The effect of youth-friendly health services on risk of pregnancy among adolescent girls and young women in Lilongwe, Malawii: a secondary analysis of the Girl Power–Malawi study

• Graybill, Lauren A ^[1] ; Westreich, Daniel ^[1] ; Maseko, Bertha ^[3] ; Phanga, Twambilile ^[1] ; Nthani, Tiyamike ^[1] ; Vansia, Dhrutika ^[1] ; Chi, Benjamin H ^[1] ; Daniels, Julie L ^[1] ; Tang, Jennifer H ^[1] ; Bekker, Linda-Gail ^[2] ; Pettifor, Audrey E ^[1] ; Rosenberg, Nora E ^[1]
  1. [1] University of North Carolina at Chapel Hill

     University of North Carolina at Chapel Hill

     Township of Chapel Hill, Estados Unidos

     
  2. [2] University of Cape Town

     University of Cape Town

     City of Cape Town, Sudáfrica

     
  3. [3] Clinical Research Programme, Malawi-Liverpool-Wellcome Trust , Blantyre 312225 ,

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• Localización: American journal of epidemiology, ISSN-e 1476-6256, ISSN 0002-9262, Vol. 194, Nº. 5, 2025, págs. 1200-1207
• Idioma: inglés
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  • Abstract In sub-Saharan Africa, adolescent girls and young women aged 15 to 24 (AGYW) experience a high risk of early and unintended pregnancy. We assessed the impact of youth-friendly health services (YFHS) on pregnancy risk among AGYW who participated in the Girl Power study. In 2016, Girl Power randomly assigned 4 government-run health centers in Lilongwe, Malawi, to provide a standard (n = 1) or youth-friendly (n = 3) model of service delivery. At 6 and 12 months, study participants (n = 250 at each health center) self-reported their current pregnancy status and received a urine pregnancy test. Because of missing pregnancy test results, we used multiple imputation to correct for outcome misclassification in self-reported pregnancy status and applied the parametric g-formula on the corrected data to estimate the effect of YFHS on the 12-month risk of pregnancy. After correcting for outcome misclassification, the risk of pregnancy under the scenario where all health centers offered YFHS was 15.8% compared to 23.2% under the scenario where all health centers offered standard of care (risk difference: –7.3%; 95% CI, –15.5% to 0.8%). Access to a model of YFHS that integrates provider training with youth-friendly clinic modifications and community outreach activities may decrease risk of pregnancy among AGYW relative to standard of care.