Youth-Friendly Health Services Reduce Pregnancy Risk in Malawian AGYW

Overview

The Girl Power study in Lilongwe, Malawi, demonstrated that youth-friendly health services (YFHS) significantly reduced the 12-month pregnancy risk among adolescent girls and young women (AGYW) compared to standard care. After correcting for misclassification, pregnancy risk was 15.8% with YFHS versus 23.2% with standard services, indicating a 7.3% absolute risk reduction.

Background

Adolescent girls and young women aged 15 to 24 in sub-Saharan Africa face a high burden of early and unintended pregnancies, contributing to significant morbidity and mortality. Structural barriers in health systems, such as judgmental provider attitudes and lack of privacy, limit contraceptive use in this population. Youth-friendly health services, integrating provider training, clinic modifications, and community outreach, are recommended to improve sexual and reproductive health outcomes but their direct impact on pregnancy risk has been understudied. The Girl Power study provides a controlled evaluation of YFHS effects on pregnancy risk among AGYW in Malawi.

Data Highlights

Key Findings

• AGYW accessing YFHS had a 7.3% lower absolute risk of pregnancy at 12 months compared to those receiving standard care.
• The study used multiple imputation to correct for missing pregnancy test results and outcome misclassification in self-reports.
• YFHS included provider training, youth-dedicated clinic spaces, extended hours, peer navigators, and community outreach.
• Contraceptive uptake was considerably higher among AGYW with access to YFHS, contributing to reduced pregnancy risk.
• The study minimized crossover bias by selecting clinics with geographically distinct catchment areas.

Clinical Implications

Implementing youth-friendly health services that address structural barriers can effectively reduce unintended pregnancies among adolescent girls and young women. Clinicians and health program planners should consider integrating provider training, dedicated youth spaces, flexible clinic hours, and peer support to improve contraceptive uptake and pregnancy outcomes in this vulnerable population.

Conclusion

Access to a comprehensive youth-friendly health service model significantly decreases pregnancy risk among AGYW in Malawi, supporting WHO recommendations for such interventions to improve reproductive health outcomes in sub-Saharan Africa.

References

1. Girl Power Study Group 2016-2017 -- Impact of Youth-Centric Health Services on Pregnancy Risk in AGYW in Malawi