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Young People and Universal

Access to Reproductive Health

• Contraceptive prevalence refers to the proportion of young women who are using (or whose partner is using) a contraceptive method at a given point in time. Contraceptive methods can refer to both modern and traditional methods. Modern methods include: hormonal methods (oral pills, injectables, skin patches, vaginal rings), intrauterine devices (IUDs), female and male sterilization, condoms, diaphragms and spermicidal gels. Traditional methods include: rhythm, withdrawal, abstinence and breast feeding. Contraceptive prevalence rates among young people have increased in many countries; however contraceptive use is still much lolower than necessary to address adolescent pregnancy and the transmission of STI's, includ-ing HIV.

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Young People and Universal

Access to Reproductive Health • In sub-Saharan Africa, where fertility rates are the highest, very small proportions of ado-

lescent girls used modern methods of contraception. For example, 4% in Benin, 10.7% in Kenya, 12.4% in Mali, 8% in Uganda, and 5.2% in Zimbabwe.3 • Young women commonly face obstacles to accessing contraceptives, such as insufficient knowledge about modern methods, limited access to services, health-care providers who discourage use of contraception among unmarried young people and weak health care sys-tems unable to ensure consistent disbursements of contraceptives.4

• Adolescent birth rates measure the annual number of births to young women between the ages of 15 – 19 yrs per 1,000 young women in that same age group. It indicates the chance of young women aged 15 – 19 yrs giving birth in a particular population. Every year, approxi-mately 16 million adolescent girls give birth, representing nearly 11% of births worldwide.5 • A number of physiological, social, cultural, and economic factors interact to create a higher risk of morbidity, mortality and negative social consequences on adolescent parents and their children as compared to older parents. For example, young mothers are often required to dis-continue their studies and have difficulties finding employment. Unmarried young parents also face considerable stigma in many contexts.

• Girls are at a much higher risk of pregnancy-related complications than women in their twenties and thirties – in developing countries, the risk of dying during childbirth is twice as high for young women between the ages of 15 – 20 as it is for women in their twenties.6

•• There is a great unmet need for comprehensive family planning services among young people, especially in developing countries. The traditional focus of family planning services on married couples excludes large numbers of unmarried sexually active young people who are in need of effective modern contraceptive methods, emergency contraception and safe abortion services.• Young married couples are also in need of better family planning services, since modern contraceptive use among married adolescents in most countries is very low.7 •• Legal barriers, such as restrictive drug registration laws, spousal or parental consent laws and the criminalization of abortion, further limit young people's access to family planning ser-vices. • Young people living with HIV and AIDS often face discrimination when seeking family plan-ning services.

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Young People and Universal

Access to Reproductive Health

• Studies have demonstrated that the integration of youth-friendly SRH services and mea-sures to strengthen health systems’ ability to respond to young people’s needs can produce positive health outcomes for young people.8,9,10

• However, in many countries, comprehensive youth-friendly SRH services are not available or not adequately integrated into health systems. This is partly due to constrained health ex-penditure and insufficient political will. For example, in many countries, unmarried adolescent health services are offered as part of child health care packages, but often do not include SRH.11

• An accurate and comprehensive understanding of one's sexuality; how to attain a healthy, satisfying and pleasurable sex life; how to prevent exposure to SRH risk factors; and where to seek treatment, counselling and evidence-based information are essential to ensure uni-versal access to RH. • Studies have shown that comprehensive sexuality education (CSE) for young people can have a significant positive effects on reproductive health outcomes.12,13 • CSE programmes have proven to be more effective in translating into positive health out-comes that programmes that promote abstinence only.14,15

• However, abstinence-only education programmes remain pervasive in countries across the world.

• 2.5 million unsafe abortions occur among women younger than 20 years in developing countries, accounting for 14% of all unsafe abortions in developing countries.16 • In sub-Saharan Africa, 25% of all unsafe abortions occur in adolescent girls between 15 – 19 yrs.17 • Unsafe abortion significantly contributes to maternal morbidity (including short-term and long-term effects of disease, injury, impairment or disability) and mortality rates, especially in developing countries. Adolescents and young women (below 24) account for almost 46% of the nearly 67,000 unsafe abortion-related deaths each year.17a

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Young People and Universal

Access to Reproductive Health • Young people aged 15–24 account for an estimated 45% of new HIV infections worldwide,

and approximately 6000 young people are infected with HIV every day.18

• The largest proportion of STIs is believed to occur in young people below the age of 25 yrs.19 • Studies reveal that integrating HIV and RH services can contribute to a reduction in HIV prevalence rates, as well as improve reproductive health outcomes.20,21

•• Vertical funding programmes (those that target a specific disease, health problem or health intervention) and health systems structures in many countries limit the ability to effectively integrate HIV & STI services with RH services. This creates a situation where various groups, including young people, lack access to comprehensive SRH services.

• Despite a trend towards later marriages in most countries, many young women continue to be married before the age of 18. Married girls are less likely to continue their education, often due to laws, school policies, household obligations and early childbearing.22

•• Exposure to STIs and HIV is high amongst young married women, because it is often diffi-cult to negotiate condom use within marriage. Also it is common for their husbands to be older, more sexually experienced and more likely to carry STIs.23 • Approximately 130 million girls and young women have experienced female genital mutilation/cutting.24

• The practice of dry sex in several countries, especially in sub-Saharan African and South-East Asia, produces adverse health effects such as vaginal lesions and tears, increasing risk of infection by STIs, including HIV.25 • Young people, especially young women are particularly affected by sexual violence. Studies in India, Jamaica, Mali, Tanzania and Zimbabwe revealed that 20 – 30% of adolescent girls have experienced sexual violence.26

• Young people's meaningful participation in decision-making and processes that directly affect them is an internationally recognized right, as outlined in the Convention on the Rights of the Child and the ICPD PoA.• Young people's participation in decision-making renders SRHR programmes and policies more effective and also offers benefits to young people, adult organizations/institutions and the broader field of SRHR. •• Youth participation has noticeably increased over the past two decades27; however token-ism persists and young people are still not fully integrated into decision-making processes that have a direct impact on their lives, especially within national governments and interna-tional policy-making.

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Young People and Universal

Access to Reproductive Health