title: Targeting factors for change: contraceptive counselling and care of female adolescents.
abstract: BACKGROUND
  Sexual and reproductive health care should empower and enable all individuals to have a sex life that is as safe and pleasurable as possible. Achievement of this goal for adolescents is often impeded by regional and sociocultural barriers.
  
  
  OBJECTIVE
  To review global barriers to provision of effective counselling and care of adolescents seeking advice on contraception and sexual and reproductive health and identify elements of best practice that can be adapted to meet their needs at regional level.
  
  
  METHODS
  Experts with clinical experience and a scholarly background in the provision of contraceptive services to adolescents participated in a stepwise process of literature review and discussion according to the agreed objectives.
  
  
  RESULTS
  The Global CARE (Contraception: Access, Resources, Education) group identified barriers to the access, availability and acceptance of contraception by adolescents, not only at the political and sociocultural level but also within health care practice. The group collected and summarized successful local strategies and tools suitable for adaptation in other regions. Elements of best practice for providing contraception regardless of setting or regional constraints, including required skills, knowledge, and attitudes, were also proposed.
  
  
  CONCLUSIONS
  Sharing of evidence-based best practice in delivering contraceptive services, improvements in health care provider education, and sharing of experience between countries will hopefully help to overcome the barriers to appropriate and effective counselling and care of adolescents.
authors.affiliation: a Department of Obstetrics and Gynecology , University Hospital , Basel , Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bitzer
authors.affiliation: b Cebu Institute of Medicine , Cebu City , Philippines.
authors.forename: Virginia
authors.initials: V
authors.lastname: Abalos
authors.affiliation: c Sexual Health Clinic , Väestöliitto (Family Federation of Finland) , Helsinki , Finland.
authors.forename: Dan
authors.initials: D
authors.lastname: Apter
authors.affiliation: d Department of OB-GYN , Hospital Universitario Fundación Santa Fe de Bogota , Bogotá , Colombia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Martin
authors.affiliation: e The Ottawa Hospital , Ottawa , Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D003267:Contraception / Q000379:methods / Q000523:psychology; D003268:Contraception Behavior; D003270:Contraceptive Agents; D003376:Counseling / Q000379:methods; D005193:Family Planning Services; D005260:Female; D014943:Global Health; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D011057:Politics; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D049168:Pregnancy, Unplanned; D012725:Sexual Behavior; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents
keywords: Adolescent; barriers; best practice; contraception; contraceptive services; counselling