Article Review: “Adolescence, a foundation for future health.”

The first article in the four-part Lancet Series on adolescent health, “Adolescence, a foundation for future health,” emphasizes the importance of health interventions during the adolescent years and argues for a “positive youth development approach” to improving adolescent health.   

The authors of this article maintain that there are many factors that affect the health outcomes of adolescents.  Biological changes during puberty affect health, behavior, and emotional well-being in complex ways. Social factors such as access to education, employment opportunities and family structures also affect adolescent health. 

Adolescence is a time when many adopt health behaviors that will not only affect their personal health but also the health of future generations. Yet, adolescents experience many negative health risks. Approximately 15% of the world’s disease burden is among 10-to 24-year-olds. Injuries,  accidents, maternal mortality, and disease are the leading causes of death among this population, challenging the widespread belief that adolescence is a healthy time of life. 

The authors of this article emphasize the need for a positive youth development approach that targets the health of adolescents as a whole rather than one that targets specific components of health.  In closing, the authors make these recommendations:

1. Increase the focus on adolescent health within larger health agendas
2. Adopt a cross-cutting approach to adolescent health addressing the health of adolescents as a whole rather than in terms of different diseases
3. Increase attention to the health of adolescents
4. Give adolescents a stronger voice by increasing youth engagement
5. Increase the capacity of adolescent health providers

All of the health and development issues raised by the authors of this article are inextricably linked to young people’s sexual and reproductive health. In the same way that social factors influence other aspects of adolescent health, factors such as unemployment and education are also tied to the sexual and reproductive health of adolescents.

For example, the economic disparities that are often associated with unemployment and lack of education fuel the HIV epidemic and contribute to other negative health outcomes among young people, especially adolescent girls. Lower income levels can increase the risk of engagement in intergenerational relationships, early marriage, and sex work, all increasing the risk of HIV infection and early or unintended pregnancy.  The reverse is also true:  the economic strength of a country suffers when its young people’s sexual and reproductive health outcomes are poor.  If young people are sick, are burdened by early marriage, or experience unintended pregnancy, then they will be less able to fully contribute to society.

There is also strong relationship between education and young people’s sexual and reproductive health. Youth who do not attend school or who drop out prematurely miss many of the fundamentals of basic education. They also lose a valuable opportunity to learn about reproductive health and HIV in a stable classroom situation. Young women who become pregnant are more likely to leave school early, have a lower income, and have more children at shorter intervals throughout their lifetime. In contrast, young women who avoid unintended pregnancy are more likely to stay in school, participate in the work force, and have healthier, more educated children.

The authors’ argument for a positive youth development approach to adolescent health is well-founded.  Programs cannot effectively address any health or social outcome in isolation; however, in order for such an approach to be effective, young people’s sexual and reproductive health must be at the forefront.

Lancet Adolescent Health Series

Today the world is home to 1.8 billion young people between the ages of 10 and 24; this is the largest generation of young people in history. Gains in child health and survival, nutrition, and infectious disease have resulted in a burgeoning youth population; however, the health of adolescents has received little attention. In the past 50 years, the health of adolescents has seen far less improvement than that of younger children.

“Surely we do not want to save children in their first decade of life only to lose them in the second.” –Anthony Lake, Executive Director, UNICEF

 A growing youth population means a growing work force, and higher rates of unemployment.  Poverty, lack of education, migration, natural disasters and political unrest lead to social situations that can devastate the health of adolescents. Adolescents face increasing health disparities; childbirth-related complications are the number one cause of death among adolescent girls ages 15-19. Road traffic accidents, suicide, and infections such as HIV are the leading causes of death among this age group.

“Irrespective of region most adolescent deaths are preventable and thus strongly justify worldwide action to enhance adolescent health.”—Lancet

Now, more than ever, greater attention to the health needs of this growing and unique population is needed.  In April, the Lancet released its second series on adolescent health. This series includes four papers, “Adolescence: a foundation for future health,” “Adolescence and the social determinants of health,” “Worldwide application of prevention science in adolescent health,” and “Health of the world’s adolescents: a synthesis of internationally comparable data.”

This landmark series emphasizes the urgent need to increase attention to adolescent health. Join us over the next few weeks as we share the key messages from these articles and discuss their implications for the sexual and reproductive health of young people.

How Do Integrated HIV and Family Planning Services Affect Contraceptive Use among Youth?

Every year, lack of access to family planning services contributes to approximately 7.4 million unintended pregnancies among adolescents. The unmet need for contraception among adolescents is as as high as 68% in some regions, such as sub-Saharan Africa, South-central Asia, and Southeast Asia.  Although young people might not be accessing family planning services, youth are increasingly using HIV testing services. 

Young people who use voluntary counseling and testing (VCT) services  likely engage in sexual behaviors that that put them at risk for both HIV and unintended pregnancy. Globally, there has been a push to integrate contraceptive services at HIV testing sites; however, little is known about the effectiveness of providing contraceptive services at VCT centers.

In 2009, researchers from FHI 360 set out to determine the factors associated with contraceptive uptake among young people visiting VCT centers.  The study was conducted in Kenya at both youth VCT clinics and general VCT clinics. At each facility, researchers conducted baseline and follow-up client interviews, provider interviews, and clinic observations to determine which client-, provider-, or facility-based characteristics were associated with same-day uptake of contraception, intention to use contraception, and use of contraceptives three months after a VCT visit.

Before visiting the VCT center, 72% of youth participants reported sexual activity in the past three months, and 37% of all participants were currently using contraceptives. Only 18% were using a modern contraceptive method other than the male condom and only 18% always used a condom. One-third of the clients reported they did not want to get pregnant, were not using a method and did not intend to use a method. Seventy-eight percent of providers reported ever counseling VCT clients on contraceptive use in the past week, and only 17% reported always asking female clients about whether they wanted to get pregnant. 

After visiting the VCT center, many clients reported they were never screened for family planning need, were not given contraceptives by the VCT provider and/or did not intend to follow up on a provider referral for contraceptive services.  Youth who had a current partner, higher levels of education, more children, and a desire to delay pregnancy were significantly more likely to begin using a contraceptive method at the time of their visit. Young people who intended to use family planning before visiting the clinic, and who were provided with contraceptives at the time of visit, were more likely to use contraceptives at the three month follow-up.

Youth who visited VCT centers that had higher scores of HIV /family planning integration were more likely to begin a contraceptive method at the time of their visit.  Clients of providers who were younger or who had received training in family planning were more likely to use contraceptives at the three month follow-up. Youth clinics (compared to general clinics) received better scores on integration and youth friendliness but clients were less likely to use contraceptives after visiting; however, youth clinics might be serving a higher-risk group of youth. 

The research results demonstrate that young people visiting VCT centers have a high risk for unintended pregnancy. However, very few clients who attended the clinics were counseled on contraceptive methods other than condoms, received contraception at the time of visit, or were referred to other family planning services.  Further research is needed to better understand the specific factors that influence contraceptive uptake among young people so that programs integrating VCT and family planning can best meet the needs of their clients.  Because young people might be more likely to visit VCT centers than family planning clinics, programs must ensure there are no missed opportunities in meeting the contraceptive needs of young people attending VCT centers.

To learn more about this issue, read the full study “Service delivery characteristics associated with contraceptive us among youth clients in integrated voluntary counseling and HIV testing clinics in Kenya.”

United Nations Adopts Landmark Resolution on Adolescents and Youth

This post originally appeared on the Women Deliver website on April 30th, 2012 and can be accessed here.

Late Friday, 27 April 2012, at the 45th Session of the United Nations Commission on Population and Development (CPD), member states issued a bold resolution in support of young people’s sexual and reproductive health and human rights.

This victory comes on the heels of a UNICEF report released this week highlighting the challenges that the largest-ever generation of young people face—including HIV/AIDS, violence, and unintended pregnancy—and reaffirms long-standing international agreements including the 1994 United Nations International Conference on Population and Development Programme of Action.

“This CPD is one of the most important events to take place – to talk about young people, for young people and with young people,” said Kgomotso Papo, speaking on behalf of the South African Delegation during the closing plenary. “We must remove all barriers that compromise the health, well-being and development of youth; and ensure the right of every individual to autonomous decision-making in regards to their bodies, their health and their sexual relationships. On these points, there can be no compromise.”

Key points of the final resolution include:

• The right of young people to decide on all matters related to their sexuality
• Access to sexual and reproductive health services, including safe abortion where legal, that respect confidentiality and do not discriminate
• The right of youth to comprehensive sexuality education
• Protection and promotion of young people’s right to control their sexuality free from violence, discrimination and coercion

Much has changed since the landmark International Conference on Population and Development (ICPD) in 1994. Shifting global health funding, a maturing HIV epidemic, and the rise of the largest-ever generation of youth have all affected the current sexual and reproductive health and rights landscape. Similarly, several key global processes—a 20-year review of global sustainable development goals (Rio+20), a 20-year review of progress towards achieving the Cairo Programme of Action (ICPD+20), and a review of the Millennium Development Goals—are happening within the next few years, all with implications on the future of the global sexual and reproductive health and rights agenda.

“At this time of global uncertainty, there is no more important investment to be made,” said Janna Oberdorf, Director of Communications at Women Deliver. “Only healthy young people whose human rights are protected can be fully productive workers and effective participants in their country’s political processes. When young people are healthy and empowered, they can contribute to building strong communities and vibrant nations.”

In closing the session, Commission Chairperson Ambassador Hasan Kleib (Indonesia) called on member states to realize these agreements at the national level, stating that “we now have to walk the walk.”

Read the Chair’s text from the 45th CPD

Why Are Youth Voices Important at CPD?

This is an excerpt of a post originally published on the IPPF blog, The Bikini, and was written by David Lawrence, a youth author from YSafe. The entire post can be accessed here.

Each year there is a different theme for the Commission on Population and Development (CPD) meeting, and the outcome document that advises countries on their strategies for sexual and reproductive health and rights (SRHR) service provision is tailored to this theme. This year the theme is “Adolescents and Youth.”

Historically, lots of decisions surrounding SRHR have been made by adults and older people, despite the fact that these decisions have a huge impact upon young people. It’s great that this year we are focusing on how SRHR services can be more tailored to young people. Even more impressive is the number of young advocates who are attending this year’s CPD.

Oftentimes there are criticisms of youth involvement in these high-level decision making processes: it can feel that we are just there in a tokenistic sense. So, it’s great to see young people facilitating sessions, contributing to discussions, and ensuring that our voices are not only heard, but also acted upon.

The morning the CPD officially began, delegates from around the globe entered the United Nations Headquarters in New York City to discuss the future of SRHR and how countries can best implement the Programme of Action (POA) that was formulated in Cairo in 1994. For the first time in recent memory, CPD was attended by the United Nations Secretary-General, Ban Ki-moon, whose speech opened the proceedings by applauding the large number of youth delegates in attendance this year.

Given that there is clearly a great deal of work left to do in this extremely important field, there is a large amount of talk about a new stage in SRHR and development known as “ICPD+20 and beyond.” The United Nations and its member countries need to evaluate the successes and shortcomings of the POA and decide on a future direction. The United Nations Population Fund (UNFPA) is conducting a global survey to help determine what the CPD process will look like after 2014. This survey aims to find out what countries are doing to implement the POA and look at how their efforts could be improved in order to ensure all people are able to attain their sexual and reproductive health.

All of this talk is wonderful and it shows that the community is still committed to implementing the POA. However, young people want some assurance that the CPD process will not just continue for another 20 years.  We want action and a sense of urgency from member states and civil society. We want real, concrete movements that will ensure that the POA is met sooner rather than later.

What is also very timely about this year’s CPD convening is that other big development programs, such as the Millennium Development Goals, are coming to the end of their term. Consequently, there is a whole new global development agenda being formulated. At this extremely important time for our world, we need to ensure that the outcome documents of this year’s CPD, and CPDs to come, are strong and will guarantee an increased focus on young people and their sexual and reproductive health and rights.

Teens in the Tinderbox

This is an excerpt from a post written by Suzanne Ehlers, president of Population Action International; the post originally posted on the Huffington Post Impact blog. The original post can be accessed here.

Next week, I head to the United Nations to attend the 45th session of the Commission on Population and Development (CPD). The Commission’s work is to “monitor, review and assess the implementation of the ICPD Programme of Action at the national, regional and international levels.”

The 2012 CPD outcome document will serve as a foundation for major upcoming international negotiations on sustainable development and population, so we’ve deemed it a strategic investment of time and energy. We’ll travel the 95-North corridor later this week and monitor the proceedings on behalf of the world’s young people in particular, because this year’s theme is “Adolescents and Youth.”

Sounds simple, but it’s a tinderbox.

The number of adolescents and young people in the world today is at an all-time high. Along with food, water and safe shelter, this huge share of the world’s population needs access to contraception and a range of sexual and reproductive health services.

There will be many at the CPD who to choose to deny that young people are sexually active. These same deniers are so out of touch with the reality of young people that they don’t consider their human rights. It’s as if they don’t have rights, or that those rights aren’t under threat. They equate access to comprehensive sexuality education with a rise in sexual activity, when sex ed actually delays sexual initiation.

These deniers also conflate the basic tenets of good health care — such as privacy, confidentiality, and informed consent — with undermining cultural, religious and familial values. The opposite is true. Young people are sophisticated enough to explore and define their values, and make informed decisions that help safeguard their well-being.

As we head into a week of tense negotiations, let’s huddle to make sure our offensive game is primed and ready:

1. We will be prepared to respond to emotionally-charged untruths about young people and their vulnerabilities with emotionally-charged facts and strong evidence.
2. We will maximize a unique and isolated circumstance (UN conference rooms) for the benefit of young people around the world, whose lives literally depend on the success of our efforts.
3. We will hold the line and reaffirm past commitments, but we will also seek to advance a visionary agenda for the full realization of young people’s sexual and reproductive health and rights.

To read more of this post, please click here.

More posts on the CPD coming soon!  Look for “Why Are Youth Voices Important at CPD?” this week, as well as an overview of the key points from the United Nations Landmark Resolution on Adolescents and Youth next week.

Homelessness, Orphaned Status, IDU and Sexual Risk

Joy Cunningham is a Senior Technical Officer at FHI 360 where she manages a portfolio of global youth activities, including oversight for activities conducted under USAID’s Interagency Youth Working Group (IYWG). 

Ukraine has one the fastest growing HIV epidemics in the world; the virus is spreading faster there than anywhere else in Europe. Youth are disproportionately affected: more than 80% of the approximately 440,000 Ukrainians living with HIV are under the age of 30. It’s also estimated that between 40,000 and 300,000 young people are living on the streets, and they are often engaged in injection drug use (IDU) and trading or selling sex for drugs, activities that put people at high risk of acquiring and transmitting HIV. 

In a recent issue of AIDS, the link between orphaned status, homelessness, IDU, and HIV risk among street youth in Ukraine is documented. In the same issue, FHI 360 experts in youth and HIV wrote an editorial comment, calling for an urgent and comprehensive approach to address the needs of most-at-risk young people. The authors argue that the response to this crisis must involve a multisectoral approach that:

• Strengthens social welfare policies and programs to support the needs of orphaned youth and young people living on the streets
• Improves the national child protection system to better prevent abuse, provide effective methods for reporting cases of abuse, and support those who have been affected by violence and abuse
• Addresses the quality of institutional care services for homeless youth, with particular attention paid to the needs of orphaned adolescents
• Reduces stigma and discrimination against homeless youth, including decriminalizing the act of living on the streets
• Includes a rights-based, evidence-informed approach with combination interventions that allow young people who inject drugs to gain full access to HIV prevention and treatment services

Too often, most-at-risk young people fall into a gap between HIV prevention programs for the broader youth population and programs for most-at-risk people that fail to address the specific needs of adolescents. Prevention and mitigation are crucial to address the growing HIV crisis in the Ukraine.

For more information on steps that programs can take to address the needs of young people most at risk of HIV, visit www.IYWG.org or download a copy of “Young People Most-at-risk of HIV” here.

Calling All Friends of the IYWG

We want to hear from you! We are currently conducting an online survey to find out what our readers think of us. Sharing the most up-to-date and relevant information on youth sexual and reproductive health is important to us. We want to be sure that the information we provide is useful to your work and helps reach the goal of improving the sexual and reproductive health of young people worldwide. 

We want to know what you have learned from the IYWG-supported activities and how your work might have benefitted from this information. Please take a few moments to fill out our online survey and share your thoughts. We’re grateful for your opinions!

We Cannot Stay Silent: Building A Movement to End Child Marriage

Laura Dickinson is communications officer for Girls Not Brides: The Global Partnership to End Child Marriage. You can follow Girls Not Brides on Twitter @GirlsNotBrides or join them on Facebook: www.Facebook.com/GirlsNotBrides

Photo Credit: Cibele Vieira, Clinton Global Initiative

“Nobody seems to talk about child brides,” says Archbishop Desmond Tutu, Nobel Peace Prize winner and Chair of The Elders. “But I cannot stay silent.”

 The plight of child brides has long been ignored by the international community, despite the sheer scale of the problem: in the next year alone, 10 million girls around the world will marry before they are 18. That’s 100 million girls within the next decade who will marry as children.

Child brides are among the world’s most voiceless and vulnerable people. Rarely do they have any choice in when or whom they marry, nor do they have a voice in their relationship with their often much older husbands. They usually drop out of school, too, which only serves to reinforce their isolation.

Hard to reach and invisible, child brides rarely benefit from aid and development programs designed to curb maternal deaths, infant mortality or the spread of HIV and AIDS – despite the fact that they are among those who could most benefit from such support. Pressured to prove their fertility, young brides often become pregnant before their bodies are physically ready for childbearing. The results can be devastating: girls under 15 are five times more likely to die in childbirth than women in their 20s.

Photo Credit: Ashenafi Tibebe,The Elders

Child brides rarely receive support and guidance on issues such as family planning and safe sexual health. They are less likely to space out their children and, unable to negotiate safe sexual practices with their husbands, they are more likely than their unmarried peers to contract HIV and other sexually transmitted infections.

The repercussions of early marriage are serious, even dangerous – so why has it received so little attention from leaders and policy makers?

Desmond Tutu is right: very few people talk about child brides. Not only are they invisible, talking about their plight is deemed taboo – a topic too closely related to sensitive issues of tradition and culture for leaders to address.

That’s why he and his fellow Elders, an independent group of global leaders working for peace and human rights, brought together Girls Not Brides, a partnership of  nongovernmental organizations from around the world that work to tackle child marriage at the grassroots, national and global levels.

The aim of the Partnership is to give girls a voice, to connect those who work closely with girls vulnerable to early marriage to the leaders and policy makers who have a real opportunity to implement policies that protect and empower young girls and help them avoid early marriage.

Addressing sensitive issues such as child marriage can be lonely work, and organizations have long had to act in isolation. By coming together in partnership, Girls Not Brides members find strength in unity, sharing experiences and learning from each other about the successful programs that have helped to reduce child marriage. It also enables them to raise their collective voice, increasing awareness of the solutions that help to end child marriage and calling on leaders to take action.

Girls Not Brides and its members are determined to show that there’s a growing, global movement to end child marriage and enable millions of girls to fulfill their potential. We won’t be staying silent.

Find out more about Girls Not Brides at www.GirlsNotBrides.org, follow us on Twitter @GirlsNotBrides or join us on Facebook. Watch our video, featuring Graça Machel, Mary Robinson and Desmond Tutu of The Elders: Traditions can change: ending child marriage

The Stories Behind the Statisics: Young People and HIV

This is the third and final post of our Gates Foundation series, “The Stories Behind the Statistics.” The following was originally posted on the Gates Foundation Blog, “Impatient Optimists” and is available here.

Jaevion Nelson is the executive director of the Jamaica Youth Advocacy Network (JYAN).

Last August, during World Youth Day in Madrid, I was conducting outreach to encourage Catholic youth to use condoms. It was there that I heard one of the most frightening things ever: One young man told me that an HIV-positive person had no right to have sex.

It wasn’t the first time I had heard such disparaging comments about people living with HIV. Shocking as it was, this conversation was instructive. It reinforced the importance of the work my colleagues and I have been doing alongside a number of organizations worldwide, particularly Advocates for Youth, in speaking out for the more than 215 million women and girls who face an unmet need for modern contraception and the 16.5 million women of reproductive age who are living with HIV.

Worldwide, too many young people are still being denied access to essential services and commodities such as modern contraception, condoms, and HIV treatment.

As I’ve seen through my outreach and advocacy in Jamaica, the heartrending thing here hasn’t been so much a matter of limited funding. Rather, as young people, our access is too often restricted on the basis of inadequate and ideology-driven programs, policies, and laws.

It’s almost as if the existing data about our needs—even when the evidence stares policy makers right in their faces―are irrelevant. 

Within this context, women and girls and young people living with HIV are severely and disproportionally impacted. They aren’t provided the resources they need to avoid HIV transmission, prevent unintended pregnancies, and plan desired pregnancies. Just as important, they aren’t respected as central stakeholders in their own health care outcomes—as change agents that can help transform their communities for the better.

Worldwide, too many young people are still being denied access to essential HIV services and care, free from stigma.

Ultimately, the reproductive health needs of young people living with HIV aren’t so unique. After you factor in our age, sexual orientation, location, income, and HIV status, we all want to have the same things. Young people living with HIV want access to friendly services that are free from stigma just as much as the young person who is not HIV-positive, and just as much as the adult for whom policies around reproductive health are usually more favorable.

Stigma and discrimination make things needlessly complex for a young person living with HIV. While I have met a number of young people who have been bold enough to demand resources on the local and governmental levels, many others are too dis-empowered to do so. I have seen too many young girls scoffed at (at health clinics, no less) because of an unplanned pregnancy―and the discrimination is almost always exacerbated when these young people are HIV-positive.

Why must we be so cruel? It costs nothing to respect people living with HIV. It takes no effort to show compassion. We aren’t so naïve. Why should we continue to deny young people living with HIV the right to live happy, healthy lives like everyone else? We all have to play our part in advancing the rights, welfare, and dignity of young people living with HIV.