Reducing inequalities: Enhancing young people’s access to SRHR Consultative meeting with African Parliamentarians on ICPD and MDGs September 2012 Sharon Phillips MD, MPH Medical Officer Department of Reproductive Health and Research, World Health Organization

Definitions (WHO)  Youth (Aged 15-24)  Young People (Aged 10-24)  Adolescents (Aged 10-19) –Most at risk for negative health outcomes 2

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Why focus on adolescents?  Growing numbers  Needs not adequately addressed by MDGs  Adolescents face unique challenges  Our future! 4

Adolescents and sexual activity  Adolescents worldwide are sexually active, within and outside of formal unions  Up to 80% of young people in sub-Saharan Africa are sexually active by the age of 20 5

Challenges faced by adolescents  Lack of access to comprehensive sexuality education  Lack of access to affordable, appropriate contraception  Adolescent girls face risks from early marriage  Early sexual activity  Pregnancy particularly dangerous for adolescents  Increased vulnerability to HIV and other STIs  Underserved or unserved by traditional health services 6

Early marriage  14% adolescent girls in developing countries married by age 15  30% married by age 18 (as many as 46% in sub- Saharan Africa)  Early marriage is decreasing 7

Early Sexual Activity  Numbers vary significantly by region and gender  Likely to occur without proper information and protection  Context varies from voluntary to coerced 8

Initiation of sexual activity under age 15 9

Early pregnancy  Caused by: –Early marriage –Lack of access to contraceptive services –Sexual coercion –Lack of access to reproductive health education  Leads to: –Increased maternal and child morbidity and mortality –Unsafe abortion 10

Effects of early pregnancy  Adolescents aged twice as likely to die during pregnancy or childbirth than women 20 and older  Adolescents aged under 15 five times more likely to die during pregnancy or childbirth than women 20 and older  Children of adolescent mothers 60% less likely to reach their first birthday  Millions of unsafe abortions 11

Unsafe abortion 12

Adolescents disproportionately affected in African region 13

HIV and other STIs  Young men more likely to engage in risky behaviors –More than 20% report multiple partners in past year  Young women especially vulnerable –In high prevalence countries, HIV prevalence among young women 2-3 times higher than that among young men  STIs often untreated, can lead to significant health problems 14

Poor adolescents especially vulnerable  Less likely to complete formal schooling –Sexuality and reproductive health education, if offered, usually offered in higher grades  Fertility rate among the poorest adolescents in developing countries has increased  Adolescent girls from the poorest fifth of population four times more likely to become pregnant than those in the richest fifth 15

Why is adolescent SRHR vital to development?  Education  Ability to participate in workforce  Future fertility 16

Recent progress for SRHR  15-year review of the ICPD PoA made strong statements on importance of PoA for MDGs  UN bodies made statements about SRHR as a human rights issue –Human Rights Council and World Health Assembly –UN General Assembly adopts “Keeping the promise: United to achieve the Millennium Development Goals”  Still missing: sexuality education, needs of adolescents, unsafe abortion 17

Where to go from here?  ICPD PoA: Strong in language, not in accountability –Focus on gender and rights-based approach –Access to safe abortion, services for adolescents, sexuality education, family planning  MDGs: Strong on accountability, but missing key components critical to SRHR –Lack holistic approach –No explicit goals for adolescent SRHR, abortion 18