access FP services without parental or spousal consent. Countries that have created such a policy environment have been placed in the green category, signifying the most favorable policy environment, because their definitive legal stance provides the necessary grounding from which to counteract social norms or religious customs that may restrict young people’s ability to access FP services. If a policy document mentions that youth are not subject to consent from one of the third parties—spouse or parent—but does not mention the other, the country is classified in the yellow category. Any country that requires consent from a parent and/or spouse is placed in the red category. If a country does not have a policy in place that addresses youth access to FP services without consent, it is placed in the gray category.

Providers often refuse to provide contraception to youth, particularly long-acting reversible methods, for non-medical reasons. Service providers may impose personal beliefs or apply inaccurate medical criteria when assessing youth FP needs, creating a barrier to youth contraceptive uptake. Three-quarters of Ugandan providers queried on their perspective of providing contraception to youth believed that youth should not be given contraception, and one-fifth of providers said they would prefer to advise abstinence instead of providing injectables to young women. To address this barrier, national laws and policies should reflect open access to medically advised FP services for youth, without youth being subject to providers’ personal beliefs.

Policies that explicitly underscore the obligation of providers to service youth without discrimination or bias are considered fully supportive of youth access to contraception and receive a green categorization under this indicator. Any country that generally supports the World Health Organization (WHO) medical eligibility criteria for contraceptive use but does not explicitly require providers to service youth despite personal beliefs is placed in the yellow category. Any country that supports providers’ non-medical discretion when authorizing FP services for youth is placed in the red category, indicating a legal barrier for youth to use contraception. Countries that lack any policy addressing non-medical provider authorization fall in the gray category.

Youth seeking contraceptives continue to face barriers to accessing services because of their age. For example, a study in Kenya and Zambia found that less than two-thirds of nurse-midwives agreed that girls in school should have access to FP.

In 2010, a WHO expert panel concluded that “the existence of laws and policies that improve adolescents’ access to contraceptive information and services, irrespective of marital status and age, can contribute to preventing unwanted pregnancies among this group.” The 2012 International Conference on Population and Development’s Global Youth Forum recommended that governments ensure that their policy landscape removes obstacles to sexual and reproductive health and rights of young people, including age of consent for FP services.”

Countries that explicitly include a provision in their laws or policies that support youth access to FP regardless of age are considered to have a supportive policy environment and are placed in the green category. Countries that restrict youth access to FP by defining an age of consent for sexual and RH services are considered to have a restrictive policy environment and are placed in the red category. Countries that do not have a policy that supports youth access to FP regardless of age are placed in the gray category.

A 2014 systematic review identified laws and policies restricting unmarried youth from accessing contraception as an impediment to youth uptake of contraception. In the absence of a legal stance on marital status, health workers can justify refusal to provide contraception to unmarried youth. Thus, strong policies providing equal access to FP services for married and unmarried youth are necessary to promote uptake of contraceptive services among all young people.

Countries are determined to have the most supportive policy environment (green category) for this indicator if they explicitly include a provision in their laws or policies for youth to access FP services regardless of marital status. If a country recognizes an individual’s legal right to access FP services regardless of marital status but includes policy language that emphasizes married couples’ right to FP, it is considered to have a promising yet inadequate policy environment and classified in the yellow category, because the policy leaves room for interpretation. A country is placed in the red category if its policies restrict youth from accessing FP services based on marital status. Finally, if a country has no policy supporting access to FP services regardless of marital status, it is placed in the gray category.  

Youth seeking contraception, particularly long-acting reversible contraceptives (LARCs), frequently face scrutiny or denial from their provider based on their age, marital status, or parity (the number of times a woman has given birth). The WHO medical eligibility criteria for contraceptive use, however, explicitly state that age and parity are not contraindications for short-acting or long-acting reversible contraception.

Provision of LARCs as part of an expanded method mix is particularly effective in increasing youth uptake of contraception. In one study, implants were offered as an alternative contraceptive option to young women seeking short-acting contraceptives at a clinic in Kenya. Twenty-four percent of the women opted to use an implant, and their rate of discontinuation was significantly lower than those using short-acting methods. Of the 22 unintended pregnancies that occurred, all were among women using short-acting methods. Another study  trained providers working in youth-friendly services to offer a full range of contraceptive methods, which resulted in an increased adoption of LARCs among sexually active women, including those who planned to delay their first pregnancy. However, many young people around the world do not know about LARCs, and if they do, they may be confused about their use and potential side effects, hesitant to use them due to social norms, or face refusal from providers.

The “Global Consensus Statement for Expanding Contraceptive Choice for Adolescents and Youth to Include Long-Acting Reversible Contraception” calls upon all youth SRH and rights programs to ensure that youth have access to a full range of contraceptive methods by:

• Providing access to the widest available contraceptive options, including long-acting reversible contraceptives (LARCS, i.e., contraceptive implants and intrauterine contraceptive devices) to all sexually active adolescents and youth (from menarche to age 24), regardless of marital status and parity.
• Ensuring that LARCs are offered and available among the essential contraceptive options during contraceptive education, counseling, and services.
• Providing evidence-based information to policy makers, ministry representatives, program managers, service providers, communities, family members, and adolescents and youth on the safety, effectiveness, reversibility, cost-effectiveness, acceptability, continuation rates, and the health and non-health benefits of contraceptive options, including LARCs, for sexually active adolescents and youth who want to avoid, delay or space pregnancy.

This indicator differs from the Restrictions Based on Age indicator by focusing on the range of methods offered to youth. Countries should have in place a policy statement that requires health providers to offer short-acting and long-acting reversible contraceptive services regardless of age. In addition, the policy should leave no ambiguity in the scope of the directive but rather explicitly mention youth’s legal right to access a full range of contraceptive services, including LARCs. Therefore, countries with an explicit policy allowing youth to access a full range of contraceptive services—regardless of age—receive a green categorization for promoting the most supportive policy environment. Countries with policies that state that youth can access a full range of methods, but do not specify that LARCs are included in the method choice, are placed in the yellow category. These countries are on the right track but would have a stronger enabling environment if their policies explicitly mentioned youth’s right to access LARCs.

A country is placed in the red category if it has a policy in place that restricts access to FP services, including specific methods, based on age, marital status, parity, or other characteristics that do not align with WHO medical eligibility criteria. Countries that do not have a policy addressing youth access to a full range of contraceptive methods are placed in the gray category.

It is important to note that the Scorecard does not assess policies’ inclusion of emergency contraception (EC) in the full range of methods for youth when determining categorization of countries for this indicator. This indicator is focused on whether short-term methods and LARCs are included in the method options that are made available to youth. Therefore, countries that do not list EC in the available methods for youth can still receive a green categorization if they have included access to LARCs. However, due to the growing attention on EC as an available method for youth, the summary of this indicator in each country section makes note of whether EC was included in the range of methods for youth.

The WHO recommends educating adolescents about sexuality and contraception to increase contraceptive use and ultimately prevent early pregnancy and poor RH outcomes. Comprehensive sexuality education (CSE) is a specific form of sexuality education that equips young people with age-appropriate, scientifically accurate, and culturally relevant SRH knowledge, attitudes, and skills regarding their SRH rights, services, and healthy behaviors.

A growing body of evidence demonstrates that informing and educating youth about sexuality and SRH have a positive impact on their RH outcomes. Sexuality education offered in schools helps youth make positive, informed decisions about their sexual behavior and can reduce sexually transmitted infections (STIs) and unintended pregnancies, in part due to increased self-efficacy and use of condoms and other contraception. A study in Brazil that implemented a school-based sexual education program in four municipalities measured a 68%increase in participating students’ use of modern contraception during their last sexual intercourse. To be most effective, sexuality education should be offered as part of a package with SRH services, such as direct provision of contraception or links to youth-friendly FP services.

Many approaches exist to implement sexuality education in and out of schools. The Scorecard considers CSE as the gold standard and relies on the “UNFPA Operational Guidance for Comprehensive Sexuality Education,” which focuses on human rights and gender as a framework to effectively implement a CSE curriculum. The UNFPA Operational Guidance outlines nine essential components of CSE that are concise and easy to measure across countries’ policy documents. Further, these guidelines recognize gender and human rights and build on global standards discussed in the United Nations Educational, Scientific, and Cultural Organization’s “International Technical Guidance on Sexuality Education.”

The nine UNFPA essential components for CSE are:

1. A basis in the core universal values of human rights.
2. An integrated focus on gender.
3. Thorough and scientifically accurate information.
4. A safe and healthy learning environment.
5. Linking to sexual and reproductive health services and other initiatives that address gender, equality, empowerment, and access to education, social and economic assets for young people.
6. Participatory teaching methods for personalization of information and strengthened skills in communication, decision-making and critical thinking.
7. Strengthening youth advocacy and civic engagement.
8. Cultural relevance in tackling human rights violations and gender inequality.
9. Reaching across formal and informal sectors and across age groupings.

A country is determined to have the most supportive policy environment and is classified in the green category if its policies not only recognize the importance of sexuality education broadly but also include each of the nine elements of CSE.

A country is considered to have a promising policy environment if it clearly mandates sexuality education in a national policy but either does not outline exactly how sexuality education should be implemented or has guidelines that are not fully aligned with the UNFPA CSE essential components. Under these criteria, a country is classified in the yellow category.

While evidence proves that sexuality education equips youth with the necessary skills, knowledge, and values to make positive SRH decisions, including increased contraceptive use, little evidence exists that abstinence-only education is similarly effective. The 2016 Lancet Commission on Adolescent Health and Wellbeing recommends against abstinence-only education as a preventive health action and found it ineffective in preventing negative SRH outcomes. In fact, some reports suggest that an abstinence-only approach increases the risk for negative SRH outcomes among youth. Therefore, a country that supports abstinence-only education is seen as limiting youth’s access to and use of contraception and, as a result, is grouped in the red category. Any country lacking a sexuality education policy is placed in the gray category.

[vii] Patton et al., "Our Future."

[viii] Santhya and Jejeebhoy, “Sexual and Reproductive Health and Rights of Adolescent Girls.”

The WHO “Guidelines on Preventing Unintended Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries” recommend that policymakers make contraceptive services adolescent-friendly to increase contraceptive use among this population. This recommendation aligns with numerous findings in the literature. A 2016 systematic assessment to identify evidence-based interventions to prevent unintended and repeat pregnancies among young people in LMICs found that three out of seven interventions that increased contraceptive use involved a component of contraceptive provision. Evidence from a 2020 study showed that providing free short and long-acting reversible contraceptives was associated with an increased likelihood of contraceptive use. Additional evaluations show that when SRH services are tailored to meet the specific needs of youth, they are more likely to use these services and access contraception.

The Scorecard draws upon the service-delivery core elements originally identified in the United States Agency for International Development’s High-Impact Practices in Family Planning (HIPs) brief, “Adolescent-Friendly Contraceptive Services,” as the framework for assessing the policy environment surrounding FP service provision. An updated version of the brief, “Adolescent-Responsive Contraceptive Services: Institutionalizing Adolescent-Responsive Elements to Expand Access and Choice,” was published in March 2021 and reaffirms the same service-delivery elements as showing a direct contribution to increased contraceptive use. The service-delivery elements addressed in this indicator are:

1. Train and support providers to offer nonjudgmental services to adolescents.
2. Enforce confidentiality and audio/visual privacy.
3. Provide no-cost or subsidized services.

Many countries have adolescent-friendly health initiatives that include a wide range of health services, but for a country to be placed in the green category, its policies should specifically reference providing FP services to youth as part of the package of services. A country is placed in the green category for this indicator if its policy documents reference the three adolescent-friendly contraceptive service-delivery elements as defined above. Simply referencing the provision of FP services to youth, but not adopting the three service-delivery elements of adolescent-friendly contraceptive services, indicates a promising but insufficient policy environment, and the country is placed in the yellow category. Countries that reference provider training in youth FP services but do not acknowledge judgment as a barrier or do not specify that the training is to combat provider discrimination receive a yellow categorization. A country is also placed in the yellow category if policies reference making youth services affordable or confidential but do not specify FP services or products.

Countries that do not have a policy that promotes FP service provision to youth are placed in the gray category.

The final indicator addresses demand-side factors, specifically efforts to make youth access to and use of a full range of contraceptive methods more socially acceptable and appropriate within their communities. To support youth’s acceptance of contraception and ensure they are comfortable seeking contraceptive services, it is imperative to spread awareness and build support for a wide range of contraceptive methods in the broader communities in which they live. The 2016 Lancet Commission on Adolescent Health and Wellbeing identified community-support interventions as a critical component of strong sexual and reproductive health (SRH) service packages.

Group engagement activities that mobilize communities through dialogue and action, rather than by only targeting individuals, are considered a promising practice to change social norms around SRH, including contraceptive use Group engagement can be useful to change the discourse around youth sexuality and address misconceptions about contraception within communities. In addition to group engagement, some studies show that gender-synchronized approaches to and male partner engagement in family planning use leads to increased contraceptive use among young married couples and male partners.

The Scorecard draws upon enabling-environment elements originally outlined in United States Agency for International Development’s High-Impact Practices in Family Planning (HIPs) brief, “Adolescent-Friendly Contraceptive Services.” The updated HIPs brief for adolescent-responsive contraceptive services does not specifically reference these two elements but does address their intent by noting that countries should “link multi-sectoral demand side and gender-transformative community engagement efforts to adolescent-responsive contraceptive services, including through strong referral networks.”

This enabling-environment elements assessed in this indicator are:

• Address gender and social norms.
• Link service delivery with activities that build support in communities.

Countries that outline specific interventions to build support within the larger community for youth FP and address gender and social norms are considered to have a strong policy environment and are placed in the green category. Countries that include a reference to building an enabling social environment for youth FP, without providing any specific plan for doing so, are placed in the yellow category. Additionally, countries that discuss one, but not both, of the enabling social environment elements in detail are placed in the yellow category. Countries without any reference to activities to build an enabling social environment for youth FP are placed in the gray category.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically advised youth FP services but does not address personal bias or discrimination.

No law or policy exists addressing age in youth access to FP services.

Law or policy exists that restricts access to FP services based on marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy outlines detailed strategy addressing two enabling social environment elements for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from both third-parties (parents and spouses).

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from one but not both third parties.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from one but not both third parties.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both enabling social environment elements.

Law or policy exists that supports access to FP services without consent from both third parties (parents and spouses).

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

No policy exists to build an enabling social environment for youth FP services.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

No policy exists supporting sexuality education of any kind.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

No policy exists to build an enabling social environment for youth FP services.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that restricts youth access to a full range of FP methods based on age, marital status, and/or parity.

Policy supports the provision of sexuality education and mentions all nine UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from one but not both third parties.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

No law or policy exists addressing youth access to a full range of FP methods. 

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both enabling social environment elements.

Law or policy exists that supports access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of CSE.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements for youth-friendly contraceptive services.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically advised youth FP services but does not address personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing one of the two enabling social environment elements for youth-friendly contraceptive services.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training
• Confidentiality and privacy
• Free or reduced cost

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both enabling social environment elements.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms,
• Build community support.

Law or policy exists that supports access to FP services without consent from one, but not both, third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically advised youth FP services but does not address personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically advised youth FP services but does not address personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from one but not both third parties (parents and spouses).

No law or policy exists that addresses provider authorization for FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that restricts youth access to a full range of FP methods based on age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both enabling social environment elements.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

No law or policy exists addressing youth access to a full range of FP methods.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements for youth-friendly contraceptive services.

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

No law or policy exists addressing youth access to a full range of FP methods. 

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

No policy exists to build an enabling social environment for youth FP services. 

No law or policy exists that addresses consent from a third party to access FP services.

No law or policy exists that addresses provider authorization for youth FP services.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that restricts youth access to a full range of FP methods based on age, marital status, and/or parity.

Policy promotes abstinence-only education or discourages sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both enabling social environment elements.

Law or policy exists that requires parental or spousal consent for access to FP services.

Law or policy exists that requires providers to authorize medically advised youth FP services but does not address personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

No policy exists to build community support for youth FP services.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements  for youth-friendly contraceptive services:

• Address gender norms,
• Build community support.

Law or policy exists that supports access to FP services without consent from one but not both third parties.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services for unmarried women, but includes language favoring the rights of married couples to FP.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy promotes abstinence-only education or discourages sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy references building an enabling social environment to support youth access to FP but does not include specific intervention activities addressing both enabling social environment elements.

Law or policy exists that supports access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

No law or policy exists that addresses consent from a third party to access FP services.

Law or policy exists that requires providers to authorize medically-advised youth FP services without personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that restricts youth access to a full range of FP methods based on age, marital status, and/or parity.

Policy supports provision of sexuality education without referencing all nine of the UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

Law or policy exists that supports access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically-advised youth FP services but does not address personal bias or discrimination.

Law or policy exists that supports youth access to FP services regardless of age.

No law or policy exists addressing marital status in access to FP services.

Law or policy exists that supports youth access to a full range of FP methods, including the provision of long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy promotes abstinence-only education or discourages sexuality education.

Policy references targeting youth in provision of FP services but mentions fewer than three of the service-delivery elements for youth-friendly contraceptive services.

Policy outlines detailed strategy addressing one of the two enabling social environment elements for youth-friendly contraceptive services.

Law or policy exists that supports access to FP services without consent from both third parties (parents and spouses).

Law or policy exists that requires providers to authorize medically advised youth FP services without personal bias or discrimination.

No law or policy exists addressing age in access to FP services.

Law or policy exists that supports access to FP services regardless of marital status.

Law or policy exists that supports youth access to a full range of FP methods without defining full range of methods to include long-acting reversible contraceptives regardless of age, marital status, and/or parity.

Policy supports the provision of sexuality education and mentions all nine UNFPA essential components of comprehensive sexuality education.

Policy outlines the following three service-delivery elements for youth-friendly contraceptive services:

• Provider training.
• Confidentiality and privacy.
• Free or reduced cost.

Policy outlines detailed strategy addressing two enabling social environment elements for youth-friendly contraceptive services:

• Address gender norms.
• Build community support.

No laws or policies reviewed address consent from a third party when youth are accessing FP services; therefore, Bangladesh is placed in the gray category for this indicator.

The “Bangladesh Essential Health Service Package (ESP), 2016” guidelines for screening for contraceptive use direct providers to follow medical eligibility criteria when clients seek FP services. Additional policies outline plans to train providers to provide non-judgmental services to adolescents, but no policies explicitly require providers to authorize medically advised youth FP services without personal bias or discrimination. Bangladesh is placed in the yellow category for this indicator.

The “National Strategy for Adolescent Health, 2017-2030" affirms adolescents’ right to health regardless of their age as guaranteed by the Constitution of Bangladesh:

Universality and Inalienability

The right to health will be universal and inalienable for all adolescent boys and girls of Bangladesh. They will be entitled to access health related information and services regardless of their gender, age, class, caste, ethnicity, religion, disability, civil status, sexual orientation, geographic divide or HIV status.

Indivisibility

The right of adolescents to their health has equal status over other rights and will not be positioned in a hierarchical order. The right to adolescent health will not be compromised at the expense of other rights.

The “Bangladesh Population Policy 2012” acknowledges the need to bring adolescents under family planning coverage to improve client-centered services but fails to state that adolescents should have access to FP regardless of age:

5. Major Strategies for Implementation of the Population Policy

5.1 Client-Centred Service

Improve service centre practices and door-to-door services to ensure client-centred services, and undertake the following strategies to make them complement each other:

…

d) bring newlyweds, adolescents, and parents of one or two children under the coverage of family planning services on a priority basis.

Though Bangladesh’s policies support adolescents’ right to health and promote client-centered services, they do not include language that explicitly supports youth access to FP services regardless of age. Bangladesh is therefore placed in the gray category for this indicator.

The “National Strategy for Adolescent Health, 2017-2030" refers to a regulation that makes sexual and reproductive health services available only to married women and eligible couples:

Finally it is important to address the issue of unmarried adolescents, who fall outside the existing reproductive health care services system, given the regulation that SRH [sexual and reproductive health] services are available only to married women and eligible couples.

While this regulation could not be identified by name and could not be located, the Strategy then acknowledges the importance of making SRH services, including family planning, accessible to all adolescents regardless of their marital status but does not detail any strategic objectives to reach this goal:

Given...the significant population of adolescents in Bangladesh, where a majority of adolescent girls are given in marriage before the age of 18 years, meeting the sexual and reproductive health needs and rights of this group becomes imperative. These needs can be met by ensuring the provision of quality and age appropriate sexuality education starting with the very young adolescent, the delivery of quality age and gender appropriate SRH information and services and mobilization of the community to accept the importance of meeting the SRH and rights of all adolescents, irrespective of their marital status.

The “Costed Implementation Plan for National Family Planning Program in Bangladesh, 2020-2022" also alludes to a regulation restricting family planning to married couples and specifically targets newly married couples in plans to scale-up FP counseling and services. Furthermore, the plan specifically includes an activity to provide contraception to the “bridegroom/bride,” with no comparable activity targeting unmarried adolescents.

As Bangladesh’s existing policy regulations restrict access to SRH services based on marital status and more recent policies do not go far enough to remove this barrier, Bangladesh is placed in the red category for this indicator.

The “Clinical Contraception Services Delivery Programme Operational Plan, 2011-2016” notes that Bangladesh’s family planning programs use medical eligibility criteria based on World Health Organization (WHO) guidelines:

Medical Eligibility Criteria for Contraceptive use has been developed in perspective of national FP programme of Bangladesh based on WHO guidelines. This criteria has been included in the FP manual. These will help in proper client screening in reducing drop-outs, side-effects/ complications and unnecessary method-switching. At the same time every effort will be made to increase the accessibility of FP users in facilities by making those more attractive and user-friendly by improving provider attitude and management of FP services through proper counseling and screening.

The Operational Plan notes that the FP manual was undergoing an update, but the update could not be accessed at the time of analysis.

As part of its strategy to target adolescents, the “Costed Implementation Plan for National Family Planning Program in Bangladesh, 2020-2022” includes an activity to ensure contraceptive availability, including long acting reversible contraceptives (LARCs), for all adolescents:

7.5 Making all services (both short and LARC) available for the adolescents in the facilities.

Phasing of adolescent friendly contraceptive services

7.5.1 Ensure availability of the logistics at all level (No additional cost required)

The “Bangladesh Essential Health Service Package (ESP), 2016” acknowledges that adolescent health covers “distribution of condoms” and “FP information and provision,” but it does not detail method eligibility for adolescents and youth. The Service Package continues to note that screening for contraceptive use follows medical eligibility criteria but provides no further detail.

The Service Package does not explicitly state that these methods are available regardless of age, parity, and marital status, and the Costed Implementation Plan is the only policy document reviewed that mentions the need to ensure the availability of contraceptives , including LARCs, to adolescents. Bangladesh is therefore placed in the yellow category for this indicator.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, it is worth noting that Bangladesh’s policies do not specify whether access to EC should be available to adolescents.

The “National Plan of Action for Adolescent Health Strategy, 2017-2030" includes a strategic objective to integrate age-appropriate comprehensive sexuality education (CSE) at all educational levels:

Key Strategy: Promote age appropriate comprehensive sexuality education, which are on par with international standards, through all academic and training instructions.

Major Activities:

• Revise Secondary School and Madrasah Curriculum (Class VI-X) to strengthen the CSE component Include adolescent development and CSE contents in B. Ed. course Conduct Peer Educator training (2 students from each school)

The Plan of Action also mentions CSE in its section focused on adolescent mental health:

Key Strategy: Develop skills among adolescents to deal with stress, manage conflict, and develop healthy relationships.

Major Activities:

• Organize sessions on Comprehensive Sexuality Education (CSE)/Life Skills Education/(LSE) for adolescents through the SHP [sexual health program], AH [adolescent health] clubs…
• Provide training on LSE.

However, the Plan of Action does not provide guidance or details on the specific components of the CSE curriculum or which students will be targeted.

Multiple policies and operational plans address improving knowledge of sexual and reproductive health (SRH) in schools and community settings without providing further details. The “National Children Policy, 2011” acknowledges the need to include information on reproductive health in the school syllabus. The “Costed Implementation Plan for National Family Planning Program in Bangladesh, 2020-2022" includes an activity to incorporate an adolescent health program into the school curriculum. The “Maternal, Neonatal, Child, and Adolescent Health Operational Plan, 2017-2022" includes effective dissemination of SRH knowledge and information through school curricula and community-based dissemination. The Operational Plan also includes an activity to link schools to SRH services, although it provides no detail on whether these linkages are also promoted in the curriculum:

Component 4: Adolescent Health

Activities: …

1. Establishment of referral linkages between school health clinics and other health facilities.

While the “Bangladesh Population Policy, 2012” includes adolescent SRH education activities, including dissemination workshops on family planning for adolescents in schools and colleges and life skills education, these activities specifically target married adolescents.

The “National Education Policy, 2010” outlines aims and objectives of education in Bangladesh and lays out additional aims, objectives, and strategies for different levels (primary, adult, secondary, vocational, etc.) and types of education (such as science, business, and engineering). The policy includes a section on “Women’s Education,” which aims to continue women’s access to education to ensure future development and economic participation and includes a strategy to include reproductive health in the curriculum:

The secondary level curriculum of last two years will include gender studies and issues of reproductive health.

Similarly, a draft version of the “National Youth Policy, 2017” aims to include life skills and education on sexual and reproductive health and rights in the curriculum, but does not outline any further steps or details on recipients or curriculum content:

Include sexual and reproductive health and rights to sexual and reproductive health in the curriculum.

…

9.1.9 Build awareness among youth about reproductive health, rights to reproductive health and about sexual health

…

10.5.3 Equip youth with greater sensibility to violation of human rights anywhere in the society or against any group or community, and motivate them to play an active role in the case of such occurrences.

The “National Communication Strategy for Family Planning and Reproductive Health, 2008,” which is designed to serve as a roadmap for increasing knowledge, improving attitudes, and changing behaviors related to family planning and reproductive health, outlines various approaches to reaching its goal among different target audiences—including adolescents and unmarried youth. Neither approach provides details on a CSE curriculum, but both address the need to increase FP knowledge and awareness about gender equity:

Audience 5: Adolescents

Sub-objectives:

• Increase the number of adolescents that have correct knowledge about their bodies, and can practice proper hygiene;
• Encourage dialogue between parents and children about marriage, fertility, reproductive health, maternal health;

…

Audience 6: Unmarried Youth

Sub-objectives:

…

• Increase awareness among youth (in-school and out-of-school) about the negative effects of gender-based violence;
• Increase knowledge about (gender-specific) sexual health rights;
• Improve the reach of life-skills/family life education programs to include greater numbers of out- of-school youth;
• Increase knowledge about sexual responsibility;
• Increase the number of unmarried youth that delay age at marriage;
• Increase the number of unmarried youth that know the advantages to having no more than two children;
• Increase the number of unmarried youth that have a positive attitude toward family planning

While Bangladesh’s policy environment acknowledges the need for CSE and SRH education in schools, no policy documents provide further details on the content of a curriculum or outline detailed activities that would support UNFPA's essential components of CSE. Bangladesh is therefore placed in the yellow category for this indicator.

In its priority area targeting adolescents and youth, the “Costed Implementation Plan for National Family Planning Program in Bangladesh, 2020-2022” includes activities to train providers to withhold judgment and ensure confidentiality and privacy for youth seeking services:

7.2 Training of providers on adolescent friendly services (AFS10) with privacy and confidentiality—FWVs [family welfare visitors] and SACMOs [sub-assistant community medical officers] focusing on providing non-judgmental services, accurate information on medical eligibility, communication strategy for adolescents.

7.3 Ensuring private and confidential counselling room with doors and window curtains, partitioning the waiting areas so that adolescents’ clients do not have to mix adult clients, not conducting history taking and screening in public

7.4 Developing adolescent friendly communication materials and digital health services.

7.5 Making all services (both short and LARC [long-acting reversible contraceptives]) available for the adolescents in the facilities, phasing of adolescent friendly contraceptive services.

The "National Strategy for Adolescent Health, 2017-2030" acknowledges the need to take into consideration “issues of affordability and accessibility of health services” for vulnerable adolescents and calls for a key focus on making contraceptives and services available to youth for free or at low cost.

The “National Plan of Action for Adolescent Health Strategy, 2017-2030" includes an activity to train providers on adolescent friendly health services and counseling:

Key Strategy: Build capacity for the delivery of age and gender sensitive sexual and reproductive health services which includes HIV/STI prevention, treatment and care.

Major Activities:

• Develop and update comprehensive training module on AFHS [adolescent-friendly health services] and Counselling (including family planning) for Service Providers and Field Workers.
• Organize [Training of Trainers] for Master trainers
• Conduct training of Service Providers and Field Workers in the provision of Adolescent Friendly Health Services and Counselling, particularly on Family planning.
• Review the medical and pre-service training curriculum of health workers (doctors, nurses, midwives, paramedics and field workers) to ensure the inclusion of adolescent health and counselling with special focus on Family planning

The Plan of Action further notes the need to train providers to adopt non-judgmental attitudes when working with adolescents in its section on health systems strengthening:

Key Strategy HWF [Health Work Force] 1: Capacity building of health providers to be sensitive to the needs of all adolescents, including those who are unmarried, through pre service, in service and on the job training;

Major Activities:

• Development of [Management Information System] for HR [human resources] Management and for gap analysis
• Training and mentoring all [healthcare providers]…on [adolescent health] and rights related issues including special health needs by providing pre- and in-service trainings
• Development of Course on Adolescent Health and incorporate it in post-graduation

 Key Strategy HWF 2: Provide health service personnel with training on counselling for adolescents and capacitate them to adopt non-judgmental attitudes when working with adolescents.

Major activities:

• Deployment of human resource to provide adolescent health services based on need
• Train [healthcare providers] on psychosocial counselling, family planning, gender diversity and value clarification issues.

Moreover, the “National Communication Strategy for Family Planning and Reproductive Health, 2008” includes a specific objective to “improve the attitudes of service providers toward adolescents and youth with regard to family planning and reproductive health seeking behavior.”

Furthermore, the “Community-Based Health Care Operational Plan, 2017-2022" outlines an implementation process to develop adolescent counseling corners to provide adolescent-friendly services. Additionally, the “Eighth Five Year Plan, 2020-2025” includes establishing 200 additional adolescent-friendly service centers among the main activities listed for family planning. While the plan aims to ensure the availability of modern contraceptives at a low cost, especially in remote areas, it does not specifically plan for youth’s access to services for free or at reduced costs.

By including provider training for youth-friendly FP services and activities to ensure privacy for youth accessing FP information and services, Bangladesh has fostered a promising policy environment. Bangladesh is placed in the yellow category for this indicator and can further improve its policy environment by ensuring FP services for youth for free or at a reduced cost.

The “Costed Implementation Plan for National Family Planning Program in Bangladesh, 2020-2022” outlines a list of activities to foster a supportive environment for adolescents’ family planning and address gender norms, especially targeting parents, religious leaders, public representatives, local elites, providers, etc.:

Strategy 2- Increasing acceptability of LARC&PM [long-acting reversible contraceptives and permanent methods] through skilled HR [human resources] and engaging males

Activities:

…

2.5 Use satisfied clients/champions for the promotion of LARC&PM in the community

…

2.7 Use religious leader for the promotion of LARC&PM: Extensive workshops to sensitize religious leaders (Note: even though these strategies are in place as stated in FP OPs[operational plans], field observation suggested that they were not effectively implemented)

...

Strategy 8- Targeting adolescents with special focus on males

Activities:

8.1 Counsel adolescent, newly married couple, in-laws, public representatives and local elites to improve gender norms.

…

8.5 Counsel and meetings for parents, providers, religious leaders, and other influential adults (public representatives and local elites etc.) who can foster a supportive environment in health    facilities, schools, places of worship, and in homes

To address underlying barriers to adolescent FP access, including community stigma associated with being sexually active, the “National Plan of Action for Adolescent Health Strategy, 2017-2030" acknowledges the need for social and behavior change communication programs to change community attitudes and behaviors and lays out three strategies:

Strategic Objectives

…

3. To use Social and Behavioral Change Communication [SBCC] interventions to bring about changes in knowledge, attitudes and practices among specific audiences.

Key Strategies

1. Development of messages and materials for communication and advocacy through sound research;
2. Utilize ICT [information and communications technology] (including call centres) and media to reach adolescents, key community members, parents and guardians;
3. Develop the capacity of respective institutions and systems to design, plan, implement and monitor SBCC interventions.

The “National Communication Strategy for Family Planning and Reproductive Health, 2008” lists specific activities to create an enabling social environment for unmarried youth’s access to family planning information and gender equity:

• Engage Imams to discuss reproductive health issues with youth;
• Conduct discussion groups with trained facilitators where youth can learn about, and practice, problem-solving skills with regard to family planning and reproductive health decision-making;
• Educate community gatekeepers (parents, teachers, religious leaders, etc.) about gender equity issues.

The “Maternal, Neonatal, Child, and Adolescent Health Operational Plan, 2017-2022" includes an objective to “create positive change in the behavior and attitude of the gatekeepers of adolescents towards reproductive health.” The plan outlines two relevant strategies to create an enabling social environment:

Advocacy meeting at community level for the gatekeepers of adolescents

...

Carry out multi-sectoral advocacy for creation of supportive environment for adolescents to practice safe behaviors

The Operational Plan does note the specific methods for community mobilization of gatekeepers, but does not go into much detail:

Community mobilization around ASRH [adolescent sexual and reproductive health] issues through court yard meetings, inter-personal communication, and workshops, through partnership with NGOs, to sensitize gatekeepers (parents, religious leaders, community leaders, school teachers, school management committees. etc.)

The “National Women Development Policy, 2011,“ “National Education Policy, 2010,” and “Eighth Five Year Plan, 2020-2025,” aim to establish gender equality, promote girl’s education, and ensure equal gender rights in family planning decision-making.

Since Bangladesh’s policy environment details activities to create an enabling social environment for youth access to family planning information and services and addresses gender norms, Bangladesh is placed in the green category for this indicator.

The right to non-discrimination in the “Loi n° 2003-04 du 03 mars 2003 relative à la santé sexuelle et à la reproduction” states that parental and partner consent is not required for patients to receive reproductive health care:

L’autorisation du partenaire ou des parents avant de recevoir des soins en matière de santé de la reproduction peut ne pas être requise, pourvu que ce procédé ne soit pas contraire à La loi.

Benin is placed in the green category for this indicator because its policies adequately prohibit parental and spousal consent.

The “Plan d’action national budgétisé de planification familiale du Bénin, 2019-2023” acknowledges that provider bias toward young people, particularly those who are unmarried, is a pervasive issue preventing young people from accessing family planning (FP) services:

Quant aux adolescents et jeunes non en union, ils craignent de rencontrer leurs parents et les autres adultes dans les points d’accès à la PF et jugent que leur utilisation de la PF est mal perçue par les prestataires qui préfèrent offrir les méthodes uniquement aux femmes en union.

The “Stratégie nationale multisectorielle de la santé sexuelle et de la reproduction des adolescents et jeunes, 2018-2022” includes an initiative to establish youth-friendly health centers that follow global standards for quality health care services for adolescents and youth. The standards note that adults’ judgement of what is best for adolescents should not supersede their obligation to respect youth rights as outlined in the International Convention on the Rights of the Child, but the standards do not specifically address providers or youth access to family planning.

Benin’s policies, however, do not explicitly state that providers must refrain from applying their personal biases and beliefs when providing FP services to youth. Therefore, Benin falls into the gray category for this indicator.

The “Loi n° 2003-04 du 03 mars 2003 relative à la santé sexuelle et à la reproduction” supports individuals’ access to reproductive health care regardless of age: 

Article 2 : Caractère universel du droit à la santé de la reproduction.

Le droit à la santé de reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans aucune discrimination fondée sur l’âge, le sexe, la fortune, la religion, l’ethnie, la situation matrimoniale.

Article 7 : Droit à la non-discrimination.

Les patients sont en droit de recevoir tous les soins de santé de la reproduction sans discrimination fondée sur le sexe, le statut marital, le statut sanitaire ou tout autre statut, l’appartenance à un groupe ethnique, la religion, l’âge ou l’habilité à payer.

The “Loi n° 2015-08 portant code de l’enfant en république du Bénin” states that individuals under age 18 have the right to access to reproductive health services:

Article 156 : Santé de la reproduction de l’enfant

L’enfant doit avoir accès à la santé de la reproduction sans aucune forme de discrimination, de coercition ou de violence. Il a le droit à l’information la plus complète sur les avantages et les inconvénients de la santé de la reproduction, sur les méthodes de planification familiale et de contraception ainsi que sur l’efficacité des services de santé sexuelle et reproductive.

Benin is placed in the green category for this indicator because the policy environment confirms that youth must be permitted access to family planning services regardless of age.

The “Loi n° 2003-04 du 03 mars 2003 relative à la santé sexuelle et à la reproduction” supports individuals’ access to reproductive health care, which includes family planning, regardless of marital status:

Article 2 : Caractère universel du droit à la santé de la reproduction.

Le droit à la santé de reproduction est un droit universel fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu. Aucun individu ne peut être privé de ce droit dont il bénéficie sans aucune discrimination fondée sur l’âge, le sexe, la fortune, la religion, l’ethnie, la situation matrimoniale.

Article 7 : Droit à la non-discrimination.

Les patients sont en droit de recevoir tous les soins de santé de la reproduction sans discrimination fondée sur le sexe, le statut marital, le statut sanitaire ou tout autre statut, l’appartenance à un groupe ethnique, la religion, l’âge ou l’habilité à payer.

Benin guarantees access to reproductive healthcare regardless of marital status; therefore, it is placed in the green category for this indicator.

While Benin’s policy environment protects the right of individuals to a full range of methods and to the method of their choice, it falls short of addressing youth access to a full range of contraceptive methods.

For example, the “Loi n° 2003-04 du 03 mars 2003 relative à la santé sexuelle et à la reproduction” states that the full range of legal contraceptives must be authorized and available after consultation as part of an individual’s right to choose from a range of effective and safe contraceptive methods. However, it does not specify that this same right must be extended to youth:

La contraception comprend toute méthode approuvée, reconnue effective et sans danger. Elle comprend les méthodes modernes (temporaires, permanentes), traditionnelles et populaires. Toute la gamme des méthodes contraceptives légales doit être autorisée et disponible après consultation. Le droit de déterminer le nombre d’enfants et de fixer l’espacement de leur naissance confère à chaque individu la faculté de choisir parmi toute gamme de méthodes contraceptives effectives et sans danger celle qui lui convient.

The “Stratégie nationale multisectorielle de santé sexuelle et de la reproduction des adolescents et jeunes au Bénin, 2010-2020,” which is specifically concerned with youth reproductive health, defines reproductive health as including the right of individuals to the contraceptive methods of their choice, without explicitly stating that youth should be able to access a full range of contraceptive options:

La santé de la reproduction suppose par conséquent que les individus aient une vie sexuelle satisfaisante et sûre, ainsi que la capacité de se reproduire et la liberté de décider quand et à quelle fréquence le faire. Cette dernière question repose implicitement sur les droits des hommes et des femmes à être informés et à accéder à des méthodes de planification familiale (PF) sûres, efficaces, abordables et acceptables qu’ils auront choisies eux-mêmes, ainsi qu’à d’autres méthodes de leur choix de régulation de la fécondité qui soient conformes à la législation.

The "Plan d’action national budgétisé de planification familiale du Bénin, 2019- 2023" includes an objective to expand the range of family planning services young people can access to include long-acting reversible methods and postpartum family planning services. However, this activity targets young people living in selected remote areas and does not guarantee their access to a full range of contraceptive methods regardless of age, marital status, or parity.

Because Benin does not have a policy extending access to a full range of methods for youth specifically, it is placed in the yellow category for this indicator. To move to the green category, Benin should clarify that youth can access a full range of methods, including long-acting reversible contraceptives.

Although the availability of emergency contraception (EC) is not factored into the categorization of this indicator, note that Benin’s policy environment does not specifically address youth access to EC.

Benin’s policy environment supports the provision of sexuality education to in-school and out-of-school youth. The “Plan d’action national budgétisé de planification familiale du Bénin, 2019- 2023” includes a strategy to unify multisectoral efforts intended to strengthen comprehensive sexuality education (CSE) by harmonizing the content of CSE programs currently used in both school and non-school environments, and teaching and providing counseling about family planning services in schools:

Stratégies

…

O4. Unifier les efforts multisectoriels (ministères connexes et autres secteurs) notamment éducatifs afin d’identifier le gap et exploiter les synergies, assurer l’efficacité des efforts humains et financiers et renforcer l’éducation complète à la sexualité

…

A02. Harmoniser le contenu des curricula et mise en œuvre de l’approche d’Éducation Complète à la Sexualité pour les adolescents (e)s et les jeunes scolarisés, et non/déscolarisés ou en situation de vulnérabilité en collaboration avec les ministères chargés de l’Éducation, de l’enseignement supérieur, etc. envisageant des visites de centres de santé accrédités, des séances de sensibilisation sur les consultations en PF en milieu scolaire, et l’enseignement potentiel de la PF avant la 3ème.

The “Stratégie nationale multisectorielle de santé sexuelle et de la reproduction des adolescents et jeunes au Bénin, 2010-2020” tasks the Ministry of Secondary Education and Technical and Vocational Training with extending SRH education to technical and vocational secondary schools and promoting SRH awareness activities at colleges. The Ministry of Family and National Solidarity is tasked with reaching vulnerable groups of youth with SRH information.

The “Stratégie nationale multisectorielle” also recognizes the need to tailor information to the specific needs of youth:

Principales options de promotion de la SRAJ [santé reproductive des adolescents et des jeunes]/VIH/sida :
La prise en compte de l’âge, du genre et des conditions socio-culturelles des adolescents et jeunes dans la définition des types et contenus des services d’information, de conseil et de prestations cliniques ou communautaires en SRAJ/VIH/sida.

These policies address two essential components of comprehensive sexuality education (CSE) by personalizing information and reaching across formal and informal sectors and across age groups.

A third component of CSE addressed in Benin’s policy documents is strengthening youth advocacy and civic engagement. The “Stratégie nationale multisectorielle” places strong emphasis on youth advocacy for adolescent reproductive health information and services:

Les Organisations de jeunesse :
… Ces organisations jouent actuellement d’important rôle de mobilisation de jeunes. Elles doivent poursuivre les activités de mobilisation des jeunes et adolescents afin d’être de puissants instruments dans la mise en œuvre de la présente Stratégie Nationale Multisectorielle. Elles doivent contribuer à la promotion de la CCC [communication pour le changement de comportement] en SRAJ, des prestations de services à base communautaire et le plaidoyer en vue de la mobilisation des leaders communautaires et des partenaires techniques et financiers.

The “Stratégie nationale multisectorielle” and the “Programme national de santé de la reproduction, 2011-2015” include a specific objective to strengthen involvement of youth in SRH programming:

Axe : Implication et responsabilisation des jeunes dans la promotion de la SSR [santé sexuelle et reproductive]/VIH/sida

Objectif spécifique : Renforcer l’implication des structures de jeunes organisées à toutes les étapes du processus de prise de décision, de planification, de mise en œuvre et de suivi évaluation.

Although the “Stratégie nationale multisectorielle” acknowledges gender issues facing youth, such as gender-based violence and forced or early marriages, it does not describe integrating gender into a CSE program. 

In addition, the “Plan stratégique intégré de la santé de la reproduction, de la mère, du nouveau-né, de l’enfant, de l’adolescent et jeune (SRMNEAJ), 2017-2021” tasks the Ministry of Secondary Education and Technical and Vocational Training with integrating SRH education into school curricula for adolescents and youth, training teachers on curriculum content, and organizing community sensitization activities. The "Plan stratégique intégré” also tasks the Ministry of Justice with extending SRH education activities for adolescents and youth who are incarcerated.

The “Stratégie nationale multisectorielle de la santé sexuelle et de la reproduction des adolescents et jeunes, 2018-2022” introduces Benin's intention to establish a CSE curriculum  in the education system with a goal to eventually scale-up the curriculum to provide it to out-of-school youth:

Interventions

…

3.6 Instauration d'un programme d’éducation à la sexualité responsable en milieu scolaire et non scolaire

Activités

3.6.1 Accompagner le processus d'intégration de l'éducation à la santé sexuelle dans le système éducatif

3.6.2 Assurer le suivi du processus d'intégration de l'éducation à la santé sexuelle dans le système éducatif

3.6.3 Rendre disponible les curricula d'éducation à la santé sexuelle en milieu extra-scolaire

3.6.4 Préparer la mise à échelle du Programme d'éducation à la santé sexuelle en milieu extra-scolaire

Benin’s policy environment is supportive of sexuality education but does not reference all nine of the United Nations Population Fund (UNFPA) essential components of CSE. Therefore, Benin is placed in the yellow category for this indicator. Going forward, additional sexuality education policies should consider all nine UNFPA essential components of CSE.

The “Stratégie nationale multisectorielle de santé sexuelle et de la reproduction des adolescents et jeunes au Bénin, 2010-2020” and the “Programme national de santé de la reproduction, 2011-2015” include specific objectives to train providers to offer adolescent-friendly contraceptive services. Additionally, provider training described in the “Plan d’action national budgétisé de la planification familiale du Bénin, 2019-2023” includes an objective to improve FP services for adolescents and young people by offering capacity-building activities to providers:

Stratégie

…

O1. Améliorer le plateau technique des formations sanitaires pour l’offre de services de PF de qualité de 2019 à 2023.

…

A4. Renforcement des capacités des prestataires des formations sanitaires publiques et privées pour l’offre de services conviviaux et adaptes de SRAJ [sante de la reproduction des adolescents et des jeunes] : Renforcer les capacités des prestataires de 5% des FS [formations sanitaires] publiques et privées (soit 114 FS offrant la PF) par an ans dans le domaine de l’offre des services de PF adaptes aux adolescentes et jeunes permettra de lever l’obstacle lie à l’attitude de certains prestataires face aux adolescents et jeunes qui se présentent dans les centres de santé pour adopter les méthodes de PF. Elle sera réalisée à travers la formation, l’aménagement des structures de soins, la supervision et le suivi des prestations.

The “Stratégie nationale multisectorielle de santé sexuelle et de la reproduction des adolescents et jeunes au Bénin, 2010-2020” states that a youth-friendly FP service setting should provide confidentiality and affordability:

La formation sanitaire attrayante pour les adolescents et jeunes se définit comme un centre d’accueil ou de conseil, une maison des jeunes, offrant un bon accueil, une ambiance de gaité, d’aise, de confidentialité, une prise en charge adéquate, un traitement et des produits à moindre coût.

The "Plan opérationnel de réduction de la mortalité maternelle et néonatale au Bénin, 2018-2022” identifies improving adolescent’s access to FP through the provision of free contraceptives as a priority :

Des priorités ont été formulées pour la période 2018 – 2022 au nombre desquelles figurent :

…

• La gratuité de la Planification Familiale favorisant l’accès des adolescentes et jeunes à la contraception

…

Activités : Offrir gratuitement toutes les gammes de produits contraceptifs dans les formations sanitaires et cabinets privés de soins.

The "Plan national de développement sanitaire, 2018-2022" also includes free access to FP for young people and women of reproductive age as a priority action to reduce morbidity and mortality among adolescents and young people:

5.5.2. Orientation Stratégique (OS2): Prestation de service et l’amélioration de la qualité des soins

Objectifs Spécifiques : 2.1 Réduire la morbidité, la mortalité de la mère, du nouveau né, de l’enfant, de l’adolescent et du jeune

Axes d’interventions : 2.1.2 Intensification des services de la Planification Familiale

Actions prioritaires:

• Assurer la disponibilité des produits traceurs de la PF jusqu’au dernier niveau des prestations de services ;
• Renforcer l’opérationnalisation du plan d’action budgétisé de PF ;
• Assurer la gratuité de l’accès des jeunes et des femmes en âge de procréer à la PF.

The “Plan d’action national budgétisé de planification familiale du Bénin, 2019-2023” includes activities to provide user-friendly family planning services to young people, such as by making contraceptive services free, creating youth-friendly centers, and training providers:

Activités

…

2.1.1 Mettre en place un mécanisme d'exemption des coûts des contraceptifs pour les adolescents et jeunes 

…

2.1.2 Augmenter  de 50% la couverture nationale  en centres conviviaux intégrés pour les adolescents et jeunes

2.1.3 Faciliter l’utilisation des contraceptifs par les adolescentes et jeunes vulnérables

2.1.4 Elaborer et mettre en œuvre l'initiative «Les formations sanitaires et centres de promotion sociale amis des adolescents et jeunes»

Because Benin’s policy documents address all three service-delivery elements of youth-friendly services, Benin is placed in the green category for youth-friendly FP service provision.

The “Stratégie nationale multisectorielle de santé sexuelle et de la reproduction des adolescents et jeunes au Bénin, 2010-2020” includes an objective to involve local leaders in information and communication activities:

Objectif spécifique N°2 : Renforcer l’implication des Elus locaux, des leaders communautaires et religieux dans les actions d’information sur la SRAJ [santé reproductive des adolescents et des jeunes]/VIH/sida chez les adolescents et jeunes.

2.1 Organiser au niveau de chaque commune du pays un atelier d’élaboration des plans opérationnels de communication en SRAJ/IST[infections sexuellement transmissibles]//VIH/sida au profit des élus locaux et les leaders communautaires et religieux en tenant compte des réalités de chaque commune.

The “Stratégie nationale multisectorielle” also aims to consider gender when designing reproductive health information and services for youth:

3.2. Principales options de promotion de la SRAJ/VIH/sida

…

2. La prise en compte de l’âge, du genre et des conditions socio-culturelles des adolescents et jeunes dans la définition des types et contenus des services d’information, de conseil et de prestations cliniques ou communautaires en SRAJ/VIH/sida.

3.3 Principes directeurs

…La prise en compte des valeurs socioculturelles, de l’éthique et du genre dans la programmation des interventions.

Additionally, the “Politique nationale de la jeunesse, 2001” contains a specific objective and corresponding strategy to consider gender as part of the sexual and reproductive health of adolescents:

Objectif Spécifique 11 : Contribuer au développement de la santé physique, mentale, psychique, sexuelle et de la reproduction des adolescents et des jeunes selon l'approche genre.

Stratégie 11- 3 : Promotion de la santé sexuelle et de reproduction des adolescents et jeunes et d'un environnement physique, légal et social favorisant l'approche genre.

The “Plan stratégique intégré de la santé de la reproduction, de la mère, du nouveau-né, de l’enfant, de l’adolescent et jeune (SRMNEAJ), 2017-2021” tasks the Ministry of Social Affairs and Microfinance with advocacy activities that include promoting dialogue between parents and their child:

Le Ministère en charge des affaires sociales :

…

Il renforcera la promotion du dialogue entre parents et enfants dans le cadre des activités de plaidoyer et de formation que développent les services centraux et décentralisés de ce ministère.

The “Stratégie nationale multisectorielle de la santé sexuelle et de la reproduction des adolescents et jeunes, 2018-2022” emphasizes the need to address gender issues in adolescent and youth reproductive health strategies, referencing the "Loi n 2003-04 du 03 mars 2003 relative à la santé sexuelle et la reproduction," which states the right to reproductive health without discrimination.  The “Plan d’action national budgétisé de planification familiale du Bénin, 2019-2023 ” also outlines an objective to achieve a supportive environment for promoting family planning services by mobilizing support from political leaders, religious figures, and local authorities:

Objectif 4 : Garantir un environnement favorable pour la PF à travers :

Le renforcement des activités de plaidoyer auprès des décideurs (Président de la République du Bénin, Première Dame du Bénin, Institutions nationales, ministère de la santé et ministères connexes) et des leaders administratifs, traditionnels, religieux et des élus.

These policies outline a detailed strategy to build community support for youth family planning services and to address gender norms, including specific interventions. Therefore, Benin is placed in the green category for this indicator.

The “Politiques et normes en matière de santé de la reproduction au Burkina Faso, 2010” states that access to reversible contraceptive methods should not require spousal consent:

Les femmes et les hommes en âge de procréer pourront avoir accès aux méthodes contraceptives réversibles sans recours au consentement de leur conjoint. Toutefois, l’accent doit être mis sur l’importance du dialogue dans le couple pour l’adoption d’une méthode contraceptive.

However, Burkina Faso’s policies do not adequately address parental consent. Therefore, Burkina Faso is placed in the yellow category for this indicator because its policies address one but not both forms of consent.

While the “Plan stratégique santé des adolescents et des jeunes, 2015-2020” describes provider judgment as a barrier to youth access to healthcare, it does not include an explicit statement that providers may not use personal bias or discrimination when offering youth FP services. Therefore, Burkina Faso is placed in the gray category for this indicator.

The “Loi portant santé de la reproduction, 2005” states that all individuals, including adolescents, have equal rights and dignity in reproductive health throughout their life, regardless of age:

Article 8 : Tous les individus y compris les adolescents et les enfants sont égaux en droit et en dignité en matière de santé de la reproduction.

Le droit à la santé de la reproduction est un droit fondamental garanti à tout être humain, tout au long de sa vie, en toute situation et en tout lieu.

Aucun individu ne peut être privé de ce droit dont il bénéficie sans discrimination aucune fondée sur l'âge, le sexe, la fortune, la religion, l'ethnie, la situation matrimoniale ou sur toute autre considération.

Because the law guarantees youth access to FP regardless of age, Burkina Faso is placed in the green category for this indicator.

The “Loi portant santé de la reproduction,