What Works to Improve Contraceptive Outcomes Among Adolescents and Young Adults in LMICs: A Rapid Evidence Assessment and Synthesis by Intervention Strategy

What Works to Improve Contraceptive Outcomes Among Adolescents and Young Adults in LMICs: A Rapid Evidence Assessment and Synthesis by Intervention Strategy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review What Works to Improve Contraceptive Outcomes Among Adolescents and Young Adults in LMICs: A Rapid Evidence Assessment and Synthesis by Intervention Strategy Jasmine Uysal, Katherine LaNasa, Gennifer Kully, Erin Pearson, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8716367/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Adolescents and young adults (AYA) in low- and middle-income countries (LMICs) experience persistently high unmet need for contraception due to intersecting individual, social, and structural barriers. Despite urgent calls for targeted investments, decision-making is constrained by a lack of consolidated, comparative evidence on which intervention strategies improve contraceptive outcomes for this population. This review synthesizes recent evidence on what works to improve contraceptive-related outcomes for AYA using an intervention-strategy lens. Methods: We conducted a rapid evidence assessment (REA) of peer-reviewed studies published between 2014 and 2024 evaluating interventions to improve contraceptive-related outcomes among AYA (ages 10–24) in LMICs. Searches were conducted in PubMed and Embase. Artificial intelligence (AI)–assisted tools (ASReview and SysRev) were used alongside human reviewers for screening, full-text review, and structured tagging. Included studies were extracted and categorized by predefined intervention strategies and outcome types, stratified by study design, and quality appraised using the Mixed Methods Appraisal Tool (MMAT). Outcome directionality and study quality were visualized in charts stratified by intervention type (multi-component vs. single component), intervention strategy, and/or study design. Results: Of 4,425 records screened, 41 studies met inclusion criteria. Most were conducted in Sub-Saharan Africa and evaluated multi-component interventions. One-third employed experimental designs, and overall study quality was moderate (mean MMAT score 59%). Over half of studies assessed contraceptive use or uptake as a primary outcome; among these, the majority reported statistically significant improvements. Evidence was most consistent for multi-strategy intervention packages that incorporated small-group education, social norms and network approaches, engaging men and boys, extension worker outreach, and couples’ communication. These interventions also demonstrated positive effects on key proximal outcomes, including contraceptive knowledge, attitudes and norms, partner communication, and service use. However, few studies isolated strategy-specific effects, assessed dose–response relationships, or explicitly tested causal mechanisms. Reporting on implementation fidelity and adaptation was limited. Conclusion: Multi-strategy interventions addressing interpersonal, normative, and service-related barriers show the most consistent promise for improving contraceptive outcomes among AYA in LMICs. However, stronger causal and implementation evidence is needed to identify which strategies drive impact, for whom, and under what conditions. Adolescents and young adults contraceptive use family planning contraception low- and middle-income countries interventions rapid evidence assessment evaluation review Figures Figure 1 Figure 2 Figure 3 Figure 4 PLAIN ENGLISH SUMMARY Adolescents and young adults in many low- and middle-income countries often want to avoid pregnancy but are not using contraception. Young people face barriers to contraceptive use like limited information, stigma about sexuality, partner or family pressure, gender inequality, cost and accessibility issues, and health services that may feel judgmental or unsafe. To inform decision-makers investments, we reviewed recent research (2014–2024) on interventions designed to improve contraceptive outcomes for young people ages 10–24. We searched two major medical databases (PubMed and Embase) and used a combination of computer-assisted tools and human review to quickly and carefully identify the most relevant studies. We then grouped each program by the types of strategies it used (for example: small group discussions, working with peers, involving male partners, changing social norms, or outreach visits) and assessed the overall quality of the evidence. We found 41 studies that met our criteria. Most were from Sub-Saharan Africa, and many tested programs that combined multiple strategies rather than relying on only one. Overall, the most consistent improvements in contraceptive use were seen in multiple-strategy programs that included small group education, social norm change efforts, involvement of men and boys, outreach visits, and couple communication activities. However, many studies did not clearly show which specific program components mattered most, how much exposure was needed, or whether programs were delivered as intended. Future research should test specific strategies and track implementation quality so effective approaches can be scaled. INTRODUCTION Adolescents and young adults (AYAs), ages 12 to 24 years old, in low- and middle-income countries (LMICs) experience disproportionately high unmet need for contraception, driven by intersecting individual, social, and structural barriers and resting in to poor reproductive health outcomes. In 2019, an estimated 43% of adolescent girls aged 15–19 in LMICs who wished to avoid pregnancy were not using modern contraception, nearly twice the rate of all women aged 15–49 ( 1 , 2 ), with demand satisfied lowest among 15–24-year-olds, particularly in Sub-Saharan Africa and South Asia ( 3 ). These disparities contribute to approximately 21 million adolescent pregnancies annually in LMICs, at least half of which are unintended ( 1 , 4 ) and associated with elevated risk of pregnancy complications, unsafe abortions, and adverse education, income, and health outcomes for girls ( 5 )( 6 ). Persistent barriers to contraceptives for AYA include limited sexual and reproductive health (SRH) information, financial constraints, restricted agency ( 7 – 9 ), stigmatizing social norms surrounding AYA sexuality and non-marital contraceptive use, gendered power imbalances that limit negotiation with partners or pressure married adolescents to demonstrate fertility ( 10 – 12 ), and health system and policy barriers such as provider bias, lack of confidentiality, parental consent laws and sexuality education bans ( 13 , 14 ). The 2025 World Health Organization (WHO) guidelines call for urgent, targeted investments to reduce early and unintended pregnancies among AYAs in LMICs ( 15 ). Effective policy and programming remains challenging, however, as decision-makers lack recent, consolidated evidence on what works to improve contraceptive outcomes for this population. Although prior reviews have examined adolescent sexual and reproductive health and rights (SRHR) ( 16 , 17 ), few focus specifically on contraceptive use. Some recent reviews have examined specific intervention strategies, including structural ( 18 ), empowerment-based ( 19 ), and financial incentive ( 20 ) approaches. However, interventions to improve SRHR outcomes are increasingly complex and multi-component, comprising interacting activities often delivered across multiple levels ( 21 ). Despite this complexity, there are no recent reviews that offer a comparative synthesis across intervention strategies. In addition to contraceptive use, a range of proximal mediating outcomes – including contraceptive intentions, reproductive norms, and contraceptive knowledge, attitudes, and self-efficacy – play a critical role in shaping future contraceptive behaviors, particularly among AYAs, many of whom have not yet initiated sexual activity but are approaching sexual debut ( 22 , 23 ). These mediating outcomes are infrequently examined or synthesized in existing reviews, limiting their usefulness for informing early and preventive programming despite their critical role in activating change pathways. At the same time, traditional systematic reviews, though rigorous, are resource-intensive and may be too slow to meet urgent programmatic and funding timelines. Artificial Intelligence (AI)-assisted methodologies are increasingly used to accelerate rapid syntheses ( 24 – 26 ), yet, to our knowledge have not yet been applied to synthesize evidence on AYA SRHR. We conducted a rapid evidence assessment (REA) using AI-assisted tools alongside human expertise to identify and appraise recent peer-reviewed evidence (2014–2024) on intervention strategies to improve contraceptive-related outcomes for AYA, conducting a comparative analysis across intervention strategies and assessing study design and quality, to inform investment decision-making. METHODS Study Design Our REA approach followed steps from Crawford et al., 2015 ( 27 ) and PRISMA guidelines ( 28 ) to answer the research question “ What has worked to improve contraceptive outcomes among adolescents and young adults (AYA) in low- and middle-income countries (LMICs) from 2014–2024?” The review team included a PhD student analyst, a master’s-level research coordinator, and two senior co-Principal Investigators. A liaison from the coordinating funding institution also provided technical input on the search and analysis methodology. To enhance efficiency given funding strategy timelines and limited human resources, we employed two AI–assisted tools for use at specific points in the review process to complement human analyst efforts: ASReview for title and abstract screening and SysRev for full-text screening and tagging. Search Strategy In collaboration with a social and behavioral health research librarian, we conducted a broad search in PubMed and Embase using MeSH terms and free-text keywords related to adolescents and young adults, contraception or family planning, and LMIC contexts. Country-specific terms were added to align with the funder’s priority geographies (e.g., Nigeria, Niger, Senegal, Ethiopia, Côte d'Ivoire, Pakistan). Several articles were also identified through expert referral. Duplicates were removed in EndNote ( 29 ). Full search terms are listed in Supplement 1. Inclusion and Exclusion Criteria Eligible studies evaluated an intervention conducted in LMICs, were published between January 1, 2014, and February 1, 2024, reported at least one quantitative contraceptive-related outcome, reported on outcomes for AYA (10–24 years old), and were written in English and published in a peer-reviewed journal. We excluded protocols, commentaries, reviews (though reference lists were scanned), grey literature, descriptive studies without an intervention strategy evaluation, studies on COVID-19, natural or conflict events, multi-country studies that include LMICs but do not disaggregate results for LMICs specifically, studies reporting exclusively qualitative outcomes, and articles not published in English. Full Population, Intervention, Context, Outcome, and Study type (PICOS) criteria are in Table 1 . Table 1 Population, Intervention, Context, Outcome, and Study type (PICOS) Inclusion and Exclusion Criteria Category Inclusion Exclusion Population Includes adolescents or young women age 10 to 24 and presents results specific to this population or was specifically designed for this population Does not include adolescents or young women age 10 to 24 or does not present any results specific to this population Intervention Evaluates intervention, program, or programmatic strategy (e.g., mass media) to improve contraceptive outcomes Evaluates contraceptive changes during COVID, natural events, conflicts, or climate change or does not evaluate an intervention, program, or programmatic strategy Context Takes place in and presents results specific to a low- or middle-income country Does not take place in a low- or middle- income country and/or presents only results from a high-income country​ Outcome Presents evaluation results on at least one quantitative family planning or contraceptive outcome​ (e.g., contraceptive use, discontinuation, SRHR knowledge, self-efficacy, intention to use, etc.) in an LMIC Does not present results on a family planning or contraceptive outcome or only presents qualitative results or implementation results or does not disaggregate LMIC outcomes from high-income countries Study type Peer-reviewed manuscript, published between January 1, 2014 to February 1, 2024 Reviews, commentaries, grey literature, conference presentations Peer-reviewed manuscripts not published in English Peer-reviewed manuscripts published outside of January 1, 2014 to February 1, 2024 Screening and Tagging Following de-duplication, records were imported into ASReview Lab, an open-source platform that uses active machine learning to continuously re-order the most relevant studies for manual human title and abstract screening ( 30 ). Prior to beginning manual screening, ten studies were pre-labeled as relevant or irrelevant (5 each) to train the AI algorithm. As the human analyst progressed through manual title and abstract screening labeling articles as relevant or irrelevant, the tool continuously re-ranked remaining citations based on relevance predictions. Per guidance on using ASReview and to conserve human resources ( 26 ), we adopted a stopping rule whereby manual screening ceased after 100 consecutive records were manually labeled as irrelevant following the last relevant article. One prior study of ASReview found, using the AI-assisted prioritization function, manually screening 15% of identified records was sufficient to identify all studies, substantially reducing the volume of manual title and abstract screening required ( 26 ). The ASReview data set was then exported into a CSV. Records labeled as relevant in the CSV file were imported into SysRev, a web-based platform used to conduct full-text screening and structured tagging (i.e., data extraction on key article attributes) ( 31 ). Full texts were manually retrieved and uploaded prior to full-text screening. Based on full-text review, articles were manually tagged as relevant or not relevant and across a variety of study attributes and inclusion/exclusion criteria. Relevant tags included: ( 1 ) article type (peer-reviewed, targeted grey literature, other); ( 2 ) included outcomes specific to AYA; included family planning (FP) outcomes; ( 3 ) article domain (factors affecting FP, intervention strategy evaluation, surveillance data, measures paper, other, or unsure); ( 4 ) geography; and ( 5 ) study design. All full-text screening and tagging were conducted by a single PhD-level analyst based in the United States with over seven years of expertise in SRHR for AYA in LMICs. To ensure consistency and quality, the senior study team provided oversight through regular check-ins, review of tagging decisions, and resolution of uncertainties through discussion. Data Extraction and Quality Assessment Studies manually labeled as relevant after full-text review were then manually extracted in Excel, including: study setting, population, design, sample size, attrition, methods, intervention characteristics, and contraceptive outcomes, with effect sizes and significance. Each study was coded into one or more of 17 predefined intervention strategies, based on the coordinating funder’s framework and the research team’s knowledge of AYA SRHR programs. In this review, we distinguish between interventions and intervention strategies to enable meaningful comparative synthesis across heterogeneous programs. We define an intervention as an intentional program or package of activities designed to improve health outcomes, often multicomponent in nature ( 21 ). By contrast, intervention strategies, drawing on implementation science and intervention design frameworks ( 32 , 33 ), are theory-informed approaches or actions within interventions hypothesized to contribute to improved outcomes. Strategies are not mutually exclusive and are often combined within a single intervention. Intervention strategies and definitions are provided in Table 2 . [Insert Table 2 here] Table 2 Intervention Strategy Typology and Operational Definitions Intervention Strategy Definition Adolescent-responsive services Health services intentionally designed or adapted to meet the unique needs, preferences, and developmental stage of adolescents. Couple communication Interventions designed to improve dialogue, negotiation, or joint decision-making between romantic or sexual partners. Digital technology Technology-based interventions such as mobile apps, SMS, or online platforms used to deliver information or support. Empowerment components Group-based platforms (e.g., savings groups or solidarity circles) that build agency, economic resilience, and social support. Engaging men and boys Strategies that involve male partners or peers to shift norms, improve communication, or support FP and SRH outcomes. Extension worker Use of community-based health workers or outreach agents to provide information, counseling, or contraceptive services directly to adolescents usually at home or in small groups. Financial incentives Monetary or in-kind support (e.g., cash transfers, vouchers) used to reduce financial barriers or motivate behavior change. Integrated service delivery Delivery of multiple health services—such as FP, HIV, and maternal health—in a coordinated manner to improve access, continuity, and efficiency of care. Interpersonal communication One-on-one support focused on improving adolescents' communication with non-romantic figures such as parents, guardians, or mentors. Mass media Use of TV, radio, print, or digital broadcast to disseminate messages to a broad adolescent audience. Peer-led approaches Interventions delivered by trained youth or community peers to influence knowledge, attitudes, or behaviors. Quality of care improvements Provider training, supervision, or systems-level changes aimed at improving the quality and person-centeredness of FP counseling. School-based education Delivery of SRH and FP content within formal school settings through curricula or extracurricular activities. Small-group education Structured, curriculum-driven sessions facilitated by an educator or health worker, focused on delivering targeted knowledge and skills (e.g., contraceptive methods, SRH information) to small cohorts. Social norms & networks Approaches that leverage social influence by engaging individuals that are influential to the target beneficiaries FP practices (e.g., partners, parents, in-laws) and/or aim to shift shared community beliefs, norms, or behaviors. Supply Interventions focused on providing access to contraceptive methods, including on-site provision, stock availability, method choice, or mobile outreach delivery. Other Interventions that do not fit within the predefined strategy categories. We stratified analyses and visualizations by study design in three categories (experimental, quasi-experimental, other), consistent with established distinctions in the causal inference and evaluation literature ( 34 , 35 ). Experimental studies were randomized evaluations with a comparison group and baseline and follow-up data collection. Quasi-experimental studies included designs with a comparison group and baseline and follow-up data collection but without random assignment. Other designs comprised observational and descriptive evaluations lacking randomization a concurrent comparison group, including longitudinal or repeated cross-sectional studies, cohort studies, single-group pre–post designs, and retrospective program evaluations. Quality appraisal used the 2018 version of the Mixed Methods Appraisal Tool (MMAT) according to study design (quantitative randomized, non-randomized, or mixed methods). Each of the five MMAT criteria were scored as “Yes” (1 point), “Partial” (0.5), “No” or “Can’t tell” (0). A total score was generated for each study, converted into a percentage. Full MMAT scoring is detailed in Supplement 2. To contextualize the strength of the evidence base, bar graphs summarized study quality appraisal results using MMAT criteria, stratified by study design and intervention strategy. Outcomes of Interest Primary outcomes were contraceptive-use outcomes, including current or ever use of any or modern contraceptive methods, contraceptive uptake or initiation, and contraceptive prevalence rates. Secondary outcomes included contraceptive-specific mediating determinants of contraceptive use ( 36 ), including indicators of contraceptive need and intention (e.g., unmet need for contraception, intention to use contraception), individual-level determinants (e.g., contraceptive knowledge, attitudes about contraception, self-efficacy to use contraception, endorsement of contraceptive-related myths), interpersonal and social determinants (e.g., partner communication about contraceptives, perceived norms regarding contraceptive use, and approval of contraceptives), and service-related outcomes (e.g., whether a health facility was visited for contraception). Other outcomes included those that disaggregated contraceptive use by method type. Family planning outcomes not specific to contraception, such as pregnancy incidence, or general empowerment, were excluded from extraction. Outcome Synthesis and Visualization Results were organized into analytical matrices stratified by intervention strategy, study design, and outcome type. Findings were synthesized using a structured narrative approach supported by tabular summaries and visualizations designed to facilitate comparison across heterogenous evidence. Bubble charts were used to map evidence by intervention, distinguishing single-strategy versus multi-strategy interventions (mutually exclusive), as well as by specific intervention strategy (not mutually exclusive). Charts were stratified by outcome type and effect directionality, with positive effects defined as statistically significant (p<.05) or marginally significant (p,1), neutral, or untested effects, and negative effects defined as statistically significant (p<.05) or marginally significant (p<.1) adverse effects. Bubble size represented the number of extracted outcomes. For primary contraceptive use outcomes, analysis prioritized a single outcome per study where possible; when studies did not report one singular primary outcome (e.g., results presented by sex, county, or study arm) all reported primary outcomes were analyzed and included in visualizations. All secondary and method-specific outcomes of interest were also included in visualizations. No outcomes were combined. Given substantial heterogeneity across study attributes and reporting, quantitative meta-analysis was not feasible nor appropriate ( 37 ). Synthesis focused on identifying intervention strategies demonstrating consistent, credible evidence of effectiveness, as well as examining strategy co-occurrence, delivery platforms, and contextual variation with examples to inform considerations of feasibility and relevance for expansion. Draft findings were reviewed with the study team, technical advisors, and the funder, and refined based on input. RESULTS We identified 4,431 records from Embase (n = 1,172), PubMed (n = 3,253), and expert input (n = 6). After removing 827 duplicates, 3,604 unique records were imported into ASReview. A human analyst screened 1,311 records (36.4%) before reaching the stopping criterion of 100 consecutive irrelevant articles, yielding 383 potentially relevant records. The remaining 2,293 records were marked as ineligible by the AI-automation tool; 10 texts were not retrievable. Of 373 full texts retrieved and reviewed in SysRev, 41 met inclusion criteria. The most common reason for exclusion was not being an intervention evaluation (n = 334, Fig. 1). Recorded reasons for exclusion were not mutually exclusive. Study Characteristics Description Most studies (88%) were conducted in Sub-Saharan Africa, with the largest number from Ethiopia (n = 7), Kenya (n = 5), and Nigeria and Uganda (n = 4 each); the remaining studies were conducted in South Asia. Approximately one-third of studies used an experimental evaluation design (n = 14, 34%), one-fifth used a quasi-experimental design (n = 9, 22%), and the remaining 19 studies (46%) employed other designs. These included cross-sectional studies (n = 6, 15%), single-group pre-post studies without a comparison group (n = 5, 12%), retrospective observational program evaluations (n = 3, 7%), repeated cross-sectional studies (n = 3, 7%), and prospective cohort studies (n = 1, 2%). Over half of studies (n = 23, 56%) reported a primary outcome of contraceptive use or uptake. Secondary outcomes included those related to contraceptive or SRH knowledge (n = 17, 41%), service (n = 6, 15%), attitudes (n = 3, 7%), communication (n = 3, 7%), contraceptive intentions (n = 3, 7%), self-efficacy/agency (n = 3, 7%), norms (n = 2, 5%), spousal approval (n = 2, 5%), unmet need (n = 1, 2%), and demand (n = 1, 2%). A subset of studies further disaggregated contraceptive use or uptake by method type (n = 8, 20%). MMAT scores ranged from 20% to 90% (mean 59%), indicating moderate overall quality; only two studies received scores above 80%. One-third of studies assessed a single intervention strategy (n = 14, 34%) while two-thirds evaluated multi-strategy interventions (n = 27, 66%). The most commonly implemented intervention strategies were small-group education (n = 18, 44%), social norms and network approaches (n = 12, 29%), peer-led approaches (n = 11, 27%), and engaging men and boys (n = 11, 27%). Other intervention strategies included extension workers (n = 10, 24%), adolescent responsive services (n = 10, 24%), school-based education (n = 9, 22%), couple communication (n = 7, 17%), interpersonal communication (n = 6, 15%), financial incentives (n = 4, 10%), mass media (n = 3, 7%), digital technology (n = 3, 7%), empowerment components (n = 2, 5%), and integrated service delivery (n = 2, 5%). Supply-side and quality of care strategies were rare (n = 1, 2% each, Table 3 ). [Insert Table 3 here] Table 3 Characteristics of Included Studies Study (Name, Year) Country Population Studied Setting/Region Study design Contraceptive Related Outcomes MMAT Score A Intervention strategies B Ahmed et al., 2020 Ethiopia Women age 15–24 Urban and rural areas of Ethiopia from Demographic and Health survey Cross-sectional Current use of modern contraception 80% Mass media Alekhya et al., 2023 India Girls enrolled in 9th-12th grades age 14–15 Bhubaneswar government schools Cluster randomized controlled trial Awareness of contraceptive methods 20% School-based education Arinze-Onyia et al., 2014 Nigeria Female students attending university age 18–26 University of Nigeria, Enugu Campus, Southwestern Nigeria Randomized controlled trial Contraceptive knowledge score 20% Supply Austrian et al., 2021 Kenya Very young adolescent girls age 11–14 Nairobi (Kibera) and Wajir (Northeastern Kenya) Cluster randomized controlled trial Knows method of modern contraception SRH knowledge score Condom self-efficacy 80% Empowerment components Financial incentives Small-group education Bajoga et al., 2015 Nigeria Women age 15–24 Six urban cities in Nigeria Cross-sectional Current use of modern contraception 60% Mass media Bakesiima et al., 2021 Uganda Female refugees age 15–19 Palabek Refugee Settlement Randomized controlled trial Contraceptive uptake 80% Peer-led approaches Bhandari et al., 2023 Nepal Women age 15–24 Karnali Province (Jajarkot, Surkhet, Dailekh, Kalikot) Pre/post without comparison group Modern contraceptive prevalence rate Any contraceptive prevalence rate Injunctive norms of community supporting delay of first pregnancy Injunctive norms of community supporting birth spacing Injunctive norms of family supporting delay of first pregnancy Injunctive norms of family supporting birth spacing Injunctive norms of provider supporting delay of first pregnancy Injunctive norms of provider supporting birth spacing 60% Adolescent-responsive services Engaging men and boys Extension worker Small-group education Social norms & networks Other Bhushan et al., 2022 Malawi Sexually active women age 15–24 Lilongwe Quasi-experimental Current use of non-barrier modern contraceptive Current use of condom 60% Couple communication Small-group education Borovac-Pinheiro et al., 2019 Brazil Adolescent mothers age 10–19 Public maternity hospital Retrospective observational program evaluation Uptake of IUD Uptake of DMPA Uptake of other method 50% Adolescent-responsive services Integrated service delivery Brooks et al., 2019 Niger Married adolescent girls age 13–19 Zinder Cross-sectional Current use of modern contraceptive methods 80% Extension worker Calhoun et al., 2023 Ethiopia Women age 15–24 who gave birth in past year Addis Ababa, Afar, Amhara, Oromia, SNNPR, Tigray Prospective cohort Initiation of contraceptive use LARC vs. traditional/non-use Short acting vs. traditional/non-use LARC vs. short acting 80% Integrated service delivery Quality of care improvements Erhardt-Ohren et al., 2022 Niger Married adolescent girls age 13–19 Dosso region Cluster randomized controlled trial Current modern contraceptive use Current LARC use 40% Couple communication Engaging men and boys Extension worker Small-group education Social norms & networks Erulkar and Tamrat, 2014 Ethiopia Married adolescent girls age 13–17 Rural Amhara region Quasi-experimental Ever used FP 60% Couple communication Engaging men and boys Extension workers Interpersonal communication Small-group education Social norms & networks Fikree et al., 2017 Ethiopia Sexually active women age 15–24 Youth friendly facilities in Amhara and Tigray Quasi-experimental Uptake of LARCs vs. short-acting methods 40% Adolescent-responsive services Peer-led approaches Fikree et al., 2018 Ethiopia Men and women age 15–24 Youth friendly facilities in Amhara and Tigray Quasi-experimental FP referral: Male FP referral: female 40% Adolescent-responsive services Peer-led approaches Fikree et al., 2020 Ethiopia Sexually active women age 15–24 Youth friendly facilities in Amhara and Tigray Retrospective observational program evaluation Uptake of LARCs vs. short-acting methods 60% Adolescent-responsive services Peer-led approaches Flanagan et al., 2021 Uganda Adolescent girls age 15–19 MSI BlueStar clinics in Central, Eastern, Northern, Western Uganda Cluster randomized controlled trial Number of visits for FP services by adolescents 60% Adolescent-responsive services Financial incentives Peer-led approaches Gage et al., 2023 [1] Democratic Republic of the Congo Nulliparous pregnant women age 15–24 Kinshasa Quasi-experimental Used a modern contraceptive within 12 months of delivery Mean number of modern methods known Mean number of FP myths endorsed Approval of FP Injunctive norms approving of postpartum FP discussion with partner Injunctive norms approving of postpartum FP use Descriptive norms that majority first-time young mothers discuss FP postpartum with partner Descriptive norms that majority first-time young mothers use postpartum FP Injunctive norms community members will say good things about women who use postpartum FP Ever discussed FP in early postpartum with partner Discussed FP with health worker in early postpartum Discussed FP with partner after delivery Went to a health facility to obtain contraception early postpartum 70% Couple communication Engaging men and boys Extension worker Interpersonal communication Small-group education Social norms & networks Gage et al., 2023 [2] Democratic Republic of the Congo First-time mothers age 15–24 reporting currently using a modern contraceptive method at endline Kinshasa Quasi-experimental Using implant vs. other modern method Informed choice 70% Couple communication Engaging men and boys Extension worker Interpersonal communication Small-group education Social norms & networks Gayles et al., 2023 Democratic Republic of the Congo Very young adolescent boys and girls age 10–14 in and out of school Kinshasa Quasi-experimental Pregnancy knowledge index score Knows where to get contraception 90% Engaging men and boys Peer-led approaches School-based education Small-group education Social norms & networks Geugten et al., 2015 Ghana In-school boys and girls age 12–20 Six junior high schools in Bolgatanga Municipality, Northern Ghana Pre/post without comparison group SRH knowledge score 40% School-based education Gichangi et al., 2022 Kenya Men and women age 18–24 with mobile phone access and SMS capability Kwale County Randomized controlled trial Contraceptive myths and misconceptions 80% Digital technology Hegdahl et al., 2022 Zambia In-school girls, grade 7, age 12–14 Rural schools Cluster randomized controlled trial Current contraceptive use Good knowledge of modern contraceptive methods 60% Financial incentives School-based education Small-group education Social norms & networks Hinson et al., 2023 Burkina Faso In-school girls, grades 9 and 10, age 14–18 Rural schools Cluster randomized controlled trial Intention to use contraceptives in the next 3 months 80% Adolescent-responsive services School-based education Huda et al., 2019 Bangladesh Married adolescent girls age 14–19 Four urban slums of Dhaka Quasi-experimental Current use of modern contraceptive methods Knows modern methods of contraception Discussed FP with husband Supports using FP Husband supports using FP 60% Small-group education Jacobs et al., 2017 Burkina Faso, Senegal Marred adolescent girls age 15–19 National DHS sample Cross-sectional Current use of a modern contraceptive method Intention to use FP in the future Knowledge of a modern contraceptive method 80% Mass media Jonas et al., 2022 South Africa Women age 15–24 Six districts across provinces Cross-sectional Use of contraceptives other than condoms at last sex Dual use of contraception at last sex 60% Peer-led approaches School-based education Small-group education Supply Other Kabir et al., 2015 Bangladesh Unmarried adolescent girls age 12–19 Rural sub-district Nabigani and urban slum in Dhaka Repeated cross-sectional Knows about contraceptive methods 40% Small-group education Social norms & networks Klinger and Asgary, 2016 Madagascar Adolescent boys and girls in secondary school age 15–19 Northern Madagascar schools Pre/post without comparison group Contraceptive attitudes Contraceptive self-efficacy 20% Extension worker School-based education Macharia et al., 2022 Kenya Adolescent boys and girls age 15–19 Kibra informal settlements Randomized controlled trial Contraceptive knowledge score 40% Digital technology Makenzius et al., 2023 Kenya Boys and girls in secondary school age 14–20 Schools in Kisumu County Quasi-experimental Contraceptive use stigma (CUS) scale 40% Engaging men and boys Peer-led approaches School-based education Morgan et al., 2023 Nigeria First-time mothers and fathers age 15–24 with children less than 6 months Cross River State Pre/post without comparison group Current use of a a modern contraceptive method Birth spacing intentions Awareness of at least three modern contraceptive methods Spousal approval of FP Discussion of FP with partner 60% Couple communication Engaging men and boys Extension worker Interpersonal communication Small-group education Social norms & networks Other Mutea et al., 2023 Kenya Adolescent girls age 10–19 Kobura ward in Kisumu County and Kholera ward in Kakamega County Repeated cross-sectional Currently using method to delay/avoid pregnancy Comfortable seeking FP service Knowledge of contraception 80% Adolescent-responsive services Interpersonal communication Peer-led approaches Nuwamanya et al., 2020 Uganda Men and women attending university age 18–30 Mbarara University of Science and Technology, Western Uganda Randomized controlled trial Contraceptive use 60% Digital technology Oberth et al., 2021 Zimbabwe Women age 10–24 Bulawayo, Chipinge, Gweru, Makoni, Mazowe, Mutare districts Retrospective observational program evaluation Use of a contraceptive method 50% Small-group education Renzaho et al., 2022 Uganda Men and women age 15–24 Kampala and Wakiso slums Repeated cross-sectional Visited a health facility to get information on FP and STDs in the past year Aware of place to get contraception Can make decisions about when and whether to have children without fear 60% Empowerment components Engaging men and boys Interpersonal communication Peer-led approaches Small-group education Rosenberg et al., 2018 Malawi Women age 15–24 who are not pregnant and are sexually active or expect to in the near future Health facilities in Lilongwe Cluster randomized controlled trial Recipet of hormonal contraceptive method (service card) Self-report current contraceptive use Mean # times hormonal contraception was received (service card) 40% Adolescent-responsive services Financial incentives Small-group education Shakya et al., 2020 Niger Married adolescent girls age 13–19 Dosso region Cross-sectional Ever used FP 80% Social norms & networks Silverman et al., 2023 Niger Married adolescent girls age 13–19 and their husbands Dosso region Cluster randomized controlled trial Current modern contraceptive use 60% Couple communication Engaging men and boys Extension worker Small-group education Social norms & networks Thakuri et al., 2023 Nepal Married adolescent girls and women age 15–24 Karnali Province Pre/post without comparison group Use of any contraceptive method Use of a modern contraceptive method Knows where to obtain FP 50% Adolescent-responsive services Engaging men and boys Extension worker Small-group education Social norms & networks Other Wondimagegene et al., 2023 Ethiopia Sexually active girls in secondary school age 15–19 Gedeo Zone, Southern Nations region schools Cluster randomized controlled trial Current contraceptive use Unmet need for contraception Contraceptive demand 80% Peer-led approaches School-based education A Score determined using the Mixed Methods Appraisal Tool (MMAT) version 2018. Different tools were used for different study designs as guided by the tool. The full MMAT scores are found in Supplemental file 2. B Strategies defined in Table 2 . Interventions Description We identified 29 distinct interventions and four observational exposures. Interventions were delivered across a range of settings, including communities (n = 15, 52%), schools or universities (n = 11, 38%), health facilities (n = 8, 28%), households (n = 6, 15%) and mobile platforms (n = 3, 7%). One intervention was delivered in a refugee setting. Nearly half of interventions were multi-level, operating across more than one setting (n = 13, 45%). Single-strategy interventions most commonly involved digital technology (n = 3), school-based education (n = 2), or small-group education (n = 2). The four observational exposures assessed extension worker home visits, integrated family planning counseling in antenatal and postnatal care, mass media exposure, and supportive social networks (n = 1 each). School-based programs primarily targeted younger, unmarried adolescents, whereas community-based interventions focused on out-of-school youth and married adolescents. Facility-based interventions emphasized service appropriateness, quality and provider training. Implementers included community health workers (CHWs), peer educators, teachers, and non-governmental organization (NGO) staff, often matched to participants by age or gender. Norms- and male-engagement strategies frequently involved spouses, families, or other gatekeepers. Intervention intensity varied ranging from single-session activities to multi-year programs, with multi-session formats being common. Details on adaptation were not reported for seven interventions (24%); among those reporting adaptation specifics (n = 22), eight involved stakeholders or participants in intervention development, and three (all digital interventions) explicitly engaged youth in design (Table 4 ). [Insert Table 4 here] Table 4 Characteristics of Included Interventions Intervention Model Description Target Population Intervention Strategies A Delivery Agent Duration / Frequency Setting Country Adaptation/ Development Studies Intervention Evaluations B Afya Halisi Training health workers on youth-friendly services, community outreach, parental dialogue sessions, ASRH information dissemination, peer-educator desk. Adolescent girls age 10–19 Adolescent-responsive services Interpersonal communication Peer-led approaches Health workers CHWs Peer educators County health teams 13-month implementation period Community Health facilities Kenya Designed based on formative assessment in participatory process Mutea et al., 2023 LARCs & Youth Project Competency-based training for youth friendly service providers to offer LARCs + supportive supervision + peer demand generation. Sexually active women age 15–24 Adolescent-responsive services Peer-led approaches YFS providers (Health officer, nurse, midwife) Regional health bureau master trainers Peer educators (trained youth) Providers: 2-week training + service for 8-months. Peer-educators: 3-day training + 6 months post-training demand generation. Scale-up: 3–5 day training; post-implementation follow-up for 13 months. Community Health facilities Ethiopia Adapted from Integrated Family Health Program + youth friendly service platform, WHO standards Fikree et al., 2017 Fikree et al., 2018 Fikree et al., 2020 (re)solve intervention Participatory, activity-based sexual and reproductive health curriculum which included a school-based participatory board game (la chance), a health facility passport, and posters/name tags. In-school girls, grades 9 and 10, age 14–18 Adolescent-responsive services School-based education Community-based facilitators Unclear - board game played at least once Health facilities Schools Burkina Faso Based on national SRH curriculum, co-designed with local stakeholders, adapted for young adolescents Hinson et al., 2023 Girl Power Malawi Youth-friendly health services (YFS) in three arms: (1) YFS only (youth-focused space, more range of times, training on YFS and peer-educators to support), (2) YFS + behavioral intervention (12 monthly facility-led curriculum-driven small-group interactive sessions, (3) YFS + behavioral intervention + conditional cash transfer (monthly cash transfer for attending each behavioral intervention session). Women age 15–24 who are not pregnant and are sexually active or expect to become so in the near future Adolescent-responsive services Couple communication Financial incentives Small-group education Trained young female facilitators (ages 20–30, post-secondary diplomas) Trained clinicians Trained peer-educators 12 monthly 2-hour sessions Community Health facilities Malawi Adapted from evidence-based SSA programs; delivered by trained young women facilitators Bhushan et al., 2022 Rosenberg et al., 2018 Healthy Transitions for Nepali Youth Multi-level strategy including: (1) Individual: AGYW “safe-space” small group sessions with curriculum and games; (2) Interpersonal: Home visits engaging families and husbands via videos; (3) Community: dialogues, street dramas, quiz events; (4) System: Adolescent-friendly health facility training and quality assessments. Women age 15–24 Adolescent-responsive services Engaging men and boys Extension worker Small-group education Social norms & networks Trained CHWs Trained health providers Save the Children Government Local NGOs AGYW groups: 24 fortnightly sessions (12 months); Home visits: ~1–2 per month (6 targeted); Community events: ~4/month plus biannual public events; Facility training: conducted once with quarterly follow-up Community Health facilities Household Schools Nepal Locally adapted intervention model based on formative research and stakeholder engagement Bhandari et al., 2023 Thakuri et al., 2023 MSI peer-referral and clinic welcome intervention Peer-referral cards (“refer-a-friend”) + youth-friendly clinic materials + wristbands; sub-group with provider training. Adolescent girls age 15–19 Adolescent-responsive services Financial incentives Peer-led approaches Community mobilizers MSI clinic staff 6-month implementation (split pre-/post-COVID pause) Health facilities Uganda Designed with behavioral insights (ideas42) based on barrier diagnosis Flanagan et al., 2021 Unnamed PNC counseling for adolescents intervention Structured contraceptive counseling and provision of educational materials prior to hospital discharge for youth maternity patients. Adolescent mothers age 10–19 Adolescent-responsive services Integrated service delivery Hospital-based health professionals One session before discharge Health facilities Brazil Designed for adolescent mothers, delivered during postpartum hospitalization Borovac-Pinheiro et al., 2019 MOMENTUM Nursing student home visits + group education using gender-transformative curriculum (Program M) for first-time mothers and partners + SBC interventions. First-time mothers age 15–24 Couple communication Engaging men and boys Extension worker Interpersonal communication Small-group education Social norms & networks Nursing students Ministry of Health 16 months implementation period Community Household Linkage to health zones Democratic Republic of the Congo Locally adapted Program M + community SBC + service linkage Gage et al., 2023 [1] Gage et al., 2023 [2] Reaching Married Adolescents (RMA) Four arm SBCC intervention: (1) home visits; (2) small group discussions; (3) combined; plus community dialogues; (4) control (no intervention). Married adolescent girls age 13–19 and their husbands Couple communication Engaging men and boys Extension worker Small-group education Social norms & networks Trained community workers Community facilitators 1.5 years intervention, 1 session/month Community Household Niger Based on theory of reasoned action Erhardt-Ohren et al., 2022 Silverman et al., 2023 Married Adolescent Girls (MAG) Program Community-based program with health education, small groups, home visits, and community dialogue to improve RH knowledge, service use, and decision-making power. Married adolescent girls age 13–17 Couple communication Engaging men and boys Extension workers Interpersonal communication Small-group education Social norms & networks Community mentors Health extension workers Weekly group sessions over 6 months Community Household Ethiopia Locally adapted to cultural context; developed through community consultation Erulkar and Tamrat, 2014 Unnamed first-time parent intervention First time parent interventions included peer group sessions with first-time mothers; small group sessions with the husbands/partners of peer group members; small group sessions with older women, typically the mothers or mothers-in-law of peer group members; home visits by community volunteers (CVs); community sensitization; and ongoing family planning service delivery at facilities and through mobile outreach. First-time mothers and fathers age 15–24 with children less than 6 months Couple communication Engaging men and boys Extension workers Interpersonal communication Small-group education Social norms & networks Other CHWs supervised by local government health staff and program facilitators 12 first-time mother peer group sessions meeting weekly over 4-months for 1 hour 6 weekly sessions for male partners with female partners who wanted them to participate, 4–6 home visits per first time mother over 4-month study period Community Household Nigeria Designed by E2A based on formative research and other service work in the area Morgan et al., 2023 ARMADILLO SMS initiative Youth-targeted mobile phone–based intervention delivering weekly audio messages via IVR to dispel contraception myths and misconceptions, aligned with national FP messaging guidelines. Men and women age 18–24 with mobile phone access and SMS capability Digital technology Ministry of Health Communications company (Well Told Story) 16 weekly audio messages Individual mobile phones Kenya Developed through focus groups and literature identifying 10 myths, including young people Gichangi et al., 2022 Unnamed mobile application A mobile application designed to provide SRH information, goods (e.g., condoms), and services (e.g., linkage to clinics). Men and women attending university age 18–30 Digital technology Research team with youth engagement Self-use of app Individual mobile phones University Uganda Developed with youth input; tailored content for university students Nuwamanya et al., 2020 Unnamed mobile USSD application Unstructured Supplementary Service Data (USSD)–based app with SRH information via Echomobile® platform. Adolescent boys and girls age 15–19 Digital technology Research team Self-use of app Individual mobile phones Kenya Designed based on health belief model in co-creation process with youth Macharia et al., 2022 Adolescent Girls Initiative - Kenya (AGI-K) Four-arm intervention including: (1) violence prevention: community conversations, contracts and action plans; (2) violence prevention + education: cash and in-kind transfers to the head of household and girl, personal and schools supply kit; (3) violence prevention + education + health: health girls groups led by mentor; and, (4) violence prevention + education + health + wealth creation: financial education in girls groups, education on financial topics, annual savings incentive to girls, opening of formal savings account, and providing home savings banks. Very young adolescent girls age 11–14 Empowerment components Financial incentives Small-group education Save the Children (Wajir), Population Council (Kibera), in collaboration with government and NGOs 2 years; frequency varies by component (e.g., regular health sessions, monthly cash transfers) Community Household Kenya Not reported Austrian et al., 2021 UPLIFT Multi-component program including life skills training, savings groups, financial literacy, SRHR information, and referrals to services. Men and women age 15–24 Empowerment components Engaging men and boys Interpersonal communication Peer-led approaches Small-group education Local implementing partners Community-based organizations 18–24 month intervention delivery Community Uganda Tailored to youth in urban informal settlements; combines economic empowerment with SRHR education Renzaho et al., 2022 Growing up GREAT! Multi-level SRH and gender transformative program using story-based curricula, community discussions, and caregiver/provider engagement. Very young adolescent boys and girls age 10–14 in and out of school Engaging men and boys Peer-led approaches School-based education Small-group education Social norms & networks Trained peer facilitators Teachers Community leaders 6-month delivery, 8–10 group sessions Community Schools Democratic Republic of the Congo Adapted from the GREAT! model for younger urban students and school delivery Gayles et al., 2023 Unnamed school stigma reduction intervention School-based stigma-reduction program promoting gender equality, equitable norms, value clarification targeting stigma around abortion and contraceptive use. Boys and girls in secondary school age 14–20 Engaging men and boys Peer-led approaches School-based education Trained facilitators including teachers and peer-educators Delivered over 3 weeks (8–9 hours) divided into four sessions and provided to mixed-gender classrooms Schools Kenya Not reported Makenzius et al., 2023 Unnamed multi-level intervention involving economic support and comprehensive sex education Economic support alone & in combination with comprehensive sex education (CSE) and community dialogues: (1) Economic support: Unconditional cash to girls/guardians + school fees for Grades 8–9; (2) CSE + community dialogue (combined arm): Youth clubs in schools teaching CSE + periodic community dialogue meetings focusing on fertility, marriage and girls’ schooling. In-school girls, grade 7, age 12–14 Financial incentives School-based education Small-group education Social norms & networks Ministry of Education Local facilitators 27-month intervention Community Schools Zambia Not reported Hegdahl et al., 2022 Unnamed peer counseling in refugee setting intervention Peer adolescents (trained) provided contraceptive counselling using WHO guide & visual aids. Female refugees age 15–19 Peer-led approaches 3 peer counselors (ages 16–19) 1 session; 15–20 minutes Refugee settlement Uganda Not reported Bakesiima et al., 2021 Unnamed school-based peer education intervention Trained peer educators provided weekly classroom-based education covering contraception, sexual health, and reproductive rights. Sexually active girls in secondary school age 15–19 Peer-led approaches School-based education Peer educators (students and teachers) trained by researchers Weekly sessions over 6 months Schools Ethiopia Not reported Wondimagegene et al., 2023 HERStory Multi-sectoral HIV prevention program including biomedical, behavioral, and structural components (such as access to contraceptives, education, and empowerment). Women age 15–24 Peer-led approaches School-based education Small-group education Supply Other Local NGOs Community workers Healthcare providers Not reported Community Health facilities Schools South Africa National adaptation of DREAMS programming in South African districts Jonas et al., 2022 Unnamed comprehensive sex education intervention Sexual and reproductive health education sessions integrated into school curriculum with trained facilitators delivering 1-hour sessions once a week for 5 weeks. In-school girls age 12–20 School-based education Trained facilitators and teachers 5 sessions (1 per week) Schools Ghana Not reported Geugten et al., 2015 Unnamed school-based SRHR education intervention Three education sessions on SRH topics including female reproductive system, puberty, pregnancy, contraception, menstruation, and STI prevention, and an interactive session to clear misconceptions. Girls enrolled in 9th-12th grades age 15 − 14 School-based education Trained school teachers Three 2-hour sessions delivered on consecutive days Schools India Based on WHO and guidelines, adapted to local context through desk/lit review by study team, reviewed by medical social workers. Alekhya et al., 2023 Unnamed SRHR curriculum intervention A 9-lesson curriculum covering reproductive anatomy, contraception, pregnancy prevention, STIs, and HIV/AIDS. Adolescent boys and girls in secondary school age 15–19 School-based education Extension worker Trained teachers and CHWs Nine weekly 45-minute sessions Schools Madagascar Locally adapted curriculum based on needs assessment and national guidelines Klinger and Asgary, 2016 Married Adolescent Girl (MAG) club Monthly peer-group sessions covering family planning knowledge, male involvement, addressing myths/fear, and contraceptive method demonstrations. Married adolescent girls age 14–19 Small-group education Trained facilitators from current club leaders recruited from NGO BRAC’s urban slum programs Three 2-hour sessions delivered on consecutive days Schools Bangladesh Developed by Government of Bangladesh and local non-governmental organizations (NGOs) Huda et al., 2019 Sista2Sista (S2S) Programme Structured group-based mentoring program delivering HIV and SRH education, psychosocial support, and life skills to vulnerable AGYW. Adolescent girls and women age 10–24 Small-group education Trained adult female mentors (“Sisters”) 12 weekly sessions Community Zimbabwe Designed by MOH, UNFPA, and partners Oberth et al., 2021 Unnamed peer-education intervention for unmarried girls Peer educators provided adolescent reproductive health information through structured group sessions. Unmarried adolescent girls age 12–19 Small-group education Social norms & networks Peer educators trained by project staff Not reported Community Bangladesh Culturally adapted peer-led approach Kabir et al., 2015 Unnamed provision of EC intervention Three health education sessions plus provision of EC pills (Postinor) vs health education alone. Female students attending university age 18–26 Supply Not reported Three education sessions on Saturdays for three weeks, length not reported, one pack of EC Schools Nigeria Not reported Arinze-Onyia et al., 2014 Observational Exposures Assessing Potential Intervention Strategies C Extension worker home visit strategy Visits by community health workers providing family planning information and services. Married adolescent girls age 13–19 Extension worker CHWs Not applicable Household Niger Not applicable Brooks et al., 2019 Integrated FP counseling in ANC/PNC strategy FP discussion during ANC, facility delivery discharge, PNC (6 weeks), and vaccination visits. Women age 15–24 who gave birth in past year Integrated service delivery Quality of care improvements Health professionals, HEWs, facility providers 1 or more discussions across 4 contact points Health facilities Community outreach Ethiopia Not applicable Calhoun et al., 2023 Mass media strategy Self-reported recent exposure to FP messages via mass media channels (newspaper, radio, mobile, tv). Women age 15–24 Mass media Not applicable Any exposure Individual Ethiopia Nigeria Burkina Faso Senegal Not applicable Ahmed et al., 2020 Bajoga et al., 2015 Jacobs et al., 2015 Social networks strategy Social networks and social network attributes. Married adolescent girls age 13–19 Social norms & networks Not applicable Not applicable Individual Household Niger Not applicable Shakya et al., 2020 A Strategies defined in Table 2 . B Includes interventions/programs with a program evaluation component. C Includes observational studies that assessed a potential intervention strategy that could be applied to future interventions. Outcome Analysis and Narrative Synthesis by Intervention Strategy Evidence was most frequently available for primary outcomes related to contraceptive use or uptake (41 measures), followed by contraceptive knowledge (36 measures), attitudes or norms (19 measures), and contraceptive method outcomes (15 measures). Measures related to intentions (n = 6), communication (n = 6), and service outcomes (n = 9) were less frequently assessed. Negative effects were rare, accounting for only 3% of assessed outcomes (n = 4), with the majority of reported effects indicating statistically significant positive associations with contraceptive-related outcomes (Fig. 2). Evidence was more concentrated for multi-strategy interventions than for single-strategy interventions. Among single-strategy interventions, moderate-to-strong positive effects were most commonly observed for contraceptive use (n = 9 outcomes, 64%) and contraceptive knowledge (n = 9 outcomes, 75%), with other outcome types infrequently assessed. In contrast, multi-strategy interventions demonstrated consistently strong positive effects across a broader range of outcomes, including contraceptive use (n = 24 outcomes, 89%), attitudes and norms (n = 15 outcomes, 88%), and service-related outcomes (n = 8 outcomes, 89%, Fig. 2). Across study designs, overall quality was moderate, with mean MMAT scores of 57% for experimental studies (n = 14), 59% for quasi-experimental studies (n = 9), and 62% for other study designs (n = 19, Fig. 3). Narrative synthesis and outcome analysis are presented below by intervention strategy. Findings reflect intervention packages that included each strategy, not isolated strategy effects; results are non–mutually exclusive and should be interpreted as patterns rather than causal attribution. [Insert Table 5 here] Table 5 Direction and Magnitude of Effects of Intervention Strategies on Contraceptive Use Outcomes Study (Name, Year) Main findings Contraceptive Outcome(s) Estimate [effect measure, estimate (95% CI or std error)] Significance at p<.05 Intervention Name Intervention strategies B Rosenberg et al., 2018 Adolescent girls allocated to receive the youth-friendly health services model had increased receipt of hormonal contraceptives, # times they up took these methods, and self-reported use of contraception compared to controls. Receipt of hormonal contraceptive method # of times hormonal contraceptives received Use of contraception Contraceptive receipt: 39% (34%-45%) # of times: 6 (4.2–8.7) Use of contraception: 20% (CI or stderr not reported) Significant (p<.05) Significant (p<.05) Significant (p<.001) Girl Power Malawi Adolescent-responsive services Couple communication Financial incentives Small-group education Bhushan et al., 2022 Those assigned to receive small group sessions had increased use of non-barrier contraceptive methods and condoms at 1-year follow-up, compared to control; some analyses suggested partial mediation of effects through partner communication. Use of non-barrier modern contraception Use of condoms Use of non-barrier method: aOR 5.1 (2.3–11.3) Use of condom: aOR 2.2 (1.2–4.1) Significant (p<.05) Significant (p<.05) Girl Power Malawi Couple communication Small-group education Bhandari et al., 2023 Modern and any contraceptive prevalence rates among married girls increased significantly from pre to post intervention. Modern contraceptive prevalence rate Any contraceptive prevalence rate mCPR: +7% (CI or stderr not reported) CPR: +9% (CI or stderr not reported) Significant (p<.01) Significant (p<.05) Healthy Transitions for Nepali Youth Adolescent-responsive services Engaging men and boys Extension worker Small-group education Social norms & networks Other Thakuri et al., 2023 Participants reported an increase in use of any and modern contraception from pre to post intervention. Use of any contraception Use of modern contraception Any contraception: % change + 9% (CI or stderr not reported) Modern contraception: % change + 7% (CI or stderr not reported) Significant (p<.001) Significant (p<.001) Healthy Transitions for Nepali Youth Adolescent-responsive services Engaging men and boys Extension worker Small-group education Social norms & networks Other Mutea et al., 2023 Adolescents in the intervention group receiving adolescent friendly services had no increase in contraceptive use over time relative to controls. Use of contraception IRR: 1.15 (0.68–1.94) * Null Afya Halisi Adolescent-responsive services Interpersonal communication Peer-led approaches Gage et al., 2023 [1] The MOMENTUM multi-component intervention increased women's reporting of using a modern contraceptive method within 12 months postpartum. Use of modern contraception within 12 months after birth aRD 0.133 (0.08–0.18) Significant (p<.01) MOMENTUM Couple communication Engaging men and boys Extension worker Interpersonal communication Small-group education Social norms & networks Erhardt-Ohren et al., 2022 Married adolescent girls in all intervention arms (household visit only, small groups only, combined) were more likely than control to have a sustained effect using modern contraception 18-months post intervention; the small group discussions group saw the largest effect. Use of modern contraception Home visits vs. control: aOR 4.11 (1.42–11.88) Small group discussion vs. control: aOR 7.94 (2.96–21.29) Combined intervention vs. control: aOR 4.53 (1.60-12.87) Significant (p<.05) Significant (p<.05) Significant (p<.05) Reaching Married Adolescents (RMA) Couple communication Engaging men and boys Extension worker Small-group education Social norms & networks Silverman et al., 2023 Intervention groups had greater relative increase in contraceptive use over time compared to controls; this change was driven by the home visits and home visits plus small groups arms. Use of modern contraception Intervention (all) vs. control: aIRR 2.33 (1.41, 3.87) Home visits only vs. control: aIRR 3.65 (1.51, 8.78) Small groups only vs. control: aIRR 1.42 (0.84, 2.41) Home visits + Small groups vs. control: aIRR 2.99 (1.68, 5.32) Significant (p=.001) Significant (p=.004) Null Significant (p<.001) Reaching Married Adolescents (RMA) Couple communication Engaging men and boys Extension worker Small-group education Social norms & networks Erulkar and Tamrat, 2014 Women exposed to both wives groups and whose husbands were exposed to husbands groups had greater contraceptive use than controls while those only exposed to wives groups had marginally greater contraceptive use. Ever use of contraception Exposed to husbands and wives groups: aOR 1.85 (1.33–2.58) Exposed to wives groups only: aOR 1.49 (0.94–2.35) Significant (p<.001) Marginally significant (p<.1) Married Adolescent Girls (MAG) Program Couple communication Engaging men and boys Extension workers Interpersonal communication Small-group education Social norms & networks Morgan et al., 2020 First-time mothers and partners use of contraception increased significantly from pre to post-intervention. Use of modern contraception First time mothers: aOR 3.3 (CI or stderr not reported) Male partners: aOR 3.7 (CI or stderr not reported) Significant (p<.001) Significant (p<.001) Unnamed first-time parent intervention Couple communication Engaging men and boys Extension worker Interpersonal communication Small-group education Social norms & networks Other Nuwamanya et al., 2020 Students receiving the USSD-messages showed increased use in contraception over time relative to controls. Use of contraception aOR 1.58 (1.02–2.46) Significant (p<.05) Unnamed mobile application Digital technology Brooks et al., 2019 Married adolescent girls who were exposed to a relias (CHW) visit in the past 3 months were more likely to be currently using modern contraceptives compared to those who were not exposed. Use of modern contraception aOR 1.94 (1.07–3.51) Significant (p=.03) Extension worker home visit strategy Extension worker Hegdahl et al., 2022 Those allocated to receive cash transfers only had no difference in contraceptive use at endline while those allocated to receive cash transfers combined with comprehensive sex education and community dialogues saw a marginally significant increase in use of modern contraception at endline. Use of modern contraception Economic vs. control: aRR 0.90 (0.74–1.11) Combined vs. control: aRR 1.14 (0.95–1.37) Null Marginally significant (p<.1) Unnamed multi-level intervention involving economic support and comprehensive sex education Financial incentives School-based education Small-group education Social norms & networks Calhoun et al., 2023 For each counseling session where FP was discussed, women had greater hazard of initiating a modern contraceptive method. Initiation of contraception aHR 1.34 (0.07) Significant (p<.0001) Integrated FP counseling in ANC/PNC strategy Integrated service delivery Quality of care improvements Ahmed et al., 2020 Mass media exposure to family planning messages was associated with reduced contraceptive use in urban areas and no effect in rural areas. Use of modern contraception Urban: aOR 0.38 (0.21–0.68) Rural: aOR 1.20 (0.85–1.70) Significant (p<.05) Null Mass media strategy Mass media Bajoga et al., 2015 Mass media exposure to family planning messages was associated with increased contraceptive use when exposed to FP messages in TV and mobile (total), and for radio in Ibadan, Ilorin, and Kaduna. Use of modern contraception Newspaper total: aOR 1.2 (0.8–1.8) Newspaper city specific: aOR 0.4-2.5 Radio total: aOR 1.3 (0.8–2.1) Radio city specific: aOR 0.2–4.6 TV total: aOR 1.6 (1.1–2.3) TV city specific: aOR 0.7-1.7 Mobile total: aOR 1.9 (1.2–2.9) Mobile city specific: aOR 1.4–2.8 Null Null in all cities Null Significant (p<.05) in Kaduna, Ilorin, Ibadan Significant (p<.05) Significant (p<.05) in Ilorin Significant (p<.05) Null in all cities Mass media strategy Mass media Jacobs et al., 2017 Young women exposed to FP messages in the media was marginally associated with greater use of contraceptives in Senegal but not in Burkina Faso. Use of modern contraception Burkina Faso: aOR 0.98 (0.43–2.30) Senegal: aOR 2.30 (0.92–5.73) Null Marginally significant (p<.1) Mass media strategy Mass media Wondimagegene et al., 2023 Girls at intervention schools had greater contraceptive uptake over time relative to controls. Use of contraception aOR 8.73 (3.66–20.83) * Significant (p=.01) Unnamed school-based peer education intervention Peer-led approaches School-based education Jonas et al., 2022 Those who participated in the HERStory intervention were more likely to have used a contraceptive method, other than condoms, at last sex compared to non-participants. Use of contraception other than condoms at last sex aPR 1.36 (1.21–1.53) Significant (p<.001) HERStory Peer-led approaches School-based education Small-group education Supply Other Bakesiima et al., 2021 Young women exposed to peer-counseling were more likely to take up a modern contraceptive method immediately after counseling compared to women receiving standard counseling. Contraceptive uptake post counseling aPR 1.24 (1.0-1.5) Significant (p = 0.02) Unnamed peer counseling in refugee setting intervention Peer-led approaches Huda et al., 2019 Those assigned to receive the small group education sessions were more likely to be using a contraceptive method post-intervention than controls. Use of modern contraception aOR: 1.77 (CI or stderr not reported) Significant (p<.01) Married Adolescent Girl (MAG) club Small-group education Oberth et al., 2021 Those who participated in the full program had an increase in contraceptive use but this effect was not detected if users missed any of the 40 group exercise sessions. Use of contraception Completed all 40 group exercises: aOR 1.38 (1.21–1.56) Completed 35 (88%) of group exercises: aOR 1.06 (0.97–1.15) Completed at least 30 (70%) group exercises: aOR 0.95 (0.87–1.04) Significant (p<.001) Null Null Sista2Sista (S2S) Programme Small-group education Shakya et al., 2020 Girls who reported that they believed their alter supported their use of family planning were more likely to have ever used contraception. Ever use of contraception beta 0.99 (0.35) Significant (p<.001) Social networks strategy Social norms & networks A Strategies defined in Table 2 . ^ 18 studies are not included in this table because they did not report on a contraceptive uptake or use outcome. Other contraceptive outcomes have been reported in Supplement 3. * Represents a DID analysis Small-group education Small group education appeared in 18 of 41 studies. Nearly all measures assessing contraceptive use or uptake (Table 5 , 36–48) reported significant or marginal improvements (n = 18, 95%) and secondary outcomes also demonstrated largely positive effects (n = 44, 80%, Fig. 4), including improvements in LARC use ( 43 , 51 ), birth spacing intentions ( 46 ), contraceptive knowledge ( 41 , 42 , 46 , 47 , 49 , 52 – 54 ), spousal approval and discussion ( 42 , 46 , 49 ), norms ( 40 , 42 ), and service use (Supplement 3, 41,47). Experimental (n = 4) and quasi-experimental (n = 5) designs comprised over half of studies, and quasi-experimental studies were of comparatively higher quality (mean MMAT score 70%; Fig. 3) than overall average MMAT scores across all study designs. Small-group education was most frequently implemented as part of multi-component interventions delivered in community, facility, or school settings. When implemented as a standalone strategy (n = 2), effects were positive but appeared sensitive to intervention intensity. For example, group-based mentoring programs targeting adolescent girls in Zimbabwe and peer-group sessions for married adolescent girls in urban Bangladesh both demonstrated improvements in contraceptive use (Bangladesh: aOR 1.77, 95% CI not reported, p<.01 ; Zimbabwe: aOR 1.38, 95% CI 1.21–1.56, p<.001, 47,48); however, in Zimbabwe, statistically significant effects were observed only among participants who completed the full 40-session course ( 48 ). Stronger and more consistent effects were observed when small-group education was embedded within broader intervention packages, particularly those addressing interpersonal, normative, or service-related barriers. The Reaching Married Adolescents (RMA) program in rural Niger isolated the contribution of sex-segregated small-group sessions for married adolescents and found substantial and sustained improvements in contraceptive use over time (small group discussion vs. control 18-months post-intervention: aOR 7.94, 95% CI 2.96–21.29, p<.05, 36,38, Tables 4 and 5 ). Other evaluations (e.g., Girl Power Malawi, Healthy Transitions for Nepali Youth, MOMENTUM) assessed small-group education as one component within multi-strategy designs, often alongside economic, community, or service-delivery interventions. In these contexts, small-group education appeared to function as an effective mechanism for reinforcing knowledge, facilitating partner communication, and linking participants to services, contributing to improvements in both contraceptive use and key proximal outcomes (Supplement 5, 36–40,49). Social norms and network strategies Social norms and network strategies were evaluated in 12 studies out of 41 studies. Nearly all measures assessing contraceptive use, prevalence, or uptake (38–45,53, Table 5 ) reported statistically significant or marginal improvements (n = 17, 94%), and secondary outcomes similarly demonstrated strong positive effects (n = 33, 85%, Fig. 4), including birth-spacing intentions ( 46 ), partner communication and approval ( 42 , 46 , 51 ), contraceptive knowledge of contraceptive methods ( 41 , 42 , 46 , 47 , 51 , 54 ), supportive attitudes and norms ( 42 , 51 ), service use ( 42 , 51 ), and use of LARCs (Supplement 3, 36,37). Experimental (n = 3) and quasi-experimental (n = 4) designs comprised over half of studies assessing this strategy (58%), and quasi-experimental evaluations were of comparatively high quality (mean MMAT score 73%, Fig. 3). All interventions employing social norms and network strategies were multi-component, often combined with small-group education and engaging men and boys. Network interventions operated through couple communication, male small-group discussion, and extension workers ( 40 – 46 , 51 ) to engage male partners, often for young married adolescents and women in contexts including Nepal, Niger, the DRC, Ethiopia, Nigeria, and Bangladesh, or through engagement of unmarried boys and/or girls in school-based education and/or small groups ( 47 , 54 , 56 ) in Bangladesh, Zambia, and the DRC. Though no intervention study isolated the effects of norm-shifting components, several evaluations reported improvements in partner communication and spousal discussion of contraception ( 42 , 44 ), key proximal outcomes closely linked to normative change in contexts where contraceptive decision-making is strongly influenced by husbands, families, and other gatekeepers. One observational study ( 55 ) among married adolescent girls in rural Niger found higher contraceptive use among girls whose nominated influential social network members (i.e., alters) were perceived as supportive of contraceptive use (beta 0.99, std 0.35, p<.001). Two studies measured changes in perceived contraceptive norms ( 40 , 42 ), both of which reported statistically significant improvements across multiple injunctive and descriptive norms related to contraceptive use and salient reference groups. Peer-led approaches Peer-led approaches were incorporated in 11 of the 41 studies identified. Among measures assessing contraceptive use, prevalence, or uptake ( 48 , 57 – 59 ), the majority reported statistically significant or marginally significant positive effects (n = 4, 80%, Fig. 4, Table 4 ). Peer-led approaches were also associated with many improvements in secondary (n = 10, 67%, Fig. 4) and methods-related outcomes, including contraceptive knowledge ( 53 , 57 ), decreased stigma ( 60 ), agency ( 53 ), decreased unmet need and increased demand ( 58 ), service ( 53 , 57 , 61 , 62 ), and LARCs (Supplement 3, 59,61). Experimental (n = 2) and quasi-experimental (n = 3) designs comprised 64% of all evaluations assessing peer-led approaches, with the remaining studies using observational or other non-experimental designs (n = 4). Overall study quality for this strategy was similar to the broader evidence base, with a small number of higher-confidence experimental evaluations (n = 3, average MMAT score 73%, Fig. 3). Peer-led approaches were only implemented as a standalone strategy in one intervention and instead primarily functioned as delivery channels for other intervention strategies. One study used peer-approaches as a standalone-strategy for adolescent girls in a Ugandan refugee setting in a high-quality (80% MMAT score) RCT, finding strong effects on contraceptive uptake among girls who received the intervention immediately post peer-counseling, compared to controls (aPR 1.24, 95% CI 1.0-1.5, p = 0.02, 57). In multi-component interventions, peer-led approaches were commonly embedded within broader packages including school-based education ( 48 , 54 , 58 , 60 ), small-group education ( 48 , 53 , 54 ), and adolescent responsive services ( 57 , 61 – 63 ). In one high quality (MMAT score 80%) cluster RCT in Ethiopia, a school-based intervention which trained peer-educators to provide weekly class-room based contraception topics to adolescent girls found a nearly 9x odds increase in contraceptive use in intervention schools compared to controls (aOR 8.73, 95% CI 3.66–20.83, p = 0.01, 56). Engaging men and boys Engaging men and boys were evaluated in 11 of the 41 included studies exclusively within multi-component interventions. Among studies assessing contraceptive use, prevalence, or uptake, nearly all reported statistically significant improvements (n = 14, 93%), and secondary outcomes similarly demonstrated strong positive effects (n = 37, 90%, Fig. 4), including intentions ( 46 ), contraceptive knowledge ( 41 , 42 , 46 , 51 , 53 , 54 ), partner approval ( 46 ), stigma ( 60 ), supportive norms ( 40 , 42 ), partner communication ( 46 , 51 ), services ( 42 , 53 ), and use of LARCs (Supplement 3, 41). Experimental (n = 2) and quasi-experimental (n = 5) designs comprised over half of studies assessing this strategy (64%). Quasi-experimental evaluations were of somewhat higher quality (mean MMAT score 66%) and experimental studies was somewhat lower (mean MMAT score 50%, Fig. 3). Interventions engaging men and boys commonly targeted contraceptive improvements for married adolescents, first-time mothers, or school-aged children. Men were engaged through couple communication, extension worker home visits, and/or small sex-segregated groups for young married adolescents in Nepal ( 40 , 41 ), Niger ( 43 , 44 ), and Ethiopia ( 45 ). Similar mechanisms were used for interventions involving first-time mothers in Nigeria ( 46 ), and the DRC ( 42 , 51 ). For school-aged children, boys were engaged through school-based curriculum or stories, peer-led approaches, and/or small group education in the DRC ( 54 ) and Kenya (Table 4 , 58). Only one intervention tried to isolate the effects of male engagement exposure, finding that married adolescent girls in the rural Amhara region of Ethiopia exposed to wives and husbands small-group sessions were associated with greater improvements in contraceptive use compared to exposure among wives alone (wives only: aOR 1.49, p < 0.10; wives and husbands: aOR 1.85, p < 0.001, Table 5 ) though both saw improvements ( 45 ). Several evaluations among married adolescents and first-time parents also reported improvements in partner communication, spousal approval of contraception ( 42 , 46 , 51 ), and perceived family support (Supplement 3, 38). The two school-based programs ( 54 , 60 ) did not measure distal outcomes of contraceptive use, but did find improvements in contraceptive use stigma (beta − 0.73, 95% CI -0.83- -0.63, p<.001) and knowledge of pregnancy (mean difference 0.48, 95% CI 0.18–0.77, p<.05, Supplement 3). Extension workers Extension workers-based strategies were evaluated in 10 of the 41 included studies all multi-component interventions, most commonly targeting married adolescents, young couples, or first-time parents. Among studies assessing contraceptive use, prevalence, or uptake, nearly all reported statistically significant improvements (n = 11, 92%), and secondary outcomes similarly demonstrated strong positive effects (n = 23, 88%, Fig. 4), including intentions ( 46 ), contraceptive knowledge ( 41 , 42 , 46 ), supportive attitudes ( 42 , 64 ), self-efficacy ( 64 ), supportive norms ( 40 , 42 ), discussion ( 42 , 46 ), spousal approval ( 46 ), service ( 42 , 51 ), and use of LARCs ( 42 , 43 ). Experimental (n = 2) and quasi-experimental (n = 3) designs comprised 53% of all evaluations assessing peer-led approaches. Quasi-experimental evaluations were of somewhat higher quality (mean MMAT score 67%) while the quality of experimental studies was somewhat lower (mean MMAT score 50%, Fig. 3). Extension workers most often delivered home-based counseling or follow-up visits, frequently in combination with small-group education, male engagement, and/or facility-based service strategies. In most evaluations, extension worker activities were embedded within broader intervention packages. Two studies provided more isolated evidence on the role of extension workers. Within the RMA program, home visits conducted by extension workers for married adolescents in rural Niger were evaluated as a distinct intervention component and were independently associated with increased contraceptive use among married adolescents (home visits only vs. control IRR 3.65, p = 0.004; home visits plus sex-segregated small groups 2.99, p<.001, Table 5 , 42). In addition, one observational study, also from Niger, reported higher current contraceptive use among women who had received a home visit from a community health worker within the prior three months (aOR 1.94, 95% CI 1.07–3.51, p = 0.03, Table 5 , 63). Other interventions used extension workers to link women to care, for example first-time mothers in the post-partum period. One intervention in Nigeria found that 4–6 extension worker visits, when combined with a compressive intervention incorporating peer-group sessions and male-partner sessions with female partners, increased reported use of modern contraception by both female and male partners (female: aOR 3.3, 95% CI not reported, p<.001, male: aOR 3.7, 95% CI not reported, p<.001, Table 5 , 44). Adolescent-responsive services Adolescent-responsive services were included in 10 of the 41 studies all within multi-component interventions through health facilities or school-linked platforms. Among measures assessing contraceptive use, prevalence, or uptake, the majority reported statistically significant or marginally significant positive effects (n = 4, 80%, Fig. 4, Table 5 ). Adolescent-responsive services were also associated with many improvements in secondary (n = 10, 83%, Fig. 4) and methods-related outcomes, including intentions ( 66 ), unmet need and demand ( 58 ), contraceptive knowledge ( 41 ), supportive norms ( 40 ), service ( 62 ), and LARC uptake (Supplement 3, 61,65). Experimental (n = 3) and quasi-experimental (n = 2) designs comprised over half of studies assessing this strategy (55%). Quasi-experimental evaluations were of substantially lower quality (mean MMAT score 40%). Adolescent-responsive services were implemented as part of multi-component intervention packages, frequently in combination with small-group education, peer-led approaches, or community-based outreach. While no studies isolated the effect of adolescent-responsive services, many found positive effects when implemented in combination with other strategies. For example, evaluations of the LARCS & Youth Project in Ethiopia, which combined youth-friendly provider service training with peer-led demand generation, reported increases in uptake of LARCs (aOR 1.3, 95% CI not reported, p<.0001, 61) and male referrals for FP (aOR 1.4, 95% CI not reported, p<.05, 59), though individual contraceptive use was not assessed. Another intervention pairing adolescent-friendly services with a participatory reproductive health curriculum in Burkina Faso schools for girls in grades 9 and 10 found a marginally significant positive increase in intention to use contraceptives within the next three months (aOR 1.59, 95% CI 0.97–2.61, p<.1, 64). Girl Power Malawi, which used youth-friendly health services alone and in combination with behavioral and microfinance components, found that girls who received any arm of the youth-friendly services model had increased receipt of contraception (30%, 95% CI 24–45%, p<.05, 36). Similarly, Healthy Transitions for Nepali Youth, which used adolescent-friendly health services in combination with home visits, girls small-groups, and community mobilization efforts, found that women aged 15–24 years old had improved contraceptive prevalence rate (mCPR + 7%, 95% CI not reported, p<.01, 38) and use of a modern contraceptive method (+ 7%, 95% CI not reported, p<.001, Table 5 , 39). The Afya Halisi intervention in Kenya, however, which trained CHWs in youth-friendly services, combined with parental dialogue, peer-education desk, and community-outreach, found no significant effects (Supplement 3, 55). School-based education School-based education was evaluated in 9 of the 41 included studies; interventions were implemented primarily among unmarried adolescents, including very young adolescents (VYA, age 10–14 years old). Among measures assessing contraceptive use, prevalence, or uptake, all reported statistically significant or marginally significant positive effects (n = 5, 100%, Fig. 4, Table 5 ). School-based contraceptive and/or reproductive health education was also associated with many improvements in secondary (n = 7, 64%, Fig. 4) and methods-related outcomes, including intention ( 66 ), unmet need and demand ( 58 ), knowledge ( 47 , 54 , 68 , 69 ), and dual use of contraceptive methods at last sex (Supplement 3, 46). Experimental (n = 3) and quasi-experimental (n = 3) designs comprised two-thirds of studies assessing this strategy (66%). Other designs were of substantially lower quality (mean MMAT score 40%). Across the evidence base, school-based education was almost always implemented as part of multi-component intervention packages, frequently combined with peer-led approaches and adolescent-responsive services. Two interventions, one in Ghana and the other in India, employed school-based educational alone, educating adolescent girls in reproductive health education sessions ( 68 , 69 ) found improved contraceptive or SRH knowledge (Ghana: mean diff 1.17, 95% CI not reported, p<.05; India: mean difference over time 79.8 percentage points, 95% CI not reported, p<.05, Supplement 5). Neither assessed contraceptive use outcomes, however, and both studies were of low to moderate quality (Table 3 ). All three studies in Zambia, South Africa and Ethiopia assessing contraceptive use in multi-component designs found significant positive effects ( 47 , 48 , 58 ), two from moderate to high-quality RCTs and one cross-sectional design, though none isolated the effects of school-based education. One study which included school-based education with adolescent-responsive services found marginally significant increases in intention to use contraception (aOR 1.59, 95% CI 0.97–2.61, p<.1, 64) and another combining school-based education with peer-led counseling found increased demand for contraception (aOR 6.06, 95% CI 2.43–15.11, p = 0.01, 56). Among VYA, the Growing Up GREAT! Intervention, which took a wholistic gender-transformative approach and targeted both in-school and out-of-school adolescents with a comprehensive curriculum and community engagement, increased knowledge of pregnancy among in-school VYA and knowledge of where to obtain a contraceptive method among out-of-school VYA ( 54 ). Couple communication Couple communication strategies were evaluated in 7 of the 41 included studies all multi-component intervention packages, most commonly targeting married adolescents, young couples or first-time parents. Among studies assessing contraceptive use, prevalence, or uptake, all reported statistically significant or marginally significant improvements (n = 12, 92%; Fig. 4, Table 5 ). Various secondary outcomes—including partner support, spousal discussion of contraception, and birth spacing intentions—were also frequently assessed and demonstrated positive effects across studies (n = 23, 96%, Fig. 4, Supplement 3). Experimental (n = 2) and quasi-experimental (n = 4) designs accounted for the majority of evaluations assessing couple communication (75%), with experimental studies being of slightly slower quality and other studies slightly higher than overall averages (experimental: average MMAT score 50%; other: average MMAT score 70%, Fig. 3). Couple communication strategies were most often delivered through couple counseling, or structured discussion activities, in combination with small-group education, male engagement, or service-delivery adaptations (Table 4 ). Several studies, including MOMENTUM among first-time parents in the DRC and another first-time parent intervention in Nigeria, reported improvements in discussion of family planning (DRC: aRD 0.09, 95% CI 0.04–0.14, p<.05; Nigeria: +39%, 95% CI not reported, p<.001, Supplement 5) and partner support (Nigeria: +12.7%, 95% CI not reported, p<.001) following exposure to interventions including communication-focused components (Supplement 3, 40,44). In one multi-component intervention, Girl Power Malawi, partner communication was examined as an intermediate outcome and an isolated intervention component. Girls who attended two small-group sessions where communication with partners and communication skill-building was a primary topic of discussion had increased contraceptive communication with partners at six months (aOR = 1.48, 95% CI 1.07–2.38, p<.05) and increased non-barrier contraceptive use at one year (aOR 3.53, 95% CI 1.86–6.69, p<.05) compared to girls who only added one or no sessions. Contraceptive use at one year was found to be partially mediated by communication with partners at six months (indirect effect = 0.04, 95% CI: 0.01–0.07, 37) among participants who had previously not communicated with their partner about contraception at baseline, highlighting its relevance as a proximal pathway within broader intervention packages. Interpersonal communication Interpersonal communication strategies were included in 6 of the 41 included studies, exclusively within multi-component intervention packages, and involved one-on-one engagement with trusted individuals including parents, in-laws, mentors, providers, or other influential individuals. Among studies assessing contraceptive use, prevalence, or uptake, five of six reported significant positive effects (83%, Fig. 4, Table 5 ). Secondary proximal outcomes were more frequently assessed and demonstrated consistent positive associations across studies (n = 26, 87%, Fig. 4) – including knowledge, spousal approval, and service outcomes (Supplement 6). Quasi-experimental (n = 3) designs accounted for half of evaluations assessing interpersonal communication, with overall study quality comparable to the broader evidence base; no evaluations employed an experimental design (Fig. 3). Interpersonal communication was implemented often alongside small-group education, male engagement, social norms strategies or service-delivery components. Although the MOMENTUM intervention among first-time parents in the DRC study reported improvements in normative outcomes among “significant others” and “community members” and discussion with a health worker in early postpartum (aRD 0.23, 95% CI 0.19–0.28, p<.05, 40), no other study evaluated directly assessed changes over time in communication quality or frequency with trusted adults other than spouses, nor examined whether such communication mediated effects on contraceptive outcomes. Financial incentives Financial incentive strategies were evaluated in 4 of the 41 included studies and mostly within multi-component intervention packages. Among studies assessing contraceptive use, prevalence, or uptake, five of six measures reported significant positive effects (83%, Fig. 4, Table 4 ). Secondary proximal outcomes were more frequently assessed but showed greater heterogeneity in positive outcomes (n = 26, 79%, Fig. 4, Supplement 6). All evidence on this strategy derived from experimental evaluations (n = 4) of moderate overall quality (mean MMAT score 60%, Fig. 3). Financial incentives were delivered primarily through service-related vouchers (e.g., transport stipends) or conditional or unconditional cash transfers. Only one study, conducted in Zambia, isolated the effect of financial incentives alone. This evaluation compared an arm providing unconditional cash transfers to girls in 8-9th grade, their guardians, and school fees with a combined arm that paired economic support with comprehensive sexuality education and community dialogues. The economic-only arm showed no change in modern contraceptive use compared to controls (aRR 0.90, 95% CI 0.74–1.11, p<.1), whereas the combined arm demonstrated marginally significant improvements (aRR 1.14, 95% CI 0.95–1.37, p<.1; Table 5 , 45). The Girl Power Malawi intervention included three arms combining youth-friendly health services, small-group education for girls, and conditional cash transfers. All intervention arms demonstrated increased hormonal contraceptive uptake relative to controls (aRD: 39%, 95% CI: 34% to 45%, p<.05), with the highest uptake observed in the arm that included conditional cash transfers (Control: 10%, Youth-friendly services arm: 52%, Youth-friendly services + small-groups arm: 35%, youth-friendly services + small groups + conditional cash transfer: 74%, 36). In contrast, the Adolescent Girls Initiative–Kenya, which included wealth-generation components alongside violence prevention, education, and health programming, reported improvements in contraceptive knowledge but did not demonstrate a clear advantage of wealth-generation activities over arms without these components ( 52 ). Mass media Mass media strategies were evaluated in 3 of the 41 included studies, all of which employed observational designs. Among studies assessing contraceptive use, prevalence, or uptake, only two of seven measures reported significant positive effects (29%) (Fig. 4, Table 5 ). Four secondary outcome measures also found positive effects (100%, Fig. 4). Study designs were all cross-sectional and had comparably higher quality than the other study design average across all studies (average MMAT score 75%, Fig. 3). Most mass media interventions stratified exposures resulting in heterogenous outcome directionality, highlighting that mass media’s effects may differ by urbanicity, country, or method of delivery. For example, one study in Nigeria found that urban AYA exposure to family planning messages in the media was associated with significantly less contraceptive use (0.38, 95% CI 0.21–0.68, p 0.1, 68). Another study using Demographic and Health Survey (DHS) data from Burkina Faso and Senegal found a null effect for Burkina Faso (aOR 0.98, 95% CI 0.42–2.30, p>.1) but a rather large marginally significant effect for Senegal (aOR 2.30, 95% CI 0.92–5.73, p<.1, 69). Finally, a third study in Nigeria found that mass media exposure was associated with higher contraceptive use but only in particular parts of the country and only through certain mediums – specifically radio, TC, and mobile exposure (Table 5 , 70). Digital technology Digital technology strategies were evaluated in 3 of the 41 included studies, all of which employed experimental RCTs as standalone strategies in East Africa. Only one evaluation, conducted among university students in Uganda, assessed contraceptive use, and reported a statistically significant increase in SRH knowledge and contraceptive use following exposure (aOR 1.58, 95% CI 1.02–2.46, p<.05; Table 5 , 71). This intervention, while including digital mobile information on contraceptives also facilitated direct connection to condoms and services at clinics. In contrast, two RCTs in Kenya ( 74 , 75 ), both of which only relied on low-intensity delivery modalities, including one-way SMS messaging or passive digital campaigns, with limited tailoring, personalization, or interactivity (Table 3 ), reported null or modest effects on contraceptive-related knowledge outcomes and did not assess contraceptive use (Fig. 4, Supplement 5). All evidence on this strategy derived from experimental evaluations (n = 3) of moderate overall quality (mean MMAT score 60%, Fig. 3). Empowerment components Empowerment-oriented strategies were evaluated in 2 of the 41 included studies within multi-component intervention packages. Seven of 13 secondary outcome measures were positive 54% (Fig. 4); no studies reported on primary outcomes. The Adolescent Girls Initiative – Kenya (AGI-K) high-quality (MMAT 80%) cluster RCT showed improved gender attitudes and knowledge among very young adolescents through a combined savings and life skills program, which targeted girls empowerment through violence prevention activities and financial empowerment (Supplement 3, 50). Another repeated cross-sectional study, UPLIFT in urban Uganda, combined life empowerment-based skills training, savings groups, financial literacy, and referrals to services for youth finding improved knowledge of where to get family planning but found no effect on AYA feeling they can make decisions about whether and when to have children without fear – a component of agency (Supplement 3, 51). Neither study isolated the empowerment platform or included other agency/empowerment measures. Integrated service delivery Integrated service delivery was tested in 2 of 41 studies, both linking family planning to maternal health care ( 67 , 76 ). In Ethiopia, a high-quality (MMAT 80%, Table 3 ) prospective cohort study found for each ANC, delivery, or PNC session where FP was discussed, women had a greater hazard of initiating a modern contraceptive method (aHR 1.34, ste 0.07, p<.0001, Table 5 , 74). In Brazil, a moderate-quality (MMAT 50%) retrospective observational program evaluation found increased uptake of IUD and other methods with exposure to FP counseling within integrated services, but decreased uptake of injections (Table 3 , Supplement 3, 65). Supply, quality of care, and other strategies were underrepresented in the identified evidence-base. Identified studies included emergency contraception (EC) provision ( 77 ), respectful care ( 76 ), arts-based approaches ( 46 ), and village-level coordination ( 40 ); however, none were evaluated as standalone strategies. As a result, conclusions regarding the effectiveness of these approaches remain highly limited. DISCUSSION This REA synthesizes recent evidence from 2014 to 2024 on intervention strategies to improve contraceptive-specific outcomes among AYA in LMICs, drawing on 41 quantitative studies. By organizing evidence using an intervention-strategy typology and presenting our findings comparatively across strategies, this review extends prior syntheses that either focus broadly on adolescent SRHR or examine single intervention types/strategies ( 14 , 16 , 17 , 20 , 78 – 81 ). A central finding is that the evidence clusters around multi-strategy intervention packages, which more consistently report statistically significant improvements across contraceptive use and key proximal outcomes than single-strategy interventions. At the same time, the review highlights persistent limitations in study quality, incomplete reporting of effectiveness based on implementation exposure, and the limited ability of the field to attribute contraceptive-related effects to individual intervention strategies. What appears most promising—and what remains uncertain Across the evidence base, interventions combining strategies that operate at multiple levels most consistently reported improvements in contraceptive use and uptake (Fig. 2). This pattern aligns with socioecological perspectives on adolescent behavior change and with the practical reality that contraceptive decision-making for AYA is shaped by intersecting influences which differ by life stage ( 82 – 84 ). However, because most studies evaluated bundled intervention packages, we have limited insight into which intervention strategies drive change, by how much, and for whom. Thus, the comparative findings should be interpreted as indicating that interventions including particular strategies tend to show positive outcomes among particular populations/settings, rather than generalizing independent effects of individual components. This reflects a broader pattern in adolescent SRHR research, where multi-component program designs often outpace the ability to evaluate their discrete effects ( 85 , 86 ). Even among the RCTs identified in this study, reporting on discrete strategy intervention arms, implementation fidelity, intensity, or adaptations was rare, hindering interpretation and real-world applicability at scale ( 87 ). These questions are of paramount importance, especially as multi-component models become more common yet harder to replicate with fidelity at the population-level ( 86 ). Evidence was strongest and most consistent for small-group education, social norms approaches, engaging men and boys, extension worker strategies, and couple communication, which all had a robust evidence base which frequently showed positive associations for contraceptive use as well as knowledge, attitudes/norms, communication, and service-related outcomes. Furthermore, all of these strategies had one or more studies with positive effects on contraceptive-related outcomes that either (A) tested the strategy in isolation in a single-strategy approach, observational study, or a separate study arm, and/or, (B) measured positive effects on specific outcomes that speak to the strategic mechanism invoked by that particular intervention strategy (e.g., increases in partner communication with interventions involving couple communication). These findings align with prior reviews, global guidance, and research agendas ( 88 – 90 ) which highlight AYAs’ desire to belong and conform to perceived norms within groups that matter to them—whether peers, family, partners, or the broader community—by fostering shared values and reference standards that guide behavior. Furthermore, this aligns with work that supports the strong influence of partners particularly among married AYA and first-time parents ( 90 ). For other strategies —such as peer-led education, adolescent-responsive services, school-based education, interpersonal communication, and financial incentives— the evidence base was smaller and/or mixed, though showed promise in particular contexts and/or intervention packages. For example, peer-led counseling may be particularly influential in refugee settings where adolescents may more readily trust someone perceived as similar to them compared to a health worker ( 59 ); other studies have found that peer-support in these settings can improve wellbeing ( 78 ). Financial incentive intervention evaluations were limited and typically embedded within broader programs; the one study isolating incentives found no effect when delivered alone, while combined packages showed more favorable outcomes. This aligns with evidence suggesting that incentives alone rarely change contraceptive behavior but may facilitate engagement with other components by reducing structural barriers ( 91 , 92 ). Interpersonal communication and adolescent-responsive services were commonly associated with improvements in knowledge, approval, and service engagement, but showed less consistent effects on contraceptive use and greater variability in study quality. Prior research similarly indicates that youth-friendly services and supportive communication improve satisfaction and service utilization, though links to contraceptive uptake remain mixed ( 79 , 93 ). School-based education demonstrated generally positive associations with contraceptive-related outcomes, but contraceptive use was assessed less frequently than secondary outcomes, and heterogeneity in study quality and measurement limited confidence in effect size and consistency; prior syntheses note that school-based programs often reach adolescents before sexual initiation, capturing upstream outcomes rather than immediate contraceptive behaviors ( 94 , 95 ). Several strategies that are frequently emphasized in programming and policy discussions – mass media, digital technology, empowerment, and integrated service delivery – remain underrepresented in the identified AYA contraceptive evidence base, though other studies among women of reproductive age (age 15–49) have shown positive impacts ( 80 , 96 – 98 ). Additionally, few studies explicitly addressed life-stage or equity segmentation. Most targeted unmarried adolescents in school or married adolescents, with limited attention to transitions like first birth. Very few studies included displaced youth, those with disabilities, or those experiencing violence or coercion, all of which have been found to be associated with poor contraceptive and reproductive health outcomes ( 99 – 101 ), and bring question to if our current intervention strategies are reaching and effective among those most in need. Implications for Future Research and Investment Findings suggest that future research should prioritize study designs that strengthen causal inference about strategy contributions within multi-component packages and test hypothesized mechanisms of change. This includes more frequent use of comparative arms (e.g., factorial, adaptive, or comparative effectiveness designs), clearer reporting of implementation fidelity and exposure-dose in addition to intent-to-treat analyses, and explicit measurement of hypothesized mediators to test pathways of change. Greater use of mixed-methods and implementation science frameworks could support understanding of context, adaptation, and scale-up feasibility ( 102 , 103 ). Additionally, targeted research in underrepresented areas and for underserved groups, including VYA, out-of-school youth, those living in humanitarian settings, and those experiencing violence is urgently needed. Role of AI in Accelerating Evidence Translation This REA also demonstrates how AI-assisted tools can support rapid evidence translation while maintaining transparent review processes. Using ASReview to prioritize screening and SysRev to support structured tagging enabled timely synthesis across a large number of records—an important advantage when decision-makers require evidence on short timelines – and has been shown to maintain quality in prior studies ( 24 – 26 ). At the same time, AI-assisted approaches require careful oversight and transparent documentation of decisions to maintain credibility and minimize the risk of missing relevant studies. As these tools mature, they may play an increasingly important role in maintaining up-to-date syntheses in fast-moving program areas such as AYA family planning. Limitations Although the REA approach enabled a timely synthesis, it involved methodological trade-offs relative to full systematic review procedures. We relied on a single reviewer for screening and data extraction, which may have introduced selection or coding bias, although oversight was provided by senior reviewers. The reliance on AI-assisted tools for screening (ASReview) prioritization may have deprioritized relevant studies, though we used a conservative stopping rule and documented screening yield. We searched two scholarly databases and included expert input, but additional studies may have been identified through expanded database coverage or inclusion of grey literature and non-English publications. Additionally, heterogeneity in intervention content, outcomes, and study designs precluded meta-analysis, limiting our ability to quantify pooled effects. Finally, the intervention-strategy typology necessarily involved reviewer judgment, and overlapping strategies within intervention packages limited attribution of effects to individual components; MMAT ratings also capture only certain dimensions of rigor and may not reflect implementation strength or contextual relevance. CONCLUSION In summary, this REA finds that multi-strategy intervention packages that incorporate male engagement, social norms/network strategies, couples’ communication, and small-peer groups are most consistently associated with improvements in contraceptive-related outcomes among AYA in LMICs. However, the evidence base remains constrained by limited evidence on effectiveness of individual intervention strategies. Advancing the field will require more rigorous comparative designs, stronger implementation measurement, and intentional investment in under-studied strategies and populations to support effective, equitable, and scalable contraceptive programming for adolescents and young adults. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials All data generated or analyzed during this study are included in this published article [and its supplementary information files]. Competing interests The authors declare that they have no competing interests. Funding This review was funded by The Gates Foundation [INV-066837]. The funder helped to conceptualize the study and provided input into methodology. The funder did not contribute to data collection, analysis, decision to publish or preparation of the manuscript. Authors' contributions JU conceptualized the study and designed the methodology with input from KH, LM, KL, and GK. JU led data curation, formal analysis, investigation, visualization, project administration, and writing – original draft preparation under supervision of KH, LM, and EP. Funding was acquired by KH and LM. JU, KH, LM, KL, GK, and EP all contributed to writing – review and editing. All authors read and approved the final manuscript. Acknowledgements We would like to acknowledge the management and coordination guidance provided by project manager, Amanda Beal, at the University of California San Diego to this research. References Sully EA, Biddlecom A, Darroch JE, Riley T, Ashford LS, Lince-Deroche N, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019. 2020 Jul 28 [cited 2025 Jul 30]; Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019 Li Z, Patton G, Sabet F, Zhou Z, Subramanian SV, Lu C. 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Available from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00635-7/fulltext Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009 Aug 7;4(1):50. Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2009 Jan;36(1):24–34. Additional Declarations No competing interests reported. Supplementary Files Supplements123.docx Supplement4.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/944c8620d85b4f30e9d4c2cf.png"},{"id":102753052,"identity":"6c7de527-5249-4dd2-b6c7-eb5f242bbb7f","added_by":"auto","created_at":"2026-02-16 09:33:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69392,"visible":true,"origin":"","legend":"\u003cp\u003eDirectionality of Outcomes by Intervention and Outcome\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/157f7f4ddc0025280735092d.png"},{"id":102753053,"identity":"5e7cf035-ef68-4d5e-b9a3-0fe8842b25d2","added_by":"auto","created_at":"2026-02-16 09:33:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":107946,"visible":true,"origin":"","legend":"\u003cp\u003eDirectionality of Outcome by Intervention Strategy and Outcome Type\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/aabb8af43c227d348b768005.png"},{"id":102753973,"identity":"0843f26c-4ce8-4df6-8bdb-3d93182f7b87","added_by":"auto","created_at":"2026-02-16 09:36:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":121065,"visible":true,"origin":"","legend":"\u003cp\u003eAverage MMAT Score by Intervention Strategy and Study Design*\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/d5f1e3fb38fe9670422155be.png"},{"id":102754954,"identity":"c6b975cd-f90d-48d2-a286-8a5e51823cba","added_by":"auto","created_at":"2026-02-16 09:40:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3177247,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/e4a1edd9-4527-4de4-84ae-14c63701951f.pdf"},{"id":102753226,"identity":"6e2246cb-c504-48b9-8049-12a31c16d100","added_by":"auto","created_at":"2026-02-16 09:34:07","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":51539,"visible":true,"origin":"","legend":"","description":"","filename":"Supplements123.docx","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/d297aec3933cd4b96c050d46.docx"},{"id":102753311,"identity":"d43bcb77-34a6-424e-98e0-218f1bbb9119","added_by":"auto","created_at":"2026-02-16 09:34:29","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":131436,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement4.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8716367/v1/a66c4af64b35be9cefcdcff1.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"What Works to Improve Contraceptive Outcomes Among Adolescents and Young Adults in LMICs: A Rapid Evidence Assessment and Synthesis by Intervention Strategy","fulltext":[{"header":"PLAIN ENGLISH SUMMARY","content":"\u003cp\u003eAdolescents and young adults in many low- and middle-income countries often want to avoid pregnancy but are not using contraception. Young people face barriers to contraceptive use like limited information, stigma about sexuality, partner or family pressure, gender inequality, cost and accessibility issues, and health services that may feel judgmental or unsafe.\u003c/p\u003e\n\u003cp\u003eTo inform decision-makers investments, we reviewed recent research (2014–2024) on interventions designed to improve contraceptive outcomes for young people ages 10–24. We searched two major medical databases (PubMed and Embase) and used a combination of computer-assisted tools and human review to quickly and carefully identify the most relevant studies. We then grouped each program by the types of strategies it used (for example: small group discussions, working with peers, involving male partners, changing social norms, or outreach visits) and assessed the overall quality of the evidence.\u003c/p\u003e\n\u003cp\u003eWe found 41 studies that met our criteria. Most were from Sub-Saharan Africa, and many tested programs that combined multiple strategies rather than relying on only one. Overall, the most consistent improvements in contraceptive use were seen in multiple-strategy programs that included small group education, social norm change efforts, involvement of men and boys, outreach visits, and couple communication activities.\u003c/p\u003e\n\u003cp\u003eHowever, many studies did not clearly show which specific program components mattered most, how much exposure was needed, or whether programs were delivered as intended. Future research should test specific strategies and track implementation quality so effective approaches can be scaled.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eAdolescents and young adults (AYAs), ages 12 to 24 years old, in low- and middle-income countries (LMICs) experience disproportionately high unmet need for contraception, driven by intersecting individual, social, and structural barriers and resting in to poor reproductive health outcomes. In 2019, an estimated 43% of adolescent girls aged 15\u0026ndash;19 in LMICs who wished to avoid pregnancy were not using modern contraception, nearly twice the rate of all women aged 15\u0026ndash;49 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with demand satisfied lowest among 15\u0026ndash;24-year-olds, particularly in Sub-Saharan Africa and South Asia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These disparities contribute to approximately 21\u0026nbsp;million adolescent pregnancies annually in LMICs, at least half of which are unintended (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and associated with elevated risk of pregnancy complications, unsafe abortions, and adverse education, income, and health outcomes for girls (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Persistent barriers to contraceptives for AYA include limited sexual and reproductive health (SRH) information, financial constraints, restricted agency (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), stigmatizing social norms surrounding AYA sexuality and non-marital contraceptive use, gendered power imbalances that limit negotiation with partners or pressure married adolescents to demonstrate fertility (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and health system and policy barriers such as provider bias, lack of confidentiality, parental consent laws and sexuality education bans (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 2025 World Health Organization (WHO) guidelines call for urgent, targeted investments to reduce early and unintended pregnancies among AYAs in LMICs (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Effective policy and programming remains challenging, however, as decision-makers lack recent, consolidated evidence on what works to improve contraceptive outcomes for this population. Although prior reviews have examined adolescent sexual and reproductive health and rights (SRHR) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), few focus specifically on contraceptive use. Some recent reviews have examined specific intervention strategies, including structural (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), empowerment-based (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and financial incentive (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) approaches. However, interventions to improve SRHR outcomes are increasingly complex and multi-component, comprising interacting activities often delivered across multiple levels (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Despite this complexity, there are no recent reviews that offer a comparative synthesis across intervention strategies.\u003c/p\u003e \u003cp\u003eIn addition to contraceptive use, a range of proximal mediating outcomes \u0026ndash; including contraceptive intentions, reproductive norms, and contraceptive knowledge, attitudes, and self-efficacy \u0026ndash; play a critical role in shaping future contraceptive behaviors, particularly among AYAs, many of whom have not yet initiated sexual activity but are approaching sexual debut (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These mediating outcomes are infrequently examined or synthesized in existing reviews, limiting their usefulness for informing early and preventive programming despite their critical role in activating change pathways. At the same time, traditional systematic reviews, though rigorous, are resource-intensive and may be too slow to meet urgent programmatic and funding timelines. Artificial Intelligence (AI)-assisted methodologies are increasingly used to accelerate rapid syntheses (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), yet, to our knowledge have not yet been applied to synthesize evidence on AYA SRHR.\u003c/p\u003e \u003cp\u003eWe conducted a rapid evidence assessment (REA) using AI-assisted tools alongside human expertise to identify and appraise recent peer-reviewed evidence (2014\u0026ndash;2024) on intervention strategies to improve contraceptive-related outcomes for AYA, conducting a comparative analysis across intervention strategies and assessing study design and quality, to inform investment decision-making.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eOur REA approach followed steps from Crawford et al., 2015 (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and PRISMA guidelines (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) to answer the research question \u0026ldquo;\u003cem\u003eWhat has worked to improve contraceptive outcomes among adolescents and young adults (AYA) in low- and middle-income countries (LMICs) from 2014\u0026ndash;2024?\u0026rdquo;\u003c/em\u003e The review team included a PhD student analyst, a master\u0026rsquo;s-level research coordinator, and two senior co-Principal Investigators. A liaison from the coordinating funding institution also provided technical input on the search and analysis methodology. To enhance efficiency given funding strategy timelines and limited human resources, we employed two AI\u0026ndash;assisted tools for use at specific points in the review process to complement human analyst efforts: ASReview for title and abstract screening and SysRev for full-text screening and tagging.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eIn collaboration with a social and behavioral health research librarian, we conducted a broad search in PubMed and Embase using MeSH terms and free-text keywords related to adolescents and young adults, contraception or family planning, and LMIC contexts. Country-specific terms were added to align with the funder\u0026rsquo;s priority geographies (e.g., Nigeria, Niger, Senegal, Ethiopia, C\u0026ocirc;te d'Ivoire, Pakistan). Several articles were also identified through expert referral. Duplicates were removed in EndNote (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Full search terms are listed in Supplement 1.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eEligible studies evaluated an intervention conducted in LMICs, were published between January 1, 2014, and February 1, 2024, reported at least one quantitative contraceptive-related outcome, reported on outcomes for AYA (10\u0026ndash;24 years old), and were written in English and published in a peer-reviewed journal. We excluded protocols, commentaries, reviews (though reference lists were scanned), grey literature, descriptive studies without an intervention strategy evaluation, studies on COVID-19, natural or conflict events, multi-country studies that include LMICs but do not disaggregate results for LMICs specifically, studies reporting exclusively qualitative outcomes, and articles not published in English. Full Population, Intervention, Context, Outcome, and Study type (PICOS) criteria are in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePopulation, Intervention, Context, Outcome, and Study type (PICOS) Inclusion and Exclusion Criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncludes adolescents or young women age 10 to 24 and presents results specific to this population or was specifically designed for this population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes not include adolescents or young women age 10 to 24 or does not present any results specific to this population\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluates intervention, program, or programmatic strategy (e.g., mass media) to improve contraceptive outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvaluates contraceptive changes during COVID, natural events, conflicts, or climate change\u003c/p\u003e \u003cp\u003eor does not evaluate an intervention, program, or programmatic strategy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContext\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTakes place in and presents results specific to a low- or middle-income country\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes not take place in a low- or middle- income country and/or presents only results from a high-income country​\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresents evaluation results on at least one quantitative family planning or contraceptive outcome​ (e.g., contraceptive use, discontinuation, SRHR knowledge, self-efficacy, intention to use, etc.) in an LMIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes not present results on a family planning or contraceptive outcome or only presents qualitative results or implementation results or does not disaggregate LMIC outcomes from high-income countries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer-reviewed manuscript, published between January 1, 2014 to February 1, 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReviews, commentaries, grey literature, conference presentations\u003c/p\u003e \u003cp\u003ePeer-reviewed manuscripts not published in English\u003c/p\u003e \u003cp\u003ePeer-reviewed manuscripts published outside of January 1, 2014 to February 1, 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eScreening and Tagging\u003c/h3\u003e\n\u003cp\u003eFollowing de-duplication, records were imported into ASReview Lab, an open-source platform that uses active machine learning to continuously re-order the most relevant studies for manual human title and abstract screening (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Prior to beginning manual screening, ten studies were pre-labeled as relevant or irrelevant (5 each) to train the AI algorithm. As the human analyst progressed through manual title and abstract screening labeling articles as relevant or irrelevant, the tool continuously re-ranked remaining citations based on relevance predictions. Per guidance on using ASReview and to conserve human resources (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), we adopted a stopping rule whereby manual screening ceased after 100 consecutive records were manually labeled as irrelevant following the last relevant article. One prior study of ASReview found, using the AI-assisted prioritization function, manually screening 15% of identified records was sufficient to identify all studies, substantially reducing the volume of manual title and abstract screening required (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The ASReview data set was then exported into a CSV.\u003c/p\u003e \u003cp\u003eRecords labeled as relevant in the CSV file were imported into SysRev, a web-based platform used to conduct full-text screening and structured tagging (i.e., data extraction on key article attributes) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Full texts were manually retrieved and uploaded prior to full-text screening. Based on full-text review, articles were manually tagged as relevant or not relevant and across a variety of study attributes and inclusion/exclusion criteria. Relevant tags included: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) article type (peer-reviewed, targeted grey literature, other); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) included outcomes specific to AYA; included family planning (FP) outcomes; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) article domain (factors affecting FP, intervention strategy evaluation, surveillance data, measures paper, other, or unsure); (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) geography; and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) study design.\u003c/p\u003e \u003cp\u003eAll full-text screening and tagging were conducted by a single PhD-level analyst based in the United States with over seven years of expertise in SRHR for AYA in LMICs. To ensure consistency and quality, the senior study team provided oversight through regular check-ins, review of tagging decisions, and resolution of uncertainties through discussion.\u003c/p\u003e\n\u003ch3\u003eData Extraction and Quality Assessment\u003c/h3\u003e\n\u003cp\u003eStudies manually labeled as relevant after full-text review were then manually extracted in Excel, including: study setting, population, design, sample size, attrition, methods, intervention characteristics, and contraceptive outcomes, with effect sizes and significance. Each study was coded into one or more of 17 predefined intervention strategies, based on the coordinating funder\u0026rsquo;s framework and the research team\u0026rsquo;s knowledge of AYA SRHR programs. In this review, we distinguish between \u003cem\u003einterventions\u003c/em\u003e and \u003cem\u003eintervention strategies\u003c/em\u003e to enable meaningful comparative synthesis across heterogeneous programs. We define an intervention as an intentional program or package of activities designed to improve health outcomes, often multicomponent in nature (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). By contrast, intervention strategies, drawing on implementation science and intervention design frameworks (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), are theory-informed approaches or actions within interventions hypothesized to contribute to improved outcomes. Strategies are not mutually exclusive and are often combined within a single intervention. Intervention strategies and definitions are provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntervention Strategy Typology and Operational Definitions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention Strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAdolescent-responsive services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth services intentionally designed or adapted to meet the unique needs, preferences, and developmental stage of adolescents.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCouple communication\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventions designed to improve dialogue, negotiation, or joint decision-making between romantic or sexual partners.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDigital technology\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnology-based interventions such as mobile apps, SMS, or online platforms used to deliver information or support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEmpowerment components\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup-based platforms (e.g., savings groups or solidarity circles) that build agency, economic resilience, and social support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEngaging men and boys\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrategies that involve male partners or peers to shift norms, improve communication, or support FP and SRH outcomes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eExtension worker\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of community-based health workers or outreach agents to provide information, counseling, or contraceptive services directly to adolescents usually at home or in small groups.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFinancial incentives\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonetary or in-kind support (e.g., cash transfers, vouchers) used to reduce financial barriers or motivate behavior change.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIntegrated service delivery\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelivery of multiple health services\u0026mdash;such as FP, HIV, and maternal health\u0026mdash;in a coordinated manner to improve access, continuity, and efficiency of care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eInterpersonal communication\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne-on-one support focused on improving adolescents' communication with non-romantic figures such as parents, guardians, or mentors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMass media\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of TV, radio, print, or digital broadcast to disseminate messages to a broad adolescent audience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePeer-led approaches\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventions delivered by trained youth or community peers to influence knowledge, attitudes, or behaviors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eQuality of care improvements\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvider training, supervision, or systems-level changes aimed at improving the quality and person-centeredness of FP counseling.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSchool-based education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelivery of SRH and FP content within formal school settings through curricula or extracurricular activities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSmall-group education\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStructured, curriculum-driven sessions facilitated by an educator or health worker, focused on delivering targeted knowledge and skills (e.g., contraceptive methods, SRH information) to small cohorts.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSocial norms \u0026amp; networks\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApproaches that leverage social influence by engaging individuals that are influential to the target beneficiaries FP practices (e.g., partners, parents, in-laws) and/or aim to shift shared community beliefs, norms, or behaviors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSupply\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventions focused on providing access to contraceptive methods, including on-site provision, stock availability, method choice, or mobile outreach delivery.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOther\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterventions that do not fit within the predefined strategy categories.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe stratified analyses and visualizations by study design in three categories (experimental, quasi-experimental, other), consistent with established distinctions in the causal inference and evaluation literature (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). \u003cem\u003eExperimental\u003c/em\u003e studies were randomized evaluations with a comparison group and baseline and follow-up data collection. \u003cem\u003eQuasi-experimental\u003c/em\u003e studies included designs with a comparison group and baseline and follow-up data collection but without random assignment. \u003cem\u003eOther\u003c/em\u003e designs comprised observational and descriptive evaluations lacking randomization a concurrent comparison group, including longitudinal or repeated cross-sectional studies, cohort studies, single-group pre\u0026ndash;post designs, and retrospective program evaluations.\u003c/p\u003e \u003cp\u003eQuality appraisal used the 2018 version of the Mixed Methods Appraisal Tool (MMAT) according to study design (quantitative randomized, non-randomized, or mixed methods). Each of the five MMAT criteria were scored as \u0026ldquo;Yes\u0026rdquo; (1 point), \u0026ldquo;Partial\u0026rdquo; (0.5), \u0026ldquo;No\u0026rdquo; or \u0026ldquo;Can\u0026rsquo;t tell\u0026rdquo; (0). A total score was generated for each study, converted into a percentage. Full MMAT scoring is detailed in Supplement 2. To contextualize the strength of the evidence base, bar graphs summarized study quality appraisal results using MMAT criteria, stratified by study design and intervention strategy.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes of Interest\u003c/h2\u003e \u003cp\u003ePrimary outcomes were contraceptive-use outcomes, including current or ever use of any or modern contraceptive methods, contraceptive uptake or initiation, and contraceptive prevalence rates. Secondary outcomes included contraceptive-specific mediating determinants of contraceptive use (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), including indicators of contraceptive need and intention (e.g., unmet need for contraception, intention to use contraception), individual-level determinants (e.g., contraceptive knowledge, attitudes about contraception, self-efficacy to use contraception, endorsement of contraceptive-related myths), interpersonal and social determinants (e.g., partner communication about contraceptives, perceived norms regarding contraceptive use, and approval of contraceptives), and service-related outcomes (e.g., whether a health facility was visited for contraception). Other outcomes included those that disaggregated contraceptive use by method type. Family planning outcomes not specific to contraception, such as pregnancy incidence, or general empowerment, were excluded from extraction.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome Synthesis and Visualization\u003c/h3\u003e\n\u003cp\u003eResults were organized into analytical matrices stratified by intervention strategy, study design, and outcome type. Findings were synthesized using a structured narrative approach supported by tabular summaries and visualizations designed to facilitate comparison across heterogenous evidence.\u003c/p\u003e \u003cp\u003eBubble charts were used to map evidence by intervention, distinguishing single-strategy versus multi-strategy interventions (mutually exclusive), as well as by specific intervention strategy (not mutually exclusive). Charts were stratified by outcome type and effect directionality, with \u003cem\u003epositive effects\u003c/em\u003e defined as statistically significant (p\u0026lt;.05) or marginally significant (p\u0026lt;.1) improvements in contraceptive-specific outcomes, \u003cem\u003enull effects\u003c/em\u003e defined as non-significant (p\u0026gt;,1), neutral, or untested effects, and \u003cem\u003enegative effects\u003c/em\u003e defined as statistically significant (p\u0026lt;.05) or marginally significant (p\u0026lt;.1) adverse effects. Bubble size represented the number of extracted outcomes. For primary contraceptive use outcomes, analysis prioritized a single outcome per study where possible; when studies did not report one singular primary outcome (e.g., results presented by sex, county, or study arm) all reported primary outcomes were analyzed and included in visualizations. All secondary and method-specific outcomes of interest were also included in visualizations. No outcomes were combined.\u003c/p\u003e \u003cp\u003eGiven substantial heterogeneity across study attributes and reporting, quantitative meta-analysis was not feasible nor appropriate (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Synthesis focused on identifying intervention strategies demonstrating consistent, credible evidence of effectiveness, as well as examining strategy co-occurrence, delivery platforms, and contextual variation with examples to inform considerations of feasibility and relevance for expansion. Draft findings were reviewed with the study team, technical advisors, and the funder, and refined based on input.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe identified 4,431 records from Embase (n\u0026thinsp;=\u0026thinsp;1,172), PubMed (n\u0026thinsp;=\u0026thinsp;3,253), and expert input (n\u0026thinsp;=\u0026thinsp;6). After removing 827 duplicates, 3,604 unique records were imported into ASReview. A human analyst screened 1,311 records (36.4%) before reaching the stopping criterion of 100 consecutive irrelevant articles, yielding 383 potentially relevant records. The remaining 2,293 records were marked as ineligible by the AI-automation tool; 10 texts were not retrievable. Of 373 full texts retrieved and reviewed in SysRev, 41 met inclusion criteria. The most common reason for exclusion was not being an intervention evaluation (n\u0026thinsp;=\u0026thinsp;334, Fig.\u0026nbsp;1). Recorded reasons for exclusion were not mutually exclusive.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Characteristics Description\u003c/h2\u003e \u003cp\u003eMost studies (88%) were conducted in Sub-Saharan Africa, with the largest number from Ethiopia (n\u0026thinsp;=\u0026thinsp;7), Kenya (n\u0026thinsp;=\u0026thinsp;5), and Nigeria and Uganda (n\u0026thinsp;=\u0026thinsp;4 each); the remaining studies were conducted in South Asia. Approximately one-third of studies used an experimental evaluation design (n\u0026thinsp;=\u0026thinsp;14, 34%), one-fifth used a quasi-experimental design (n\u0026thinsp;=\u0026thinsp;9, 22%), and the remaining 19 studies (46%) employed other designs. These included cross-sectional studies (n\u0026thinsp;=\u0026thinsp;6, 15%), single-group pre-post studies without a comparison group (n\u0026thinsp;=\u0026thinsp;5, 12%), retrospective observational program evaluations (n\u0026thinsp;=\u0026thinsp;3, 7%), repeated cross-sectional studies (n\u0026thinsp;=\u0026thinsp;3, 7%), and prospective cohort studies (n\u0026thinsp;=\u0026thinsp;1, 2%).\u003c/p\u003e \u003cp\u003eOver half of studies (n\u0026thinsp;=\u0026thinsp;23, 56%) reported a primary outcome of contraceptive use or uptake. Secondary outcomes included those related to contraceptive or SRH knowledge (n\u0026thinsp;=\u0026thinsp;17, 41%), service (n\u0026thinsp;=\u0026thinsp;6, 15%), attitudes (n\u0026thinsp;=\u0026thinsp;3, 7%), communication (n\u0026thinsp;=\u0026thinsp;3, 7%), contraceptive intentions (n\u0026thinsp;=\u0026thinsp;3, 7%), self-efficacy/agency (n\u0026thinsp;=\u0026thinsp;3, 7%), norms (n\u0026thinsp;=\u0026thinsp;2, 5%), spousal approval (n\u0026thinsp;=\u0026thinsp;2, 5%), unmet need (n\u0026thinsp;=\u0026thinsp;1, 2%), and demand (n\u0026thinsp;=\u0026thinsp;1, 2%). A subset of studies further disaggregated contraceptive use or uptake by method type (n\u0026thinsp;=\u0026thinsp;8, 20%).\u003c/p\u003e \u003cp\u003eMMAT scores ranged from 20% to 90% (mean 59%), indicating moderate overall quality; only two studies received scores above 80%.\u003c/p\u003e \u003cp\u003eOne-third of studies assessed a single intervention strategy (n\u0026thinsp;=\u0026thinsp;14, 34%) while two-thirds evaluated multi-strategy interventions (n\u0026thinsp;=\u0026thinsp;27, 66%). The most commonly implemented intervention strategies were small-group education (n\u0026thinsp;=\u0026thinsp;18, 44%), social norms and network approaches (n\u0026thinsp;=\u0026thinsp;12, 29%), peer-led approaches (n\u0026thinsp;=\u0026thinsp;11, 27%), and engaging men and boys (n\u0026thinsp;=\u0026thinsp;11, 27%). Other intervention strategies included extension workers (n\u0026thinsp;=\u0026thinsp;10, 24%), adolescent responsive services (n\u0026thinsp;=\u0026thinsp;10, 24%), school-based education (n\u0026thinsp;=\u0026thinsp;9, 22%), couple communication (n\u0026thinsp;=\u0026thinsp;7, 17%), interpersonal communication (n\u0026thinsp;=\u0026thinsp;6, 15%), financial incentives (n\u0026thinsp;=\u0026thinsp;4, 10%), mass media (n\u0026thinsp;=\u0026thinsp;3, 7%), digital technology (n\u0026thinsp;=\u0026thinsp;3, 7%), empowerment components (n\u0026thinsp;=\u0026thinsp;2, 5%), and integrated service delivery (n\u0026thinsp;=\u0026thinsp;2, 5%). Supply-side and quality of care strategies were rare (n\u0026thinsp;=\u0026thinsp;1, 2% each, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Included Studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy (Name, Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePopulation Studied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSetting/Region\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive Related Outcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMMAT Score \u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntervention strategies \u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUrban and rural areas of Ethiopia from Demographic and Health survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlekhya et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGirls enrolled in 9th-12th grades age 14\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBhubaneswar government schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAwareness of contraceptive methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArinze-Onyia et al., 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale students attending university age 18\u0026ndash;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUniversity of Nigeria, Enugu Campus, Southwestern Nigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSupply\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAustrian et al., 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery young adolescent girls age 11\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNairobi (Kibera) and Wajir (Northeastern Kenya)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eKnows method of modern contraception\u003c/p\u003e \u003cp\u003eSRH knowledge score\u003c/p\u003e \u003cp\u003eCondom self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEmpowerment components \u003c/p\u003e \u003cp\u003eFinancial incentives \u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBajoga et al., 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSix urban cities in Nigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBakesiima et al., 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale refugees age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePalabek Refugee Settlement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive uptake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhandari et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNepal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKarnali Province (Jajarkot, Surkhet, Dailekh, Kalikot)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre/post without comparison group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModern contraceptive prevalence rate\u003c/p\u003e \u003cp\u003eAny contraceptive prevalence rate\u003c/p\u003e \u003cp\u003eInjunctive norms of community supporting delay of first pregnancy\u003c/p\u003e \u003cp\u003eInjunctive norms of community supporting birth spacing\u003c/p\u003e \u003cp\u003eInjunctive norms of family supporting delay of first pregnancy\u003c/p\u003e \u003cp\u003eInjunctive norms of family supporting birth spacing\u003c/p\u003e \u003cp\u003eInjunctive norms of provider supporting delay of first pregnancy\u003c/p\u003e \u003cp\u003eInjunctive norms of provider supporting birth spacing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhushan et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexually active women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLilongwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of non-barrier modern contraceptive\u003c/p\u003e \u003cp\u003eCurrent use of condom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorovac-Pinheiro et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent mothers age 10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePublic maternity hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetrospective observational program evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUptake of IUD\u003c/p\u003e \u003cp\u003eUptake of DMPA\u003c/p\u003e \u003cp\u003eUptake of other method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eIntegrated service delivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrooks et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZinder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of modern contraceptive methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalhoun et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24 who gave birth in past year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAddis Ababa, Afar, Amhara, Oromia, SNNPR, Tigray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProspective cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInitiation of contraceptive use\u003c/p\u003e \u003cp\u003eLARC vs. traditional/non-use\u003c/p\u003e \u003cp\u003eShort acting vs. traditional/non-use\u003c/p\u003e \u003cp\u003eLARC vs. short acting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntegrated service delivery\u003c/p\u003e \u003cp\u003eQuality of care improvements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErhardt-Ohren et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDosso region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent modern contraceptive use\u003c/p\u003e \u003cp\u003eCurrent LARC use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErulkar and Tamrat, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRural Amhara region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEver used FP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension workers\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFikree et al., 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexually active women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYouth friendly facilities in Amhara and Tigray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUptake of LARCs vs. short-acting methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFikree et al., 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYouth friendly facilities in Amhara and Tigray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFP referral: Male\u003c/p\u003e \u003cp\u003eFP referral: female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFikree et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexually active women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYouth friendly facilities in Amhara and Tigray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetrospective observational program evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUptake of LARCs vs. short-acting methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlanagan et al., 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent girls age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMSI BlueStar clinics in Central, Eastern, Northern, Western Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNumber of visits for FP services by adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services \u003c/p\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGage et al., 2023 [1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNulliparous pregnant women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKinshasa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUsed a modern contraceptive within 12 months of delivery\u003c/p\u003e \u003cp\u003eMean number of modern methods known\u003c/p\u003e \u003cp\u003eMean number of FP myths endorsed\u003c/p\u003e \u003cp\u003eApproval of FP\u003c/p\u003e \u003cp\u003eInjunctive norms approving of postpartum FP discussion with partner\u003c/p\u003e \u003cp\u003eInjunctive norms approving of postpartum FP use\u003c/p\u003e \u003cp\u003eDescriptive norms that majority first-time young mothers discuss FP postpartum with partner\u003c/p\u003e \u003cp\u003eDescriptive norms that majority first-time young mothers use postpartum FP\u003c/p\u003e \u003cp\u003eInjunctive norms community members will say good things about women who use postpartum FP\u003c/p\u003e \u003cp\u003eEver discussed FP in early postpartum with partner\u003c/p\u003e \u003cp\u003eDiscussed FP with health worker in early postpartum\u003c/p\u003e \u003cp\u003eDiscussed FP with partner after delivery\u003c/p\u003e \u003cp\u003eWent to a health facility to obtain contraception early postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGage et al., 2023 [2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst-time mothers age 15\u0026ndash;24 reporting currently using a modern contraceptive method at endline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKinshasa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUsing implant vs. other modern method\u003c/p\u003e \u003cp\u003eInformed choice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGayles et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery young adolescent boys and girls age 10\u0026ndash;14 in and out of school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKinshasa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePregnancy knowledge index score\u003c/p\u003e \u003cp\u003eKnows where to get contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeugten et al., 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn-school boys and girls age 12\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSix junior high schools in Bolgatanga Municipality, Northern Ghana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre/post without comparison group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSRH knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGichangi et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women age 18\u0026ndash;24 with mobile phone access and SMS capability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKwale County\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive myths and misconceptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHegdahl et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZambia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn-school girls, grade 7, age 12\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRural schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent contraceptive use\u003c/p\u003e \u003cp\u003eGood knowledge of modern contraceptive methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHinson et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurkina Faso\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn-school girls, grades 9 and 10, age 14\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRural schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntention to use contraceptives in the next 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services \u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuda et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 14\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFour urban slums of Dhaka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of modern contraceptive methods \u003c/p\u003e \u003cp\u003eKnows modern methods of contraception\u003c/p\u003e \u003cp\u003eDiscussed FP with husband\u003c/p\u003e \u003cp\u003eSupports using FP\u003c/p\u003e \u003cp\u003eHusband supports using FP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJacobs et al., 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurkina Faso, Senegal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarred adolescent girls age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNational DHS sample\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of a modern contraceptive method\u003c/p\u003e \u003cp\u003eIntention to use FP in the future\u003c/p\u003e \u003cp\u003eKnowledge of a modern contraceptive method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJonas et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSix districts across provinces\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUse of contraceptives other than condoms at last sex\u003c/p\u003e \u003cp\u003eDual use of contraception at last sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSupply\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKabir et al., 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnmarried adolescent girls age 12\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRural sub-district Nabigani and urban slum in Dhaka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRepeated cross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eKnows about contraceptive methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKlinger and Asgary, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMadagascar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent boys and girls in secondary school age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNorthern Madagascar schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre/post without comparison group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive attitudes\u003c/p\u003e \u003cp\u003eContraceptive self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacharia et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent boys and girls age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKibra informal settlements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMakenzius et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoys and girls in secondary school age 14\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchools in Kisumu County\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive use stigma (CUS) scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorgan et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst-time mothers and fathers age 15\u0026ndash;24 with children less than 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross River State\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre/post without comparison group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent use of a a modern contraceptive method\u003c/p\u003e \u003cp\u003eBirth spacing intentions\u003c/p\u003e \u003cp\u003eAwareness of at least three modern contraceptive methods\u003c/p\u003e \u003cp\u003eSpousal approval of FP\u003c/p\u003e \u003cp\u003eDiscussion of FP with partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication \u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eInterpersonal communication \u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMutea et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent girls age 10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKobura ward in Kisumu County and Kholera ward in Kakamega County\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRepeated cross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrently using method to delay/avoid pregnancy\u003c/p\u003e \u003cp\u003eComfortable seeking FP service\u003c/p\u003e \u003cp\u003eKnowledge of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuwamanya et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women attending university age 18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMbarara University of Science and Technology, Western Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContraceptive use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOberth et al., 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZimbabwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 10\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBulawayo, Chipinge, Gweru, Makoni, Mazowe, Mutare districts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetrospective observational program evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUse of a contraceptive method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenzaho et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKampala and Wakiso slums\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRepeated cross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVisited a health facility to get information on FP and STDs in the past year\u003c/p\u003e \u003cp\u003eAware of place to get contraception\u003c/p\u003e \u003cp\u003eCan make decisions about when and whether to have children without fear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEmpowerment components\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRosenberg et al., 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24 who are not pregnant and are sexually active or expect to in the near future\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth facilities in Lilongwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRecipet of hormonal contraceptive method (service card)\u003c/p\u003e \u003cp\u003eSelf-report current contraceptive use\u003c/p\u003e \u003cp\u003eMean # times hormonal contraception was received (service card)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services \u003c/p\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShakya et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDosso region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEver used FP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilverman et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19 and their husbands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDosso region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent modern contraceptive use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThakuri et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNepal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls and women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKarnali Province\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre/post without comparison group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUse of any contraceptive method\u003c/p\u003e \u003cp\u003eUse of a modern contraceptive method\u003c/p\u003e \u003cp\u003eKnows where to obtain FP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWondimagegene et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexually active girls in secondary school age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGedeo Zone, Southern Nations region schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCluster randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent contraceptive use\u003c/p\u003e \u003cp\u003eUnmet need for contraception\u003c/p\u003e \u003cp\u003eContraceptive demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eA\u003c/sup\u003e Score determined using the Mixed Methods Appraisal Tool (MMAT) version 2018. Different tools were used for different study designs as guided by the tool. The full MMAT scores are found in Supplemental file 2.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eB\u003c/sup\u003e Strategies defined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInterventions Description\u003c/h2\u003e \u003cp\u003eWe identified 29 distinct interventions and four observational exposures. Interventions were delivered across a range of settings, including communities (n\u0026thinsp;=\u0026thinsp;15, 52%), schools or universities (n\u0026thinsp;=\u0026thinsp;11, 38%), health facilities (n\u0026thinsp;=\u0026thinsp;8, 28%), households (n\u0026thinsp;=\u0026thinsp;6, 15%) and mobile platforms (n\u0026thinsp;=\u0026thinsp;3, 7%). One intervention was delivered in a refugee setting. Nearly half of interventions were multi-level, operating across more than one setting (n\u0026thinsp;=\u0026thinsp;13, 45%). Single-strategy interventions most commonly involved digital technology (n\u0026thinsp;=\u0026thinsp;3), school-based education (n\u0026thinsp;=\u0026thinsp;2), or small-group education (n\u0026thinsp;=\u0026thinsp;2). The four observational exposures assessed extension worker home visits, integrated family planning counseling in antenatal and postnatal care, mass media exposure, and supportive social networks (n\u0026thinsp;=\u0026thinsp;1 each).\u003c/p\u003e \u003cp\u003eSchool-based programs primarily targeted younger, unmarried adolescents, whereas community-based interventions focused on out-of-school youth and married adolescents. Facility-based interventions emphasized service appropriateness, quality and provider training. Implementers included community health workers (CHWs), peer educators, teachers, and non-governmental organization (NGO) staff, often matched to participants by age or gender. Norms- and male-engagement strategies frequently involved spouses, families, or other gatekeepers. Intervention intensity varied ranging from single-session activities to multi-year programs, with multi-session formats being common. Details on adaptation were not reported for seven interventions (24%); among those reporting adaptation specifics (n\u0026thinsp;=\u0026thinsp;22), eight involved stakeholders or participants in intervention development, and three (all digital interventions) explicitly engaged youth in design (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Included Interventions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTarget Population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention Strategies \u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDelivery Agent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration / Frequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdaptation/ Development\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eStudies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntervention Evaluations\u003c/b\u003e \u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfya Halisi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining health workers on youth-friendly services, community outreach, parental dialogue sessions, ASRH information dissemination, peer-educator desk.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent girls age 10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealth workers\u003c/p\u003e \u003cp\u003eCHWs\u003c/p\u003e \u003cp\u003ePeer educators\u003c/p\u003e \u003cp\u003eCounty health teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13-month implementation period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDesigned based on formative assessment in participatory process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMutea et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLARCs \u0026amp; Youth Project\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompetency-based training for youth friendly service providers to offer LARCs\u0026thinsp;+\u0026thinsp;supportive supervision\u0026thinsp;+\u0026thinsp;peer demand generation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexually active women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services \u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYFS providers (Health officer, nurse, midwife)\u003c/p\u003e \u003cp\u003eRegional health bureau master trainers\u003c/p\u003e \u003cp\u003ePeer educators (trained youth)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProviders: 2-week training\u0026thinsp;+\u0026thinsp;service for 8-months. Peer-educators: 3-day training\u0026thinsp;+\u0026thinsp;6 months post-training demand generation. Scale-up: 3\u0026ndash;5 day training; post-implementation follow-up for 13 months.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdapted from Integrated Family Health Program\u0026thinsp;+\u0026thinsp;youth friendly service platform, WHO standards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFikree et al., 2017\u003c/p\u003e \u003cp\u003eFikree et al., 2018\u003c/p\u003e \u003cp\u003eFikree et al., 2020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(re)solve intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipatory, activity-based sexual and reproductive health curriculum which included a school-based participatory board game (la chance), a health facility passport, and posters/name tags.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn-school girls, grades 9 and 10, age 14\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services \u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity-based facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnclear - board game played at least once\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBurkina Faso\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBased on national SRH curriculum, co-designed with local stakeholders, adapted for young adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHinson et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirl Power Malawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYouth-friendly health services (YFS) in three arms:\u003c/p\u003e \u003cp\u003e(1) YFS only (youth-focused space, more range of times, training on YFS and peer-educators to support), \u003c/p\u003e \u003cp\u003e(2) YFS\u0026thinsp;+\u0026thinsp;behavioral intervention (12 monthly facility-led curriculum-driven small-group interactive sessions, \u003c/p\u003e \u003cp\u003e(3) YFS\u0026thinsp;+\u0026thinsp;behavioral intervention\u0026thinsp;+\u0026thinsp;conditional cash transfer (monthly cash transfer for attending each behavioral intervention session).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24 who are not pregnant and are sexually active or expect to become so in the near future\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained young female facilitators (ages 20\u0026ndash;30, post-secondary diplomas)\u003c/p\u003e \u003cp\u003eTrained clinicians\u003c/p\u003e \u003cp\u003eTrained peer-educators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 monthly 2-hour sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMalawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdapted from evidence-based SSA programs; delivered by trained young women facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBhushan et al., 2022\u003c/p\u003e \u003cp\u003eRosenberg et al., 2018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy Transitions for Nepali Youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulti-level strategy including: \u003c/p\u003e \u003cp\u003e(1) Individual: AGYW \u0026ldquo;safe-space\u0026rdquo; small group sessions with curriculum and games; \u003c/p\u003e \u003cp\u003e(2) Interpersonal: Home visits engaging families and husbands via videos; \u003c/p\u003e \u003cp\u003e(3) Community: dialogues, street dramas, quiz events; \u003c/p\u003e \u003cp\u003e(4) System: Adolescent-friendly health facility training and quality assessments.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained CHWs\u003c/p\u003e \u003cp\u003eTrained health providers\u003c/p\u003e \u003cp\u003eSave the Children\u003c/p\u003e \u003cp\u003eGovernment\u003c/p\u003e \u003cp\u003eLocal NGOs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAGYW groups: 24 fortnightly sessions (12 months); \u003c/p\u003e \u003cp\u003eHome visits: ~1\u0026ndash;2 per month (6 targeted); \u003c/p\u003e \u003cp\u003eCommunity events: ~4/month plus biannual public events;\u003c/p\u003e \u003cp\u003eFacility training: conducted once with quarterly follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNepal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLocally adapted intervention model based on formative research and stakeholder engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBhandari et al., 2023\u003c/p\u003e \u003cp\u003eThakuri et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSI peer-referral and clinic welcome intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer-referral cards (\u0026ldquo;refer-a-friend\u0026rdquo;) + youth-friendly clinic materials\u0026thinsp;+\u0026thinsp;wristbands; sub-group with provider training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent girls age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eFinancial incentives \u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity mobilizers\u003c/p\u003e \u003cp\u003eMSI clinic staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6-month implementation (split pre-/post-COVID pause)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDesigned with behavioral insights (ideas42) based on barrier diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFlanagan et al., 2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed PNC counseling for adolescents intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStructured contraceptive counseling and provision of educational materials prior to hospital discharge for youth maternity patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent mothers age 10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eIntegrated service delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHospital-based health professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOne session before discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDesigned for adolescent mothers, delivered during postpartum hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBorovac-Pinheiro et al., 2019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOMENTUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing student home visits\u0026thinsp;+\u0026thinsp;group education using gender-transformative curriculum (Program M) for first-time mothers and partners\u0026thinsp;+\u0026thinsp;SBC interventions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst-time mothers age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNursing students\u003c/p\u003e \u003cp\u003eMinistry of Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 months implementation period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003cp\u003eLinkage to health zones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLocally adapted Program M\u0026thinsp;+\u0026thinsp;community SBC\u0026thinsp;+\u0026thinsp;service linkage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGage et al., 2023 [1]\u003c/p\u003e \u003cp\u003eGage et al., 2023 [2]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReaching Married Adolescents (RMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour arm SBCC intervention: \u003c/p\u003e \u003cp\u003e(1) home visits; \u003c/p\u003e \u003cp\u003e(2) small group discussions; \u003c/p\u003e \u003cp\u003e(3) combined; plus community dialogues;\u003c/p\u003e \u003cp\u003e(4) control (no intervention).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19 and their husbands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained community workers\u003c/p\u003e \u003cp\u003eCommunity facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5 years intervention, 1 session/month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBased on theory of reasoned action\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eErhardt-Ohren et al., 2022\u003c/p\u003e \u003cp\u003eSilverman et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried Adolescent Girls (MAG) Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunity-based program with health education, small groups, home visits, and community dialogue to improve RH knowledge, service use, and decision-making power.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension workers\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity mentors \u003c/p\u003e \u003cp\u003eHealth extension workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWeekly group sessions over 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLocally adapted to cultural context; developed through community consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eErulkar and Tamrat, 2014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed first-time parent intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst time parent interventions included peer group sessions with first-time mothers; small group sessions with the husbands/partners of peer group members; small group sessions with older women, typically the mothers or mothers-in-law of peer group members; home visits by community volunteers (CVs); community sensitization; and ongoing family planning service delivery at facilities and through mobile outreach.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst-time mothers and fathers age 15\u0026ndash;24 with children less than 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCouple communication \u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension workers\u003c/p\u003e \u003cp\u003eInterpersonal communication \u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCHWs supervised by local government health staff and program facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 first-time mother peer group sessions meeting weekly over 4-months for 1 hour\u003c/p\u003e \u003cp\u003e6 weekly sessions for male partners with female partners who wanted them to participate,\u003c/p\u003e \u003cp\u003e4\u0026ndash;6 home visits per first time mother over 4-month study period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDesigned by E2A based on formative research and other service work in the area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMorgan et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARMADILLO SMS initiative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYouth-targeted mobile phone\u0026ndash;based intervention delivering weekly audio messages via IVR to dispel contraception myths and misconceptions, aligned with national FP messaging guidelines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women age 18\u0026ndash;24 with mobile phone access and SMS capability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMinistry of Health\u003c/p\u003e \u003cp\u003eCommunications company (Well Told Story)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 weekly audio messages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual mobile phones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDeveloped through focus groups and literature identifying 10 myths, including young people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGichangi et al., 2022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed mobile application\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA mobile application designed to provide SRH information, goods (e.g., condoms), and services (e.g., linkage to clinics).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women attending university age 18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResearch team with youth engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelf-use of app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual mobile phones\u003c/p\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDeveloped with youth input; tailored content for university students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNuwamanya et al., 2020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed mobile USSD application\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstructured Supplementary Service Data (USSD)\u0026ndash;based app with SRH information via Echomobile\u0026reg; platform.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent boys and girls age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResearch team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelf-use of app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual mobile phones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDesigned based on health belief model in co-creation process with youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMacharia et al., 2022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent Girls Initiative - Kenya (AGI-K)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour-arm intervention including: \u003c/p\u003e \u003cp\u003e(1) violence prevention: community conversations, contracts and action plans; \u003c/p\u003e \u003cp\u003e(2) violence prevention\u0026thinsp;+\u0026thinsp;education: cash and in-kind transfers to the head of household and girl, personal and schools supply kit; \u003c/p\u003e \u003cp\u003e(3) violence prevention\u0026thinsp;+\u0026thinsp;education\u0026thinsp;+\u0026thinsp;health: health girls groups led by mentor; and,\u003c/p\u003e \u003cp\u003e(4) violence prevention\u0026thinsp;+\u0026thinsp;education\u0026thinsp;+\u0026thinsp;health\u0026thinsp;+\u0026thinsp;wealth creation: financial education in girls groups, education on financial topics, annual savings incentive to girls, opening of formal savings account, and providing home savings banks.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery young adolescent girls age 11\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmpowerment components \u003c/p\u003e \u003cp\u003eFinancial incentives \u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSave the Children (Wajir), Population Council (Kibera), in collaboration with government and NGOs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 years; frequency varies by component (e.g., regular health sessions, monthly cash transfers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAustrian et al., 2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUPLIFT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulti-component program including life skills training, savings groups, financial literacy, SRHR information, and referrals to services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen and women age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmpowerment components\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLocal implementing partners Community-based organizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u0026ndash;24 month intervention delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTailored to youth in urban informal settlements; combines economic empowerment with SRHR education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRenzaho et al., 2022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrowing up GREAT!\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulti-level SRH and gender transformative program using story-based curricula, community discussions, and caregiver/provider engagement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery young adolescent boys and girls age 10\u0026ndash;14 in and out of school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained peer facilitators Teachers\u003c/p\u003e \u003cp\u003eCommunity leaders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6-month delivery, 8\u0026ndash;10 group sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity \u003c/p\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdapted from the GREAT! model for younger urban students and school delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGayles et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed school stigma reduction intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool-based stigma-reduction program promoting gender equality, equitable norms, value clarification targeting stigma around abortion and contraceptive use.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoys and girls in secondary school age 14\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained facilitators including teachers and peer-educators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDelivered over 3 weeks (8\u0026ndash;9 hours) divided into four sessions and provided to mixed-gender classrooms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMakenzius et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed multi-level intervention involving economic support and comprehensive sex education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEconomic support alone \u0026amp; in combination with comprehensive sex education (CSE) and community dialogues:\u003c/p\u003e \u003cp\u003e(1) Economic support: Unconditional cash to girls/guardians\u0026thinsp;+\u0026thinsp;school fees for Grades 8\u0026ndash;9; \u003c/p\u003e \u003cp\u003e(2) CSE\u0026thinsp;+\u0026thinsp;community dialogue (combined arm): \u003c/p\u003e \u003cp\u003eYouth clubs in schools teaching CSE\u0026thinsp;+\u0026thinsp;periodic community dialogue meetings focusing on fertility, marriage and girls\u0026rsquo; schooling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn-school girls, grade 7, age 12\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMinistry of Education\u003c/p\u003e \u003cp\u003eLocal facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27-month intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eZambia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHegdahl et al., 2022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed peer counseling in refugee setting intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer adolescents (trained) provided contraceptive counselling using WHO guide \u0026amp; visual aids.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale refugees age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 peer counselors (ages 16\u0026ndash;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 session; 15\u0026ndash;20 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRefugee settlement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBakesiima et al., 2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed school-based peer education intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrained peer educators provided weekly classroom-based education covering contraception, sexual health, and reproductive rights.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSexually active girls in secondary school age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePeer educators (students and teachers) trained by researchers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWeekly sessions over 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWondimagegene et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHERStory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulti-sectoral HIV prevention program including biomedical, behavioral, and structural components (such as access to contraceptives, education, and empowerment).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSupply\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLocal NGOs\u003c/p\u003e \u003cp\u003eCommunity workers \u003c/p\u003e \u003cp\u003eHealthcare providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNational adaptation of DREAMS programming in South African districts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eJonas et al., 2022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed comprehensive sex education intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSexual and reproductive health education sessions integrated into school curriculum with trained facilitators delivering 1-hour sessions once a week for 5 weeks.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn-school girls age 12\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained facilitators and teachers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 sessions (1 per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGeugten et al., 2015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed school-based SRHR education intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThree education sessions on SRH topics including female reproductive system, puberty, pregnancy, contraception, menstruation, and STI prevention, and an interactive session to clear misconceptions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGirls enrolled in 9th-12th grades age 15\u0026thinsp;\u0026minus;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained school teachers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThree 2-hour sessions delivered on consecutive days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBased on WHO and guidelines, adapted to local context through desk/lit review by study team, reviewed by medical social workers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAlekhya et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed SRHR curriculum intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA 9-lesson curriculum covering reproductive anatomy, contraception, pregnancy prevention, STIs, and HIV/AIDS.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent boys and girls in secondary school age 15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained teachers and CHWs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNine weekly 45-minute sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMadagascar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLocally adapted curriculum based on needs assessment and national guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eKlinger and Asgary, 2016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried Adolescent Girl (MAG) club\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonthly peer-group sessions covering family planning knowledge, male involvement, addressing myths/fear, and contraceptive method demonstrations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 14\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained facilitators from current club leaders recruited from NGO BRAC\u0026rsquo;s urban slum programs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThree 2-hour sessions delivered on consecutive days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDeveloped by Government of Bangladesh and local non-governmental organizations (NGOs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHuda et al., 2019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSista2Sista (S2S) Programme\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStructured group-based mentoring program delivering HIV and SRH education, psychosocial support, and life skills to vulnerable AGYW.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent girls and women age 10\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrained adult female mentors (\u0026ldquo;Sisters\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 weekly sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eZimbabwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDesigned by MOH, UNFPA, and partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOberth et al., 2021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed peer-education intervention for unmarried girls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer educators provided adolescent reproductive health information through structured group sessions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnmarried adolescent girls age 12\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePeer educators trained by project staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCulturally adapted peer-led approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eKabir et al., 2015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnnamed provision of EC intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThree health education sessions plus provision of EC pills (Postinor) vs health education alone.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale students attending university age 18\u0026ndash;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupply\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThree education sessions on Saturdays for three weeks, length not reported, one pack of EC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSchools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eArinze-Onyia et al., 2014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eObservational Exposures Assessing Potential Intervention Strategies\u003c/b\u003e \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtension worker home visit strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVisits by community health workers providing family planning information and services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCHWs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBrooks et al., 2019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated FP counseling in ANC/PNC strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFP discussion during ANC, facility delivery discharge, PNC (6 weeks), and vaccination visits.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24 who gave birth in past year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntegrated service delivery\u003c/p\u003e \u003cp\u003eQuality of care improvements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealth professionals, HEWs, facility providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 or more discussions across 4 contact points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealth facilities\u003c/p\u003e \u003cp\u003eCommunity outreach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCalhoun et al., 2023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMass media strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-reported recent exposure to FP messages via mass media channels (newspaper, radio, mobile, tv).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen age 15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAny exposure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003cp\u003eBurkina Faso Senegal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAhmed et al., 2020\u003c/p\u003e \u003cp\u003eBajoga et al., 2015\u003c/p\u003e \u003cp\u003eJacobs et al., 2015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial networks strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial networks and social network attributes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried adolescent girls age 13\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual\u003c/p\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eShakya et al., 2020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003eA\u003c/sup\u003e Strategies defined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003eB\u003c/sup\u003e Includes interventions/programs with a program evaluation component. \u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003eC\u003c/sup\u003e Includes observational studies that assessed a potential intervention strategy that could be applied to future interventions.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOutcome Analysis and Narrative Synthesis by Intervention Strategy\u003c/h2\u003e \u003cp\u003eEvidence was most frequently available for primary outcomes related to contraceptive use or uptake (41 measures), followed by contraceptive knowledge (36 measures), attitudes or norms (19 measures), and contraceptive method outcomes (15 measures). Measures related to intentions (n\u0026thinsp;=\u0026thinsp;6), communication (n\u0026thinsp;=\u0026thinsp;6), and service outcomes (n\u0026thinsp;=\u0026thinsp;9) were less frequently assessed. Negative effects were rare, accounting for only 3% of assessed outcomes (n\u0026thinsp;=\u0026thinsp;4), with the majority of reported effects indicating statistically significant positive associations with contraceptive-related outcomes (Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eEvidence was more concentrated for multi-strategy interventions than for single-strategy interventions. Among single-strategy interventions, moderate-to-strong positive effects were most commonly observed for contraceptive use (n\u0026thinsp;=\u0026thinsp;9 outcomes, 64%) and contraceptive knowledge (n\u0026thinsp;=\u0026thinsp;9 outcomes, 75%), with other outcome types infrequently assessed. In contrast, multi-strategy interventions demonstrated consistently strong positive effects across a broader range of outcomes, including contraceptive use (n\u0026thinsp;=\u0026thinsp;24 outcomes, 89%), attitudes and norms (n\u0026thinsp;=\u0026thinsp;15 outcomes, 88%), and service-related outcomes (n\u0026thinsp;=\u0026thinsp;8 outcomes, 89%, Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eAcross study designs, overall quality was moderate, with mean MMAT scores of 57% for experimental studies (n\u0026thinsp;=\u0026thinsp;14), 59% for quasi-experimental studies (n\u0026thinsp;=\u0026thinsp;9), and 62% for other study designs (n\u0026thinsp;=\u0026thinsp;19, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eNarrative synthesis and outcome analysis are presented below by intervention strategy. Findings reflect intervention packages that \u003cem\u003eincluded\u003c/em\u003e each strategy, not isolated strategy effects; results are non\u0026ndash;mutually exclusive and should be interpreted as patterns rather than causal attribution. \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDirection and Magnitude of Effects of Intervention Strategies on Contraceptive Use Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy (Name, Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMain findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContraceptive Outcome(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003cp\u003e[effect measure, estimate (95% CI or std error)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificance at p\u0026lt;.05\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntervention Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntervention strategies \u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRosenberg et al., 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdolescent girls allocated to receive the youth-friendly health services model had increased receipt of hormonal contraceptives, # times they up took these methods, and self-reported use of contraception compared to controls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReceipt of hormonal contraceptive method \u003c/p\u003e \u003cp\u003e# of times hormonal contraceptives received\u003c/p\u003e \u003cp\u003eUse of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eContraceptive receipt: 39% (34%-45%)\u003c/p\u003e \u003cp\u003e# of times: 6 (4.2\u0026ndash;8.7)\u003c/p\u003e \u003cp\u003eUse of contraception: 20% (CI or stderr not reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGirl Power Malawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhushan et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThose assigned to receive small group sessions had increased use of non-barrier contraceptive methods and condoms at 1-year follow-up, compared to control; some analyses suggested partial mediation of effects through partner communication.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of non-barrier modern contraception\u003c/p\u003e \u003cp\u003eUse of condoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUse of non-barrier method: aOR 5.1 (2.3\u0026ndash;11.3)\u003c/p\u003e \u003cp\u003eUse of condom: aOR 2.2 (1.2\u0026ndash;4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGirl Power Malawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhandari et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModern and any contraceptive prevalence rates among married girls increased significantly from pre to post intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModern contraceptive prevalence rate\u003c/p\u003e \u003cp\u003eAny contraceptive prevalence rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emCPR: +7% (CI or stderr not reported)\u003c/p\u003e \u003cp\u003eCPR: +9% (CI or stderr not reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.01)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHealthy Transitions for Nepali Youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThakuri et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants reported an increase in use of any and modern contraception from pre to post intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of any contraception\u003c/p\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAny contraception: % change\u0026thinsp;+\u0026thinsp;9% (CI or stderr not reported)\u003c/p\u003e \u003cp\u003eModern contraception: % change\u0026thinsp;+\u0026thinsp;7% (CI or stderr not reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHealthy Transitions for Nepali Youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMutea et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdolescents in the intervention group receiving adolescent friendly services had no increase in contraceptive use over time relative to controls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIRR: 1.15 (0.68\u0026ndash;1.94) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNull\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAfya Halisi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdolescent-responsive services\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGage et al., 2023 [1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe MOMENTUM multi-component intervention increased women's reporting of using a modern contraceptive method within 12 months postpartum.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception within 12 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaRD 0.133 (0.08\u0026ndash;0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMOMENTUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErhardt-Ohren et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried adolescent girls in all intervention arms (household visit only, small groups only, combined) were more likely than control to have a sustained effect using modern contraception 18-months post intervention; the small group discussions group saw the largest effect.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHome visits vs. control: aOR 4.11 (1.42\u0026ndash;11.88)\u003c/p\u003e \u003cp\u003eSmall group discussion vs. control: aOR 7.94 (2.96\u0026ndash;21.29)\u003c/p\u003e \u003cp\u003eCombined intervention vs. control: aOR 4.53 (1.60-12.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReaching Married Adolescents (RMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSilverman et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention groups had greater relative increase in contraceptive use over time compared to controls; this change was driven by the home visits and home visits plus small groups arms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention (all) vs. control: aIRR 2.33 (1.41, 3.87)\u003c/p\u003e \u003cp\u003eHome visits only vs. control: aIRR 3.65 (1.51, 8.78)\u003c/p\u003e \u003cp\u003eSmall groups only vs. control: aIRR 1.42 (0.84, 2.41)\u003c/p\u003e \u003cp\u003eHome visits\u0026thinsp;+\u0026thinsp;Small groups vs. control: aIRR 2.99 (1.68, 5.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p=.001)\u003c/p\u003e \u003cp\u003eSignificant (p=.004)\u003c/p\u003e \u003cp\u003eNull\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReaching Married Adolescents (RMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErulkar and Tamrat, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWomen exposed to both wives groups and whose husbands were exposed to husbands groups had greater contraceptive use than controls while those only exposed to wives groups had marginally greater contraceptive use.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEver use of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExposed to husbands and wives groups: aOR 1.85 (1.33\u0026ndash;2.58)\u003c/p\u003e \u003cp\u003eExposed to wives groups only: aOR 1.49 (0.94\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003cp\u003eMarginally significant (p\u0026lt;.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMarried Adolescent Girls (MAG) Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCouple communication\u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension workers\u003c/p\u003e \u003cp\u003eInterpersonal communication\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorgan et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst-time mothers and partners use of contraception increased significantly from pre to post-intervention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFirst time mothers: aOR 3.3 (CI or stderr not reported)\u003c/p\u003e \u003cp\u003eMale partners: aOR 3.7 (CI or stderr not reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnnamed first-time parent intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCouple communication \u003c/p\u003e \u003cp\u003eEngaging men and boys\u003c/p\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003cp\u003eInterpersonal communication \u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuwamanya et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents receiving the USSD-messages showed increased use in contraception over time relative to controls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR 1.58 (1.02\u0026ndash;2.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnnamed mobile application\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDigital technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrooks et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried adolescent girls who were exposed to a relias (CHW) visit in the past 3 months were more likely to be currently using modern contraceptives compared to those who were not exposed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR 1.94 (1.07\u0026ndash;3.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p=.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExtension worker home visit strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExtension worker\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHegdahl et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThose allocated to receive cash transfers only had no difference in contraceptive use at endline while those allocated to receive cash transfers combined with comprehensive sex education and community dialogues saw a marginally significant increase in use of modern contraception at endline.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEconomic vs. control: aRR 0.90 (0.74\u0026ndash;1.11)\u003c/p\u003e \u003cp\u003eCombined vs. control: aRR 1.14 (0.95\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNull\u003c/p\u003e \u003cp\u003eMarginally significant (p\u0026lt;.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnnamed multi-level intervention involving economic support and comprehensive sex education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalhoun et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFor each counseling session where FP was discussed, women had greater hazard of initiating a modern contraceptive method.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInitiation of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaHR 1.34 (0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.0001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntegrated FP counseling in ANC/PNC strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntegrated service delivery\u003c/p\u003e \u003cp\u003eQuality of care improvements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMass media exposure to family planning messages was associated with reduced contraceptive use in urban areas and no effect in rural areas.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUrban: aOR 0.38 (0.21\u0026ndash;0.68)\u003c/p\u003e \u003cp\u003eRural: aOR 1.20 (0.85\u0026ndash;1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eNull\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMass media strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBajoga et al., 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMass media exposure to family planning messages was associated with increased contraceptive use when exposed to FP messages in TV and mobile (total), and for radio in Ibadan, Ilorin, and Kaduna.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNewspaper total: aOR 1.2 (0.8\u0026ndash;1.8)\u003c/p\u003e \u003cp\u003eNewspaper city specific: aOR 0.4-2.5\u003c/p\u003e \u003cp\u003eRadio total: aOR 1.3 (0.8\u0026ndash;2.1)\u003c/p\u003e \u003cp\u003eRadio city specific: aOR 0.2\u0026ndash;4.6\u003c/p\u003e \u003cp\u003eTV total: aOR 1.6 (1.1\u0026ndash;2.3)\u003c/p\u003e \u003cp\u003eTV city specific: aOR 0.7-1.7\u003c/p\u003e \u003cp\u003eMobile total: aOR 1.9 (1.2\u0026ndash;2.9)\u003c/p\u003e \u003cp\u003eMobile city specific: aOR 1.4\u0026ndash;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNull\u003c/p\u003e \u003cp\u003eNull in all cities\u003c/p\u003e \u003cp\u003eNull\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05) in Kaduna, Ilorin, Ibadan\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05) in Ilorin\u003c/p\u003e \u003cp\u003eSignificant (p\u0026lt;.05)\u003c/p\u003e \u003cp\u003eNull in all cities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMass media strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJacobs et al., 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoung women exposed to FP messages in the media was marginally associated with greater use of contraceptives in Senegal but not in Burkina Faso.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBurkina Faso: aOR 0.98 (0.43\u0026ndash;2.30)\u003c/p\u003e \u003cp\u003eSenegal: aOR 2.30 (0.92\u0026ndash;5.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNull\u003c/p\u003e \u003cp\u003eMarginally significant (p\u0026lt;.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMass media strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMass media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWondimagegene et al., 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls at intervention schools had greater contraceptive uptake over time relative to controls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR 8.73 (3.66\u0026ndash;20.83) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p=.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnnamed school-based peer education intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJonas et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThose who participated in the HERStory intervention were more likely to have used a contraceptive method, other than condoms, at last sex compared to non-participants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of contraception other than condoms at last sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaPR 1.36 (1.21\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHERStory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003cp\u003eSchool-based education\u003c/p\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003cp\u003eSupply\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBakesiima et al., 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoung women exposed to peer-counseling were more likely to take up a modern contraceptive method immediately after counseling compared to women receiving standard counseling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContraceptive uptake post counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaPR 1.24 (1.0-1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026thinsp;=\u0026thinsp;0.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnnamed peer counseling in refugee setting intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePeer-led approaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuda et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThose assigned to receive the small group education sessions were more likely to be using a contraceptive method post-intervention than controls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of modern contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR: 1.77 (CI or stderr not reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMarried Adolescent Girl (MAG) club\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOberth et al., 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThose who participated in the full program had an increase in contraceptive use but this effect was not detected if users missed any of the 40 group exercise sessions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUse of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCompleted all 40 group exercises: aOR 1.38 (1.21\u0026ndash;1.56)\u003c/p\u003e \u003cp\u003eCompleted 35 (88%) of group exercises: aOR 1.06 (0.97\u0026ndash;1.15)\u003c/p\u003e \u003cp\u003eCompleted at least 30 (70%) group exercises: aOR 0.95 (0.87\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003cp\u003eNull\u003c/p\u003e \u003cp\u003eNull\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSista2Sista (S2S) Programme\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSmall-group education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShakya et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls who reported that they believed their alter supported their use of family planning were more likely to have ever used contraception.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEver use of contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebeta 0.99 (0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant (p\u0026lt;.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSocial networks strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSocial norms \u0026amp; networks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eA\u003c/sup\u003e Strategies defined in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e^ 18 studies are not included in this table because they did not report on a contraceptive uptake or use outcome. Other contraceptive outcomes have been reported in Supplement 3. \u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Represents a DID analysis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSmall-group education\u003c/h2\u003e \u003cp\u003eSmall group education appeared in 18 of 41 studies. Nearly all measures assessing contraceptive use or uptake (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 36\u0026ndash;48) reported significant or marginal improvements (n\u0026thinsp;=\u0026thinsp;18, 95%) and secondary outcomes also demonstrated largely positive effects (n\u0026thinsp;=\u0026thinsp;44, 80%, Fig.\u0026nbsp;4), including improvements in LARC use (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), birth spacing intentions (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), contraceptive knowledge (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan additionalcitationids=\"CR53\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), spousal approval and discussion (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), norms (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), and service use (Supplement 3, 41,47). Experimental (n\u0026thinsp;=\u0026thinsp;4) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;5) designs comprised over half of studies, and quasi-experimental studies were of comparatively higher quality (mean MMAT score 70%; Fig.\u0026nbsp;3) than overall average MMAT scores across all study designs.\u003c/p\u003e \u003cp\u003eSmall-group education was most frequently implemented as part of multi-component interventions delivered in community, facility, or school settings. When implemented as a standalone strategy (n\u0026thinsp;=\u0026thinsp;2), effects were positive but appeared sensitive to intervention intensity. For example, group-based mentoring programs targeting adolescent girls in Zimbabwe and peer-group sessions for married adolescent girls in urban Bangladesh both demonstrated improvements in contraceptive use (Bangladesh: aOR 1.77, 95% CI not reported, p\u0026lt;.01 ; Zimbabwe: aOR 1.38, 95% CI 1.21\u0026ndash;1.56, p\u0026lt;.001, 47,48); however, in Zimbabwe, statistically significant effects were observed only among participants who completed the full 40-session course (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStronger and more consistent effects were observed when small-group education was embedded within broader intervention packages, particularly those addressing interpersonal, normative, or service-related barriers. The Reaching Married Adolescents (RMA) program in rural Niger isolated the contribution of sex-segregated small-group sessions for married adolescents and found substantial and sustained improvements in contraceptive use over time (small group discussion vs. control 18-months post-intervention: aOR 7.94, 95% CI 2.96\u0026ndash;21.29, p\u0026lt;.05, 36,38, Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Other evaluations (e.g., Girl Power Malawi, Healthy Transitions for Nepali Youth, MOMENTUM) assessed small-group education as one component within multi-strategy designs, often alongside economic, community, or service-delivery interventions. In these contexts, small-group education appeared to function as an effective mechanism for reinforcing knowledge, facilitating partner communication, and linking participants to services, contributing to improvements in both contraceptive use and key proximal outcomes (Supplement 5, 36\u0026ndash;40,49).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSocial norms and network strategies\u003c/h2\u003e \u003cp\u003eSocial norms and network strategies were evaluated in 12 studies out of 41 studies. Nearly all measures assessing contraceptive use, prevalence, or uptake (38\u0026ndash;45,53, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) reported statistically significant or marginal improvements (n\u0026thinsp;=\u0026thinsp;17, 94%), and secondary outcomes similarly demonstrated strong positive effects (n\u0026thinsp;=\u0026thinsp;33, 85%, Fig.\u0026nbsp;4), including birth-spacing intentions (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), partner communication and approval (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), contraceptive knowledge of contraceptive methods (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), supportive attitudes and norms (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), service use (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), and use of LARCs (Supplement 3, 36,37). Experimental (n\u0026thinsp;=\u0026thinsp;3) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;4) designs comprised over half of studies assessing this strategy (58%), and quasi-experimental evaluations were of comparatively high quality (mean MMAT score 73%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eAll interventions employing social norms and network strategies were multi-component, often combined with small-group education and engaging men and boys. Network interventions operated through couple communication, male small-group discussion, and extension workers (\u003cspan additionalcitationids=\"CR41 CR42 CR43 CR44 CR45\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) to engage male partners, often for young married adolescents and women in contexts including Nepal, Niger, the DRC, Ethiopia, Nigeria, and Bangladesh, or through engagement of unmarried boys and/or girls in school-based education and/or small groups (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e) in Bangladesh, Zambia, and the DRC. Though no intervention study isolated the effects of norm-shifting components, several evaluations reported improvements in partner communication and spousal discussion of contraception (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), key proximal outcomes closely linked to normative change in contexts where contraceptive decision-making is strongly influenced by husbands, families, and other gatekeepers.\u003c/p\u003e \u003cp\u003eOne observational study (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) among married adolescent girls in rural Niger found higher contraceptive use among girls whose nominated influential social network members (i.e., alters) were perceived as supportive of contraceptive use (beta 0.99, std 0.35, p\u0026lt;.001). Two studies measured changes in perceived contraceptive norms (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), both of which reported statistically significant improvements across multiple injunctive and descriptive norms related to contraceptive use and salient reference groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePeer-led approaches\u003c/h2\u003e \u003cp\u003ePeer-led approaches were incorporated in 11 of the 41 studies identified. Among measures assessing contraceptive use, prevalence, or uptake (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e), the majority reported statistically significant or marginally significant positive effects (n\u0026thinsp;=\u0026thinsp;4, 80%, Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Peer-led approaches were also associated with many improvements in secondary (n\u0026thinsp;=\u0026thinsp;10, 67%, Fig.\u0026nbsp;4) and methods-related outcomes, including contraceptive knowledge (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), decreased stigma (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), agency (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), decreased unmet need and increased demand (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e), service (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e), and LARCs (Supplement 3, 59,61). Experimental (n\u0026thinsp;=\u0026thinsp;2) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;3) designs comprised 64% of all evaluations assessing peer-led approaches, with the remaining studies using observational or other non-experimental designs (n\u0026thinsp;=\u0026thinsp;4). Overall study quality for this strategy was similar to the broader evidence base, with a small number of higher-confidence experimental evaluations (n\u0026thinsp;=\u0026thinsp;3, average MMAT score 73%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003ePeer-led approaches were only implemented as a standalone strategy in one intervention and instead primarily functioned as delivery channels for other intervention strategies. One study used peer-approaches as a standalone-strategy for adolescent girls in a Ugandan refugee setting in a high-quality (80% MMAT score) RCT, finding strong effects on contraceptive uptake among girls who received the intervention immediately post peer-counseling, compared to controls (aPR 1.24, 95% CI 1.0-1.5, p\u0026thinsp;=\u0026thinsp;0.02, 57). In multi-component interventions, peer-led approaches were commonly embedded within broader packages including school-based education (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), small-group education (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), and adolescent responsive services (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). In one high quality (MMAT score 80%) cluster RCT in Ethiopia, a school-based intervention which trained peer-educators to provide weekly class-room based contraception topics to adolescent girls found a nearly 9x odds increase in contraceptive use in intervention schools compared to controls (aOR 8.73, 95% CI 3.66\u0026ndash;20.83, p\u0026thinsp;=\u0026thinsp;0.01, 56).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eEngaging men and boys\u003c/h2\u003e \u003cp\u003eEngaging men and boys were evaluated in 11 of the 41 included studies exclusively within multi-component interventions. Among studies assessing contraceptive use, prevalence, or uptake, nearly all reported statistically significant improvements (n\u0026thinsp;=\u0026thinsp;14, 93%), and secondary outcomes similarly demonstrated strong positive effects (n\u0026thinsp;=\u0026thinsp;37, 90%, Fig.\u0026nbsp;4), including intentions (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), contraceptive knowledge (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), partner approval (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), stigma (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), supportive norms (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), partner communication (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), services (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), and use of LARCs (Supplement 3, 41). Experimental (n\u0026thinsp;=\u0026thinsp;2) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;5) designs comprised over half of studies assessing this strategy (64%). Quasi-experimental evaluations were of somewhat higher quality (mean MMAT score 66%) and experimental studies was somewhat lower (mean MMAT score 50%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eInterventions engaging men and boys commonly targeted contraceptive improvements for married adolescents, first-time mothers, or school-aged children. Men were engaged through couple communication, extension worker home visits, and/or small sex-segregated groups for young married adolescents in Nepal (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), Niger (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), and Ethiopia (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Similar mechanisms were used for interventions involving first-time mothers in Nigeria (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), and the DRC (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). For school-aged children, boys were engaged through school-based curriculum or stories, peer-led approaches, and/or small group education in the DRC (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e) and Kenya (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, 58). Only one intervention tried to isolate the effects of male engagement exposure, finding that married adolescent girls in the rural Amhara region of Ethiopia exposed to wives and husbands small-group sessions were associated with greater improvements in contraceptive use compared to exposure among wives alone (wives only: aOR 1.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.10; wives and husbands: aOR 1.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) though both saw improvements (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Several evaluations among married adolescents and first-time parents also reported improvements in partner communication, spousal approval of contraception (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), and perceived family support (Supplement 3, 38). The two school-based programs (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) did not measure distal outcomes of contraceptive use, but did find improvements in contraceptive use stigma (beta\u0026thinsp;\u0026minus;\u0026thinsp;0.73, 95% CI -0.83- -0.63, p\u0026lt;.001) and knowledge of pregnancy (mean difference 0.48, 95% CI 0.18\u0026ndash;0.77, p\u0026lt;.05, Supplement 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eExtension workers\u003c/h2\u003e \u003cp\u003eExtension workers-based strategies were evaluated in 10 of the 41 included studies all multi-component interventions, most commonly targeting married adolescents, young couples, or first-time parents. Among studies assessing contraceptive use, prevalence, or uptake, nearly all reported statistically significant improvements (n\u0026thinsp;=\u0026thinsp;11, 92%), and secondary outcomes similarly demonstrated strong positive effects (n\u0026thinsp;=\u0026thinsp;23, 88%, Fig.\u0026nbsp;4), including intentions (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), contraceptive knowledge (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), supportive attitudes (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e), self-efficacy (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e), supportive norms (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), discussion (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), spousal approval (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), service (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), and use of LARCs (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Experimental (n\u0026thinsp;=\u0026thinsp;2) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;3) designs comprised 53% of all evaluations assessing peer-led approaches. Quasi-experimental evaluations were of somewhat higher quality (mean MMAT score 67%) while the quality of experimental studies was somewhat lower (mean MMAT score 50%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eExtension workers most often delivered home-based counseling or follow-up visits, frequently in combination with small-group education, male engagement, and/or facility-based service strategies. In most evaluations, extension worker activities were embedded within broader intervention packages. Two studies provided more isolated evidence on the role of extension workers. Within the RMA program, home visits conducted by extension workers for married adolescents in rural Niger were evaluated as a distinct intervention component and were independently associated with increased contraceptive use among married adolescents (home visits only vs. control IRR 3.65, p\u0026thinsp;=\u0026thinsp;0.004; home visits plus sex-segregated small groups 2.99, p\u0026lt;.001, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 42). In addition, one observational study, also from Niger, reported higher current contraceptive use among women who had received a home visit from a community health worker within the prior three months (aOR 1.94, 95% CI 1.07\u0026ndash;3.51, p\u0026thinsp;=\u0026thinsp;0.03, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 63). Other interventions used extension workers to link women to care, for example first-time mothers in the post-partum period. One intervention in Nigeria found that 4\u0026ndash;6 extension worker visits, when combined with a compressive intervention incorporating peer-group sessions and male-partner sessions with female partners, increased reported use of modern contraception by both female and male partners (female: aOR 3.3, 95% CI not reported, p\u0026lt;.001, male: aOR 3.7, 95% CI not reported, p\u0026lt;.001, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 44).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAdolescent-responsive services\u003c/h2\u003e \u003cp\u003eAdolescent-responsive services were included in 10 of the 41 studies all within multi-component interventions through health facilities or school-linked platforms. Among measures assessing contraceptive use, prevalence, or uptake, the majority reported statistically significant or marginally significant positive effects (n\u0026thinsp;=\u0026thinsp;4, 80%, Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Adolescent-responsive services were also associated with many improvements in secondary (n\u0026thinsp;=\u0026thinsp;10, 83%, Fig.\u0026nbsp;4) and methods-related outcomes, including intentions (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e), unmet need and demand (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e), contraceptive knowledge (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), supportive norms (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), service (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e), and LARC uptake (Supplement 3, 61,65). Experimental (n\u0026thinsp;=\u0026thinsp;3) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;2) designs comprised over half of studies assessing this strategy (55%). Quasi-experimental evaluations were of substantially lower quality (mean MMAT score 40%).\u003c/p\u003e \u003cp\u003eAdolescent-responsive services were implemented as part of multi-component intervention packages, frequently in combination with small-group education, peer-led approaches, or community-based outreach. While no studies isolated the effect of adolescent-responsive services, many found positive effects when implemented in combination with other strategies. For example, evaluations of the LARCS \u0026amp; Youth Project in Ethiopia, which combined youth-friendly provider service training with peer-led demand generation, reported increases in uptake of LARCs (aOR 1.3, 95% CI not reported, p\u0026lt;.0001, 61) and male referrals for FP (aOR 1.4, 95% CI not reported, p\u0026lt;.05, 59), though individual contraceptive use was not assessed. Another intervention pairing adolescent-friendly services with a participatory reproductive health curriculum in Burkina Faso schools for girls in grades 9 and 10 found a marginally significant positive increase in intention to use contraceptives within the next three months (aOR 1.59, 95% CI 0.97\u0026ndash;2.61, p\u0026lt;.1, 64). Girl Power Malawi, which used youth-friendly health services alone and in combination with behavioral and microfinance components, found that girls who received any arm of the youth-friendly services model had increased receipt of contraception (30%, 95% CI 24\u0026ndash;45%, p\u0026lt;.05, 36). Similarly, Healthy Transitions for Nepali Youth, which used adolescent-friendly health services in combination with home visits, girls small-groups, and community mobilization efforts, found that women aged 15\u0026ndash;24 years old had improved contraceptive prevalence rate (mCPR\u0026thinsp;+\u0026thinsp;7%, 95% CI not reported, p\u0026lt;.01, 38) and use of a modern contraceptive method (+\u0026thinsp;7%, 95% CI not reported, p\u0026lt;.001, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 39). The Afya Halisi intervention in Kenya, however, which trained CHWs in youth-friendly services, combined with parental dialogue, peer-education desk, and community-outreach, found no significant effects (Supplement 3, 55).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSchool-based education\u003c/h2\u003e \u003cp\u003eSchool-based education was evaluated in 9 of the 41 included studies; interventions were implemented primarily among unmarried adolescents, including very young adolescents (VYA, age 10\u0026ndash;14 years old). Among measures assessing contraceptive use, prevalence, or uptake, all reported statistically significant or marginally significant positive effects (n\u0026thinsp;=\u0026thinsp;5, 100%, Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). School-based contraceptive and/or reproductive health education was also associated with many improvements in secondary (n\u0026thinsp;=\u0026thinsp;7, 64%, Fig.\u0026nbsp;4) and methods-related outcomes, including intention (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e), unmet need and demand (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e), knowledge (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e), and dual use of contraceptive methods at last sex (Supplement 3, 46). Experimental (n\u0026thinsp;=\u0026thinsp;3) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;3) designs comprised two-thirds of studies assessing this strategy (66%). Other designs were of substantially lower quality (mean MMAT score 40%).\u003c/p\u003e \u003cp\u003eAcross the evidence base, school-based education was almost always implemented as part of multi-component intervention packages, frequently combined with peer-led approaches and adolescent-responsive services. Two interventions, one in Ghana and the other in India, employed school-based educational alone, educating adolescent girls in reproductive health education sessions (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e) found improved contraceptive or SRH knowledge (Ghana: mean diff 1.17, 95% CI not reported, p\u0026lt;.05; India: mean difference over time 79.8 percentage points, 95% CI not reported, p\u0026lt;.05, Supplement 5). Neither assessed contraceptive use outcomes, however, and both studies were of low to moderate quality (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). All three studies in Zambia, South Africa and Ethiopia assessing contraceptive use in multi-component designs found significant positive effects (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e), two from moderate to high-quality RCTs and one cross-sectional design, though none isolated the effects of school-based education. One study which included school-based education with adolescent-responsive services found marginally significant increases in intention to use contraception (aOR 1.59, 95% CI 0.97\u0026ndash;2.61, p\u0026lt;.1, 64) and another combining school-based education with peer-led counseling found increased demand for contraception (aOR 6.06, 95% CI 2.43\u0026ndash;15.11, p\u0026thinsp;=\u0026thinsp;0.01, 56). Among VYA, the Growing Up GREAT! Intervention, which took a wholistic gender-transformative approach and targeted both in-school and out-of-school adolescents with a comprehensive curriculum and community engagement, increased knowledge of pregnancy among in-school VYA and knowledge of where to obtain a contraceptive method among out-of-school VYA (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eCouple communication\u003c/h2\u003e \u003cp\u003eCouple communication strategies were evaluated in 7 of the 41 included studies all multi-component intervention packages, most commonly targeting married adolescents, young couples or first-time parents. Among studies assessing contraceptive use, prevalence, or uptake, all reported statistically significant or marginally significant improvements (n\u0026thinsp;=\u0026thinsp;12, 92%; Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Various secondary outcomes\u0026mdash;including partner support, spousal discussion of contraception, and birth spacing intentions\u0026mdash;were also frequently assessed and demonstrated positive effects across studies (n\u0026thinsp;=\u0026thinsp;23, 96%, Fig.\u0026nbsp;4, Supplement 3). Experimental (n\u0026thinsp;=\u0026thinsp;2) and quasi-experimental (n\u0026thinsp;=\u0026thinsp;4) designs accounted for the majority of evaluations assessing couple communication (75%), with experimental studies being of slightly slower quality and other studies slightly higher than overall averages (experimental: average MMAT score 50%; other: average MMAT score 70%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eCouple communication strategies were most often delivered through couple counseling, or structured discussion activities, in combination with small-group education, male engagement, or service-delivery adaptations (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Several studies, including MOMENTUM among first-time parents in the DRC and another first-time parent intervention in Nigeria, reported improvements in discussion of family planning (DRC: aRD 0.09, 95% CI 0.04\u0026ndash;0.14, p\u0026lt;.05; Nigeria: +39%, 95% CI not reported, p\u0026lt;.001, Supplement 5) and partner support (Nigeria: +12.7%, 95% CI not reported, p\u0026lt;.001) following exposure to interventions including communication-focused components (Supplement 3, 40,44). In one multi-component intervention, Girl Power Malawi, partner communication was examined as an intermediate outcome and an isolated intervention component. Girls who attended two small-group sessions where communication with partners and communication skill-building was a primary topic of discussion had increased contraceptive communication with partners at six months (aOR\u0026thinsp;=\u0026thinsp;1.48, 95% CI 1.07\u0026ndash;2.38, p\u0026lt;.05) and increased non-barrier contraceptive use at one year (aOR 3.53, 95% CI 1.86\u0026ndash;6.69, p\u0026lt;.05) compared to girls who only added one or no sessions. Contraceptive use at one year was found to be partially mediated by communication with partners at six months (indirect effect\u0026thinsp;=\u0026thinsp;0.04, 95% CI: 0.01\u0026ndash;0.07, 37) among participants who had previously not communicated with their partner about contraception at baseline, highlighting its relevance as a proximal pathway within broader intervention packages.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eInterpersonal communication\u003c/h2\u003e \u003cp\u003eInterpersonal communication strategies were included in 6 of the 41 included studies, exclusively within multi-component intervention packages, and involved one-on-one engagement with trusted individuals including parents, in-laws, mentors, providers, or other influential individuals. Among studies assessing contraceptive use, prevalence, or uptake, five of six reported significant positive effects (83%, Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Secondary proximal outcomes were more frequently assessed and demonstrated consistent positive associations across studies (n\u0026thinsp;=\u0026thinsp;26, 87%, Fig.\u0026nbsp;4) \u0026ndash; including knowledge, spousal approval, and service outcomes (Supplement 6). Quasi-experimental (n\u0026thinsp;=\u0026thinsp;3) designs accounted for half of evaluations assessing interpersonal communication, with overall study quality comparable to the broader evidence base; no evaluations employed an experimental design (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eInterpersonal communication was implemented often alongside small-group education, male engagement, social norms strategies or service-delivery components. Although the MOMENTUM intervention among first-time parents in the DRC study reported improvements in normative outcomes among \u0026ldquo;significant others\u0026rdquo; and \u0026ldquo;community members\u0026rdquo; and discussion with a health worker in early postpartum (aRD 0.23, 95% CI 0.19\u0026ndash;0.28, p\u0026lt;.05, 40), no other study evaluated directly assessed changes over time in communication quality or frequency with trusted adults other than spouses, nor examined whether such communication mediated effects on contraceptive outcomes.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFinancial incentives\u003c/h2\u003e \u003cp\u003eFinancial incentive strategies were evaluated in 4 of the 41 included studies and mostly within multi-component intervention packages. Among studies assessing contraceptive use, prevalence, or uptake, five of six measures reported significant positive effects (83%, Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Secondary proximal outcomes were more frequently assessed but showed greater heterogeneity in positive outcomes (n\u0026thinsp;=\u0026thinsp;26, 79%, Fig.\u0026nbsp;4, Supplement 6). All evidence on this strategy derived from experimental evaluations (n\u0026thinsp;=\u0026thinsp;4) of moderate overall quality (mean MMAT score 60%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eFinancial incentives were delivered primarily through service-related vouchers (e.g., transport stipends) or conditional or unconditional cash transfers. Only one study, conducted in Zambia, isolated the effect of financial incentives alone. This evaluation compared an arm providing unconditional cash transfers to girls in 8-9th grade, their guardians, and school fees with a combined arm that paired economic support with comprehensive sexuality education and community dialogues. The economic-only arm showed no change in modern contraceptive use compared to controls (aRR 0.90, 95% CI 0.74\u0026ndash;1.11, p\u0026lt;.1), whereas the combined arm demonstrated marginally significant improvements (aRR 1.14, 95% CI 0.95\u0026ndash;1.37, p\u0026lt;.1; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 45).\u003c/p\u003e \u003cp\u003eThe Girl Power Malawi intervention included three arms combining youth-friendly health services, small-group education for girls, and conditional cash transfers. All intervention arms demonstrated increased hormonal contraceptive uptake relative to controls (aRD: 39%, 95% CI: 34% to 45%, p\u0026lt;.05), with the highest uptake observed in the arm that included conditional cash transfers (Control: 10%, Youth-friendly services arm: 52%, Youth-friendly services\u0026thinsp;+\u0026thinsp;small-groups arm: 35%, youth-friendly services\u0026thinsp;+\u0026thinsp;small groups\u0026thinsp;+\u0026thinsp;conditional cash transfer: 74%, 36). In contrast, the Adolescent Girls Initiative\u0026ndash;Kenya, which included wealth-generation components alongside violence prevention, education, and health programming, reported improvements in contraceptive knowledge but did not demonstrate a clear advantage of wealth-generation activities over arms without these components (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eMass media\u003c/h2\u003e \u003cp\u003eMass media strategies were evaluated in 3 of the 41 included studies, all of which employed observational designs. Among studies assessing contraceptive use, prevalence, or uptake, only two of seven measures reported significant positive effects (29%) (Fig.\u0026nbsp;4, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Four secondary outcome measures also found positive effects (100%, Fig.\u0026nbsp;4). Study designs were all cross-sectional and had comparably higher quality than the other study design average across all studies (average MMAT score 75%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eMost mass media interventions stratified exposures resulting in heterogenous outcome directionality, highlighting that mass media\u0026rsquo;s effects may differ by urbanicity, country, or method of delivery. For example, one study in Nigeria found that urban AYA exposure to family planning messages in the media was associated with significantly less contraceptive use (0.38, 95% CI 0.21\u0026ndash;0.68, p\u0026lt;.05) but found a null effect for rural AYA (aOR 1.20, 95% CI 0.85\u0026ndash;1.70, p\u0026thinsp;\u0026gt;\u0026thinsp;0.1, 68). Another study using Demographic and Health Survey (DHS) data from Burkina Faso and Senegal found a null effect for Burkina Faso (aOR 0.98, 95% CI 0.42\u0026ndash;2.30, p\u0026gt;.1) but a rather large marginally significant effect for Senegal (aOR 2.30, 95% CI 0.92\u0026ndash;5.73, p\u0026lt;.1, 69). Finally, a third study in Nigeria found that mass media exposure was associated with higher contraceptive use but only in particular parts of the country and only through certain mediums \u0026ndash; specifically radio, TC, and mobile exposure (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 70).\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eDigital technology\u003c/h2\u003e \u003cp\u003eDigital technology strategies were evaluated in 3 of the 41 included studies, all of which employed experimental RCTs as standalone strategies in East Africa. Only one evaluation, conducted among university students in Uganda, assessed contraceptive use, and reported a statistically significant increase in SRH knowledge and contraceptive use following exposure (aOR 1.58, 95% CI 1.02\u0026ndash;2.46, p\u0026lt;.05; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 71). This intervention, while including digital mobile information on contraceptives also facilitated direct connection to condoms and services at clinics. In contrast, two RCTs in Kenya (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e), both of which only relied on low-intensity delivery modalities, including one-way SMS messaging or passive digital campaigns, with limited tailoring, personalization, or interactivity (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), reported null or modest effects on contraceptive-related knowledge outcomes and did not assess contraceptive use (Fig.\u0026nbsp;4, Supplement 5). All evidence on this strategy derived from experimental evaluations (n\u0026thinsp;=\u0026thinsp;3) of moderate overall quality (mean MMAT score 60%, Fig.\u0026nbsp;3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eEmpowerment components\u003c/h2\u003e \u003cp\u003eEmpowerment-oriented strategies were evaluated in 2 of the 41 included studies within multi-component intervention packages. Seven of 13 secondary outcome measures were positive 54% (Fig.\u0026nbsp;4); no studies reported on primary outcomes. The Adolescent Girls Initiative \u0026ndash; Kenya (AGI-K) high-quality (MMAT 80%) cluster RCT showed improved gender attitudes and knowledge among very young adolescents through a combined savings and life skills program, which targeted girls empowerment through violence prevention activities and financial empowerment (Supplement 3, 50). Another repeated cross-sectional study, UPLIFT in urban Uganda, combined life empowerment-based skills training, savings groups, financial literacy, and referrals to services for youth finding improved knowledge of where to get family planning but found no effect on AYA feeling they can make decisions about whether and when to have children without fear \u0026ndash; a component of agency (Supplement 3, 51). Neither study isolated the empowerment platform or included other agency/empowerment measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eIntegrated service delivery\u003c/h2\u003e \u003cp\u003eIntegrated service delivery was tested in 2 of 41 studies, both linking family planning to maternal health care (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). In Ethiopia, a high-quality (MMAT 80%, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) prospective cohort study found for each ANC, delivery, or PNC session where FP was discussed, women had a greater hazard of initiating a modern contraceptive method (aHR 1.34, ste 0.07, p\u0026lt;.0001, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, 74). In Brazil, a moderate-quality (MMAT 50%) retrospective observational program evaluation found increased uptake of IUD and other methods with exposure to FP counseling within integrated services, but decreased uptake of injections (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Supplement 3, 65).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSupply, quality of care, and other strategies\u003c/b\u003e were underrepresented in the identified evidence-base. Identified studies included emergency contraception (EC) provision (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e), respectful care (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e), arts-based approaches (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), and village-level coordination (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e); however, none were evaluated as standalone strategies. As a result, conclusions regarding the effectiveness of these approaches remain highly limited.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis REA synthesizes recent evidence from 2014 to 2024 on intervention strategies to improve contraceptive-specific outcomes among AYA in LMICs, drawing on 41 quantitative studies. By organizing evidence using an intervention-strategy typology and presenting our findings comparatively across strategies, this review extends prior syntheses that either focus broadly on adolescent SRHR or examine single intervention types/strategies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79 CR80\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). A central finding is that the evidence clusters around multi-strategy intervention packages, which more consistently report statistically significant improvements across contraceptive use and key proximal outcomes than single-strategy interventions. At the same time, the review highlights persistent limitations in study quality, incomplete reporting of effectiveness based on implementation exposure, and the limited ability of the field to attribute contraceptive-related effects to individual intervention strategies.\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eWhat appears most promising\u0026mdash;and what remains uncertain\u003c/h2\u003e \u003cp\u003eAcross the evidence base, interventions combining strategies that operate at multiple levels most consistently reported improvements in contraceptive use and uptake (Fig.\u0026nbsp;2). This pattern aligns with socioecological perspectives on adolescent behavior change and with the practical reality that contraceptive decision-making for AYA is shaped by intersecting influences which differ by life stage (\u003cspan additionalcitationids=\"CR83\" citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). However, because most studies evaluated bundled intervention packages, we have limited insight into which intervention strategies drive change, by how much, and for whom. Thus, the comparative findings should be interpreted as indicating that interventions \u003cem\u003eincluding\u003c/em\u003e particular strategies tend to show positive outcomes among \u003cem\u003eparticular\u003c/em\u003e populations/settings, rather than generalizing independent effects of individual components. This reflects a broader pattern in adolescent SRHR research, where multi-component program designs often outpace the ability to evaluate their discrete effects (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). Even among the RCTs identified in this study, reporting on discrete strategy intervention arms, implementation fidelity, intensity, or adaptations was rare, hindering interpretation and real-world applicability at scale (\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e). These questions are of paramount importance, especially as multi-component models become more common yet harder to replicate with fidelity at the population-level (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence was strongest and most consistent for small-group education, social norms approaches, engaging men and boys, extension worker strategies, and couple communication, which all had a robust evidence base which frequently showed positive associations for contraceptive use as well as knowledge, attitudes/norms, communication, and service-related outcomes. Furthermore, all of these strategies had one or more studies with positive effects on contraceptive-related outcomes that either (A) tested the strategy in isolation in a single-strategy approach, observational study, or a separate study arm, and/or, (B) measured positive effects on specific outcomes that speak to the strategic mechanism invoked by that particular intervention strategy (e.g., increases in partner communication with interventions involving couple communication). These findings align with prior reviews, global guidance, and research agendas (\u003cspan additionalcitationids=\"CR89\" citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e) which highlight AYAs\u0026rsquo; desire to belong and conform to perceived norms within groups that matter to them\u0026mdash;whether peers, family, partners, or the broader community\u0026mdash;by fostering shared values and reference standards that guide behavior. Furthermore, this aligns with work that supports the strong influence of partners particularly among married AYA and first-time parents (\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor other strategies \u0026mdash;such as peer-led education, adolescent-responsive services, school-based education, interpersonal communication, and financial incentives\u0026mdash; the evidence base was smaller and/or mixed, though showed promise in particular contexts and/or intervention packages. For example, peer-led counseling may be particularly influential in refugee settings where adolescents may more readily trust someone perceived as similar to them compared to a health worker (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e); other studies have found that peer-support in these settings can improve wellbeing (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). Financial incentive intervention evaluations were limited and typically embedded within broader programs; the one study isolating incentives found no effect when delivered alone, while combined packages showed more favorable outcomes. This aligns with evidence suggesting that incentives alone rarely change contraceptive behavior but may facilitate engagement with other components by reducing structural barriers (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). Interpersonal communication and adolescent-responsive services were commonly associated with improvements in knowledge, approval, and service engagement, but showed less consistent effects on contraceptive use and greater variability in study quality. Prior research similarly indicates that youth-friendly services and supportive communication improve satisfaction and service utilization, though links to contraceptive uptake remain mixed (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). School-based education demonstrated generally positive associations with contraceptive-related outcomes, but contraceptive use was assessed less frequently than secondary outcomes, and heterogeneity in study quality and measurement limited confidence in effect size and consistency; prior syntheses note that school-based programs often reach adolescents before sexual initiation, capturing upstream outcomes rather than immediate contraceptive behaviors (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral strategies that are frequently emphasized in programming and policy discussions \u0026ndash; mass media, digital technology, empowerment, and integrated service delivery \u0026ndash; remain underrepresented in the identified AYA contraceptive evidence base, though other studies among women of reproductive age (age 15\u0026ndash;49) have shown positive impacts (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan additionalcitationids=\"CR97\" citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e). Additionally, few studies explicitly addressed life-stage or equity segmentation. Most targeted unmarried adolescents in school or married adolescents, with limited attention to transitions like first birth. Very few studies included displaced youth, those with disabilities, or those experiencing violence or coercion, all of which have been found to be associated with poor contraceptive and reproductive health outcomes (\u003cspan additionalcitationids=\"CR100\" citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e), and bring question to if our current intervention strategies are reaching and effective among those most in need.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImplications for Future Research and Investment\u003c/h3\u003e\n\u003cp\u003eFindings suggest that future research should prioritize study designs that strengthen causal inference about strategy contributions within multi-component packages and test hypothesized mechanisms of change. This includes more frequent use of comparative arms (e.g., factorial, adaptive, or comparative effectiveness designs), clearer reporting of implementation fidelity and exposure-dose in addition to intent-to-treat analyses, and explicit measurement of hypothesized mediators to test pathways of change. Greater use of mixed-methods and implementation science frameworks could support understanding of context, adaptation, and scale-up feasibility (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e). Additionally, targeted research in underrepresented areas and for underserved groups, including VYA, out-of-school youth, those living in humanitarian settings, and those experiencing violence is urgently needed.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eRole of AI in Accelerating Evidence Translation\u003c/h2\u003e \u003cp\u003eThis REA also demonstrates how AI-assisted tools can support rapid evidence translation while maintaining transparent review processes. Using ASReview to prioritize screening and SysRev to support structured tagging enabled timely synthesis across a large number of records\u0026mdash;an important advantage when decision-makers require evidence on short timelines \u0026ndash; and has been shown to maintain quality in prior studies (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). At the same time, AI-assisted approaches require careful oversight and transparent documentation of decisions to maintain credibility and minimize the risk of missing relevant studies. As these tools mature, they may play an increasingly important role in maintaining up-to-date syntheses in fast-moving program areas such as AYA family planning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAlthough the REA approach enabled a timely synthesis, it involved methodological trade-offs relative to full systematic review procedures. We relied on a single reviewer for screening and data extraction, which may have introduced selection or coding bias, although oversight was provided by senior reviewers. The reliance on AI-assisted tools for screening (ASReview) prioritization may have deprioritized relevant studies, though we used a conservative stopping rule and documented screening yield. We searched two scholarly databases and included expert input, but additional studies may have been identified through expanded database coverage or inclusion of grey literature and non-English publications. Additionally, heterogeneity in intervention content, outcomes, and study designs precluded meta-analysis, limiting our ability to quantify pooled effects. Finally, the intervention-strategy typology necessarily involved reviewer judgment, and overlapping strategies within intervention packages limited attribution of effects to individual components; MMAT ratings also capture only certain dimensions of rigor and may not reflect implementation strength or contextual relevance.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn summary, this REA finds that multi-strategy intervention packages that incorporate male engagement, social norms/network strategies, couples\u0026rsquo; communication, and small-peer groups are most consistently associated with improvements in contraceptive-related outcomes among AYA in LMICs. However, the evidence base remains constrained by limited evidence on effectiveness of individual intervention strategies. Advancing the field will require more rigorous comparative designs, stronger implementation measurement, and intentional investment in under-studied strategies and populations to support effective, equitable, and scalable contraceptive programming for adolescents and young adults.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis review was funded by The Gates Foundation [INV-066837]. The funder helped to conceptualize the study and provided input into methodology. The funder did not contribute to data collection, analysis, decision to publish or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eJU conceptualized the study and designed the methodology with input from KH, LM, KL, and GK. JU led data curation, formal analysis, investigation, visualization, project administration, and writing \u0026ndash; original draft preparation under supervision of KH, LM, and EP. Funding was acquired by KH and LM. JU, KH, LM, KL, GK, and EP all contributed to writing \u0026ndash; review and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the management and coordination guidance provided by project manager, Amanda Beal, at the University of California San Diego to this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSully EA, Biddlecom A, Darroch JE, Riley T, Ashford LS, Lince-Deroche N, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019. 2020 Jul 28 [cited 2025 Jul 30]; Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019\u003c/li\u003e\n\u003cli\u003eLi Z, Patton G, Sabet F, Zhou Z, Subramanian SV, Lu C. Contraceptive Use in Adolescent Girls and Adult Women in Low- and Middle-Income Countries. 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J Adolesc Health. 2015 Jan;56(1 Suppl):S15-21.\u003c/li\u003e\n\u003cli\u003eCartwright AF, Alspaugh A, Britton LE, Noar SM. mHealth Interventions for Contraceptive Behavior Change in the United States: A Systematic Review. J Health Commun. 2022 Feb 1;27(2):69\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eAung B, Mitchell JW, Braun KL. Effectiveness of mHealth Interventions for Improving Contraceptive Use in Low- and Middle-Income Countries: A Systematic Review. Global Health: Science and Practice. 2020 Dec 23;8(4):813\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eContraceptive Access and Fertility: The Impact of Supply-Side Interventions | IPA [Internet]. [cited 2025 Jul 31]. Available from: https://poverty-action.org/publication/contraceptive-access-and-fertility-impact-supply-side-interventions\u003c/li\u003e\n\u003cli\u003eLogie CH, MacKenzie F, Malama K, Lorimer N, Lad A, Zhao M, et al. 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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009 Aug 7;4(1):50.\u003c/li\u003e\n\u003cli\u003eProctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2009 Jan;36(1):24\u0026ndash;34.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescents and young adults, contraceptive use, family planning, contraception, low- and middle-income countries, interventions, rapid evidence assessment, evaluation, review","lastPublishedDoi":"10.21203/rs.3.rs-8716367/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8716367/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAdolescents and young adults (AYA) in low- and middle-income countries (LMICs) experience persistently high unmet need for contraception due to intersecting individual, social, and structural barriers. Despite urgent calls for targeted investments, decision-making is constrained by a lack of consolidated, comparative evidence on which intervention strategies improve contraceptive outcomes for this population. This review synthesizes recent evidence on what works to improve contraceptive-related outcomes for AYA using an intervention-strategy lens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a rapid evidence assessment (REA) of peer-reviewed studies published between 2014 and 2024 evaluating interventions to improve contraceptive-related outcomes among AYA (ages 10–24) in LMICs. Searches were conducted in PubMed and Embase. Artificial intelligence (AI)–assisted tools (ASReview and SysRev) were used alongside human reviewers for screening, full-text review, and structured tagging. Included studies were extracted and categorized by predefined intervention strategies and outcome types, stratified by study design, and quality appraised using the Mixed Methods Appraisal Tool (MMAT). Outcome directionality and study quality were visualized in charts stratified by intervention type (multi-component vs. single component), intervention strategy, and/or study design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of 4,425 records screened, 41 studies met inclusion criteria. Most were conducted in Sub-Saharan Africa and evaluated multi-component interventions. One-third employed experimental designs, and overall study quality was moderate (mean MMAT score 59%). Over half of studies assessed contraceptive use or uptake as a primary outcome; among these, the majority reported statistically significant improvements. Evidence was most consistent for multi-strategy intervention packages that incorporated small-group education, social norms and network approaches, engaging men and boys, extension worker outreach, and couples’ communication. These interventions also demonstrated positive effects on key proximal outcomes, including contraceptive knowledge, attitudes and norms, partner communication, and service use. However, few studies isolated strategy-specific effects, assessed dose–response relationships, or explicitly tested causal mechanisms. Reporting on implementation fidelity and adaptation was limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Multi-strategy interventions addressing interpersonal, normative, and service-related barriers show the most consistent promise for improving contraceptive outcomes among AYA in LMICs. However, stronger causal and implementation evidence is needed to identify which strategies drive impact, for whom, and under what conditions.\u003c/p\u003e","manuscriptTitle":"What Works to Improve Contraceptive Outcomes Among Adolescents and Young Adults in LMICs: A Rapid Evidence Assessment and Synthesis by Intervention Strategy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 09:13:29","doi":"10.21203/rs.3.rs-8716367/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10fd41fd-f01d-4478-9423-fc8c6ac2bbd8","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T09:13:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 09:13:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8716367","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8716367","identity":"rs-8716367","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}