ACCELERATING INVESTMENT IN SEXUAL REPRODUCTIVE HEALTH, REPOSITIONING FALIMY TO ADDRESS SRH NEEDS OF ADOLESCENT GIRLS, ” THE BEST WAY TO SHAPE THE DIRECTION OF THEIR LIVES AND THEIR FAMILIES”

INTRODUCTION
Against the backdrop of the Millennium Development Goals (MDGs) and other international commitments to reduce poverty and improve sexual and reproductive health outcomes among adolescents, together with the social context of adolescents in the global community, efforts to effectively address adolescent health outcomes still present complex challenges.
Adolescence is a decisive age for young people around the world. What transpires during a girl’s teenage years shapes the direction of her life and that of her family. For many girls in developing countries, the mere onset of puberty that occurs during adolescence marks a time of heightened vulnerability—to leaving school, child marriage, early pregnancy, and exposure to HIV, sexual exploitation, coercion and violence. Adolescent girls are less likely than older women to access sexual and reproductive health care, including modern contraception and skilled assistance during pregnancy and childbirth.

It’s no surprise that many of the adolescents especially in devolving countries are very poor, have little control over household income, have limited knowledge about sexual and reproductive health issues, and lack the ability to make independent and informed decisions about their health and lives. UNFPA and Guttmacher Institute, 2009. Moreover, they often have limited access to health care that meets their specific needs. (Center for Global Development, 2009)

Today, 88 per cent of adolescents live in developing countries. UNICEF, 2011. Adolescent populations are growing fastest in Sub-Saharan Africa and the least developed countries overall. For example in countries like Uganda the 57% of the total population is below 19years while 21% between ages 19-30 years. UDHS 20012. In such countries the risk associated with pregnancy and childbirth is highest. United Nations, MDG Report 2011. For example 16 women die every day in Uganda due to pregnancy related complications. Uganda Population Secretariat 2012.

Such existing challenges in adolescent health therefore call for an urgent need to increase investment in comprehensive programmes, including sexual and reproductive health care for adolescent girls mainly in law developed counties like Uganda. Doing so would yield multiple benefits that would enable our adolescents especially girls, to stay healthy, avoid unintended pregnancies, finish an education, engage in productive work, and choose to have fewer and healthier babies, when they are ready. The choices that girls have and the actions they take during these seminal years have far-reaching consequences within their societies, economies and environments, which ultimately affect all of us around the world. Center for Global Development, 2009.

THE CURRENT SITUATION
While some trends in adolescent health and social outcomes have improved over the past three decades, including school enrolment and retention, early marriage and early pregnancy WHO 2012, disparities in many adolescent health outcomes persist by age, income, gender, region and other social cultural factors. Adolescents are a diverse group of people whose capacities and needs differ by age, sex, living arrangements, area of residence, level of education, and by their status in terms of marriage, childbearing and employment. These differences must be addressed when attempting to improve and maintain their health and development. As described below is an analysis of the current adolescent health situation in developing countries.

Complications in pregnancy and childbirth are the leading causes of death among adolescent girls ages 15-19 in low- and middle-income countries, resulting in thousands of deaths each year, WHO 2012. The risk of maternal mortality is higher for adolescent girls, especially those under age 15, compared to older women. WHO 2010

Adolescent pregnancy brings detrimental social and economic consequences for a girl, her family, her community and her nation. Many girls who become pregnant drop out of school, drastically limiting their future opportunities. A woman’s education is strongly correlated to her earning potential, her health and the health of her children. Thus, adolescent pregnancy fuels the intergenerational cycle of poverty and poor health. WHO Feb 2012

The younger a girl is when she becomes pregnant, whether she is married or not, the greater the risk to her health. It is estimated that girls under the age of 15 are at greater risk of dying in childbirth than women in their 20s and so do their babies. UN General Assembly, the Girl Child 2011
Whether married or unmarried, young women are less likely than their older counterparts to use modern contraceptives. Married adolescents may feel social pressure to bear a child and thus not seek family planning services. Unmarried adolescent girls face a different type of social pressure, fearing judgment or dealing with a socially-unsanctioned pregnancy. Increasing their vulnerability, some adolescent girls are subject to sexual exploitation and abuse, and many have limited knowledge about how to protect their health. UNFPA and Guttmacher Institute, 2009.

Approximately one in three adolescent girls is married before age 18 in the Low developed counties mainly in Sub-Saharan Africa. The poorest and least educated girls are those most likely to be married earlier, UNICEF 2011 Girls who enter into marriage early face serious health risks; being married, they are more likely to be exposed to frequent, unprotected sex compared to their unmarried peers, and hence are more vulnerable to adverse pregnancy outcomes, HIV infection and violence. Centre for Global Development 2009. If the current trend in child marriage continues, the rate will jump by 14%, from 14.2 million in 2010, to nearly 15.1 million in 2030, UNFPA, “Marrying Too Young: End Child Marriage,” 2012.

Adolescent pregnancies put newborns at risk. The risk of death during the first month of life is fifty percent higher among babies born to adolescent mothers. The younger the mother is, the higher the risk for the baby. World Health Organization, “Adolescent Pregnancy,” Accessed March 8, 2012.

15% of all unsafe abortions in low- and middle-income countries are among adolescent girls aged 15-19 years. Shah 2009 et.l. In 2008, there were an estimated 3.2 million unsafe abortions in developing countries among girls aged 15-19,18 and adolescents are more seriously affected by complications than are older women, WHO “Adolescent Pregnancy” 2012. Unsafe abortion is responsible for about 13 per cent of all maternal deaths, with adolescents disproportionately affected. WHO, “Opening Remarks at the Roundtable with Women Leaders on MDG5,” 2012.

Young people aged 15-24 account, for 41% of new HIV infections worldwide. UNICEF, “Opportunities in Crisis: Preventing HIV from early adolescence to young adulthood,” 2011.Adolescent girls are at far greater risk of contracting HIV than adolescent boys. Young women make up 64% of all new infections among young people worldwide. This is not just because they are more physiologically susceptible; they are also at high risk for sexual violence and rape, both inside and outside of marriage. Inside a marriage or partnership, adolescent girls often have limited control over contraceptive use or whether sex takes place at all, UNICEF, “The State of the World’s Children 2011.”

What Must Be Done?
Investments in the health, education and employment of young people, particularly adolescent girls, are among the most cost-effective development expenditures in terms of the social returns they generate. Unfortunately however, the health needs of adolescent girls are ignored in many developing countries.

There is urgent need for expanding access to information and services that address the specific reproductive and sexual health issues of young people, especially the poorest and most vulnerable girls. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
The situation also calls for governments, development partners and all other stakeholders to invest additional resources in adolescent development and to pay explicit attention to gender inequalities in order to provide targeted policies, programs, and services. UNFPA, “The Case for Investing in Young People,” 2010.

This requires increasing the number of health service providers that offer sensitive, confidential services tailored to adolescent girls, thereby reducing the fear and stigma that many adolescents face in seeking health care more so HIV and other SRH services. It also requires scaling up comprehensive sex education within and outside of schools to teach girls and boys how they can protect their health and to counter misinformation. UNFPA and Guttmacher Institute, “Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health,” 2009.

Governments also should put in place and support laws and policies that demand eliminating negative social, economical and cultural practices against women and children such as child marriage and other forms of forced marriages, female genital mutilation practices as well as challenging restrictive laws and policies that limit girls’ access to services, such as laws requiring a parent’s or husband’s written permission to access contraceptives. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.

Investing in girls’ rights and well-being will bring major long-term social and economic benefits. Such as supporting girl child education and other forms of girl child empowerment is also key and pertinent in reducing adolescent health challenges.

Governments and other stake holders should also invest more in family planning programmes by making them available, affordable and accessible to the full range of users, including adolescents, unmarried people, and all others who need it.
Include emergency contraception in the range of supplies available through family planning programmes.
Engage men and boys in family planning, for their own benefit and to support the right of women and girls to use contraception.

Compiled by;

Patrick Mwesigye
Director
Uganda Youth and Adolescents Health Forum.
patsew@gmail.com
http://www.uyahf.org

References.
1. UNFPA and Guttmacher Institute, “Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health,” 2009.
2. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
3. UNICEF, “The State of the World’s Children 2011.”
4. United Nations, “The Millennium Development Goals Report 2011.”
5. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
6. World Health Organization, “Interventions for Preventing Unintended Pregnancies Among Adolescents,” Accessed March 13, 2012.
7. World Health Organization, “Maternal Mortality Fact Sheet,” November 2010.
8. World Health Organization, “Adolescent Pregnancy,” Accessed February 18, 2012.
9. UN General Assembly, “The Girl Child – Report of the Secretary General,” 2011.
10. UNFPA and Guttmacher Institute, “Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health,” 2009.
11. UNICEF, “The State of the World’s Children 2011.”
12. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
13. UNFPA, “Marrying Too Young: End Child Marriage,” 2012.
14. World Health Organization, “Fact Sheet on Adolescent Health,” Accessed March 13, 2012.
15. UNFPA and Guttmacher Institute, “Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health,” 2009.
16. World Health Organization, “Adolescent Pregnancy,” Accessed March 8, 2012.
17. Shah, IH, E. Ahman, “Unsafe abortion differentials in 2008 by age and developing country region: high burden among young women,” Reproductive Health Matters 2012, 20(39): 169-173.
18. World Health Organization, ”WHO guidelines on preventing early pregnancy and poor reproductive health outcomes among adolescents in developing countries,” 2011.
19. World Health Organization, “Adolescent Pregnancy,” Accessed February 18, 2012.
20. World Health Organization, “Opening Remarks at the Roundtable with Women Leaders on MDG5,” Accessed March 13, 2012.
21. UNICEF, “Opportunities in Crisis: Preventing HIV from early adolescence to young adulthood,”
22. UNICEF, “The State of the World’s Children 2011.”
23. UNFPA, “The Case for Investing in Young People,” 2010.
24. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
25. UNFPA, “The Case for Investing in Young People,” 2010.
26. UNFPA and Guttmacher Institute, “Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health,” 2009.
27. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
28. UNFPA and Guttmacher Institute, “Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health,” 2009.
29. UNFPA, “Marrying Too Young: End Child Marriage,” 2012.
30. World Health Organization, “Adolescent Pregnancy.” Accessed February 18, 2012.
31. Center for Global Development, “Start with a Girl: A New Agenda for Global Health,” 2009.
32. UNICEF, “The State of the World’s Children 2011.”

IMG_0806.JPG

IMG_0834.JPG

IMG_0811.JPG

IMG_0811-0.JPG

IMG_0805.JPG

IMG_0837.JPG

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s