The Changing World of Adolescent Sexual and Reproductive Health and Rights

The world in which adolescents live has changed dramatically in the last 25 years and the response to their sexual and reproductive health and rights has evolved in important ways.

A new supplement in the Journal of Adolescent Health celebrates gains, confronts barriers, and identifies key areas of action for countries and key stakeholders to build on progress in the critical decade ahead.

The four published articles were developed by technical teams at WHO and UNFPA, along with governments, academia, civil society, and funding organizations. They were co-authored by young people from six regions around the world.

Some positive trends in adolescent sexual and reproductive health and rights

In 1994, the International Conference on Population and Development (ICPD) announced the arrival of adolescent sexuality and adolescent sexual and reproductive health on the global agenda.

An additional 163 million adolescents (aged 10-19) have come of age since then. There are now 1.2 billion adolescents in the world, with diverse interests, needs, and concerns. Many of them are benefiting from shifting development, health, and social trends.

There have been concrete improvements in some aspects of adolescent sexual and reproductive health and rights. Many adolescents initiate sexual activity later than adolescents in the past. They less likely to have sex with a partner who they are not married to or living with and more likely to use condoms when they are sexually active.

Girls are less likely to be married and to have children before age 18, more likely to use contraception and to obtain maternal health care. They are less likely to experience female genital mutilation, internationally recognised as a human rights violation.

Slow progress for adolescents on other key issues

In spite of greater awareness of the sexual and reproductive health needs of adolescents, some key issues have not improved.

In many contexts, menstruation is still seen as a taboo topic. Adolescents are the only age group in which HIV-related deaths are not decreasing and from the limited data available, their levels of other sexually transmitted infections are high and growing. An unacceptably high proportion of adolescent girls have experienced physical and/or sexual intimate partner violence. There is still a lack of good data on levels of unsafe abortion among adolescents, and the risk of mortality and morbidity resulting from it.

When it comes to gender, adolescents are still expected to conform to specific gender norms. The supplement notes that girls are taught to be ‘modest and polite’, whereas boys are encouraged to be ‘brave and independent’.

These expectations can worsen other inequalities such as those related to poverty, education and employment, and contribute to differences in adolescent health and well-being along gender lines. For example, while boys are more likely to experience injuries and to use tobacco and alcohol, girls are more likely to experience intimate partner violence.

A time-bound opportunity

Progress over the last 25 years has strengthened the position of adolescent sexual and reproductive health and rights on global, regional and national agendas. There is more investment and a growing evidence-base, with committed advocacy movements and strong governmental responses in a small but increasing number of countries. This presents new opportunities for all adolescents to achieve and exercise their full potential.

Looking forward, the supplement lays out specific considerations for delivering a comprehensive package of sexual and reproductive health interventions to adolescents. It also proposes specific actions in relation to five strategic areas: political and social support, funding, laws and policies, data and evidence, and the implementation of programmes at scale with quality and equity.

Adolescents have a right to make decisions governing their bodies and to access services that support those rights – and more so than ever before, the international agenda is paying attention.