Facilitators and barriers in the utilization of World Health Organization's Preventing Early Pregnancy Guidelines in formulating laws, policies and strategies: what do stakeholders in Ethiopia say?

Background Each year, approximately 16 million 15-19 year-old girls give birth. In 2011 the World Health Organization (WHO) published the evidence-based "Preventing Early Pregnancy and Poor Reproductive Outcomes among Adolescents in Low and Middle Income Countries" guidelines to inform policies and programs. However, little is known about their country-level use to influence supportive environments to reduce early childbearing. We sought to identify alignment of Ethiopian laws, polices and strategies with these guidelines, whether these guidelines contributed to them, and identify facilitators and barriers to their utilization. Methods First, we analyzed Ethiopian legal, policy, and strategy documents relating to adolescent pregnancy to determine their alignment with the WHO early pregnancy guidelines. We then conducted and thematically analyzed 11 interviews with key informants (KIs) working in adolescent and/or reproductive health at the national level. Results Laws, policies, and strategies to address early childbearing are in place in Ethiopia and address the six domains of the WHO adolescent pregnancy guidelines. KIs reported that they were aware of the WHO adolescent pregnancy guidelines, but none mentioned it without prompting. Six barrier/facilitator themes emerged: knowledge, national agenda, laws, resources, culture, and cooperation. Conclusions Ethiopia has a policy framework consistent with WHO's adolescent pregnancy guidelines which may have contributed to their development. The lack of spontaneous identification of the guidelines by the KIs we interviewed, raises questions of their knowledge and use of the guidelines. Targeted dissemination of guidelines by WHO to relevant stakeholders may facilitate their use.