BOUAKÉ DEPARTMENT, Côte d’Ivoire – Thérèse Kouadio, 18, is the eldest of five siblings from the N'Gattakro district, in Côte d’Ivoire’s central Bouaké Department.
Raised by her grandmother, she left school at just 14 years old to take a job as a cleaner in the capital Abidjan to help pay the family bills. But before turning 18 she had already experienced two early pregnancies close together.
“I gave birth to my two children by Caesarean section at the University Hospital in Bouaké,” she told UNFPA, the United Nations sexual and reproductive health agency.
“The first was in 2023, a girl who’s now more than one year old, and then my son in October 2024. After I gave birth to the first, I wanted to use contraception but I couldn’t make up my mind. When I went to see the midwife, she told me to wait until my period came.”
Family planning can help women to space out their pregnancies and avoid becoming pregnant without intending to – especially when they are still children.
“But I didn't see my period at all,” continued Ms. Kouadio. “Then I noticed something moving in my belly – that's when I went to the hospital and found out I was six months pregnant.”
Adapting sexuality education to meet real needs
Warned by her doctor about the dangers of early and closely-spaced pregnancies, Ms. Kouadio looked for a contraceptive solution. She discovered that the School and University Health Services for Adolescents and Young People – commonly known as the school health service – offered a range of free options adapted to the needs of young people, regardless of whether or not they are actually attending school.
“I didn't see my period at all. Then I noticed something moving in my belly.”
“I'd heard about it but had never been there before – it was a local woman who advised me to come to the school clinic for contraceptive methods and said that it's free. I don't want to be surprised by another pregnancy, so I quickly came to get the implant.”
UNFPA supports the school health services initiative to increase access to sexual and reproductive healthcare for young people and adolescents. The centre Ms. Kouadio visited is one of 98 school health service centres and 135 high school infirmaries that are part of the programme. Together they offer promotion and prevention programmes, counselling and discussions in safe spaces and youth clubs, and an app with information and advice on sexual and reproductive health.
Regular medical check-ups and free family planning are also provided, as well as consultations, medical care for young mothers, and support for people living with HIV/AIDS.
These services are also being provided at fixed health facilities and through mobile consultations – all efforts to reach young people where they are. This is important because surveys show girls often don't know where or how to reach the health services intended for them. According to the latest data, nearly one quarter of adolescent girls in Côte d’Ivoire become pregnant before they turn 19, with rates twice as high in rural areas compared to urban ones.
Early and unintended pregnancies are just one consequence of the lack of sexual and reproductive health information and care. Other consequences include unsafe abortions and sexually transmitted diseases, both of which can cause lasting health concerns or even death.
Treating young people with respect and dignity
“Our mission is to provide a non-judgmental welcome and solutions to help young people regain their self-confidence,” said Dr. Aoura, Deputy Chief Medical Officer of the school health service in Bouaké’s Commerce district.
That was the kind of care Ms. Kouadio received: She was welcomed by midwife Sylvie Yébouet, who explained the different contraceptive options available. After Ms. Kouadio made her selection, a long-acting contraceptive implant, Ms. Yébouet inserted the device into her arm.
“It's different from the hospitals I went to when I was pregnant. Here the midwife was kind, she didn't talk down to me, she didn't shout at me, she gave me advice and took good care of me,” Ms. Kouadio said, noting that she would recommend the health centre to other young people.
Realizing reproductive agency for women and girls requires ready access to high-quality reproductive healthcare, including appropriate and affordable contraception.
Unfortunately, it is estimated that some 257 million women globally want to avoid pregnancy but are not using safe and effective family planning methods, whether because of lack of access to information and services or resistance from their partners and communities.
UNFPA is working closely with the Government of Côte d’Ivoire to ensure adolescents and other young people can receive the supportive services they need to fulfil their potential. Ms. Kouadio, for one, has been able to work odd jobs that earn enough to pay for her evening classes and is working towards the goal of becoming a care assistant.
