Adolescents: Strengthening Evidence to Address their SRHR Needs AFP Partners Meeting, Kenya Adolescents: Strengthening Evidence to Address their SRHR Needs Michelle J Hindin, MHS PhD Scientist

Adolescents Definitions: How many? Adolescents 10-19 year olds Youth 15-24 year olds Young people 10-24 year olds How many? There are approximately 1.2 billion adolescents They make up 18% of the world’s population 88% of adolescents live in low- and middle-income countries One in every six people in low-income countries is an adolescent In 2050, sub-Saharan Africa is projected to have more adolescents than any other region. Adolescents are not a homogenous group and have diverse Sexual and Reproductive Health (SRH) needs http://www.unicef.org/sowc2011/pdfs/Demographic-Trends.pdf

What do we know? Pregnancy In developing countries, 15-19 year olds will have about 21 million pregnancies About half end in abortion, often unsafe Unsafe sex and lack of contraceptive use are leading risk factors of morbidity for young people (ages 15-24). Pregnancy during adolescence can have long-ranging adverse social, educational and economic consequences. These consequence vary by social context, marital status, age, wealth and education. Darroch JE et al., Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, New York: Guttmacher Institute, 2016 https://www.guttmacher.org/report/ adding-it-meeting-contraceptive-needs-of-adolescents.

What do we know: Contraception Approximately 38 million 15-19 year olds women in developing countries are sexually active and do not want a child in the next two years. 40% are using a modern contraceptive method 60% are not using a modern or any method at all In Africa, unmet need need for modern contraception is higher among married adolescents. In Asia, unmet need for modern contraception is higher among unmarried sexually active adolescents In Latin America and the Caribbean, unmet need is similar between married and unmarried. Woog V et al., Adolescent Women’s Need for and Use of Sexual and Reproductive Health Services in Developing Countries, New York: Guttmacher Institute, 2015, Years. Married women Unmet need among married women aged 15–19 was lowest in Rwanda (6%) and highest in Ghana (62%). • Asia 7% in Indonesia to 42% in Nepal. • Latin America and the Caribbean ranged from 13% in Cuba to 57% in Haiti. Unmarried sexually active women • • Unmet need among this group was especially acute in Africa: In 20 countries, more than 50% of unmarried, sexually active 15–19-year-olds had an unmet need for contraception. • Asia 25% in Kazakhstan to 94% in Laos. • LAC 14% Cuba 55% range. Darroch JE et al., Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, New York: Guttmacher Institute, 2016 https://www.guttmacher.org/report/ adding-it-meeting-contraceptive-needs-of-adolescents.

Which Interventions work? Reviewed published and gray literature review of interventions for young people on pregnancy prevention >30,000 screened 21 articles of high quality (interventions, evaluations) What works to prevent pregnancy? Method provision (Kenya) Economic Incentives/School Uniforms (Kenya, Malawi) But also didn’t work in Kenya, Malawi, Zambia Education program/teacher training (Kenya) What works to increase contraceptive use? Provision of methods (Keya) Life skills training/Peer education (Ethiopia, Uganda, Senegal, India, Cameroon) Mass media (India) Hindin MJ et al (In Press) “Interventions to prevent unintended and repeat pregnancy among young people in low- and middle-income countries: A systematic review of the grey and published literature. Journal of Adolescent Health

Current Research for ASRH in WHO/HRP Better use of existing data Systematic reviews (Global) pharmacy provision of RH commodities provider bias in service provision DHS secondary analyses of Adolescents (40+ countries) early and first births (by age and socio-demographic characteristics) contraceptive use patterns (never, ever, current use) pharmacy as source of contraceptive method Improve access to and quality of SRH services AHEAD (facility-based intervention to prevent rapid repeat pregnancy) ARMADILLO (digital health intervention to improve contraceptive knowledge and use) Address contextual, social and policy barriers GEAS (gender norms and social context) Policy analyses and documenting best practices Adolescent briefers (disaggregated by marital status)

For additional information Michelle J Hindin hindinm@who.int WHO/RHRhttp://www.who.int/reproductivehealth/about_us/en/ HRP http://www.who.int/reproductivehealth/about_us/hrp/en/ Filename