Scaling Contraceptive Service Delivery for Adolescents in Ethiopia: The Case of Smart Start

Wassie Lingerh, Population Services International Ethiopia
Meghan Cutherell, Population Services International (PSI)
Beatrice Symoti, Population Services International
Mary Phillips, Population Services International

In Ethiopia, teenage pregnancy rates remain high at 13%, with the majority of pregnancies occurring in the context of marriage. Standard approaches to contraceptive counselling were not yielding rapid change in the adolescent pregnancy rate, so in 2021 the Ministry of Health decided to scale up an innovative approach, Smart Start, which was shown to increase mCPR among adolescents in the pilot phase. This paper examines the impact of scaling Smart Start on contraceptive method use by married adolescents ages 15-19 between 2022 and 2024. The study used an interrupted time series design to collect data from government health management information systems (HMIS) across 4,555 sample health posts on contraceptive uptake. The analysis examines three time periods: pre-implementation, early scale-up, and mature scale-up. In the six months following scale-up, there was a 36% increase in monthly adolescent contraceptive users in government-led health posts. This study demonstrates that the scale-up of Smart Start generated substantial increases in contraceptive uptake among adolescents aged 15-19 in sampled sites. Questions remain about how best to sustain this impact over the long-term and institutionalize the practices introduced.

Keywords: Sexual and Reproductive Health and Rights, Children, Adolescents, and Youth

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