Adolescent sexual and reproductive health

Around half the world’s population is under 25, with 1.8 billion people aged between 10 and 24 years—90 percent of whom live in low- and middle-income countries.

The challenges faced by adolescents across the world include early pregnancy and parenthood, difficulties accessing contraception and safe abortion, and high rates of HIV and sexually transmitted infections. Girls in particular face increased risk of exposure to sexual coercion, exploitation, and violence.

Early pregnancy and maternal health

Sixteen million girls aged 15–19 give birth each year, and 95 percent of these births occur in low- and middle-income countries. Important regional differences exist; for example, births to adolescents as a percentage of all births range from around 2 percent in China, to 18 percent in Latin America and the Caribbean, to more than 50 percent in Sub-Saharan Africa.

Ten percent of girls who first had sex before age 15 reported that they had been coerced into sex. Sexual violence and exploitation contributes to unwanted adolescent pregnancies, and seriously damages the physical and mental wellbeing of girls.

Adolescents face a higher risk of complications and death as a result of pregnancy than older women. For example, in Latin America, the risk of maternal death is four times higher in girls under 16 years old than women in their twenties. Complications from pregnancy and childbirth are the leading cause of death in girls aged 15–19 years in low- and middle-income countries. Up to 86 percent of women with obstetric fistula develop the condition as adolescents, with traumatic, often lifelong consequences.

Family planning, safe abortion, and STIs including HIV

More than 220 million women in low- and middle-income countries have an unmet need for family planning. Research suggests that if current family planning needs were met, another 104 000 lives would not be lost, many of which would be adolescents.

Unmet contraceptive needs lead to high levels of unsafe abortion. Worldwide, nearly 4.5 million adolescents undergo an abortion each year, with approximately 40 percent performed under unsafe conditions, almost all in low- and middle-income countries.

Young people are currently the group most severely impacted by HIV and AIDS, though only a minority of adolescents have access to affordable, high quality STI and HIV services. Worldwide, an estimated five million young people are living with HIV. Most of these young people live in Sub-Saharan Africa, most are women, and most do not know their status.

Barriers to improving adolescent sexual and reproductive health

In many countries sexual health concerns are stigmatised, and unmarried sexually active girls and young women subject to judgemental attitudes. It can be difficult to discuss adolescent sexual and reproductive health, as many societies disapprove of adolescent sexual activity and there may be restrictive laws and policies in place.

In some regions, accepted practices of early marriage and childbearing, age differences between partners, and social pressure prohibiting use of contraceptive methods damage adolescent sexual and reproductive health. Conflict, migration, and lack of access to education may compound the situation further.

Poor systems for sexual health, family planning, and maternal health are common, with unmarried adolescents ignored in some cases, married adolescents in others, and an overall lack of youth-friendly services. There is often a lack of integration as services that might address counselling and family planning fail to include STI care, etc. Services may also be hampered by corruption and lack/erratic availability of supplies and equipment.

Financial difficulties and distance restrict adolescents’ access to services where they do exist. On a personal level, young people may be restricted because of fear (of people finding out and other confidentiality issues that may result in violence), embarrassment, lack of knowledge, misinformation and myths, stigma, and shame.

The attitude of their healthcare provider can also have a big impact. Health professionals may put adolescents off from using services if they don’t respect confidentiality, show judgemental attitudes, disrespect, or don’t take their patients' needs seriously.

Opportunities for action

We must ensure access to quality, youth-friendly, integrated services, provided by healthcare workers who have been trained to work with adolescents. Sex education programs should be scaled up and offer accurate, comprehensive information while building skills for negotiating sexual behaviours.

Healthcare workers must be equipped to provide accurate, balanced information about contraception and condoms so that young people have the means to protect themselves, provided within a context of healthy sexuality, without stigma or judgement. Many improvements require political and legal changes, and healthcare workers can be advocates for legal abortion and other health initiatives.

FIGO is committed to promoting adolescent sexual and reproductive health. We have been working with partners and member associations to:

  • Map existing adolescent sexual and reproductive health activities and resources
  • Survey knowledge, attitudes, and perceptions of obstetricians and gynecologists among our 130 member societies
  • Bring health professionals and young people together through workshops in Africa, Asia, Latin America, and Europe to discuss ways to improve adolescent sexual and reproductive health.

Obstetricians and gynecologists—in their individual roles, through their national associations, and through FIGO at the international level—have an important role to play in the advancement of adolescent sexual and reproductive health services.

Political efforts need to be directed to providing youth-appropriate services, and the health establishment must follow a comprehensive, evidence-based approach that raises the capacity of health workers and implements bold initiatives for, and with, adolescents.