In all societies, adolescence can be a tricky phase of life. For starters, it’s when we go through puberty. No matter where you live or what your cultural or religious beliefs are, puberty is a universal experience. Not only do our bodies physically change, but the way we think and how we relate to others (and ourselves) changes as well. What happens in this critical phase of our development impacts the rest of our lives. But while puberty is universal, the quality of sexual and reproductive health care adolescents receive is not.
Consider this: an estimated 1.3 million adolescent girls and 780,000 adolescent boys are living with HIV worldwide, and 79 percent of new HIV infections among adolescents are in Sub-Saharan Africa. An estimated 16 million births annually occur to girls aged 15-19, and 95 percent of these births are in developing countries. Early childbearing is linked to increased risk of maternal mortality as well as illegal and unsafe abortions.
A complex set of factors contribute to sexual and reproductive health problems among adolescents (read my colleague’s blog on this topic), but these problems are exacerbated by the lack of youth-friendly health services and accurate information on safe sex and contraceptive use. Despite numerous agreements by governments to guarantee sexual and reproductive health services as a fundamental human right, including for adolescents, we have yet to see significant commitment and funding for programs we know would improve the lives of millions of young people.
A special supplement to the Journal of Adolescent Health this month identifies a number of effective strategies for providing sexual and reproductive health services to adolescents. These are strategies that have been proven to work in diverse settings, from Jamaica to Mongolia, Madagascar to Nepal. The evidence shows that a combination of tactics is needed to make a significant impact.
The most effective strategy involves a three-pronged approach: modifying health facilities so they are youth-friendly (for example, extending hours of operation, reducing prices, and modifying physical layout to increase privacy); training health workers and staff to improve their attitudes, knowledge, and skills in addressing the needs of young people; and raising awareness among adolescents through outreach in communities and schools and through mass media.
One well-documented initiative is Mozambique’s “Geracao Biz” (“Busy Generation”) program, which included refurbishing adolescent-only clinics, developing training materials for workers, and recruiting peer activists to welcome and educate clients in the waiting room. The program also used varied marketing strategies to reach in- and out-of-school youth, such as an innovative mobile app (MoBiz) and a mentorship program for adolescent girls. This saw a dramatic increase in clinic attendance and condom distribution. Moreover, several studies have shown significant changes in the knowledge, attitudes, and sexual behavior of youth across Mozambique (for example, use of contraceptives during first sexual intercourse increased from 35 percent to 60 percent, and the number of young people getting tested for HIV more than tripled).
We also know about strategies that do not work. In particular, mixed-use youth centers have been largely ineffective at providing adolescents with sexual and reproductive health services and information. These centers are overwhelmingly used by older male youth for recreational purposes and vocational or technical training. This may be intimidating for younger adolescents, especially girls, who are seeking information about their changing bodies or budding sexuality.
We also need to do more to reach the most vulnerable adolescents. Girls who are out of school—often poor and rural—and girls who are married need special attention. So too do boys in gangs, HIV-positive youth, and girls and boys who engage in transactional sex for survival. These populations are heavily stigmatized and face even more barriers to services than their peers.
Still, we know enough to act. If governments prioritize the sexual and reproductive health of young people and scale up the programs that work, we can transform societies. It’s not only the smart thing to do to ensure sustainable development, it’s a fundamental human right.
This blog post is the fifth of a five-part series summarizing the research featured in the January 2015 special supplement to the Journal of Adolescent Health. The supplement reviews the progress on adolescent sexual and reproductive health and rights since the 1994 International Conference on Population and Development.