Getting Serious About Adolescent Girls’ Sexual and Reproductive Health Rights
Significant progress has been made over the past 25 years to reduce maternal mortality and improve maternal health outcomes for women and their newborns, but there is still a long way to go. Picking up where the Millennium Development Goals left off, the international community under the Sustainable Development Goals now seeks to reduce the maternal mortality ratio to less than 70 deaths per 100,000 live births by 2030. If we are going to reach this ambitious goal, then we need to get serious about how we talk about adolescent sexual and reproductive health and rights.
Annually, 16 million girls between the ages of 15 to 19 and another nearly one million girls under the age of 15 give birth. The health consequences associated with these early pregnancies can be severe. The strain of pregnancy on the bodies of young girls who have not yet reached physical maturity heightens their risk of miscarriage and complications, including obstetric fistula. Adolescent girls may also be particularly vulnerable to unsafe abortion as they often face even greater barriers and stigma to accessing safe abortion services than older women. The World Health Organization estimates that more than 3 million girls each year resort to unsafe abortion to end their pregnancies. Additionally, other common issues in girls lives such as poor nutrition compound many of the risks they face during pregnancy and childbirth.
The impact of all this is staggering, though not surprising; Maternal Mortality is the second leading cause of death among adolescent girls.
However, it doesn’t have to be this way. Improving adolescent girls’ access to not only quality and respectful maternal health care, but also to other sexual and reproductive health information and services could go a long way towards reducing adolescent maternal mortality. The barriers that adolescents face to accessing these services differ in each context but often include a lack of information about pregnancy prevention, or for those already pregnant, information about the importance of antenatal care, or where and how to access these contraceptive and maternal health services. While these issues could be addressed through things such as comprehensive sexuality education (at least for those adolescents in school), work must also be done with health care facilities to ensure that adolescents feel comfortable seeking services without stigma and can trust that their confidentiality will be maintained. Compounding these issues in many places are the legal and policy barriers that restrict adolescents access to certain types of care or information, including around contraceptives.
Furthermore, we must address the contexts in which adolescents are becoming pregnant. In the developing world, where nearly a third of girls are married before age 18, the majority of adolescent pregnancies occur within marriage. For these young brides, pregnancy is often less a choice than it is an expectation to begin bearing children immediately following their union.
Last month the United States took a step forward on this issue with the release of the U.S. Global Strategy to Empower Adolescent Girls, which I wrote about in detail at that time. The strategy emphasizes a comprehensive approach to addressing the unique, complex needs of girls, which looks not only at the whole of the girl but the whole of the U.S. government’s foreign and humanitarian assistance and diplomatic efforts. The strategy outlines how the U.S. is and will continue to address a number of key issues related to adolescent girls including early pregnancy, and other areas impacting girl’s maternal health, such as child, early and forced marriage, gender-based violence, and the overall lack of information and access to sexual and reproductive health services.
Adolescent girls must be recognized as a key population to reach the goal of reducing and eventually ending preventable maternal mortality. Maternal mortality in adolescents and the underlying issue of early pregnancy are complicated and multifaceted problems that touch health care, education, nutrition, legal systems, gender norms, long-standing, albeit harmful practices, and nearly everything in between. Effectively addressing these issues is going to require thinking outside the traditional siloed approaches to international development. However, the payoff can be great and will impact adolescent girls today and for generations to come.