1. ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH & RIGHTS (ASRHR) By Ellen Hagerman, Regional Project Manager, Hivos Southern Africa Hivos | 20111

2. General Trends: ASRHR Early sexual debut Child marriage (adolescent girls) School Drop-outs Low transition to high school and less further education & training Age disparate, transactional sex No/Inadequate access to services 2

3. A Global Comparison of Teen Pregnancies Across the region adolescent fertility rates remain persistently high at: 108.2 live births for 1,000 girls aged 15–19 This is two times higher than the world average: 53.4 per 1,000 girls Hivos | 2011 3

4. Statistics: Teen Pregnancy in the Region 8% of all pregnancies are teen pregnancies 16% of all births are teen pregnancies 36% of all maternal deaths are teens By age 17, at least 20% of young women in six countries in the region have started childbearing. This rises to over 35% among 19 year olds in 10 countries in the region 4

5. Overall Trends in the Region: Beliefs and Practices  Belief that males and females should wait until over 18, finished school or working to have children.  Belief that teenage pregnancy negatively affects ones’ future- limits including education.  Family members punish or don’t support young parents. They stigmatise and gossip about them. Hivos | 20115

6. Teen Perspectives on being pregnant  Being a young mother is seen as in fashion – trendy and peer pressure on males to become fathers  Feelings of shame at becoming pregnant so hide it for a long time Hivos | 20116

7. Girls are Getting Pregnant Earlier  There is a widespread perception that it is now common for younger girls (11-15) to have sex and fall pregnant  What’s more, many of these sexual encounters are coerced Hivos | 20117

8. Low Contraceptive Use Despite high levels of knowledge about modern methods of contraception: Many young people do not use contraception Many use it inconsistently and incorrectly Use depends upon the partner Girls find it difficult to negotiate condom use Hivos | 2011 8

9. Stigma on Teen Pregnancy  There is immense stigma around teen pregnancy from peers and elders  Even though teen parents face intense stigma, teens experience peer pressure to have a baby early -- not just for girls. Boys also express this sentiment about fatherhood Hivos | 20119

10. Teenagers take risks  Relatively high risk takers:  Consequences might be known but not considered “in the moment “  Education follows onset of being sexually active  Denial – it won’t happen to me.  Don’t pay attention to warnings/ good advice  More concerned about risk of HIV than pregnancy Hivos | 201110

11. Social & economic pressure on teens to have sex  Boys manipulate girls into having sex  Alcohol and drugs contribute to forced sex  Fear of sexual rejection fuels the pressure  Older men more likely to coerce girls than their peers  Family pressures – e.g. sexual violence, incest and rape  Mothers force daughters to prostitute themselves once they have had a child – to provide money for family  Poverty leads to transaction sex – sugar daddies, survival sex, social status Hivos | 201111

12. Poverty and family environment is a critical driver  Parents who neglect / abuse children are more likely to have teenagers who become pregnant  Sexual debut is younger for girls who are orphans  If mistreated at home, teenage girls seek solace in others – e.g. sugar daddies  Teenagers without parents escape the stress of living alone by turning to alcohol and sex Hivos | 201112

13. Information comes from different sources  Young people want their parents to talk to them about sex BUT parents don’t’ talk to about SRH because of feeling uncomfortable  Some young people prefer to get SRH info from the Internet rather than parents/guardians because of privacy and confidentiality  Some young people use pornography to inform their sexual actions Hivos | 201113

14. Established practices of intergenerational and transactional sex  Girls go with taxi drivers for money, and sometimes from familial pressure  Sugar daddies force sex if girls refuse and discourage the use of condoms for dual protection  In South Africa (KZN) there is the “Kati and Ubisi game” which ostensibly means when older men buy younger women alcohol in exchange for sex Hivos | 201114

15. ANTE-NATAL CARE: Reasons for Poor Attendance  Not sure about the right time to begin  Uncertainty about the importance of check ups  Want to avoid testing for HIV/AIDS  Hiding a pregnancy so don’t present  Fear of being scolded  Teens don’t have the information, support and encouragement they need to attend ante natal care Hivos | 201115

16. Negative attitudes when seeking ante natal care  Judged and met with disapproval by older women in the waiting room  Nurses care about the unborn baby more than the mother  Teenagers wait longer than other patients- affects schooling and self esteem  Fear of confidentiality – especially in small community clinics Hivos | 201116

17. Teen Pregnancy: Consequences Adolescent pregnancy brings detrimental social and economic consequences for a girl, her family and the broader community: it leads to a girl dropping out of school the health risks for adolescents are greater, with higher risks of birth complications and maternal mortality Economic impacts due to loss of productive work force: disabilities, absenteeism or caring for baby 17

18. Teen Pregnancy: Consequences Medical complications from pregnancy and childbirth are among the leading causes of death for girls aged 15–19 globally Hivos | 2011 18

19. ASRHR Abortion 19

20. Abortion: the facts Unsafe abortions are responsible for 13% of maternal deaths in sub-Saharan Africa 58 % of abortions in Southern Africa are deemed unsafe 47,000 women die/year from unsafe abortions with 45% of young women account for these deaths 20

21. Abortion: the facts for youth The majority of women undergoing unsafe abortion are under 24 years of age Adolescent girls in developing countries undergo at least 2.2 to 4 million unsafe abortions each year Among the 3.2 million unsafe abortions in women aged 15–19 years old globally, almost 50 % are in the Africa region 21

22. ADOLESCENT DEATHS RELATED TO UNSAFE ABORTIONS Source: Iqbal Shah and Elisabeth Ahman, “Age Patterns of Unsafe Abortion in Developing Country Regions,” Reproductive Health Matters 12, no. 24 (supplement, 2004). Percent

23. Safe Abortion: Barriers Stigma linked to religious and cultural beliefs Ignorance about rights and services Refusal, objections or fear by Health Workers Lack of facilities that offer safe abortions Long distances to facilities Lack of political will to legalize or offer safe abortions Hivos | 201123

24. ASRHR Adolescents and the HIV/AIDS Epidemic Hivos | 2011 24

25. ASRHR and HIV High numbers of new HIV infections among youth (HIV incidence) The younger the infected – the longer the treatment duration Stigma and discrimination prevent testing and treatment: more acute for boys and men Knowledge remains low Hivos | 2011 25

26. ASRHR and HIV Knowledge about HIV prevention is increasing among young women and young men The average for sub-Saharan Africa is 26 % for females aged from 15–24 Far below the 2010 target of 95 % comprehensive knowledge. (UN General Assembly Special Session on HIV/AIDS, 2001) 26

27. ASRHR Recommendations Hivos | 2011 27

28. Services Tailored for Youth & Adolescents Prevention of mother-to-child transmission of HIV (PMTCT) Safe delivery and post-partum care Ante-Natal Care Voluntary medical male circumcision Diagnostic testing and treatment for STIs Ensure clinic hours accommodate school- going youth Hivos | 2011 28

29. Attitudes towards Adolescents Values Training to improve attitudes and address stigma and discrimination of service providers, parents and community members towards adolescents including: Health Care Workers School Nurses/Principals/Teachers Community Leaders/Clinic Committees Social Workers Hivos | 2011 29

30. Contraceptives and Abortion Hivos | 2011 30 Adolescents require access to a range of services including: A choice of modern contraception: female and male condoms, hormonal contraception such as pills or injectables, implants, intrauterine devices (IUD) and diaphragms Abortion where legal Post-abortion care Pregnancy advice and care where abortion is restricted

31. Communications: Youth and Adolescents Information material targeted, adapted and developed by youth & adolescents: tailored to different age groups Use of social media Engage Youth Champions and Leaders Peer Educators Fast-tracked services to reduce waiting times Ensure confidentiality, privacy AND respect Mobile Clinics Hivos | 2011 31

32. Comprehensive Sexuality Education Develop material on sex education tailored to the needs of youth and adolescents of different age groups Specialized training for teachers Engage parents and community members Ensure political commitment at all levels Hivos | 2011 32

33. Thank-you Contact details: ehagerman@hivos.org Hivos | 2011 33