Unmet Adolescent Need for Contraception: BE Framework

A [Very] Late Follow Up to International Youth Day

August 12th was International Youth Day. Many in the development community celebrated this day, by spotlighting the role the youth will play in meeting the U.N . Sustainable Development Goals.

One article on Devex.com particularly stuck with me. The article presents the findings of a Guttmacher Institute Report, regarding the costs of meeting the contraceptive needs of adolescent girls in developing countries. The report estimates that 21 million women between the ages of 15-19 (adolescents) in developing countries will become pregnant this year, and almost half of those pregnancies will be unintended. Further, the report estimates there are 38 million adolescent women in developing countries worldwide, who (1) are sexually active and (2) do not want a child in the next 2 years.  23 million of these women (61%) do not use a modern contraceptive method, and are thus defined as having an “unmet need for modern contraception.”

But what is an “unmet need for modern contraception” through the lens of Behavioral Economics? If we set aside market and structural barriers to contraceptive access, there remains a population of women who have unmet need because of a mismatch between actions and stated intentions. While these adolescent women do not want to become pregnant, for one reason or another they are not acting on this intention by using modern contraceptives.

The BERI White Paper breaks down the behavioral and cognitive biases at the root of this mismatch:

  • Thinking Fast vs Thinking SlowCognition is a limited resource, and people living in poverty often exhibit a depletion of cognitive capacity due to the complexity and unpredictability of daily life. Contraceptives may not be the top cognitive priority for women who have other unmet basic needs.
  • Self vs Other Social / cultural norms, influence of parents or partner/husband, provider bias, etc. Pressure from husbands or other family members may “persuade” a woman to not use contraceptives, even though it would align with her stated interests.
  • Today vs TomorrowIndividuals inconsistently value costs and benefits in the present vs the future. While an adolescent woman may intend to invest in contraception, she may instead spend her money on things that provide more immediate returns.
  • Illusion vs Reality – Incorrect beliefs about facts or probabilities can lead to unintended choices. For example, misinformation about the side effects and effectiveness of contraceptives has been shown to depress take up among women seeking to prevent pregnancy.

In adolescents, these biases can be furthered  by physiological changes in the developing brain, including shifts in impulse control and risk-taking. There is mounting evidence that adolescents do not respond to reproductive risks in the same way that young adults do.

While a greater understanding of adolescence and sexual behavior is evolving, our knowledge base is still limited. We lack evidence on how behavioral and cognitive biases interact with economic and structural factors that influence contraceptive access and need. BERI researcher Manisha Shah is studying adolescent aspirations and decision-making in an ongoing project in Tanzania, and developmental psychologists at UC Berkeley have partnered with the Adolescents 360 initiative to understand voluntary take-up of contraceptives by 15-19 year olds. These efforts could shed light on how to more effectively scale interventions to address unmet need for contraceptives among adolescent women and men.

Click here to read the full devex.com article, entitled “Addressing contraceptive needs of adolescent women in developing regions

Click here to read the full Guttmacher Insititue Report “Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents

Click here to read the full BERI White Paper “A Review of Behavioral Economics in Reproductive Health