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					 Reproductive health services for
 adolescents: do they exist?


                                         Adolescent
                                         pregnancy
     Service options, availability and
     access for married pregnant
     adolescents



Dr Alma Virginia Camacho
Adolescent Health Program
Child and Adolescent Health Department
1. What do we mean by adolescence ?
2. What are the reasons for investing in
the health of adolescents ?
3. What is the magnitude of adolescent
pregnancy ?
                                           Adolescent
4. What are the consequences of
adolescent pregnancy ?                     pregnancy.
5. What are the causes of adolescent
pregnancy ?
6. What needs to be done to respond to
adolescent pregnancy ?
 More than 90% of the 14 million births to
adolescent girls are in developing countries.


                                             The characteristics of
                                             young mothers are
                                             common across the
                                             regions of the world:
                                             -Little education,
                                             -Rural dwelling,
                                             -Low income.


 Source: Growing up global: The Changing Transitions to Adulthood in
 Developing Countries (National Research Council, 2005).
  More than 1/5 of women in the poorest
     regions have a child by age 18.
            35
            30
            25
            20
            15
            10
              5
              0
                  West Asia     South     Carribean    South,     Eastern & Western &
                   & North     America    & Central   Central &   Southern   Middle
                   Af rica                 America      South      Af rica   Af rica
                                                      East Asia



Source: Tabulations of demographic & health surveys from 51 countries,1990-2001. (National Research
Council, Growing up global: The Changing Transitions to Adulthood in Developing Countries, 2005).
Teenage pregnancy by regions (N=35, DHS 2001-2005)
Percent distribution of women aged 15-19 who were pregnant with their first child, of the
women interviewed in the survey.



                        Teenage pregnancy at the age of 15-19
                        (pregnant with first child)

    6
              5.1
    5
                                                                       4
    4
                                                   2.9
    3                           2.5

    2

    1

    0
          Sub-Saharan    North Africa/West       South &        Latin America &
             Africa        Asia/ Europe      Southeast Asia        Caribbean
               Teenage pregnancy by countries (N=35, DHS 2001-2005)
 Percent distribution of women aged 15-19 who were pregnant with their first child, of the
                            women interviewed in the survey


                                                           Teenage pregnancy at the age of 15-19 (pregnant with firtst child)
 10
                                                                                                                                                           8.7
  9
  8                                                                                                                                                                      6.9 7
  7               6.4 6.4                                                                                6.3                                                                                                                                       6.5
      6.1 5.8                                                                                                                                     6.1
              5.7                                                                                                                                                                                                                                                  5.7
  6                                                                                                                                 4.9                                                                                                                                                                                                                                                 5.2
                                                                                                                       4.5                                                                                                                                                                                                                  4.8
  5                                                                                                                                                                                                    4.3                                                                                                                                                                                                                                            4.3 4.3 4.2 4
                                                                                            3.5                                                                                                                                     3.6                                                                3.6
  4                                                                  3 3.1                                                                                                                                                                                                                                                                                                                                                              3
  3                                                                                                                                                                                                                                                                                     2.3                                        2.2                              2                                1.8 1.6
  2                                                                                                                                                                                                                                                                                                                 1.2 1.3
                                                                                                                                                                                                                      0.8
  1
  0




                                                                                                                                                                                                                                                                                                                         Moldova Republic
                                                       (Brazzaville) 2005




                                                                                                                                    Madagascar 2003/2004




                                                                                                                                                                                                                                                                                                                    Morocco 2003-2004 (2)
                                                                                                                       Kenya 2003




                                                                                                                                                           Malawi 2004
                                                                                                                                                                         Mali 2001
                                                                                                                                                                                     Mozambique 2003




                                                                                                                                                                                                                                                   Tanzania 2004




                                                                                                                                                                                                                                                                                                       Egypt 2005




                                                                                                                                                                                                                                                                                                                                                                                                                                       Bolivia 2003
      Benin 2001




                                                             Chad 2004


                                                            Eritrea 2002
                                                                            Ethiopia 2005
                                                                                            Ghana 2003
                                                                                                         Guinea 2005




                                                                                                                                                                                                       Nigeria 2003
                                                                                                                                                                                                                      Rwanda 2005
                                                                                                                                                                                                                                    Senegal 2005




                                                                                                                                                                                                                                                                                        Armenia 2005


                                                                                                                                                                                                                                                                                                                             Jordan 2002




                                                                                                                                                                                                                                                                                                                                                                                        Nepal 2001


                                                                                                                                                                                                                                                                                                                                                                                                                        Vietnam 2002




                                                                                                                                                                                                                                                                                                                                                                                                                                                       Republic 2002


                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Nicaragua 2001
                                                                                                                                                                                                                                                                   Zambia 2001/02 (1)




                                                                                                                                                                                                                                                                                                                                            Bangladesh 2004 (3)
                   Burkina Faso 2003
                                       Cameroon 2004




                                                                                                                                           Lesotho 2004




                                                                                                                                                                                                                                                                                                                                                                  Indonesia 2002/2003


                                                                                                                                                                                                                                                                                                                                                                                                     Philippines 2003




                                                                                                                                                                                                                                                                                                                                                                                                                                                      Colombia 2005


                                                                                                                                                                                                                                                                                                                                                                                                                                                      Honduras 2005
                                                                                                                                                                                                                                                                                                                                                                                                                                                        Dominican
                                                                                                                                                                                                                                                                                                                             of 2005
                                                            Congo




                                                                                                   Sub-Saharan Africa                                                                                                                                                                      North Africa/West                                South & Southeast                                                                                  Latin America &
                                                                                                                                                                                                                                                                                             Asia/Europe                                          Asia                                                                                           Caribbean


1) GPS dataset is incomplete
2) The Morocco Survey will be a collaboration between MEASURE DHS+ and PAPFAM of the League of the Arab States
3) Data collected for women 10-49, indicators calculated for women 15-49
      Adolescents are less likely than young
      adults to use modern contraceptives.
                       40
                                                                               Eastern &
                       35                                                      Southern
                       30                                                      Africa
                       25                                                      Western &
                                                                               Middle Africa
                       20
                       15
                                                                               Central
                       10                                                      America &
                         5                                                     Caribbean
                         0                                                     South America
                               Ages         Ages
                               15-19        20-24

Source: Tabulations of Demographic & Health Surveys from 51 countries, 1990-2001.
(National Research Council, Growing up Global: The Changing Transitions to Adulthood in Developing Countries, 2005).
Unmet need among young women, Latin America and
the Caribbean (2001-2004)


                       Unmet need for family planning among young women aged 15-24
                                                    years

                30                                           26.3
                25   22
                                                                                               15-19 Unmet need - space
P ercen tag e




                20        15.314.9                                  15.4      15               15-19 Unmet need - limit
                15     11.1           12.6
                                                                                     10.9
                                                 7.5                                           20-24 Unmet need - space
                10                                                                       6.1
                                           3.7                         4.5         4.8         20-24 Unmet need - limit
                5                                      3        2.8
                0
                     Bolivia 2003     Colombia 2005            Dominican     Nicaragua 2001
                                                             Republic 2002
                                     Latin America and the Caribbean


                     SOURCE REF.ORC Macro 2007 Measure DHS
                      Unmet need for family planning among young
                      women in Sub-Saharan Africa (2001-2005)

                                                                         Unmet need for family planning among young women aged 15 - 24 years

           45                                                                                                                                 41.7
           40
           35                                               30.1                                                      28.6                                              30.1 28.8         15-19 Unmet need - space
                     27.2                                                                                                                                  27.2
P e r c e n ta g e




           30                     24.7                                                                   23.5                                                                             15-19 Unmet need - limit
           25                                  19.9                       18.8 20.8         20.6                                   20
           20                                                                                                                                                                             20-24 Unmet need - space
           15                                                                                                                                                               8.2
           10                                                                                                                                                                       5.6   20-24 Unmet need - limit
            5               0.6          0.7          0.2          0.4        0.7     0.9          0.2          0.3          0.5        0.6          1.2          1.2
            0
                       Benin 2001              Burkina Faso 2003           Cameroon 2004       Chad 2004                    Congo               Eritrea 2002             Ethiopia 2005
                                                                                                                      (Brazzaville) 2005

                                                                                                   Sub-Saharan Africa


          SOURCE REF.ORC Macro 2007 Measure DHS
                                  Access to SBA by women age under 20 (doctor or other health professionals)


    120

                                                                                  100    99.5100                                  98.3
    100                                                                                                                        92.2
                    89.8

     80                                                                                                                  74 73.1         73.6
                                                                                      70.6      70.3
                                                                               67.3
             61.6                                                                                         63.6
                                         59.1   56.6
                                                   56.4                                                           57.1
     60
%




                                                                 53.2 51.6
                                                                    50.5
                                      48.6                                                             49.3
          43.3                     45.6
                                44.8                                     46.1
                                             40.2             40.1
     40                  32.7
                                                          28.1                                                 29.6                  30.1
                 19.5                                  18.6
     20                                                                                            15.7
                            7.3

      0




                        Source, DHS Macro International 2000-2006
Even if health services are accessible & acceptable,
           not all groups of adolescents
     can obtain the health services they need.
Greater likelihood of maternal mortality.
                          1400
                          1200
                          1000
  •   The risk of dying   800
      from pregnancy-                                                       20-34 years
      related causes is   600                                               15-19 years
      twice as high for
      adolescents         400
      aged 15-19, as
      for older women.    200
                            0
                                 Ethiopia     B'desh        Brazil

                                  Source: Safe Motherhood Initiative Factsheet, 1998.
                                  Adolescent Sexuality & Childbearing.
    Babies born to adolescent mothers
            face higher risks.
• Adolescents are at an increased risk for pre-term
  labour & delivery, compared to older women.
• Babies born to adolescent mothers are more likely
  to be of low birth weight.
• Babies born to adolescent mothers are at an
  increased risk of perinatal & infant mortality.

Source: Adolescent pregnancy – Issues in adolescent health and development. Geneva. WHO 2004.
     Babies born to adolescent mothers
             face higher risks.
 • Adolescents are at an increased risk for pre-term       !
                                                   oth ers
   labour & delivery, compared to older women.   m
                                             ent
                                        lesc
 • Babies born to adolescent mothers are more likely
                                      o
   to be of low birth weight.e    r ad
                           oung
                       in y
                  a er
 • Babies borntto adolescent mothers are at an
                e
           i
   increaseds gr risk of perinatal & infant mortality.
    r is k
The
 Source: Adolescent pregnancy – Issues in adolescent health and development. Geneva. WHO 2004.
Potential risks to the adolescent
    mother's life prospects.
 •Pregnancy can bring status for a married adolescent in cultures
 where motherhood is the core aspect of a woman's identity.


                         • On the other hand, an
                           unmarried pregnant
                           adolescent may be
                           driven away by her
                           family, or abandoned by
                           her partner & be left with
                           no means of support.
   Socio-economic deprivation:
both a cause & consequence of adolescent pregnancy




                              Too early
    Poverty
                              pregnancy




                                          " We young women are not prepared to
                                          become mothers. I would like to continue my
                                          studies. But since I have had my daughter,
                Loss of                   my options have changed because I have
              educational
                   &                      many more obligations now. I hope that this
              employment                  will not be a barrier for me to succeed in life."
              opportunities

                                          Eylin 19, Honduras January 2006.
                                          Source: World Development Report 2006 (World Bank, 2006.)
1. What do we mean by adolescence ?
2. What are the reasons for investing in
the health of adolescents ?
3. What is the magnitude of adolescent
pregnancy ?
                                           Adolescent
4. What are the consequences of
adolescent pregnancy ?                     pregnancy.
5. What are the causes of adolescent
pregnancy ?
6. What needs to be done to respond to
adolescent pregnancy ?
   Circumstances in which
adolescent pregnancy occurs.

 Sex within
  marriage     Intended
              pregnancy

                           Adolescent
                           Pregnancy.


              Unintended
              pregnancy
   Circumstances in which
adolescent pregnancy occurs.

  Sex within
   marriage          Intended
                    pregnancy
   Sex outside a
 recognised union                Adolescent
                                 Pregnancy.


                    Unintended
                    pregnancy
   Circumstances in which
adolescent pregnancy occurs.

   Sex within
    marriage                     Intended
                                pregnancy
   Sex outside
    marriage
                                             Adolescent
                                             Pregnancy
Consensual sex
  - Within marriage
 - Outside a recognised union
                                Unintended
                                pregnancy
     Circumstances in which
  adolescent pregnancy occurs.

      Sex within
       marriage                     Intended
                                   pregnancy
      Sex outside a
    recognised union                            Adolescent
                                                Pregnancy
  Consensual sex
     - Within marriage
    - Outside a recognised union
                                   Unintended
                                   pregnancy


Non-consensual sex
               Preventing subsequent
                 pregnancies is key

Preventing second pregnancies by
supporting adolescent mothers.
Useful reference: McNeil P. Women's Centre of Jamaica
Foundation. Preventing second adolescent pregnancies by
supporting young mothers. Youth Adult Reproductive Health.
Project Highlights. Focus on Young Adults Directions in
Global Health. 1998.
        Poor awareness of & access to
     Emergency Contraceptive Pills (ECPs).

 •    Adolescents' limited
      awareness & knowledge about
      ECPs
 •    Adolescents' limited access to
      to ECPs
 •    Limited provider awareness &
      knowledge about ECPs
 •    Provider reluctance to provide
      ECPS to adolescents
 •    Legal & social restrictions of
      ECP provision to adolescents


Source: Adolescents & Emergency Contraceptive Pills in Developing Countries. Family Health International, 2005.
                Unsafe abortion
Percentage distribution by age & region.
100%
 90%
 80%
 70%
 60%                                                                 25-49
 50%                                                                 20-24
 40%                                                                 15-19
 30%
 20%
 10%
  0%
        Developing       Africa          Asia         Latin
         Countries                                  America &
                                                    Carribbean

Source: Age patterns of unsafe abortions in developing country regions.
(Shah I, Ahman A, Reproductive Health Matters 12, 24).
1. What do we mean by adolescence ?
2. What are the reasons for investing in
the health of adolescents ?
3. What is the magnitude of adolescent
pregnancy ?
                                           Adolescent
4. What are the consequences of
adolescent pregnancy ?                     pregnancy.
5. What are the causes of adolescent
pregnancy ?
6. What needs to be done to respond
to adolescent pregnancy ?
We need to generate political commitment,
addressing adolescent pregnancy within the
     drive to reduce maternal mortality
  • A precondition for successful maternal mortality
    reduction is sustained political commitment. This
    commitment enables the implementation of wider
    policies & legislation to support maternal well-being.
  • Improving the availability & use of data is crucial
    to raising public, professional & political awareness of
    the problem and support evidence - based decision
    making
  • Addressing the specific needs of adolescents is
    vital to reducing maternal mortality overall given that
    they make up a significant proportion of the burden
We need to put effective interventions in place,
  to reduce maternal mortality and morbidity:
adolescent girls need to be part of this strategy
• Ensuring access to skilled attendance at birth
  and evidence- based interventions
• Care & transport to care either provided
• Financial, cultural and social access to services
  for adolescents is crucial
• Empowering adolescent girls to enhance their
  capacities to make right decisions about their
  health and wellbeing
• Involvement of men and family members is
  critical
We need to constantly bear in mind the needs
    of the adolescents we want to serve.

   " For too long, when an
   adolescent becomes pregnant, we
   have pointed the finger at her. It is
   time that we pointed the finger at
   ourselves. If a girl gets pregnant
   that is because we have not
   provided her with the information,
   education, training and support
   she needs to prevent herself
   becoming pregnant."

   Pramilla Senanayake,
   Former assistance Director
   International Planned Parenthood Federation.

				
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