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This post is the introduction to a monthly series of posts, Stories Behind the Statistics, produced by the IYWG for the Gates Foundation. The original post is available on the Gates Foundation blog, Impatient Optimists.
For many women, receiving a positive pregnancy test can be one of the happiest moments of their lives; for an adolescent it can be terrifying. Approximately 16 million girls between the ages of 15 and 19 give birth each year and, in developing countries, approximately one-third of adolescent girls give birth before their 20th birthday. The social impacts of pregnancy on adolescent girls can be devastating: girls who become pregnant often face discrimination within their communities, drop out of school, and are sometimes forced into early marriage. Girls who become pregnant are more likely to 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, better-educated children.
Not only does pregnancy during adolescence have negative social impacts, it poses significant risks to the health and lives of young women. Pregnancy in adolescence is life-threatening for many. Childbirth-related complications are the number one cause of death among girls ages 15-19. Pregnancy during adolescence also increases the risk of anemia, postpartum hemorrhage, prolonged obstructed labor, obstetric fistula, malnutrition, and mental health disorders, including depression.
Many factors—such as poverty, gender inequality, lack of education, and early marriage—place adolescent girls at high risk of early or unintended pregnancy. But, unintended and early pregnancy is preventable. Interventions to help girls stay in school and delay marriage can have numerous positive effects on the lives of young women, including decreasing their risk of unintended pregnancy. Proven interventions such as comprehensive sex education for both in-school and out-of-school youth, as well as improved access to contraception (including condoms), can vastly reduce high rates of pregnancy among this age group.
The next two blog entries in this series, published on Impatient Optimists next week, written by young people living in Zimbabwe and Nepal, will provide first-hand accounts of the challenges many adolescents who become pregnant face. These two authors will share the stories behind these striking statistics.
To learn more about adolescent pregnancy visit the Interagency Youth Working Group’s “Adolescent Pregnancy” topic page.
Are you inspired to act on behalf of women and girls who deserve the opportunity to determine their own futures and who desperately need access to family planning education and contraceptives? Look for ongoing information about, and ways to pledge support for, the upcoming Family Planning Summit on July 11, 2012. The Summit is being hosted by the Gates Foundation and the UK’s Department for International Development (DFID). It will address the unmet need for the 120 million women who, over the next eight years, will want contraceptives but won’t have access to them unless we invest in women and girls and put family planning front and center on the global agenda. Join the conversation with @gatesfoundation and check Impatient Optimists regularly for details.
This is the third post in our series, Adolescent Girls, Microbicides, and HIV Prevention Trials. Ms. Doreen Bangapi, community recruitment officer; Ms. Anna Kaale, study coordinator; and Dr. Sylvia Kaaya, local principal investigator, are with Muhimbili University of Healthand Allied Sciences (MUHAS) and work with FHI 360 on the study.
A unique aspect of the trial titled “Adolescents, Women and Microbicide Trials: Assessing the Opportunities and Challenges of Participation,” is the involvement of a youth interactive group (YIG) in various aspects of the research process. The YIG, which is composed of Tanzanian youth ages 20 to 26, was formed as a strategy for involving the community in this study. Community involvement before and throughout HIV prevention trials is essential for a successful trial. Youth are a particularly important group of stakeholders given that this study focuses on adolescent participation in trials. Thus far, YIG members have participated in a research literacy workshop and a study initiation meeting, and they have attended regular meetings where their feedback on various research issues has been solicited. For example, YIG members have provided suggestions and strategies for recruiting study participants, finding high-risk youth to participate, retaining participants in the study, and making our study clinic more youth-friendly and informative.
YIG members have been particularly helpful in the recruitment of study participants. They have helped develop and distribute brochures about the study and they have participated in peer education sessions with potential participants—explaining the study and answering their questions. In a focus group discussion, YIG members told us that challenges to recruitment included participants’ reluctance to admit sexual activity and sexual matters with adults as well as the need for parental support (and perhaps consent) for study participation. Members also said that recruitment was difficult because many youth in the Dar es Salaam area are highly mobile. One YIG member noted, “You find today a young woman is here but some few days later you find she has shifted to another place.”
YIG members felt there were numerous benefits to adolescents and young women participating in the study. Benefits included learning more about sexual health and their risk of HIV/STIs, gaining more opportunities to talk with parents and guardians about HIV and other health issues (particularly for 15-year-olds, who require parental consent to participate), knowing their HIV status, and learning more about the process of evaluating new health products such as microbicides. In addition, YIG members said that study participants might become valuable sources of sexual and reproductive health information within their own peer networks.
Regarding the benefits of their own participation in the research, one YIG participant said, “First of all, I like being part of the YIG of the study because I discover new experiences about reproductive health among girls…and second, I get to know how people know about HIV/AIDS.”
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.
The third article in the Lancet series describes advances in prevention science that improve health outcomes among adolescents and offers suggestions on making the most of these advances through systematic efforts to adapt and scale up successful interventions. The authors explain the way in which problems associated with adolescence, such as teen pregnancy and depression, can be linked to (1) the accumulation of problems from early in life, (2) a lack of protective factors, and (3) the presence of negative influences that occur during adolescence.
A systematic review of randomized and quasi-experimental trials shows that programs that increase positive influences and decrease risk factors for young people, both in early childhood and during adolescence, have achieved increases in educational attainment and reductions in young people’s misuse of alcohol and drugs, risky sexual activity, depression, and delinquency and crime. The authors then advocate for the increased use of effective programs and discuss barriers to and strategies for doing so.
This article clearly explains the multitude of ways in which effective prevention programs for adolescents can be structured. It also provides an excellent call to action for dedicating more resources to the adaptation and use of proven approaches, as well as specific programs that have been shown to work through rigorous evaluations. Many of the programs profiled in the article focused on issues that are the explicit focus of the Interagency Youth Working Group (IYWG), such as teen pregnancy and STI infection, and the others addressed factors that affect youth sexual and reproductive health (SRH), such as young people’s alcohol use and educational attainment.
Importantly, the article goes beyond the discussion of what works to a discussion of how to make programs that work available where they’re needed. The authors discuss a range of ways to scale up successful programs, including making research findings more user-friendly, providing cost information to help potential users of a new prevention program make decisions, and building capacity to adapt programs for use in new contexts. They also advocate for communities to learn how to identify their most salient needs so that they can identify programs best-suited to the problems they face. Special attention is paid to adapting programs designed and evaluated in developed countries to developing settings. Sexuality education is given as an example of one area in which western-based behavior change theories have been effectively used to reduce adolescent sexual risk across cultures and countries.
This article reminds us of all that has already been shown to work to improve youth outcomes — from changing contraceptive policy to promoting healthy families — and all the work that remains to be done to spread and adapt these evidence-based practices more widely. The dedication, expertise, and local knowledge of adolescent reproductive health practitioners around the globe, and the network of these practitioners formed through organizations such as the IYWG, create the opportunity to take on the Lancet’s challenge and make sure that what works in one place has the opportunity to do so for more young people around the world.