Adolescents andFamily Planning:What theEvidence ShowsICRWInternational Centerfor Research on Womenwhere insight and action connect1
This review was made possible by thegenerous support of the Bill and MelindaGates Foundation and was conductedby Allison Glinski, Magnolia Sexton andSuzanne Petroni, with technical andeditorial guidance and input from EllenWeiss, Anjala Kanesathasan, JeffreyEdmeades, Jennifer McCleary-Sills, AnnWarner, Kirsten Stoebenau and GwennanHollingworth, all of the InternationalCenter for Research on Women (ICRW).Photos by Jennifer Abrahamson, David Snyder, Robyne Hayes 2014 International Center for Research on Women (ICRW).Portions of this report may be reproduced without expresspermission from but with acknowledgment to ICRW.Definitions For the purposes of this Supply is defined as the pro-study, adolescents arevision of reproductive healthdefined as those ages 10-24services, particularly familyyears old.planning, that are appropri- D emand is conceptualizedwith a nuanced understanding of how gender dynamics influence adolescents’ate for adolescents’ needsand are available in a waythat is accessible to them. Accessibility in this contextreproductive desires. Theseincludes issues such as theinclude the number, timingavailability of an appropri-and spacing of children, asate mix of contraceptivewell as whether they want tomethods, infrastructure,use various options to controlhealth systems and providertheir fertility and have theknowledge, attitudes andagency to do so effectively.competence.1
Adolescents and Family Planning:What the Evidence ShowsIntroductionThe International Center for Research on Women (ICRW) conducted areview of the literature to identify barriers to adolescents’ access to anduse of family planning services, programmatic approaches for increasingaccess and uptake of those services, gaps in the evidence that requirefurther research, and areas that are ripe for future investment.The Importance of Family Planning for AdolescentsRoughly one-quarter of the world’spopulation — 1.8 billion people — isbetween 10 and 24 years of age.2Among the many sexually activeadolescents worldwide, largenumbers want to avoid, delayor limit pregnancy but lack theknowledge, agency or resourcesto make decisions regarding theirreproduction. On average, unmetneed for contraception is greateramong unmarried adolescents thanthose who are married, howevermarried adolescents ages 15-19experience a higher percentageof unmet need than all marriedwomen.3 Among unmarriedadolescents, the need is significantlygreater among 15-19 year olds, ascompared to those ages 20-24.4Indeed, marital status is a factorthat cannot be overlooked in aworld where one-third of girls indeveloping countries are wed beforeage 18, and one in nine is married bythe age of 15.5 While both marriedand unmarried girls are sexuallyactive, some 90 percent of thebirths experienced by adolescentmothers occur within marriage.6Socio-cultural and structural barriersoften prevent adolescents fromachieving their reproductive desires,which can result in unintendedMethodsICRW’s literature review in-adolescent family planning in-their perspectives on what isand instead fall within a morecluded 24 systematic reviewsformation and/or services. Theneeded to advance adolescentcomprehensive framework ofpublished since 2000 thatanalysis was supplementedsexual reproductive health andsexual and reproductive healthevaluated programs providingwith reviews of more than 200rights and family planning.and rights. Finally, limitedfamily planning informationadditional peer-reviewed arti-Limitations of this re-and services. All of thesecles and grey literature reportssearch: Adolescents may notwhich strategies and programsstudies used experimental orthat identified best practices,demonstrate measurablemost effectively reach distinctquasi-experimental methods.recent findings and innovativebehavioral results until wellgroups of adolescents, suchWhile not every study focusedsolutions for different typesafter the end of the programas married and unmarried,specifically on adolescentsof programmatic approaches.or evaluation, so successfulrural and urban, and youngerand family planning (i.e., someFinally, to corroborate and ex-interventions may be missedand older youth. Evidenceincluded family planning forpand upon the gaps in the ev-in the literature. Also, fewregarding effective strategiesadults or primarily addressedidence that were identified inadolescent-focused initiativesfor reaching very young ad-HIV prevention), all includedthe literature, we interviewedare specifically defined asolescents (10-14 years old) issome level of attention toseveral donors to understand“family planning” programsparticularly thin.evidence is available about3
Adolescents and Family Planning: What the Evidence Showsand unhealthy pregnancies,among other outcomes. To helpadolescents better access anduse family planning services, wemust understand the barriersthey encounter in defining theirreproductive intentions, andin demanding, accessing andusing contraceptives. And wemust understand what works inempowering them to overcomethese obstacles.Effectively addressing these issuesresults in stronger families andsocieties: When girls grow uphealthy, educated and empowered,they become productive andeffective leaders, earners, providersand, if they so choose, mothers. Thisin turn has a ripple effect on children,households, communities andnations. And when girls and boys areprovided with education, informationand services to protect and promotetheir sexual and reproductive health,they are better equipped to engagein healthy decisions and behaviorsnow and for decades to come.Such positive outcomes thereforemake it critical for us to understandadolescents’ reproductive desiresand enable them to achieve theseaspirations by providing them withappropriate, high-quality informationand services.4Conceptual FrameworkThe following conceptual frameworkwas developed to guide ICRW’sanalysis, and is based on pastexaminations of reproductivehealth barriers and programmaticapproaches, as well as ICRW’sWomen’s Demand for ReproductiveControl paper.7 It postulates thatadolescents must achieve threedemand-side objectives and twosupply-side objectives, though notnecessarily in sequencea, in orderto sustainably and effectively usefamily planning to fulfill their desiredreproductive outcomes throughouttheir lifetimes.The first three objectives operateprimarily on the demand side.Achieving Objective 1 signifies thatadolescents want to avoid, delay,limit or space their pregnancies.They understand the benefits ofwaiting to initiate sexual activityor of having [more] children andwant to control their reproduction.With Objective 2, adolescentshave a desire to use family planningmethods, which demands a basicunderstanding of contraceptivemethods and how reproductionoccurs. However, wanting to usefamily planning methods is notsufficient to enable adolescents toactually use them. Adolescents needto be able to achieve Objective 3 —possess the agency to access anduse contraceptives — which meansthey must be empowered with theknowledge and self-efficacy to makeand act on their decisions.8 While wehave categorized Objective 3 as a“demand-side” factor, it can also beviewed as the bridge between thetraditional demand-side and supplyside components to contraceptiveuse. For example, even if adolescentswant to use family planning methodsand there are high-quality, youthfriendly methods available, if they donot have the confidence to walk into aclinic and ask for contraception, theywill not be able to use it.Objectives 4 and 5 represent the“supply-side” components. AchievingObjective 4 means that adolescentshave access to family planningmethods at a location, time andprice that is feasible and convenient.Objective 5 is attained when servicesare not only available for adolescents,but they are high quality, youthfriendly and offer a variety of methodsthat are appropriate for them. Byachieving all of these objectives,adolescents are able to effectively usefamily planning methods in line withtheir fertility intentions throughouttheir lives. This is an importantdistinction, as reproductive desiresand appropriate methods will changeover one’s reproductive lifetime.Accomplishing these objectivesis dependent on the individualadolescent. This is also stronglyinfluenced by — but not limited to —the social norms of the environmentin which adolescents live, as well asthe local political atmosphere, healthsector and the legal frameworks.The young person’s partner, parents,family, peers and community alsoplay a role in how he/she forms andachieves his or her reproductivedesires.
OIRTENMNGoal: Sustained, effective use of family planningAdolescents are effectively able to use familyplanning methods to reach their reproductive desiresover their life course.aObjective 2: Desire to use family planningNot only do adolescents wish to avoid, delay, space,or limit births, but they want to use family planningmethods to do so.EnObjective 3: Agency to use family planningNot only do adolescents wish to use family planningmethods to avoid, delay, space, or limit births, butthey have the ability to act on their desires andmake decisions regarding their reproduction.bliHEngALEnvironmentTHSECTOMSRNO RSOCIALObjective 5: Provision of quality,youth-friendly servicesNot only do adolescents have access to services,but the services are of high quality and areappropriate for their reproductive needs.Objective 4: Access to family planning servicesAdolescents have access to services at a time,location, and price point that areconvenient for them.DEMANDEnabling EnviLGALEMEWORKFRAronmentPOLITISUPPLYCALENVThe Conceptual FrameworkObjective 1: Desire to avoid, delay, space orlimit childbearingAdolescents wish to avoid, delay, space, or limitthe number of children they have.While the framework is presented as a series of objectives,these are not necessarily sequential. Demand and supplyobjectives could be achieved simultaneously, or supply-sidefacilitators, such as the provision of youth-friendly services,could be present before it is socially or culturally acceptablefor adolescents to use contraceptives in a particular context.aAdditionally, as an adolescent’s reproductive desires shift,the required agency and type of services needed will shift.For example, while it may be acceptable for an unmarriedadolescent to want to avoid pregnancy, societal views mayshift once the adolescent gets married, and then shift againafter the first birth.Adolescents and Family Planning: What the Evidence ShowsFor each objective, we identified keybarriers adolescents face, as well asrigorously evaluated programmaticapproaches that, either directly orindirectly, address these obstacles.While factors that influenceadolescents’ family planning desires,decisions and actions may notalways be changed or influencedby programmatic approaches, theymust be considered when designingand implementing programs.In general, we found thatinterventions were better able toachieve measurable improvementsin knowledge and attitudes thanin behavior. Such programs weremost effective when they combinedindividual education, improvement ofservices and community outreach/mobilization to inform communitiesabout available services and toincrease acceptability of adolescents’use of family planning. Some ofthe most effective efforts includededucational interventions, massmedia, interpersonal/peer-to-peercommunication and education,conditional cash transfers (CCTs),and improvements to health services.Meanwhile, programs that impactedbehavior were more likely tochange contraceptive behaviorthan sexual behavior. Those thatinvolved adolescents in programdesign tended to be more successfuland programs that increasedcontraceptive use usually had ahealth services component.5
Adolescents and Family Planning: What the Evidence ShowsDemand SideOBJECTIVE 1: How to IncreaseDesire to Avoid, Delay, Space orLimit ChildbearingPrograms that aim to increase thevalue of girls and promote thebenefits and cultural acceptabilityof delaying sexual activity and firstpregnancy, and ultimately, of havingsmaller families, directly addressbarriers that inhibit girls fromwanting to avoid, delay, space orlimit their childbearing.Some of the interventions thathave been most successful inachieving Objective 1 are indirectapproaches that increase schoolenrollment, which contributes todelayed marriage and pregnancy. Inparticular, programs that offer CCTs,incentives or support in the form ofschool uniforms and supplies lowerbarriers to attending school andincrease the opportunity cost ofmissing school and getting pregnant.While there is not as much evidenceof their effect on reproductivedesires, youth developmentprograms are able to buildadolescents’ self-confidence andprovide them with a greater sense ofopportunities throughout the courseof their life other than parenthood,which can indirectly discourage earlymarriage and pregnancy.OBJECTIVE 2: How to Increasethe Desire to Use Family PlanningMethodsPrograms that disseminateinformation about sexual andreproductive health and aboutfamily planning methods areessential to increasing adolescents’understanding of how fertility andpregnancy prevention work. Thisinformation, along with programsthat change social norms around thecultural acceptability of adolescents’contraceptive use, can enable youthto overcome barriers to wanting touse family planning methods.Programs that have been mostsuccessful in achieving Objective2 provide information and changesocial norms through education andmedia campaigns. In order to besuccessful, such programs need tobe sure to provide both adolescentboys and girls with reproductivehealth information that is culturallyappropriate and relevant to them.For school-based educationalprograms to achieve Objective2, they must be appropriatelydesigned and teachers needto be suitably trained and feelcomfortable with the material.Some communication programsthat target specific contraceptivemethod use and deliver messagesthrough the Internet, mobile phones,Demand-Side BarriersObjectiveBarriersfor Girls(1) Desire to avoid, delay,space or limit childbearing(2) Desire to use family planning(3) Agency to use family planning Gendered roles/expectationso Wife/mothero Remain chaste S tigma around accessing andusing methods and adolescentsexuality L imited decision-makingautonomy and power Need to prove fertility T aboos around communication Low value of childbearingalternatives Lack of understanding of:o Reproductive healtho Family planning methods,including side effects Poor partner communication C ultural taboos in providinginformation about reproductivehealth and family planning Transactional sex Religious values Son preference Desire to secure a relationshipBarriersfor Boys Gendered roles/expectationso Fathero Sexually active N eed to prove sexual prowessand fertility6 Religious values Son preference S tigma around accessingand using Taboos around communication Lack of understanding of:o Reproductive healtho Family planning methods L ack of perceived responsibility infamily planning use Early marriage F amily pressure to havechildren/not use a method S exual coercion and other formsof violence Limited self-efficacy Limited self-efficacy
social media and other sources,have been shown to be effective.These programs were mostsuccessful when they addressedgender norms that shape boys’notions of masculinity and limit girls’control over sex.OBJECTIVE 3: How to IncreaseAgency to Use Family PlanningAgency-building programs canincrease adolescent girls’ capacityto negotiate sexual behaviors,comfort with discussing issuesrelated to reproductive health, andself-confidence to not only choosetheir own path for the future, butalso effectively pursue it. Programsthat promote multiple, positive rolesthat girls can play in society reinforcethe fact that girls have the power tochoose what they want and that theyneed not be limited by traditionalnorms. Increasingly, evidencesuggests that working directly withmarried adolescent girls and theirfamilies can improve their agencywithin relationships as well.Informational programs,specifically peer-to-peer educationinterventions, have been mostsuccessful at enabling adolescentsto achieve Objective 3, byincreasing their communication andnegotiation skills related to theirreproductive desires. Indirectly,youth development programs havealso effectively built adolescents’self-confidence and empoweredthem to advocate for their rightsand beliefs.Demand-Side Programmatic ApproachesObjective(1) Desire to avoid, delay,space or limit childbearingDirectProgrammaticApproaches Informationo Alternative roles/options forgirlso Benefits of delaying, spacingand limiting Mass mediao Acceptability of avoiding,delaying, spacing, or limitingsmall familiesIndirect ProgrammaticApproaches Youth development(2) Desire to use family planning(3) Agency to use family planning I nformation (School/curriculum-based education, workplace-based education, interpersonal/peer-to-peer education,new media)o Sexual and reproductivehealtho Family planning methods Information (School/curriculum-based education, interpersonal/peer-to-peer education)o Alternative roles/optionsfor girlso Sexual activity negotiation skills Mass mediao Acceptability of method use Youth development CCTs/incentives7
Adolescents and Family Planning: What the Evidence ShowsSupply SideOBJECTIVE 4: How to IncreaseAccess to Family Planning Servicesapproaches that boost adolescents’knowledge and awareness of familyplanning (demand-side), frequentlyalso result in them better knowingwhere and how to use services.While there is some evidencearound the use of community-baseddistribution/outreach, vouchersand social franchises to achieveObjective 4, more research isneeded. What the evidence doesdemonstrate is that lack of access tofamily planning services is anothersignificant hurdle for adolescentsseeking reproductive control. Theirability to use services requires fourbasic components: a convenientand secure location, an affordablecost, convenient operating hoursand knowledge of the services andhow to access them. These are allsupply-side challenges. However,Similarly, supply-side efforts toimprove the quality of servicesoften include components designedto improve access and vice-versa.Indeed, the evidence shows thatefforts to increase young people’saccess to services are most effectivewhen linked to interventions thattarget young people’s knowledge,skills, attitudes and behaviors.Specifically, creating links or referralsystems between schools andreproductive health services canSupply-Side BarriersObjective(4) Access to family planning services(5) Provision of quality, youth-friendly servicesBarriers for Girls Lack of awareness of services Lack of provider quality/ competence Inaccessible location /limited mobility Provider reluctance to provide contraceptives to adolescents Inconvenient operating hours Unavailability of appropriate methods Long wait times Stock-outs Costs Restrictions on use Lack of access to financial resources Gender biases in service provisionBarriers for Boys Lack of privacy/ confidentiality Lack of perceived responsibility in family planning useSupply-Side Programmatic ApproachesObjective(4) Access to family planning services(5) Provision of quality, youth-friendly servicesProgrammaticApproaches Informationo Where/how to access services Information (new media)o How methods worko What methods are best for each adolescent’s needs Mass mediao Where/how to access services Community-based distributiono Youth centerso Links/referral with schools Vouchers8 Social franchises Youth-friendly services Community-based distributiono Youth centers Vouchers Social franchises Youth-friendly services
UNFPA: Essential and Supportive Elements of Youth-Friendly Services —Addressing Objectives 4 & 5increase adolescents’ knowledge ofand access to reproductive healthservices, as can community-basedoutreach and distribution throughinnovative models such as vouchersand social franchises.EssentialSupportiveAccessAccess Convenient hours Outreach services available Reasonable waiting time Accessible location Affordable fees M ale and female youth welcomed andserved S eparate space and/or hours foryouth, where neededOBJECTIVE 5: How to IncreaseProvision of Quality, Youth-friendlyServicesFor family planning services toeffectively meet adolescents’ uniqueneeds, providers must be trained tounderstand the nuances of youngpeople’s sex lives and to deliverboth counseling and appropriatemethods to meet their reproductivedesires. A comprehensive, consistentmethod mix should be available, andproviders should be able to explainhow different methods work andtheir associated side effects. Servicesshould be private, confidential andlinked with other health services.Specifically, vouchers have shownsome success in increasing theprivacy and confidentiality ofservices as well as increasingproviders’ competence in providingneeded services and counseling. Publicity that informs and reassuresyoung peopleQualityQuality Specially trained staff Comfortable setting Respect for youth Adequate space A dequate time for client-providerinteraction Youth input/feedback to operations Privacy and confidentiality Educational materials available Package of essential services available Provision of additional educationalopportunities Referrals available Peer providers/counselors available S ufficient supply of drugs andcommodities Range of contraceptives offered E mphasis on dual protection/condoms (male and female)(Adapted from UNFPA, Expanding Access to Youth Services: )In addition to these key characteristics of youth-friendly service provision, programsshould be tailored to meet the specific needs and barriers of underserved youth invarious settings. (Gay, 2010)For Objective 5, evidence suggeststhat programs delivering all of thesecomponents increase the generalquality and “youth-friendliness” ofreproductive health services.9
Adolescents and Family Planning: What the Evidence ShowsConclusions and RecommendationsThis analysis provides a synthesisof the evidence base in regard tointerventions that have worked,directly or indirectly, to impact thefamily planning knowledge, attitudesand practices of adolescents inthe developing world. While wehave only scratched the surface interms of understanding the variousadvantages and limitations of theunique and diverse interventionsimplemented over the years, wefeel confident that there is a pathforward. This path leads towardcreating a more supportiveenvironment that enables youthto overcome the “demand-side”and “supply-side” barriers to moreeffectively and sustainably usefamily planning to reach their fertilitydesires over the course of their lives.10There is a great deal of evidenceabout what works to empoweradolescents to reach their fertilitydesires over the course of their lives.However, many gaps and unknownsstill remain. Much of the existingevidence is not sufficiently rigorous,and various evaluation findingspresent nuanced contradictions.As with many other issues inglobal health, there is no singularprogrammatic approach or solutionthat is guaranteed to work; withso much depending on contextualfactors, various approaches andcombinations of approaches arenecessary in different circumstances.Despite this challenge, severalconclusions can be drawn from theevidence regarding which typesof approaches and what specificcomponents or characteristics ofeach work best to tackle the barriersto achieving various objectives ofadolescent family planning demand,access and use. We have tried topresent those conclusions in this brief.To further advance the field andthe evidence base, we offer severalrecommendations.1) Donors should invest in long-termstudies that capture the results ofinterventions with adolescents overtime, as their needs and fertilitydesires change. Where longitudinalstudies may be challenging andresource-intensive, donors canleverage existing or past programdata about program participants tounderstand the long-termeffects of an intervention.2) I mplementation research thatelucidates how and why certain5) Advocacy is needed in bothprograms are successful in certaindonor and developing countriesplaces can help the field betterto improve the relationshipunderstand whether particularbetween articulated policies andinterventions or programtheir implementation in practice.elements can be replicated and/Two examples follow:or scaled up. This could applyto interventions that aim toa. C omprehensive sexualityinfluence both the “demand-side”education (CSE) with certainand “supply-side” factors.key characteristics can havepositive impacts on reproductivehealth knowledge, attitudes3) Future research should considerand practices, including familymulti-component interventions,planning; and school-basedsuch as combining mass mediaCSE has the potential to reachprogramming and capacitya significant proportion ofbuilding for local organizationsadolescents, including verywith youth-friendly health services.young adolescents. However,This approach would enablewhile many governments noteanalysis of programs that work onthe importance of CSE and haveboth demand and supply sides.policies on the books pertainingto it, very few are investing4) All programmatic interventionsadequately in it, and fewer yetaimed at influencing adolescentutilize evidence-based curriculasexual and reproductive healthand/or training programs tooutcomes should strive tobuild teacher capacity.include a substantial monitoringand evaluation framework andstrategy from the beginning, sob. In many countries,that the field can better capturegovernments’ statements,and learn from the differentialpolicies and plans regardingimpacts of the various elementsadolescents’ access toof interventions.contraception are forward-
thinking, but in practice,many government-supportedservice providers are reluctantto provide contraception tounmarried youth. Researchin select countries on theseinconsistencies can buildevidence to inform countrylevel advocacy and policychange that has the potentialto foster large-scale change inthe short-term.6) T here are 70 million girls underthe age of 18 who are currentlymarried, and 14.2 million more aremarried each year. Addressingchild marriage therefore has thepotential to significantly impactfamily planning and otherreproductive health outcomes.Within the context of addressingthe social norms needed toimprove all of the demandside factors addressed in thispaper, donors and implementersshould work to prevent earlymarriage, and better understandhow delaying marriage impactsfirst birth. At the same time,understanding how best tosupport married girls, includinghelping them to delay and/orspace first, second and thirdpregnancies, would serve as acritical contribution to the field.EndnotesMcCleary-Sills, J., McGonagle, A., &Malhotra, A. (2012). Women’s demandfor reproductive control: Understandingand addressing gender barriers.Washington, DC: ICRW.1Malhotra, A., & Shuler, S. (2005).Women’s empowerment as a variable ininternational development. In MeasuringEmpowerment: Cross-DisciplinaryPerspectives. 71–88. Narayan, D. ed.Washington D.C.: World Bank, Genderand Development Group.Bongaarts, J. (2008). Fertility transitionsin developing countries: Progress orstagnation? Studies in Family Planning,39, 105-10.United Nations, Department ofEconomic and Social Affairs, PopulationDivision (2013). World PopulationProspects: The 2012 Revision, KeyFindings and Advance Tables (WorkingPaper No. ESA/P/WP.227). New York:UN Department of Economic and SocialAffairs, Population Division.2Presler-Marshall, E., & Jones, N. (2012).Charting the future - Empowering girlsto prevent early pregnancy. OverseasDevelopment Institute: London3MacQuarrie, K. (Forthcoming - 2013).Tailored to fit: Programming for thesexual and reproductive health of youngwomen in Africa. Measure DHS Report.Calverton, MD: Measure DHS.4UNFPA. (2012). Marrying too young:End child Marriage. New York: UNFPA.56UNFPA, 2012McCleary-Sills, McGonagle & Malhotra,20127Golla, A.M., Malhotra, A., Nanda, P.and Mehra, R. (2011). Understandingand measuring women’s economicempowerment: Definition, frameworkand indicators. Washington, DC: ICRW.87) Finally, this study has demonstrated the tremendous need forsharing data, information andresources regarding adolescentreproductive health amongst awide range of donors, researchersand implementing agencies. Wehope that this report is but onecontribution toward that goal.A more comprehensive versionof this paper, with a completelist of citations, is available atwww.icrw.org.11
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family planning information and services. All of these studies used experimental or quasi-experimental methods. While not every study focused specifically on adolescents and family planning (i.e., some included family planning for adults or primarily addressed HIV prevention), all included some level of attention to adolescent family planning in-
WORKING PAPER JUNE 2004 Richard S. Strickland, Ph.D. Consultant Published in collaboration with: 2 About the author: After several years as a project director at ICRW, Dr. Richard Strickland currently serves as a Social Science Advisor to the USAID Bureau for Africa, providing technical input for strategic planning and evaluation on a range of social development issues. This paper resulted .
CENTER FOR RESEARCH ON WOMEN For nearly 40 years, ICRW has been the premier applied research institute focused on women and girls. Headquartered in Washington, D.C., with regional offices in South Asia and Africa, ICRW provides evidence-based research to inform programs and policies that he
REQUEST FOR PROPOSALS INFORMATION TECHNOLOGY SUPPORT . 2 I. Introduction A. International Center for Research on Women (ICRW) is soliciting proposals from qualified . Computer equipment: . ICRW expects the vendor proposal to define, in detail, the approach to
positive association of adolescents' and friends' changeable attributes. Consider the friendship ties and the level of alcohol use of four adolescents A, B, C, and D (Figure 1.1). Some of these adolescents are friends and others are not. Arrows between adolescents represent friendship nominations outgoing from one adolescent and
According to the 2019 National Survey on Drug Use and Health, 17.2 percent of all adolescents aged 12 to 17 used illicit drugs in the past year. An estimated 4.5 percent of adolescents had a past year SUD. The percentage of adolescents who used alcohol in the past month was 9.4 percent, while the percentage who used cigarettes was 2.3 percent.
Catan Family 3 4 4 Checkers Family 2 2 2 Cherry Picking Family 2 6 3 Cinco Linko Family 2 4 4 . Lost Cities Family 2 2 2 Love Letter Family 2 4 4 Machi Koro Family 2 4 4 Magic Maze Family 1 8 4 4. . Top Gun Strategy Game Family 2 4 2 Tri-Ominos Family 2 6 3,4 Trivial Pursuit: Family Edition Family 2 36 4
Figure 3. Important Considerations for Family Planning in the PHC Service Delivery Components The government believes that integrating family planning with PHC will increase family planning coverage and improve overall population health. Malawi has made progress in creating and meeting demand for family planning, but it has a long way to
Prosedur Akuntansi Hutang Jangka Pendek & Panjang BAGIAN PROYEK PENGEMBANGAN KUR IKULUM DIREKTORAT PENDIDIKAN MENENGAH KEJURUAN DIREKTORAT JENDERAL PENDIDIKAN DASAR DAN MENENGAH DEPARTEMEN PENDIDIKAN NASIONAL 2003 Kode Modul: AK.26.E.6,7 . BAGIAN PROYEK PENGEMBANGAN KURIKULUM DIREKTORAT PENDIDIKAN MENENGAH KEJURUAN DIREKTORAT JENDERAL PENDIDIKAN DASAR DAN MENENGAH DEPARTEMEN PENDIDIKAN .