Evaluating the Impact of Youth-Friendly Service Redesign on Contraceptive Prevalence Among Married Adolescents in Mombasa, Kenya: A Pre- and Post-Intervention Survey

Married adolescents in sub-Saharan Africa encounter substantial barriers to accessing sexual and reproductive health services. This contributes to low contraceptive prevalence and high unintended pregnancy rates. In Mombasa, Kenya, standard clinic services were frequently not adapted to the specific needs of this demographic. This study evaluated the impact of a youth-friendly service redesign on the contraceptive prevalence rate among married adolescents aged 15–19 in Mombasa. The primary objective was to measure the change in contraceptive prevalence before and after the intervention. A pre- and post-intervention survey design was used. Baseline and endline data were collected from a representative sample of married adolescents residing in the catchment areas of 15 public health clinics. The clinics implemented a youth-friendly service redesign, comprising staff training in adolescent counselling, creation of private consultation spaces, introduction of extended operating hours, and community mobilisation. The primary outcome was the change in self-reported current use of any modern contraceptive method. The contraceptive prevalence rate increased significantly following the intervention. The pre-intervention rate was 22.4%, which rose to 41.7% post-intervention. The most notable increases were observed in the use of injectables and implants. The redesign of clinic services to be more youth-friendly was associated with a marked increase in contraceptive use among married adolescents in this setting. This indicates that structural and procedural modifications within public health facilities can improve service uptake for this group. Public health policy should prioritise and resource the integration of youth-friendly service standards into routine clinic operations. Sustained implementation requires ongoing staff training and community engagement to maintain improvements. adolescent health, contraceptive prevalence, youth-friendly services, Kenya, sub-Saharan Africa, health services research This research provides evidence on the effectiveness of a clinic-based youth-friendly service redesign in a low-resource urban setting, directly informing programme and policy efforts aimed at improving contraceptive access for married adolescents.