What Works to Improve Contraceptive Outcomes Among Adolescents and Young Adults in LMICs: A Rapid Evidence Assessment and Synthesis by Intervention Strategy

Background: Adolescents and young adults (AYA) in low- and middle-income countries (LMICs) experience persistently high unmet need for contraception due to intersecting individual, social, and structural barriers. Despite urgent calls for targeted investments, decision-making is constrained by a lack of consolidated, comparative evidence on which intervention strategies improve contraceptive outcomes for this population. This review synthesizes recent evidence on what works to improve contraceptive-related outcomes for AYA using an intervention-strategy lens. Methods: We conducted a rapid evidence assessment (REA) of peer-reviewed studies published between 2014 and 2024 evaluating interventions to improve contraceptive-related outcomes among AYA (ages 10–24) in LMICs. Searches were conducted in PubMed and Embase. Artificial intelligence (AI)–assisted tools (ASReview and SysRev) were used alongside human reviewers for screening, full-text review, and structured tagging. Included studies were extracted and categorized by predefined intervention strategies and outcome types, stratified by study design, and quality appraised using the Mixed Methods Appraisal Tool (MMAT). Outcome directionality and study quality were visualized in charts stratified by intervention type (multi-component vs. single component), intervention strategy, and/or study design. Results: Of 4,425 records screened, 41 studies met inclusion criteria. Most were conducted in Sub-Saharan Africa and evaluated multi-component interventions. One-third employed experimental designs, and overall study quality was moderate (mean MMAT score 59%). Over half of studies assessed contraceptive use or uptake as a primary outcome; among these, the majority reported statistically significant improvements. Evidence was most consistent for multi-strategy intervention packages that incorporated small-group education, social norms and network approaches, engaging men and boys, extension worker outreach, and couples’ communication. These interventions also demonstrated positive effects on key proximal outcomes, including contraceptive knowledge, attitudes and norms, partner communication, and service use. However, few studies isolated strategy-specific effects, assessed dose–response relationships, or explicitly tested causal mechanisms. Reporting on implementation fidelity and adaptation was limited. Conclusion: Multi-strategy interventions addressing interpersonal, normative, and service-related barriers show the most consistent promise for improving contraceptive outcomes among AYA in LMICs. However, stronger causal and implementation evidence is needed to identify which strategies drive impact, for whom, and under what conditions.