Young people make up the greatest proportion of the population in sub-Saharan Africa, with more than one-third of the population between the ages of 10 and 24. And sub-Saharan Africa is the only region of the world in which the number of young people continues to grow substantially. By 2025, the number of young people (aged 10 to 24) in this region is expected to increase to 436 million. Furthermore, the population is projected to further increase to 605 million by 2050.
Adolescents in sub-Saharan Africa have particular reproductive health vulnerabilities such as high adolescent birth rate, gender inequality, early marriage, abduction, harmful traditional practices (such as female genital cutting), unwanted and closely spaced pregnancies, unsafe abortions, and STIs. These young people need access to sexual and reproductive health information and services so they can use contraception, prevent unintended pregnancy and decide if and when to have children. At the same time, these investments allow young people especially girls to take advantage of education and employment opportunities. Ultimately, if nations want to give young people a healthy start; they must protect their right to sexual and reproductive health information and services.
Sexual activity, marriage and childbearing
Marriage is generally a decisive transition to adulthood, but the perception that it is always a safe transition is at odds with the reality faced by some female adolescents in Sub-Saharan Africa. Early marriage is still common throughout the region. Women who marry very early may have greater risks for negative outcomes than their sexually active unmarried peers, largely because married women generally have intercourse more frequently than sexually active unmarried women do, and because married women often have unprotected sex due to the pressure to have children. Early marriage can lead to pregnancies that put young women at risk for obstetric fistula and can also be a risk factor for HIV infection. Adolescent sexual activity, within or outside of marriage, can lead to negative reproductive health outcomes. Unprotected sexual activity can expose young women to the risks of unintended pregnancy, unwanted childbearing and abortion, as well as HIV and other STIs. This can lead to school dropout or expulsion, since the school policy in many countries in Africa is unfriendly to pregnant adolescents.
Contraceptive use and an unmet need
Without reproductive health information and contraceptives, women face unwanted pregnancies, sexually transmitted infections, and serious health issues. In Sub-Saharan Africa, many sexually active young people who want to avoid pregnancy are not using modern family planning methods for various reasons, including a lack of access to services or disapproval by health providers. Thirty-three percent of married adolescent women in the region want to avoid a birth in the next two years, but 67 percent are not currently using any contraceptive method. Although contraceptive use of adolescents is substantially less than that of all women of reproductive age, adolescent women have similar levels of unmet need. As a result, the percentage of adolescents who have their demand for contraception satisfied is much lower than that of all women age 15 to 49.
HIV and AIDS
Most youth living with HIV are women. Overall, sixty-four percent of youth living with HIV are young women. The vast majority (3.8 million/76 percent) of young people living with HIV or AIDS are in Africa. Girls are more vulnerable to HIV because they face greater risks of sexual violence, forced marriage and trafficking. They are far less likely than boys to have the information they need to protect themselves, but even if they have that information, they may not be empowered to use it. We must do more to protect all adolescents and empower them to protect themselves and their health. In fact, we cannot end the epidemic without a global movement to end AIDS-related deaths and new HIV infections among adolescents. To achieve an AIDS-free generation, we have to prevent the spread of HIV and ensure those who are living with HIV/AIDS know their status, receive treatment, and are virally suppressed. We must address the challenges that remain and include adolescents in the conversation.
Policies and programs that address adolescents’ reproductive health
Regardless of whether adolescents have had sex, what demands our attention is most young people are having doing so during their teenage years. Schools are an effective place to offer adolescents sexual and reproductive health related information and skills because it provides an excellent forum for reaching a large number of adolescents in a structured setting. Comprehensive, school-based sex education is effective and contrary to some beliefs it does not lead to increased sexual activity among adolescents.
Out-of-school adolescents have similar needs for sexual and reproductive (SRHR) health information and services. These youth, live in rural areas or are geographically scattered and it is often difficult to provide them with SRHR services. Strategies are needed to reach this group of adolescents. One approach is to use school facilities for after-school life skills programs that include both in and out-of-school adolescents, or adult education classes that cover sexual and reproductive health topics. Programs must be flexible and include innovative curriculum design, approaches that appeal to youth and health information to the places where young people work and spend free time.
Cover Photo Credit: DFID UK, Flickr Creative Commons