Investing when it counts: Reviewing the Evidence and charting the course for very young adolescents Martha Brady, Senior Associate, Population Council Girls and HIV AIDS2016 Satellite Session Durban, South Africa July 21, 2016

A research guide on the instinctive needs of very young adolescents (VYAs) Illuminate health and social dimensions of lives of VYAs Identify evidence Recommendations for research and programming www.popcouncil.org/investwhenitcounts

Investing in VYAs: Why it matters VYAs are generally overlooked, relatively low burden of disease Critical life phase for shaping future health and development Source: Sawyer et al., Lancet 2012

Stages of early adolescence

Diverging worlds of girls and boys Percentage of adolescents ages 10-14 and 15-19 enrolled in school by gender, four selected countries Gender differences in transitions from primary to secondary school In LMICs, there is general pattern of VYA girls beginning to drop out of school at onset of puberty; diverge from path for boys Issue is that VYAs who leave school may lack or have decreased access to educational and social resources (e.g., access to institutions and social networks, knowledge/skills/self-efficacy, self-esteem) afforded through schools Data Sources: Demographic and Health Surveys, Ethiopia 2005; Zambia 2007; Kenya 2008-9; Malawi 2004.

Pivotal moment where lives can go off-track

Harmful gender attitudes are associated with: Low rates of condom use (Impett et al 2006; Karim et al, 2003; Pleck, Sonenstein & Ku, 1993; Tang et al, 2001; Zambrana et al 2004) Low rates of contraceptive use (Impett et al 2006; Kowaleski-Jones & Mott, 1998; Marsiglio, 1993; Pulerwitz and Barker, 2008; Stephenson et al, 2006) Multiple sexual partners (Karim et al, 2003; Pleck et al 1993) Some studies have looked at sequencing… they found its not just an association… e.g. Stephenson 2006 found that among couples in which the husband held more conservative gender role attitudes about women’s roles and behaviors were significantly less likely to subsequently adopt modern methods of contraception (hazards ratio 0.79, p<0.001)

is associated with: Less consistent condom use Unintended pregnancy Unequal power in intimate sexual relationships is associated with: Less consistent condom use (Greig and Koopman, 2003; Pulerwitz et al, 2002) Unintended pregnancy (Jewkes et al 2001; Miller et al 2010) Sexually transmitted infections (STIs) (Raiford et al 2013) HIV infection (Dunkle et al, 2004; Jewkes et al, 2010) Longitudinal study in So Africa found that women with low relationship power equity at baseline were significantly more likely to acquire HIV than women with medium or high relationship power equity (IRR 1.51, p=0.027; Jewkes et al 2010, Lancet)

Recommendations for research Validate methods of gathering information among VYAs Disaggregate data: 2- and 3-year age intervals Gender Build program evidence base about what works, for which segments of VYAs Embed research into program initiatives