Global Patterns and Challenges in Teen Contraceptive Use: A Systematic Review

Abstract

Adolescent sexual and reproductive health has become an increasingly prominent topic in global public health discourse due to the significant impact of teenage pregnancy, unsafe abortion, and maternal complications on both individual well-being and broader societal development. Adolescent contraceptive use remains a critical global health issue, as unintended pregnancies among teenagers contribute significantly to maternal morbidity, unsafe abortions, and school dropout rates. This review explores current trends in contraceptive use among adolescents across different regions, highlighting variations influenced by cultural norms, socioeconomic status, education, and healthcare infrastructure. A comprehensive search of the literature was performed across multiple databases, including PubMed, Scopus, Web of Science, Embase, Google Scholar, and RefSeek. The search was limited to studies published between January 2000 and July 2024. These comprised cross-sectional studies, longitudinal cohort studies, qualitative interviews, systematic reviews, meta-analyses, and policy reports.Cross-sectional and cohort studies were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist, while qualitative studies were evaluated using the Critical Appraisal Skills Programme (CASP) tool. In sub-Saharan Africa, studies reveal that only about 18% of sexually active adolescent girls use modern contraception, with substantial variation between countries. In West African countries such as Nigeria and Mali, contraceptive prevalence rates among adolescents remain below 10%, while East African countries like Kenya and Ethiopia report somewhat higher levels, closer to 25%. Evidence suggests that while contraceptive prevalence has improved in some high-income and middle-income countries, adolescents in low-income regions—particularly in sub-Saharan Africa and parts of South Asia—continue to face substantial barriers. Key barriers include limited knowledge, stigma, lack of adolescent-friendly health services, religious opposition, and gender inequalities. The findings of this review demonstrate that adolescent contraceptive use is shaped by a complex interplay of social, cultural, structural, and policy-related factors, resulting in stark regional disparities. The results also reveal striking differences between married and unmarried adolescents in terms of contraceptive use. In South Asia and parts of the Middle East, early marriage often places teenage girls in situations where they are expected to prove fertility soon after marriage, reducing both their autonomy and their contraceptive options. This global review underscores the urgent need for context-specific strategies that address not only access to contraceptive commodities but also the broader structural and cultural determinants of use. Future policies and programs should prioritise adolescent voices, ensure equitable access, and foster environments where informed choices about contraception can be made without stigma or discrimination. By addressing these multidimensional barriers, global health stakeholders can reduce unintended pregnancies, improve adolescent health outcomes, and advance progress toward achieving universal sexual and reproductive health rights.