Access to youth friendly health services is vital for ensuring sexual and reproductive
health (SRH) and well-being of adolescents. This study is a descriptive review of
the effectiveness of initiatives to improve adolescent access to and utilization of
sexual and reproductive health services (SRHS) in low- and middle-income countries.
We examined four SRHS intervention types: (1) facility based, (2) out-of-facility
based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions
to generate demand and/or community acceptance. Outcomes assessed across the four
questions included uptake of SRHS or sexual and reproductive health commodities and
sexual and reproductive health biologic outcomes. There is limited evidence to support
the effectiveness of initiatives that simply provide adolescent friendliness training
for health workers. Data are most ample (10 initiatives demonstrating weak but positive
effects and one randomized controlled trial demonstrating strong positive results
on some outcome measures) for approaches that use a combination of health worker training,
adolescent-friendly facility improvements, and broad information dissemination via
the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based
strategies, except for those delivered through mixed-use youth centers that demonstrated
that SRHS in these centers are neither well used nor effective at improving SRH outcomes.
There was an absence of studies or evaluations examining outcomes among vulnerable
or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation
activities demonstrated at least some association with adolescent SRHS use. Of 15
studies on parental and other community gatekeepers' approval of SRHS for adolescents,
which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive
results. Packages of interventions that train health workers, improve facility adolescent
friendliness, and endeavor to generate demand through multiple channels are ready
for large-scale implementation. However, further evaluation of these initiatives is
needed to clarify mechanisms and impact, especially of specific program components.
Quality research is needed to determine effective means to deliver services outside
the facilities, to reach marginalized or vulnerable adolescents, and to determine
effective approaches to increase community acceptance of adolescent SRHS.