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Alexandra Hervish is an international education specialist with nearly 10 years of experience in capacity building, training and youth development. She has adapted and delivered policy communications workshops for youth and adults in both international and domestic settings. In addition, Alex has developed multimedia presentations that use innovative technologies to educate global and country-level audiences about population, health, and environment issues.
In January, the InternationalCenter for Research on Women (ICRW) and the United Nations Foundation (UNF) hosted a discussion about milestones in adolescent and youth health and development. All of the presenters emphasized the need for a holistic approach to the health and development of young people—one that enables them to delay marriage and childbearing, access youth-friendly health services, prevent the onset of mental disorders and non-communicable diseases, and thrive in a supportive environment. Amanda Keifer of the Public Health Institute highlighted that with the creation of the Bali Global Youth Forum Declaration, the global community is moving in the right direction by putting young people’s rights at the heart of development.
However, a participant raised an interesting point during the event: if we have compelling arguments about the importance of investing in adolescents and youth, why can’t we translate this information into tangible financial and political commitments? In my opinion, there are two distinct, yet inter-related answers to this question:
- We just do not have enough data. Upon opening the 8-page “centerfold” from the Lancet series on adolescents, one would immediately notice the abundance of dashes in lieu of data points for many countries around the world (particularly low- and middle-income countries). In fact, we only just recently calculated how many adolescents die every year. Contrary to what many would assume (after all, adolescence is considered the healthiest time of a person’s life), the figure is rather high: in 2004, 2.6 million people ages 10-24 died, with deaths increasing from adolescence into young adulthood.
- Even when we have reliable data, we are not doing enough with it. Though far from a complete picture, we have quite a bit of data about the sexual and reproductive health status of young people thanks to several large-scale surveys. But certainly, we cannot expect to achieve the types of investments we need across all sectors—health, education, economic development, governance, and gender, among others—if these data remain on our bookshelves and do not get into the hands of decision makers who determine funding levels and government priorities.
And that’s where we come into the picture. At the Population Reference Bureau, we are in the business of communicating technical data and research to decision makers in compelling, clear formats. One of the ways we achieve this goal is through our ENGAGE presentations. Integrating Trendalyzer and multimedia software platforms, ENGAGE presentations explore associations among fertility, health, economic, and environment indicators in a visually stimulating way. They have been used to define agendas, focus discussions, and encourage dialogue about solutions to today’s development challenges.
And there is even a presentation about young people! The ENGAGE presentation The Time is Now: Invest in Sexual and Reproductive Health for Young People delivers evidence-based messages about how sexual and reproductive health investments protect the well-being of young people and advance social and economic development. Using data and graphics, the presentation seeks to prioritize sexual and reproductive health for young people on policy agendas in sub-Saharan Africa. The presentation is available online in narrated and un-narrated formats in French and English with supporting presenter materials. And there are other issue-focused presentations to explore about family planning and poverty reduction as well as country-specific presentations and mini presentations.
It will take time to populate all of the dashes from the Lancet series with data points. But in the meantime, using policy advocacy tools that are available to us (like ENGAGE presentations) we can educate leaders about the importance of investing in young people to maximize their potential for healthy, productive lives.
This post, written by Percilla Obunga, FHI 360 project management specialist on gender and girls’ education in Kenya, originally appeared on FHI 360’s Degrees blog, and can be accessed here.
For the last four years, the Four Pillars PLUS project has been working with girls of primary and secondary school age in Kenya to address the complex barriers to achieving their educational success. The project is funded by the General Electric Foundation for the years 2008–2015. Using the Four Pillars strategy — scholarship, teacher professional development, mentoring of girls and community participation — notable changes have been realized in girls’ enrollment, retention and completion at the primary school level and in their improved performance, transition and retention at the secondary school level. The community has gradually accepted and supported the important role of girls in society, and teachers too are motivated to use the gender lens in achieving success in educational programs.
It has been a long journey to work with the girls as they go through so many challenges in life. My personal experience in working with communities has been challenging and rewarding at the same time. Communities — especially those with cultural barriers to girls’ education — need to be involved from day one, and throughout all the stages of project implementation, if support of the girl child is to be effective. Additionally, girls need to be empowered to know and believe that they are not inferior. That is why the Four Pillars PLUS project collaborates with women role models who represent hope and support as they mentor girls on life skills, good decision making, healthy choices and reproductive health issues. This approach has helped girls make greater strides in achieving educational success.
Creating lasting changes in the lives of girls has always been at the forefront for the Four Pillars PLUS team and, indeed, it continues to be a rewarding experience to see future productive women in our society. The girls are working hard in school, teachers are very committed to ensuring good performance and school administrators all join hands to make the school environment friendly to the girl child.
The Four Pillars PLUS strategy is a holistic approach that has proven to work wonders in improving educational outcomes for girls and other vulnerable children in the society.
According to the UNFPA, girls in developing countries who receive seven or more years of education marry, on average, four years later and have approximately 2.2 fewer children.
At USAID’s Mini University this year, adolescent health expert Dr. Robert Blum led a session titled, “Adolescent Health: How Far We Have Come, How Far We Have to Go.” During this session, Dr. Blum explained how advancements in science, research and advocacy have improved adolescent health and, yet, how much work stills remains. More than 2.6 million young people ages 10 to 24 die each year; among the 10 leading causes of death among this age group, six are socially determined. Mental health issues are on the rise among young people; approximately 20% experience a mental health problem, and psychiatric disorders are the leading cause of disability among adolescents and young adults. Approximately 5 million young people are living with HIV, and youth account for 40% of all new HIV infections. Rates of adolescent pregnancy are staggeringly high, with 16 million girls ages 15 to 19 giving birth every year. Both malnutrition and obesity are epidemic among youth and tobacco and alcohol use threaten the health of millions of young people. Today’s generation of young people is the largest in history, and these young people face a variety of health challenges that deserve urgent attention.
How Far Have We Come?
The future of adolescent health is not in a state of despair; recent gains in science, research and advocacy have improved understanding of and attention toward adolescent health needs. During his presentation, Dr. Blum highlighted the following:
- We have a much richer sense of data related to adolescent health.
- We have better research, including neurodevelopmental and genetic research.
- We have improved conceptual models to guide our work.
- We better understand the social determinants of health.
- There is more global attention to adolescent health than ever before.
Through advancements in science, we have come to better understand adolescent brain development; we now understand how the brain continues to develop throughout the adolescent years, and how brain development affects adolescent health behaviors. We have a greater understanding of the role of genetics in health outcomes; we have learned that genetic factors alone only account for approximately 5% of disease, whereas most diseases are the combined result of biology and environment. This has shaped our understanding of how to address adolescent health issues and has guided the development of conceptual models that address both risk and protective factors leading to today’s prevailing notion of positive youth development.
How Far Do We have to Go?
Despite these gains there is much more we need to do to fully address adolescent health. According to Dr. Blum we still need:
- Better quality age-disaggregated data
- Improved information on successful interventions
- Improved advocacy
- To move away from the unhelpful mindset of deterrence
- To do the “do-able”
While data and information about adolescent health outcomes have improved much is lacking; specific information about young people is often hidden within national data sets. Along with more data on adolescent health outcomes, we need more data on successful interventions. There is a lack of clarity about what the best approach to adolescent health is. Dr. Blum suggests we push the envelope; he stated that programs “have to have a high tolerance for failure or they are just not doing enough.” We need not only to improve our programs but also to improve our advocacy efforts. Finally, we need to continue to implement those programs that are working. Simple low-cost interventions that are proven successful can vastly improve the health of adolescents. These interventions include providing iron supplements, promoting access to contraception, increasing school enrollment, offering life skills education, encouraging hand washing, and providing vaccination. In the words of Dr. Blum, to achieve improved health outcomes among adolescents, we need to “do the do-able.”
Tomorrow, FHI 360 on behalf of the IYWG, will host a panel presentation at 2012 Global Youth Economic Opportunities Conference on the intersection of adolescent girls’ economic empowerment and sexual and reproductive health.
Adolescent girls face multiple economic disparities and sexual and reproductive health challenges. Adolescent girls are more vulnerable to HIV and other STIs than males, and experience high rates of sexual violence, pregnancy, maternal mortality and morbidity and early marriage. Females make up more than 60% of all young people living with HIV and account for 72% of young people living with HIV in sub-Saharan Africa. An estimated 16 million girls between the ages of 15 and 19 give birth each year and childbirth related complications are the number one cause of death among girls ages 15-19. One out of seven girls in developing countries marries before age 15, and approximately 1 in 5 females will be a victim of rape or attempted rape in her lifetime.
Along with myriad sexual and reproductive health challenges, adolescent girls also face multiple economic disparities. Of all out-of-school youth, 70% are girls. Globally, young women are less likely to be employed than young men and earn lower wages than young men. Furthermore, increased household responsibilities among adolescent girls hinder their ability to find work outside of the home and to attend school.
Economic disparity is both a cause and a consequence of negative sexual and reproductive health outcomes.
Girls with low socioeconomic standing are at an increased risk of marrying early and of engaging in transactional sex or intergenerational relationships. Lower socioeconomic standing also increases young women’s chances of experiencing sexual and intimate partner violence; all increasing adolescent girls’ risk of early pregnancy and HIV infection. Likewise, early and unintended pregnancy as well as HIV infection can hinder young women’s economic opportunities. Girls who become pregnant are more likely to leave school early, bear more children at shorter intervals, and have a lower income throughout their lifetime. Adolescent girls who become infected with HIV may be less able to find work because of stigma surrounding the disease, or less able to keep work because of their illness.
Research suggests that multi-faceted program approaches to adolescent girl’s health and economic empowerment can improve these outcomes. Our panel tomorrow, entitled, “Exploring the Intersection of Adolescent Girls’ Reproductive Health and Economic Empowerment,” will share innovative programs from Population Council, ICRW, and Restless Development all addressing the intersection of girls’ economic empowerment and sexual and reproductive health.
“Exploring the Intersection of Adolescent Girls’ Reproductive Health and Economic Empowerment” will take place on September 12, 2012 at 9:00 a.m. in room 300 of the Inter-American Development Bank’s Conference Center.
Callie Simon is technical advisor for adolescent and youth sexual and reproductive health (AYSRH) at Pathfinder International. Based in Washington DC, Ms. Simon provides technical assistance to Pathfinder’s AYSRH programs globally, in addition to supporting Pathfinder’s AYSRH advocacy efforts domestically and abroad.
Claire Cole is technical documentation advisor at Pathfinder International. Based in Boston, MA, she supports Pathfinder’s global offices in implementation analysis to advance technical practice.
Today’s generation of young people is the largest in history. Through the sheer size of their numbers and where they live— predominantly in resource-limited countries—young people represent the future and present of development. Yet, essential sexual and reproductive (SRH) health services that have the power to help a young person shape the direction of his or her life (and health) are often out of reach. Young people are unable to access the high-quality services they need because of community and provider stigma, lack of confidentiality and privacy, and health-system limitations like cost, operating hours, location of services, and shortages of trained providers.
Thankfully, in recent decades this issue has increased in prominence among our global health professional community. The concept of youth-friendly services (YFS) is more readily discussed as a core part of global health services—as evidenced at the 2011International Conference on Family Planning in Dakar, as well as the 2012 International AIDS Conference just last month in Washington, D.C.
Unfortunately though, when we think of the size of the global population of young people, we have to recognize how insufficient current coverage of YFS is to meet the challenge posed to us. Boutique YFS programs and small-scale pilots are never going to enable us to ensure these populations have the health services they need. Scalable YFS strategies are essential to fulfilling the rights of the nearly 3 billion people under the age of 25 who need these services now, and who will continue to need them in the years to come. But getting to this goal will require multi-dimensional thinking on our part. What does multi-dimensional thinking mean in this context? It means recognizing that geographic expansion to more and more clinics is not going to be a sufficient answer to the challenges posed by larger upstream factors that create barriers to sustainable, institutionally-supported YFS. We need solutions like pre-service training, which has the power to produce providers readily able to respond to young clients’ needs from the start of their medical careers, and policies that support young people’s right to quality SRH —regardless of marital status or sexual orientation. We need to capitalize on opportunities to take existing YFS to scale, and push wherever possible to introduce YFS into current large-scale programming.
In Pathfinder’s experience in Ethiopia over the past eight years, we’ve learned a substantial amount about what it looks like to do this. We found ways to mainstream adolescent and youth sexual and reproductive health by introducing YFS into large-scale reproductive health and family planning programs. When funding gaps looked to be signaling the end to our first large-scale YFS effort, we found ways to work YFS into our next large-scale collaboration with the FMOH—in this case via the Integrated Family Health Program (IFHP). Working in regions that comprise more than 80 percent of the country’s population, the potential for geographic scale was a given. But institutional scale—that is, ensuring that YFS was part of the national reproductive health strategy, that there were national training curricula, guidelines, and standards for YFS, and that YFS was a part of regional MOH work planning and monitoring structures—was equally important. Working at these two angles in tandem, we were able to support the FMOH in navigating the myriad challenges that are inevitably part of scaling a critical but often neglected and stigmatized service like YFS.
But more is needed. We need collective action, partnerships, and learning to ensure YFS is brought to scale more regularly across our global health landscape. Across agencies, we need to share our lessons, our challenges, and our failures from implementation as we strive toward this goal. With the increased attention being given to YFS, there’s good cause for optimism that this learning-oriented dialogue around YFS will only continue to grow. Our recent technical brief, Bringing Youth Friendly Services to Scale in Ethiopia, captures many of the key lessons and take-aways from our experience scaling YFS through IFHP. We look forward to continuing this important dialogue with the greater YFS community in the future.
IFHP is a five-year (2008-2013) USAID-funded project that collaborates with the government of Ethiopia to promote an integrated model to strengthen family planning, reproductive health, and maternal and child health services for rural and hard-to-reach populations. The project works in six regions: Oromiya; Tigray; Southern Nations, Nationalities, and Peoples (SNNPR); Amhara; and parts of BenishangulGumuz and Somali. The project is led by Pathfinder International and John Snow, Inc. in partnership with the Consortium of Reproductive Health Associations (COHRA) and 11 other local implementing partners.
Millions of people around the world have been captivated by this year’s Olympic Games. The world is likely enthralled by many aspects of the games, such as the excitement of the competition and the athletes’ almost super-human abilities. But one of the most heart-warming characteristics of the games is witnessing individuals achieve their childhood dreams. Last week the U.S. morning news show, the “Today Show,” interviewed the gold-medal-winning U.S. Olympic gymnastics team. This group of five teen women shared stories about how, as children, they watched the Olympic gymnastics teams and dreamed of one day competing in the international arena.
Like the U.S. gymnasts and many other Olympic athletes, little girls all over the world dream of a bright future. They dream of becoming astronauts, doctors, cowgirls, even Olympians. Yet for some, the dreams are more modest: a future where a girl is able to complete school, marry a man she chooses, and avoid early pregnancy. However, for many girls, poverty, gender inequality, high rates of early marriage, lack of education, and negative sexual and reproductive health outcomes put these dreams out of reach.
New research suggests that involvement in sports might help to mitigate barriers that hinder the future of many adolescent girls. Sports can help build social networks for girls in developing countries, allowing them to challenge gender norms that contribute to their vulnerability. In addition to promoting gender equity, sports can enhance physical and mental well-being, promote social integration for girls, provide girls with adult mentors and encourage the development of new skills, knowledge, and self-confidence.
Additional research is beginning to show that participation in sports might have a positive effect on sexual behaviors, knowledge, and attitudes as well. Many HIV prevention programs are beginning to incorporate sports as a platform for disseminating HIV prevention messages. Girls-only sports programs might be able to address issues such as self-confidence, social identity, and the way that family and communities perceive girls.
While not every girl who is involved in a sports program will become an Olympic athlete; the evidence suggests that sports programs might enable adolescent girls to achieve many other childhood dreams.
To learn more about how participation in sports can help girls build social networks, challenge gender norms, and enhance their physical and mental well-being, also see the latest IYWG YouthLens: Sports for Adolescent Girls.
“I was very shocked when I visited one of the communities in the outskirts of town… to find a 9-year-old boy and his 11-year-old sister drunk.” –Amplify Your Voice
This alarming statement, written by a young woman in Tanzania, portrays the sad reality of adolescent alcohol use. Globally, more young people are drinking at a younger age, and the consequences are dire. Adolescent alcohol use is associated with alcohol-fueled homicide and suicide, alcohol dependence, and alcohol poisoning. Alcohol also contributes to an increased risk of mental health problems and alcohol-related injuries from motor vehicle accidents, falls, burns, and drowning. Approximately 10–20% of the violent deaths among young people are alcohol related. Vulnerable young people, such as street youth and young people who sell sex, are at far greater risk of early initiation of alcohol use and frequent consumption of alcohol than the general youth population.
Alcohol lowers inhibitions and contributes to higher rates of risky sexual behaviors, such as early initiation of sexual activity, multiple sexual partners, inconsistent condom use and transactional sex. For example, adolescents who use alcohol are approximately three times less likely to use condoms. These factors all place young people who use alcohol at a greater risk of unplanned pregnancy and of contracting HIV and other STIs.
People who begin drinking at an early age, who drink frequently, or who drink large amounts are at high risk for developing alcohol dependence and are at greater risk of being perpetrators and victims of violence than their non- or less-drinking counterparts. Hazardous and harmful levels of alcohol use, as well as alcohol dependence, are risk factors for intimate partner violence. Alcohol-fueled violence contributes to young people’s vulnerability to physical injury, psychological trauma, HIV infection and unintended pregnancy.
“It was a …party, everyone was handing me alcohol, and I just wanted to fit in. I downed one shot, then two shots, then a beer, then two beers, until I had consumed more alcohol than words… I don’t remember anything after that. He had sex with me…This doesn’t happen to me. This couldn’t have happened to me.”—youth author, Scarleteen
The potential negative sexual and reproductive health outcomes associated with young people’s alcohol use are alarming, and measures to reduce alcohol consumption and the potentially harmful, sometimes fatal, results of alcohol use among this age group are imperative. We invite you to join us July 10-11 for an online discussion about alcohol and its effect on young people’s sexual and reproductive health. Moderated by FHI 360 and USAID, this forum will give participants an opportunity to discuss alcohol use among young people, associated sexual and reproductive health consequences, programmatic responses to alcohol use among adolescents, and policies aimed at reducing alcohol use. To learn more about this topic, read our recently released YouthLens publication, “Alcohol and Its Effect on Young People’s Reproductive and Sexual Health.”
The recent Lancet series emphasizes the urgent need to increase attention to adolescent health, with a growing acceptance for a life-course framework. This more holistic approach is an important step in moving the health issues of young people from a marginalized minority into mainstream global health. Yet, as the fourth paper in the series demonstrates, there are not only major gaps in youth programs targeting these issues, but also insufficient data collected on both risk and protective factors in many countries. Without comprehensive data, it is extremely difficult for practitioners and policy-makers to take the necessary steps to improve health outcomes of young people worldwide.
The article “Health of the world’s adolescents: a synthesis of internationally comparable data” uses 25 core indicators to assess the available sources of health information for young people. Details about how the indicators were determined and the countries included in the review are outlined in the article.
The authors included 192 countries in this review, constituting 99.53% of the 1.79 billion young people (ages 10-24) living in UN member states. They describe the discrepancies in health outcomes between countries based on geography, income level, population size and other relevant demographics. However, the article quickly shifts focus from the differences in health outcomes to the lack of data available for many of the indicators around the world, particularly in low-income regions. Several key points were clear at the conclusion of the article: most glaring are the incomplete health information and inequities between country profiles for almost all aspects of adolescent health. These differences are apparent not only between, but also within geographical regions. Information on mental health and non-fatal disabilities in this age group is particularly lacking. Aside from a Millennium Development Goal focus on HIV, there are also major gaps on data about health service delivery in every region.
Young people’s sexual and reproductive health has had significant policy and programmatic attention in recent years, leading to more clearly defined indicators and better data collection than many other issues. However, the article highlights concerns about the strength of these current data collection methods, particularly as they relate to the exclusion of young people at highest risk– including those out-of-school, homeless, and in juvenile detention. As outlined in a previous blog post, for the proposed comprehensive approach to be effective, young people’s sexual and reproductive health must be at the forefront of the movement. Many of the health indicators raised by the authors of this series are closely linked to YSRH and should not be reviewed in isolation.
The authors provided three sets of recommendations for improving the gaps and obstacles in collecting data on the health of young people worldwide. They include:
- Improving development and measurement of indicators
- Stronger research and the development of indicators in neglected areas of adolescent heath
- Better coordination and integration of present data collection
- Define a core set of global indicators
- Synchronize measures across surveys, including school-based
- Extending data coverage
- Improvement of data coverage for major health problems affecting young people
- Development of strategies to collect data on most-at-risk young people
- Enhanced leadership and coordination
- Development of strategies to fill the present knowledge gaps and align current systems, drawing in expertise from UN and its agencies, academia and other global partners
- Countries should be encouraged to produce a report on the health of young people to allow for coordinated efforts (both governmental and NGO) of health initiatives
- There is a need for detailed data strategies to guide policies for young people within future global health initiatives, considering age and sex disaggregation, risk and protective factors that occur during adolescence
The attention given to young people’s health in this series is sure to provide momentum toward improved programs and policies around the world. However, without consistent monitoring and review of existing health indicators at the global level, young people’s health will continue to languish in many regions around the world. Simply put, it will be difficult for global health leaders to improve future outcomes for young people when the current health information systems are so incomplete. This article takes the important first steps of outlining not only the current gaps in adolescent health data, but also proposes guidance for improvement. The future of young people may depend on paying attention to it.