Denno, D. M., Hoopes, A. J., and Chandra-Mouli, V. Journal of Adolescent Health (January 2015), doi: 10.1016/j.jadohealth.2014.09.012.
This review summarized initiatives to improve adolescent access to and use of sexual and reproductive health services (SRHS) in low- and middle-income countries. The authors examined four types of SRHS initiatives: (1) facility-based, (2) non-facility-based, (3) interventions to reach marginalized or vulnerable populations, and (4) interventions to generate demand and/or community acceptance. For the facility-based interventions, the authors found that combining health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media was more effective than initiatives that only provided adolescent-friendliness training for health workers. Moreover, non-facility interventions (taking the services where adolescents live and congregate such as schools) were not well used, and did not improve sexual and reproductive health outcomes. Also, out-of-facility interventions were not likely to be cost-effective because of the high operating costs associated with providing multiple (including non-health-related) services. Interventions to generate demand and/or community acceptance were associated with adolescent SRHS use, and interventions to foster approval of SRHS among parents and other gatekeepers showed positive results. The authors could not identify any interventions that reported outcomes specifically for vulnerable or marginalized groups. They recommended additional research to identify the best mechanisms for delivering packages of interventions that train health workers, improve facility adolescent-friendliness, and generate demand for services among adolescents.