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“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in our series on early marriage. The original post, located on “Impatient Optimists,” is available here.

Every day more than 37,000 girls get married, and if present trends continue, an estimated 15 million girls will become child brides every year beginning in 2021. Early marriage has devastating social and health impacts on adolescent girls. Girls who are married are forced to take on roles for which they are not emotionally and physically prepared. When girls marry at a young age, they often leave their homes, stop attending school, and lose contact with family and friends. Many married adolescents experience domestic and sexual violence. 

For many girls, marriage marks the beginning of their sexual life.  Married adolescents have sex more often than their unmarried peers; are less able to refuse sex or negotiate safe sex; and often have older, more sexually experienced partners — all factors that increase their risk of HIV infection.  Young women are often expected to demonstrate their fertility by becoming pregnant. Many give birth within the first year of marriage when their bodies are not fully matured.  Childbirth- and pregnancy-related complications are the number one cause of death among girls ages 15-19; of the 16 million adolescent girls who give birth each year, 90% are married.  Furthermore, because adolescents’ bodies are not yet fully developed, they are at a greater risk pregnancy complications including obstructed labor, which can cause obstetric fistula. The consequences of obstetric fistula are devastating: the baby usually dies, and the woman can suffer from constant leakage of urine or feces or both. The condition can result in stigma, isolation, and abuse.

Early marriage is an egregious violation of human rights with severe consequences for girls’ sexual and reproductive health. All girls deserve to enjoy their adolescence, and the cycle of early marriage can be broken. Programs that can help include those that provide better economic opportunities for girls, that help girls stay in school, and that work to change traditional attitudes and policies about early marriage, as well as those that offer sexual and reproductive health services to married adolescents.

In the next two blog posts, two youth authors, one from Zimbabwe and one from the Philippines, will share the direct impact of early marriage on their communities.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the second in our on young people and HIV. The original post, located on “Impatient Optimists,” is available here. John Mwikwabe is a peer educator with the Kenya Red Cross Naivasha Sub Branch.

In a country where half of its population lives below the poverty line and many people make less than a dollar per day, life can be challenging. Many families struggle just to put food on the table. The responsibility to be the breadwinner, traditionally borne by parents, is extended to all family members.  Children are forced to contribute to running the households, often before completing their primary level studies. Many young people find it difficult to get well-paying jobs, and often end up opening up “vibandas” (small vendors shop) to sell vegetables and groceries. In Naivasha, where I live, I see more and more young girls entering into sex work. As a peer educator, I have worked with some of the girls, their classmates and their neighbors and from them have learned staggering information.

“At first I just wanted to help at home, earn some money and save enough to help my mum. But later I realized I could buy whatever I wanted and that felt good for a change.” –  13-year-old female who is involved in sex work

The young woman quoted above is a standard 8 pupil at a nearby primary school. Her mother is fully aware of her daughter’s night shift duties but feels there is little she can do. Often, her daughter can bring home Kshs. 1,500 to Kshs. 2,500 (about $16-27 USD) in one night. The mother had to divorce her husband because of his heavy drinking and sees her daughter’s work as their family’s life-line despite the risks her daughter is exposed to.

I have seen other young women become involved with older men to supplement their family’s incomes; these types of relationships also increase young women’s vulnerability to STIs and HIV. There is a huge gap in providing these young girls who are in school, especially in primary school, with relevant information on prevention messages. There have been programs, but they often occur on the weekends when many adolescent girls go to visit their “clandes” (men who have money and are married).

As a peer educator, I mostly work with out-of-school youth—however even for those in school, comprehensive sexuality education is not available.  The gap in available information about HIV risk impedes the war against HIV and AIDS and the promise of a brighter future for adolescent girls. Young people, and especially adolescent females, need information about reproductive health services and HIV prevention so that they are empowered to make informed decisions concerning their lives.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in our series on young people and HIV. The original post, located on “Impatient Optimists,” is available here.

In the approximately two minutes it will take you to read this post, four young people will become infected with HIV.

Five million young people are living with HIV, and youth (ages 15‒24) account for 41 percent of all new HIV infections. Approximately 79 percent of new HIV infections among youth occur in sub-Saharan Africa, and adolescent females make up more than 60 percent of all young people living with HIV. Young men who have sex with men, young people who sell or trade sex, and young injecting drug users are also disproportionately affected by the HIV epidemic.

There are many factors that contribute to the high rates of HIV among young people including lack of appropriate sex education, lack of access to condoms, economic disparities, sexual violence, early marriage, stigma surrounding HIV, lack of access to counseling and testing, and criminalization of risky behaviors. Globally, only 34 percent of young people ages 15‒24 have a comprehensive understanding of how HIV is transmitted. Many young people living with HIV do not know they are infected; stigma associated with HIV infection can prohibit young people’s willingness or ability to seek testing. The behaviors of adolescents most at risk of HIV infection (young people who inject drugs, young people who sell or trade sex, and young men who have sex with men) are also often stigmatized or criminalized, which further marginalizes these young people, undermining their self-efficacy, their confidence in health and social services, and their willingness to make contact with service providers.

Income and gender inequality, sexual violence, and harmful traditional practices like early marriage, also fuel the HIV epidemic among adolescent girls. Economic disparity can lead to involvement in cross-generational or transactional sexual relationships, which limit young people’s ability to negotiate condom use and increase the likelihood of multiple partners and sex with older partners. Married adolescent females have little to no decision-making power related to condom use or sexual activity.  In developing countries, 80 percent of unprotected sex among adolescent girls occurs within marriage. In some settings, young married girls (ages 15 to 19) have been shown to have higher rates of HIV infection than sexually active unmarried youth of the same ages.

HIV is preventable, but to halt the epidemic, young people need access to information and the tools to protect themselves. These include condoms, counseling and testing centers, and other preventive services. Interventions that provide young people with opportunities to stay in school, develop life skills, and avoid early marriage are essential to addressing the risk factors that increase young people’s vulnerability to HIV infection.  The 2,500 young people who are infected with HIV every day are a glaring example of the insufficient attention to HIV prevention among this population. Young people deserve better.

In the next post in this series, we will hear from one young person in Kenya, about the factors that contribute to HIV among young people in his community and what he sees as the necessary solution to the global HIV pandemic among youth.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the second in our three-part series on contraception. The original post, located on “Impatient Optimists,” is available here. Primrose Nanchani Manyalo is a field officer at Restless Development, a youth-led development agency.

No matter where you live in the world, contraceptive access is essential to the sexual and reproductive health of young people. This is also true of young people in Zimbabwe, where I live and work. My experiences with young people in this country have taught me that they face numerous challenges in trying to access contraceptives and the repercussions young people deal with when they can’t: teen pregnancies, unsafe abortions, death due to child birth, and HIV/STIs (sexually transmitted infections).

At Restless Development, a youth-led organization to address the most urgent issues facing young people around the world, we have set up youth-friendly corners and centers around Zimbabwe (the country where I’m from and in which I work) that are a haven for young people who need services. These services include providing access to condoms, and offering ways to meaningfully engage in advocacy about the reproductive health and rights of young people. At one of the youth-friendly corners we run, young people tell us that contraceptives are available at the local pharmacies and clinics. These include morning after pills, barrier methods, implants and other hormonal methods. Nevertheless, there are still many hindrances that lead to the overall unavailability of contraceptives among young people in Zimbabwe.

Young people in the city of Harare say they cannot walk into a pharmacy or clinic and purchase or request contraceptives because they think providers will feel that “they are still too young.” Others revealed that they fear being laughed at by their peers or treated as outcasts in their community because they “shamefully indulged in sex before marriage.”  These psychological and social barriers are further exacerbated by provider bias, cultural barriers, the high cost of contraceptives at private pharmacies, and a lack of youth-friendly services.

Natsai, one of our youth group members, told us she could not speak openly about contraceptives with her peers, teachers, or parents. When she became pregnant at 16, her mother took her to the clinic to get the hormonal IUD (a type of contraceptive), which would prevent her from becoming pregnant again until she was at least 23. Though the move was noble, it came too late.  If the contraceptive service had come earlier, it would have prevented her from becoming pregnant at such a young age, dropping out of school, being rejected by her boyfriend, and living with the psychological trauma that comes with motherhood at an early age.

Finally, some young people in my community decide not to use contraceptives because of myths they’ve heard and misconceptions about how contraception works. Some young people believe that if you use contraceptives you will not be able to bear children later on. Clearly, there is a need to educate young people about contraception.

Having contraceptive access and choice is a basic health right. If contraceptive access is realized, some of the appalling sexual and reproductive health challenges faced by young people, particularly by girls and young women, will be addressed.  Efforts to ensure contraceptive access for young people, coupled with provision of comprehensive sexual and reproductive health education, can help young people make healthier and informed choices about their lives.

Finally, advocacy efforts should address not only issues of access, but also young people’s need for youth-friendly and affordable services provided by nonjudgmental health care workers. Policy-makers, donors, young people, and other relevant stakeholders should work together to develop policies and strategies to improve access to contraceptives and other sexual and reproductive health services for young people in Zimbabwe.  By also addressing societal attitudes, and cultural barriers we could go a long way in protecting young people’s lives.

You can help Restless Development empower the youth of Zimbabwe. Learn more and share with your friends and family.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the second in our three-part series on contraception. The original post, located on “Impatient Optimists,” is available here. Max Kamin-Cross is a self-proclaimed political junky and youth activist

There is one action that we, as a world population, could take today to change our future more than any other single action.

We could lift millions of people of all races and both genders out of poverty throughout the world. By doing this action, we could significantly decrease the number of premature deaths, as well as the number of lives claimed by deadly infections like HIV. Accessibility to food and medications for people living in developing countries would increase, and the quality of life for millions more people would be drastically improved. This single action, if done in conjunction with the major governments of the world, would complete all of this and more. The action: improving access to contraceptives.

More than 700,000 women and newborns die every year during or shortly after birth of an unintended pregnancy. While contraceptive access can be a controversial topic here in the United States, where I live, other developed countries, such as the United Kingdom, have realized that this is an international health issue. In some developing regions, more than 60 percent of young women report that they lack proper access to contraception that they would like to use. If that number were in the single digits, our world would be a much different place. Women would be able to put off childbirth until they were both emotionally and financially ready. They would also be able to plan the spacing of their children and the size of their family, increasing their chances of rising out of poverty. Adequate access to condoms would also greatly reduce a young woman’s chances of being infected with HIV.

Contraception isn’t cheap, not by a long shot. Data from the Center for American Progress suggest a woman in the United States can expect to pay well over $10,000 in her lifetime for contraception.

If she doesn’t have insurance for all or even just part of her life, that cost quickly comes closer to $70,000. This overwhelming burden can hurt the people who need birth control most: impoverished women and young people. In almost every country in the world there is a growing, and unmet, need for low-cost contraception.

This issue should not be controversial. The future of my generation truly may rely on the fate of contraceptive access.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in our three-part series on contraception. The original post, located on “Impatient Optimists,” is available here.

Over the past couple of months, in our Stories Behind the Statistics series, we shared with readers the overwhelming rate of adolescent pregnancy and its devastating effect on the lives of girls. One of the commitments made on July 11, 2012 at the Family Planning Summit was to increase access to contraceptives for young women and girls.  These global commitments could not be timelier in a world where approximately 16 million girls between the ages of 15 and 19 give birth each year; one million die or suffer serious injury or disease as a result of pregnancy; and millions more face discrimination in their communities, are forced to drop-out of school, and face social isolation as a result of unplanned or unintended pregnancy.

It is estimated that as many as half of all pregnancies worldwide are unintended and a disproportionate amount of unintended pregnancies occur among young, unmarried girls who often lack access to contraception. Approximately 85-95 percent of sexually active young women who do not use contraceptives become pregnant within one year of initiating intercourse.

In some regions of the world, such as sub-Saharan Africa, South-central Asia, and Southeast Asia the unmet need for contraception among adolescents is as high as 68 percent.  Young people face multiple barriers to accessing contraceptives including lack of information, social stigma, provider bias, lack of confidentiality, and policy restrictions.

Lack of information about contraceptives, and myths related to side effects, are commonly reported by young people as reasons for not using contraceptives.  Young people need information, skills, and products to make informed decisions about how they can protect themselves from pregnancy in a way that is consistent with their own values. Young people also face multiple medical and institutional barriers to receiving contraceptive services, including provider bias, parental consent restrictions, notification laws, and unnecessary medical tests such as pelvic exams.

In many societies, young women have limited control over their contraceptive choice. Often they do not have the power to negotiate contraceptive use with their partners; their family planning decisions might be made for them by parents, partners, spouses, or in-laws. Married adolescents face particular barriers to contraceptive access including increased societal pressure to have children, fear of their spouse, or lack of transportation to health services.

Fulfilling the unmet need for family planning among adolescents could prevent an estimated 7.4 million unintended pregnancies.  Preventing unintended pregnancies among adolescents would reduce the number of maternal deaths as well as improve educational and employment opportunities for young women.  Expanding young people’s access to contraceptives means giving girls and young women the choice to determine their own future.

In the next two posts of this series we will hear from two young people–one from Zimbabwe and one from the United States– about why contraceptive access is important to them.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the third in our three-part series on adolescent pregnancy. The original post, located on “Impatient Optimists,” is available here.

Gaj Bahadur Gurung works as the program coordinator for the National Federation of Women Living with HIV and AIDS in Nepal.

For a young girl in Nepal or South Asia, pregnancy can be disastrous. If it occurs outside the context of marriage, it will bring her disgrace and might lead to expulsion from her family and school. The young woman may be perceived as deviant in the community and will be considered a curse for her family.

Young women have little choice or control over contraceptives. For unmarried young girls in South Asia, male condoms are their only contraceptive option. Yet, patriarchal gender roles and norms make it difficult or impossible for girls to negotiate condom use with a male partner and often inhibit girls from even buying condoms or other types of contraception.

A lack of appropriate information also contributes to adolescent pregnancy. Parents rarely discuss sexual and reproductive health with their children, and the school curriculum has outdated and inadequate information. In spite of the attempts by nongovernmental organizations to disseminate information, some people are difficult to reach, especially low-income girls in mobile populations.

Early marriage is another major contributor to pregnancy among adolescents. Early marriage is quite normal in this culture, and once married, a young woman is expected to give birth to prove her family’s honor. Once a young married woman becomes pregnant, she receives tons of affection, but often she drops out of school, becomes more economically dependent on her family, and has less social interaction.

Policies and programs must both help prevent early and unintended pregnancy (for married and unmarried women) and mitigate the negative consequences for girls who do become pregnant. Programs should provide young women access to, control over, and informed choice about sexual and maternal health services. Youth-friendly maternity services with easy access for young girls would minimize health risks to mother and baby during pregnancy, delivery, and the post-delivery period.

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 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.

This is the second 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.

Catherine Gathoni works at K-Note as a field officer in the prevention program where she leads a support group for mothers ages 12-19, in Kenya.

I lead a support group for mothers ages 12-19, in Kenya. Most of the mothers I work with are out-of-school youth; many live on the streets, work in the informal economy, or are orphaned. As a part of our support program, we provide weekly peer-to-peer sessions focusing on uptake of antenatal care, child welfare, family planning services, post-rape care, and antiretroviral therapy.  The support groups for the adolescent mothers are formed to provide social support and reduce stigma.

The majority of the girls who get pregnant at this age never plan the pregnancies. Most of the unplanned pregnancies are a result of transactional sex; sexual and gender-based violence, including rape and incest; or alcohol and substance abuse. Many of these girls have grown up in challenging family environments, and within their communities early pregnancies are often accepted as normal.

I remember one girl telling me that when she visited a clinic, the nurses told her that family planning services were for women not girls, and if they provided her with these services it would be equal to them permitting her to go have sex.

It can be very hard for a young woman to receive family planning information or contraceptives. There are many myths and misconceptions in our community about contraceptives, and many girls do not know about the services available for pregnancy prevention.  Those who do know about the services are often afraid of being judged by health care workers. 

Many health service providers are hesitant to offer these services to girls less than 21 years old who do not yet have children.  I remember one girl telling me that when she visited a clinic, the nurses told her that family planning services were for women not girls, and if they provided her with these services it would be equal to them permitting her to go have sex.  It is this sort of judgment that often prevents young women from seeking reproductive health services.

Without access to family planning services, many young women end up unintentionally pregnant. 

When “Shiro” first came to our group she looked like a 9-year-old. She asked me to take her to the hospital; she said she had stopped going to school after developing vaginal discharge that would wet her dress and make pupils ridicule her. An examination and some tests established that she had not only contracted an STI (sexually transmitted disease), but she was also pregnant. She did not seem to comprehend what this meant. She only wanted to get treated so that she could go back to school.

“Shiro” never went back to school and currently works in an illegal liquor den.

Life is very challenging for adolescent mothers. Often they are unable to secure a meaningful source of income and end up working in illegal liquor dens, as sand harvesters, or as sex workers. Or they marry very early.

One young woman in my support group, “Rozie,” is 18 years old. She has never admitted to being involved in sex work but will occasionally mention having slept with someone in exchange of cash or food. This is sometimes the only means she has to feed her two sons, whom she lives with on the street.   Sometimes when I am working with girls like Rozie, I feel totally helpless.

Making family planning and pregnancy prevention services more accessible would greatly improve the lives of girls. They would get to have an education, escape becoming involved in sex work, and avoid HIV infection. We need interventions to reduce their vulnerability, empower them to take charge of their own health, and allow them to become economically independent.  The needs of adolescent girls are serious and pressing but currently they are not being addressed.

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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