ArticleFrontiers in reproductive health2026
Optimising the implementation of adolescent-friendly health services and its effects on contraceptive uptake and adolescent pregnancy in rural Mozambique: an implementation research study of the S-NICE intervention.
Article in Frontiers in reproductive health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite national policies promoting adolescent- and youth-friendly health services, implementation gaps hinder improvements in adolescent sexual and reproductive health outcomes in Mozambique. S-NICE is a structured, participatory decision-support intervention designed to strengthen delivery through routine data use, multisectoral coordination, and local action planning. This study evaluates the implementation and effectiveness of S-NICE in rural Sofala Province. Methods: A mixed methods design integrating qualitative and quantitative approaches. The effectiveness component applied a quasi-experimental Difference-in-Difference analysis comparing eight intervention and eight comparison facilities over two six-month periods. The indicators of effectiveness were the increase in new users of modern contraceptive methods among girls aged 15-19 years and a drop in rates of adolescent pregnancy measured through attendance of first antenatal care appointment. The implementation component used a multiple case-study design guided by the Consolidated Framework for Implementation Research, drawing on 68 in-depth interviews and 21 focus group discussions ( Results: Within intervention facilities, coverage of new modern contraceptive users increased from 5.45% to 10.12% (+4.67 percentage points; Conclusions: S-NICE was associated with favourable trends in adolescent sexual and reproductive health outcomes and demonstrated strong implementation performance in routine health system settings. Although causal effects could not be conclusively established in a quasi-experimental study, our findings suggest that structured, data-driven, multisectoral implementation strategies may strengthen adolescent- and youth-friendly health services delivery in low-resource contexts. Longer-term and larger-scale evaluations are warranted to evaluate impact and assess sustainability.
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