National Level Stakeholders’ Perceptions of Facilitators and Barriers in Utilization of World Health Organizations’ Preventing Early Pregnancy Guidelines in National Level Health Policy Creation

Thesis (Master's)--University of Washington, 2016-07Background: Each year 16 million girls aged 15-19 years give birth and 70,000 die due to complications. In response, the World Health Organization (WHO) developed the evidence-based Reducing Adolescent Pregnancy guidelines to inform policies and programs aimed at preventing early pregnancies. [1] However, little is known regarding their impact on country-level policy creation. This study aims to identify the facilitators and barriers to utilization of the guideline in Ethiopia in order to better understand how the WHO can more effectively produce and disseminate their guidelines. Methods: This study consisted of: 1) an adolescent pregnancy legal, policy, and strategy document review to understand how well they align with WHO guidelines and 2) key informants interviews (KIIs) with national-level stakeholders working in adolescent and/or reproductive health which were conducted via telephone and thematically analyzed. Results: Laws, policies, and strategies predating the 2011 Preventing Early Pregnancy guideline were consistent across all its six domains. Key informants (KIs) reported that policies to address adolescent pregnancy are in place in Ethiopia. No KI could name the Reducing Adolescent Pregnancy guideline before being specifically asked about it. Some KIs felt that upcoming strategies which will supersede sun setting strategies may cover adolescent health more broadly, but adolescent sexual and reproductive health in less depth. KI perceived barriers and facilitators emerged into five themes: knowledge, national agenda, laws, resources, and cooperation. Conclusions: The Ethiopian government has created a strong policy framework that is consistent with WHO guidelines and that facilitates programs to prevent adolescent pregnancy. Vigilance is needed to insure that policies are not diluted over time. Systems issues are important barriers to creation of health strategies that adapt WHO guidelines, but there are opportunities for WHO to target guideline dissemination to influential decision makers which may help to overcome obstacles in national health strategy creation