Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation

Int J Environ Res Public Health. 2022 Nov 3;19(21):14414. doi: 10.3390/ijerph192114414.


Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.

Keywords: adolescent; cash transfer; contraception; empowerment; family planning; intervention evaluation; norms; schooling; structural; upstream.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Contraception / methods
  • Contraceptive Agents*
  • Developing Countries*
  • Family Planning Services
  • Female
  • Humans
  • Poverty
  • Pregnancy


  • Contraceptive Agents

Grants and funding

This project was funded by the Centre of Excellence for Development Impact and Learning (CEDIL) (funding number: S188), supported by UK aid from the UK Government. The views expressed in this research project paper do not necessarily reflect the UK Government’s official policies or CEDIL.