Adolescents’ Access to Contraception in Lesotho: A Gender and Social Inclusion Perspective

Abstract

Adolescents’ access to contraception is a serious global and regional concern as a public health component. Therefore, this chapter analyses adolescents’ access to contraception, using gender and social inclusion lens, where the access to contraception services and information is explored. Thus, legislative and administrative measures as well as practices focusing on access to contraception are analysed in this chapter, using desk review and content analysis from the gender and social inclusion perspective. The results reveal that Lesotho is a state party to treaties that obligate states to ensure access to contraception for adolescents from the gender and social inclusion perspective, and this has also been implicated in the Constitution of Lesotho. However, other laws do not provide for gender- and social-inclusive access to contraception for adolescents. Administratively, the National Family Planning Guidelines for Health Service Providers of 2017 and National Strategic Development Plan II are the only strategies that are gender-responsive and use social inclusion lens to facilitate access to contraception for adolescents. Other policies are gender-blind and silent about adolescents and access to contraception. Lastly, statistics show that many adolescents do not have access to contraception, and gender- and social-inclusion issues are not taken into consideration.

1. Introduction

Contraception is one of the most significant determinants of fertility in developing countries [1]. The World Health Organisation emphasises that there is no method of contraception contraindicated on the basis of age alone [2]. Thus, this statement extends to adolescents who have the right to sexual and reproductive health services, including contraceptive care and counselling [3]. However, adolescents’ access to contraception is a serious global and regional concern as a public health component [4]. Hence, Cook and Dickens argue that national healthcare services fail to respond to sexual and reproductive health needs of adolescents [5]. In addition, adolescents of Lesotho have a challenge of accessing contraception at the health facilities [6], thereby increasing the vulnerability of adolescents to pregnancy and sexually transmitted infections [7]. Adolescence is a challenging stage for young people who rely on ‘their families, peers, schools and health service providers for affirmation, advice, information and the skills to navigate the sometimes difficult transition to adulthood’ [8]. For instance, statistics reveal that adolescents engage in sexual debut at a progressively younger age [9, 10], and this practice is linked to an increase in teenage pregnancy and sexually transmitted infections (see [7], p. 136). 50% of teenage pregnancies are unintended and result from low contraceptive usage [11].

Besides challenges faced by adolescents globally and regionally, the Government of Lesotho has made some strides to provide contraception to adolescents with the aim of promoting sexual and reproductive health and rights in the country. In this endeavour, the government is supported by development partners, international nongovernmental organisations and the civil society. Nevertheless, it is not clear if the access to contraception for adolescents has gender and social integration, even though it is expected that access to contraception is experienced differently by different groups of adolescents in the society in terms of gender, disability, geographic location and education. It has been noted that adolescents are a heterogeneous group. Therefore, it is significant to examine how adolescent girls and boys, as well as other socially excluded adolescents, have access to contraception in Lesotho. Thus, legislative and administrative measures as well as practices focusing on access to contraception shall be discussed in this chapter, using desk review and content analysis from the gender- and social-inclusion perspective.

2. International human rights law and adolescents’ access to contraception

Articles 2, 11 and 18 of the Vienna Convention on the Law of Treaties provide that once a state party accedes to an international or regional treaty, it is bound by the treaty and has to refrain from acts that would impede the achievement of the treaty’s objectives and purpose [12]. Therefore, human rights treaties, of which Lesotho has ratified or acceded to, are binding, and they are analysed in relation to the adolescents’ access to contraception through gender- and social-inclusion lens. The following human rights treaties are ratified by Lesotho and are analysed in this section: International Covenant on Economic, Social and Cultural Rights (ICESCR), Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Convention on the Rights of the Child (CRC), Convention on the Rights of Persons with Disabilities (CRPD), African Charter on Human and Peoples’ Rights (Banjul Charter) and Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol).

2.1 International covenant on economic, social and cultural rights

Article 12 of this covenant enjoins state parties to have the provision for the reduction of the stillbirth rate and infant mortality and for the healthy development of the child. In addition, according the General Comment 14 of the Committee on Economic, Social and Cultural Rights, access to sexual and reproductive health services should not be hindered by practices based on conscience. That is, provision of sexual and reproductive health services should not be hampered by conscientious objection. Although this article is not specific about adolescents’ access to contraception as one of the sexual and reproductive services, it is relevant to adolescents’ access to contraception because if they do not have access to contraception for controlling their fertility or reproduction, some adolescents are prone to having unhealthy child development due to not having been developed enough to take care of babies. Furthermore, when the adolescents do not have access to contraception, they are susceptible to having stillbirths and infant mortalities, as contraception is effective for preventing pregnancy and reducing its adverse effects among both adolescents and babies [13].

It is noted from the provisions of the ICESCR, especially article 12, that it does not have a gender- or social-inclusion lens for adolescents’ access to contraception. It is gender-blind and does not integrate social-exclusion considerations related to access to contraception for adolescents in Lesotho. Therefore, the state is not bound by the treaty to ensure that different categories of adolescents in different geographic locations of Lesotho have equal access to contraception, thereby necessitating strengthening sexual and reproductive health for Basotho adolescents, especially access to contraception in order to prevent unintended pregnancies that may result in maternal death due to unsafe abortion. ‘Unsafe abortions continue to contribute to high maternal death numbers in the SADC region’ [14]. According to the United Nations Population Fund, governments are obliged to take affirmative actions that ensure adolescents’ access to contraception in both law and practice, applying a human rights-based approach [15]. The UNFPA assertion implicates that the international and domestic laws need to make provisions for access to contraception for the adolescents, although the ICESCR is silent on this issue.

Nevertheless, the General Comment 14 of the Committee on Economic, Social and Cultural Rights (CESCR) expounds that access to contraception should not be impeded by practices based on conscience; thus, the International Covenant on Economic, Social and Cultural Rights is against a social norm of regarding contraception as a taboo for adolescents, thereby deterring adolescents’ access to contraception. Thus, there is a need to adopt social norms approaches that will be used to challenge conscientious objection in relation to providing adolescents with contraception because of age. In accordance with social norms approaches, the misalignment between people’s behaviours, attitudes and existing social norms should be harnessed in order to effect change [16]. Strategies could include changing gender norms and attitudes among an influential group [17]. Accordingly, there should be strategies geared towards changing gender norms and attitudes of policymakers as an influential group in relation to access to contraception by adolescents. Parents also need to be targeted as they have influence on adolescents, thereby controlling their access to contraception. Inversely, active participation of parents in ensuring access of contraception to adolescents will result in making supportive parents to adolescents’ access to contraception. Adolescents are reluctant to seek sexual and reproductive health services because of systematic and legal barriers; adolescents also do not want their parents to find out that they are sexually active [18].

2.2 Convention on the elimination of all forms of discrimination against women

Article 12 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) provides that states parties should ensure equal access of men and women to health-care services related to family planning. Moreover, article 16 obligates states to ensure that women have a right to decide on the number of children to have and how to space them, and the CEDAW Committee General Recommendation 24 on article 12 states that women should not be impeded by states to pursue their health goals. A commitment to the two articles implicates that Lesotho is expected to avail equal access to sexual and reproductive health services, which include access to contraception, thereby including respecting other fundamental human rights. Cook asserts that the right to liberty and security of a person is violated when his/her fertility is denied by the state [19]. Therefore, Lesotho provides for access to contraception for adolescent girls concomitantly with CEDAW, even though it has been noted that the convention regards adolescent girls as a homogeneous group. Access to information about contraception and contraceptive services is determined by different factors such as literacy, age geographic location, disability and social norms.

Furthermore, the CEDAW Committee raised a concern about Basotho women’s limited access to quality sexual and reproductive services in rural and remote areas [20]. As a result, the committee urges the state to ensure that women in rural areas and remote areas do not have barriers to access to family planning information and services and to promote education on sexual and reproductive health targeting adolescent girls and boys. Sochacki argues that the CEDAW Committee should do more to pressurise states parties to increase access to contraception as many international treaty-monitoring bodies have not fully exercised their powers to ensure that member states comply with ensuring access to contraception. It is against this backdrop that it has been discovered that although Lesotho has ratified CEDAW, thereby necessitating access to contraception by adolescent girls, there is no compliance to international law. Adolescent girls do not have access to contraception. Therefore, the CEDAW Committee needs to devise monitoring tools that will ensure that Lesotho ensures access to contraception for adolescents, using a gender- and social-inclusion lens in order to prevent maternal mortality and morbidity linked to adolescence. Culwell et al. state that states must provide enough health care to prevent maternal mortality and morbidity, as well as reduce unwanted pregnancies and unsafe abortions [21], as Maziwisa argues that the right to contraception is intricately linked to the right to life [see 18].

2.3 Convention on the rights of the child

Article 24 of the Convention on the Rights of the Child (CRC) obligates states parties to take effective and relevant measures to abolish traditional practices that are prejudicial to the health of children. Traditional practices which are detrimental to the health of children include teenage pregnancy or the practice of young mothers (young mothers are female adolescents who have babies), and the aforesaid practices affect both adolescent girls and boys, adolescents living in the urban or rural areas, literate or illiterate, and adolescents without or with disabilities. Cook asserts that article 9(1) of the International Covenant on Civil and Political Rights (ICCPR) read with article 19 of the CRC shows that lack of access to contraception-related information, education and services violates adolescent girls’ rights to liberty and security of the person (see [19]). Therefore, impeding access to information and education about contraception by the adolescents is a violation of fundamental human rights.

Failure to ensure access to sexual and reproductive health and rights (SRHR) education results in increased risk of early pregnancies that may result in complications such as foetus loss, infant mortality and vesicovaginal fistulas for adolescent girls (see [19]). That is why Durojaye argues that there is a strong existing correlation between adolescent girls’ literacy and sexual and reproductive health and rights [22]. ‘Literacy facilitates access to SRHR information and can help reduce early pregnancies, STIs, HIV, and early marriage, especially in the rural areas where adolescent-friendly services are not easily accessible’ (see [18]). Therefore, states must facilitate education on the correct use and effects of contraceptives to enable adolescent girls to protect themselves when they begin exploring their sexuality (see [18]). Nevertheless, more focus on the raised arguments is based on adolescent girls as a homogenous group, not unpacking all groups of adolescents.

The Committee on the Rights of the Child General Comment No.20 states that all adolescents need access to confidential, adolescent-responsive and non-discriminatory sexual and reproductive health services that include contraception, because access to high-quality child-friendly sexual and reproductive health services could transform the situation [23]. In addition, General Comment No.4 emphasises that states should reduce maternal morbidity and mortality in adolescent girls. This implies that the practice of deterring adolescents from having access to contraception as a social-exclusion practice is a prejudice against adolescents which may negatively affect their health. In addition, article 3(1) of the CRC enjoins states parties to take all actions concerning children, prioritising the best interests of the child. Similarly, in cases where the child’s views and/or interests are distinct from those of parents, the best-interests test can be used to legitimately respect the child’s right to receive sexual and reproductive health services, including counselling and treatment, and override parental consent. Thus, failure to facilitate access to contraception by adolescents does not prioritise the principle of the best interest of the child because when adolescents prioritise not to bear children, yet there are no contraceptive services that help them prevent pregnancy; they are more prone to unintended pregnancy that may result in adverse health effects. Kangaude et al. posit that adolescent pregnancy and childbearing have adverse health and social effects on adolescent girls [24]. Therefore, Lesotho as a state party to CRC has committed itself to facilitate access to contraception for the adolescents in order to protect and improve their health, although the convention does not precisely refer to gender- and social-inclusion considerations.

2.4 Convention on the rights of persons with disabilities

The Convention on the Rights of Persons with Disabilities (CRPD) enjoins states parties to recognise that persons with disabilities (PWDs) have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. Thus, article 25 provides that states parties should ensure access to gender-sensitive health services which include sexual and reproductive health services to persons with disabilities. However, the Committee on the Rights of Persons with Disabilities Draft General Comment No. 3 of 2016 notes that women with disabilities are denied access to information related to contraception and family planning because they are assumed to be asexual, yet they have the right to choose the number and spacing of their children like all women. Moreover, children with disabilities lack access of a full range of appropriate and freely chosen contraceptives; as a result, adolescent girls with disabilities experience unwanted pregnancies and sexually transmitted infections [25].

It has been noted that Lesotho has ratified CRPD; therefore, it is obligated to provide adolescents with disabilities with access to gender-sensitive contraception. Thus, the expectation is that this provision of the CRPD is reflected in the health-related legislation, policies, guidelines and practices of the Kingdom of Lesotho. Nevertheless, there are also some gaps identified in the convention: PWDs have been stated as a homogeneous group in the convention. As a result, literacy issues and geographic locations of other people with disabilities have been ignored by the convention.

2.5 Protocol to the African charter on human and peoples’ rights on the rights of women in Africa

Under the African human rights system, Lesotho has ratified the African Charter on Human and Peoples’ Rights (Banjul Charter) and African Charter on Human and Peoples’ Rights and Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol). The Banjul Charter is silent on contraception or sexual and reproductive health; nevertheless, article 14 of the Maputo Protocol focuses on sexual and reproductive rights of women in Africa. Article 14 binds states parties to ensure that the right to sexual and reproductive health of women is respected and promoted, including the right to choose any method of contraception, control fertility, have family planning education and decide whether to have children, the number of children and the spacing of children. Accordingly, Maziwisa argues that article 14 of the Maputo Protocol protects the rights of adolescent girls to family planning education, controlling their fertility by deciding whether to have children, the number and spacing of children and choosing any method of contraception [see 18]. Maziwisa further states that Maputo Protocol obligates states to ensure that they protect adolescent girls against sexually transmitted infections such as HIV and AIDS and stay informed about their own or partners’ health status, especially if they are infected with sexually transmitted infections.

In addition, Maziwisa asserts that article 14(2) enjoins states to take appropriate measures geared towards providing enough, affordable and accessible sexual and reproductive health and rights education in rural areas. The cost of contraception services and methods may be too costly for adolescents, thereby prohibiting them from accessing contraceptives [26]. Therefore, Lesotho has committed itself to provide adolescent girls with affordable and accessible sexual and reproductive health and rights and education in the rural areas. On the other hand, Maputo Protocol does not have provisions for adolescent boys and specific provisions for adolescents with disabilities. Thus, the protocol does not entail contraception issues for adolescents through the gender- and social-inclusion lens, thereby leaving gaps for binding Lesotho to ensure equitable access to contraception for adolescent girls and boys, even though it could be argued that the protocol is gender-specific – it is focusing on women only in Africa.

3. Domestic laws for adolescents’ access to contraception in Lesotho

This section entails constitutional provisions and other statutory provisions that link access to contraception for adolescents, and they shall be linked in conformity with international norms.

3.1 Constitution of Lesotho

Sexual and reproductive health rights of adolescents, including a right to contraception, are enshrined in the Constitution of 1993, which provides that every citizen has fundamental human rights and freedoms. Section 27(1)(a) provides that Lesotho shall adopt policies aimed at ensuring the highest attainable standard of physical and mental health for its citizens, including policies designed to reduce stillbirth rate and infant mortality rate and improve health development of the child. Thus, adolescents are citizens of Lesotho, and they have a right to health, including contraception. However, the right to health is non-justiciable because it is a socio-economic right in the Constitution of Lesotho. The right to health is closely related to and dependent on the realisation of the right to life [27]. ‘Therefore, violation of the right to health is concurrently a violation of the right to inherent life’ [28]. Moreover, the case of International Pen and others (On behalf of Ken Saro-Wiwa) v Nigeria links the right to health to the right to life [29]. The right to life is provided in Section 5 of the Constitution. Shah and Ahman assert that unwanted pregnancy is a serious risk to the life, survival and development of adolescents in Africa [30], thereby necessitating protection of life by ensuring that children avoid unwanted pregnancy and have access to contraception (see [24]).

Section 18 of the Constitution prohibits discrimination, and Section 18(2) provides that no person shall be treated in a discriminatory manner by any person acting by virtue of any written law or in the performance of the functions of any public office or any public authority. Kangaude et al. assert that non-discrimination means that health-care providers should not discriminate against minor girls in terms of access to contraceptives; moreover, states should be aware of intersectional discrimination in terms of age, gender and disability (see [24]). It seems that the Constitution does not discriminate between adolescents against access to contraception from the gender- and social-inclusion perspective, though it is not explicitly stated.

Furthermore, Section 14(1) provides for the freedom of expression for every person, including freedom to receive ideas and information without interference. According to UN Committee on the Rights of the Child (CRC) General comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), 17 April 2013, CRC/C/GC/15, children should express their views on accessing and using contraception, as well as their experience of the quality of care [31]. Therefore, health-care providers should provide appropriate information to adolescents in a manner that respects their level of maturity and engage the adolescents in decision-making according to their evolving capacities [32]. Section 14(1) of the Constitution of Lesotho protects different groups of adolescents against violation of the freedom to receive information about contraception and express their opinions about contraceptive services they receive. Therefore, the Constitution implicates access to contraception for adolescents using the gender- and social-inclusion lens because it makes a provision for freedom to receive information for every Mosotho.

3.2 Children’s protection and welfare act 2011

Section 6 of the Children’s Protection and Welfare Act of 2011 (CPWA) makes a provision of protecting adolescents against any form of discrimination on the basis of sex, disability or socio-economic status. Therefore, CPWA provides for equal access to contraception for adolescents where such services are available. In addition, Section 11(1) and (6) of the act upholds children’s rights to access to sexual and reproductive health information appropriate to their age. Thus, the act provides for access to contraception information for adolescents. On the other hand, the enforcement of this law is a challenge [33]. Nevertheless, the act does not have provisions in terms of gender equality and social inclusion so as to ensure equal access to contraception information. As a result, disadvantaged and marginalised adolescents are excluded from being protected by the aforementioned section of the CPWA. It has also been noted that the act is silent on access to contraception.

4. Administrative measures for providing contraception

This section provides details about administrative measures taken by the state to ensure that there is access to contraception. The measures will be analysed by looking into adolescents’ access to contraception from gender- and social-inclusion perspective.

4.1 Lesotho health policy 2011

The objective of the Lesotho Health Policy of 2011 is to make pregnancy and childbirth safe for mothers and newborns and reproductive health services acceptable to individuals, families and communities. The policy measures include:

• Ensuring access to safe, effective, affordable and acceptable reproductive health services including family-planning services to youth, women and men.

• Promoting and enhancing adolescent sexual and reproductive health, including prevention of transmission of HIV and other STIs.

This policy facilitates adolescents’ access to contraception where it makes reference to ensuring access to family-planning services to youth and promoting and enhancing adolescent sexual and reproductive health. However, the policy is gender-blind because it does not clarify gender considerations linked to adolescents in terms of access to contraception. Furthermore, social-inclusion issues such as considering access to contraception in the rural areas and for adolescents with disabilities have not been part of the policy.

4.2 Village health Programme policy 2020

The Village Health Programme Policy’s mission is to have equitable access to quality health services. Assumably, quality health services include sexual and reproductive health services that include equitable access to contraception for adolescents. Furthermore, one of the guiding principles of the policy is gender sensitivity and responsiveness, as well as special consideration of women because of their special reproductive role. The objectives of the policy include to extend health-care coverage to all citizens of Lesotho, including people with disabilities and people living in remote, rural and hard to reach parts of the country.

The policy generalises facilitation of equitable access to health-care services at the community level with a specific objective on inclusive health-care services. However, the policy is silent on adolescents as a group; they are assumed to be part of the society eligible for access to health-care services at the community level. Moreover, the policy is silent on access to sexual and reproductive health services, and therefore, it does not have policy objectives or strategic actions on access to contraception for adolescents. Thus, the Village Health Programme Policy of 2020 is not gender-responsive or socially inclusive for advancing access to contraception for adolescents at the community level.

4.3 National Family Planning Guidelines for health service providers 2017

The guidelines state that it is crucial to ensure that adolescents have access to youth-friendly contraceptive information, services and counselling in Lesotho. Furthermore, the guidelines provide that all individuals have a right to access to sexual and reproductive services, regardless of their gender or sexual orientation, marital status, age, religious or political beliefs, ethnicity or disability or any other characteristics which could make individuals prone to discrimination. In addition, one of the general guiding principles of these guidelines is that ‘family planning services should be made available to all who need them, including adolescents, men and people with disabilities and special needs’. Lastly, there is a specific section about adolescents, including adolescents with disabilities, in the National Family Planning Guidelines for Health Service Providers.

The National Family Planning Guidelines for Health Service Providers guide health-care service providers to provide equitable and inclusive contraceptive services to adolescents, using a gender- and social-inclusion lens because the guidelines do not regard adolescents as a homogenous group. Therefore, these guidelines are responsive to the needs of adolescents in terms of access to contraception in Lesotho.

4.4 National Strategic Development Plan II

One of the strategic objectives of the National Strategic Development Plan II (NSDP II) 2018–2023 is to increase access, coverage and effectiveness of quality health-care service delivery for all by providing universal access to sexual and reproductive health-care services to all people, with a focus on adolescents, youth and other vulnerable groups. Thus, NSDP II plans to promote equitable and inclusive access to contraception to adolescents because it singles out adolescents and other vulnerable groups.

4.5 Lesotho gender and development policy 2018: 2023

The objective of this policy is to ensure access to health services to different groups of people of all ages and encourage male involvement in sexual and reproductive health issues. Furthermore, its strategic actions are to promote quality health for all regardless of gender or sexual orientation and provide a wide range of family planning methods and contraceptive options. The Lesotho Gender and Development Policy is not adolescent-responsive because it does not address adolescents’ sexual and reproductive health issues from the gender perspective – it is silent about adolescents as a group. Apart from that, the policy is also silent about access to contraception for adolescents.

4.6 National Adolescent Health Policy 2006

The National Adolescent Health Policy of 2006 points out that male adolescents who herd animals are more likely to have their rights violated than other adolescents. Moreover, through this policy, the Government of Lesotho commits itself to ensure that quality sexual and reproductive health services are available to all adolescents, and objective 4 of the policy is to reduce the levels of unwanted pregnancies among adolescents by raising the contraceptive use in sexually active adolescents by 20%.

The policy identifies male adolescents having barriers to access to sexual and reproductive services, thereby not having access to contraception. Therefore, this part is gender-sensitive. On the other hand, the target of 20% is not sex-disaggregated or disaggregated by social groups.

4.7 Empirical findings

Lesotho Demographic and Health Survey of 2014 shows that 79.9% of sexually active females aged 15–19 years were not using any contraception. It also shows pregnancy and pregnancy-related deaths that cause mortality for married and unmarried girls between the ages of 15 and 19 in Lesotho. According to 2016 Population and Housing Census Report of Lesotho, teenage pregnancy is as follows in Lesotho (Table 1).

Age	Percentage (%)
13	0.1
14	0.5
15	1.6
16	6.3
17	15.3
18	29.4
19	46.9

Table 1.

Teenage pregnancy in Lesotho.

Source: 2016 Population and Hosing Census Report of Lesotho.

In addition to the findings of the Population and Housing Census Report, the Lesotho Multiple Indicator Cluster Survey 2018 shows that adolescent birth rate¹ is 59 in the urban areas and 114 in the rural areas; in ecological zones, it is 77 in the lowlands, 163 in the foothills, 114 in the mountains and 91 in the Senqu River Valley. Furthermore, the survey shows that the percentage of male adolescents aged 15–19 years who have fathered a live birth is 0.4% for both urban and rural areas.

The three reports show that there is high teenage pregnancy in Lesotho, and this implies that adolescents are still debarred from having access to contraception. Moreover, there are some identified gender gaps and social-exclusion issues in terms of access to contraception for adolescents. The surveys did not capture information on adolescents and contraception using a gender lens or focus on social inclusion issues. This shows that administrative measures to facilitate access to contraception for adolescents are not gender-responsive and integrating social inclusivity. Accordingly, the CEDAW Committee recommended Lesotho to target adolescent girls and boys with special attention to early pregnancy and the control of STIs by providing them with sexual and reproductive health education.

5. Conclusion

It has been found that Lesotho is a state party to different treaties which bind it to promote access to contraception for adolescents from the gender- and social-inclusion perspective, though some treaties are not gender-specific. Thus, Lesotho facilitates access to contraception for adolescents from the gender- and social-inclusion perspective in respect of international law, and this has barriers to implementation because provisions of treaties are only justiciable in Lesotho if they have been domesticated.

The Constitution of Lesotho implicates equitable access to contraception for adolescents from the gender- and social-inclusion perspective because the Constitution provides for gender sensitive and inclusive access to information on sexual and reproductive health. Nevertheless, the Children’s Protection and Welfare Act does not have provisions on gender equality and social inclusion so as to ensure equal access to contraception information for adolescents. As a result, disadvantaged and marginalised adolescents are excluded from being protected by the law with respect to right to access to contraception. The act is also silent on access to contraception.

Administratively, National Family Planning Guidelines for Health Service Providers of 2017 and National Strategic Development Plan II are the only strategies which are gender-responsive and use social-inclusion lens to facilitate access to contraception for adolescents. Other policies are gender-blind and silent on adolescents and access to contraception. Lastly, empirical findings show that many adolescents do not have access to contraception, and gender- and social-inclusion issues are not taken into consideration where adolescents may have access to contraception. Therefore, concerted efforts of different stakeholders are required for advancing adolescents’ access to contraception from a gender- and social-inclusion perspective in order to enhance universal access to contraception by adolescents in Lesotho.