Changing provider attitudes to youth and LARCs: lessons from Mali Ange Aminata Diakité Youth Centre Manager MSI Mali

“Do your parents know that you are here?” “You are too young to be getting an implant” “Do your parents know that you are here?” ANGE: HERE YOU CAN SAY THAT THESE ARE QUOTES FROM PROVIDERS “You can’t give an IUD to a girl before she’s given birth”

Providers are part of communities too… Ange – you could speak here about these points: -Providers can share some of the community’s resistance around LARCs and youth -They may be privately supportive, but it’s difficult/dangerous for them to provide LARCs because of community resistance

How have we overcome this in Mali? ANGE – HERE YOU COULD TALK ABOUT TRAINING OF PROVIDERS – WHEN PROVIDERS START WITH MSI THEY DON’T ALWAYS BELIEVE IN PROVIDING LARCS TO YOUTH. HOW DO WE OVERCOME THIS? SENSITISATION OF PUBLIC SECTOR STAFF – HOW SUCCESSFUL IS THIS? SEEING THE DEMAND FOR LARCS AMONGST YOUNG PEOPLE – DOES THIS HELP TO CONVINCE PROVIDERS? Feedback from FHI to incorporate into provider bias: I think its also important to note that for a long time, providers were taught that LARCs are not a great option for young people, particularly nulliparous young people. They rightly still hold onto the things they were taught in medical school and other trainings.  Can we include something around providers not having up to date info on youth and LARCs, and most have been taught that they’re not a good option for women without children, furthering hesitance, resistance to or lack of confidence in providing a LARC to youth.

25% of MSI Mali’s LARC clients on mobile outreach are under 20 What happens when you turn providers into LARC champions? A high proportion of the women we see on rural outreach in Mali are under 20 and most of them choose LARCs

Who are our adolescent LARC clients? Half are married Just over half have children 4 out of 5 weren’t using an FP method before coming for the service 2 out of 5 wanted to delay their first birth This information is from exit interviews

It’s not just MSI providers…. Across Mali – of those using contraception, one in four adolescents and one in two under 25s is using a LARC (DHS 2012) Numbers are small, but the choice is clear!

What challenges do we still face? ANGE- HERE YOU COULD TELL THE STORIES OF THE PROVIDERS WHO GET REPORTED TO THE POLICE BY PARENTS.

Questions for discussion How might we support health providers in becoming LARC champions for youth? What other barriers do providers face, and how might we work to overcome those barriers?

Thank you!