Map 2.1 Child marriage is still common in many regions of the world, Page 20 Despite positive trends toward decreasing rates of child marriage, the practice remains widespread in many parts of the world. Excluding China, 36% of 20–24-year-old women in the developing world marry before age 18. The frequency of child marriage varies regionally, with 49% of 20–24-year-olds married by 18 in South Asia and 44% in West and Central Africa. Child marriage robs girls of the opportunity for education, skills, and social networks which could help build healthier lives and improve outcomes for themselves and their children. Child marriage is most common where other alternatives for girls, such as schooling and opportunities to improve their livelihoods, are limited.

Map 2.2 Early Childbearing is common, Page 26 Some 60,000 to 70,000 girls aged 15–19 die from complications of pregnancy and childbirth annually. Adolescents account for just over one-tenth of births but a disproportionate 23% of infections from maternal conditions. Adolescent mothers are two to five times more likely to die in pregnancy and childbirth than women in their twenties. Adolescents are at risk because first births tend to be riskier regardless of the mother’s age, and adolescents are smaller, poorly nourished, suffer disproportionately from malaria, and are relatively uninformed about how to manage a pregnancy and birth. Complications from pregnancy are the leading cause of death worldwide for adolescent girls. The main causes of adolescent maternal death are hemorrhage, hypertension, puerperal sepsis, and septic abortion. For those who survive pregnancy and delivery complications, long-term consequences may include vesicovaginal fistulae (a devastating complication of prolonged labor), uterine prolapse, reproductive tract infections, and infertility.

Map 2.3 Young women have a high prevalence of HIV in many countries, Page 30 Young people 15–24 account for almost half of new HIV infections worldwide. According to the latest UNAIDS statistics, the global HIV infection rate for young women ages 15-24 is 0.6%, and for young men it is 0.4%. In sub-Saharan Africa, it is a shocking 3.2% for young women and 1.1% for young men. This means that in many countries in the region, more than three times as many girls as boys are living with HIV. Married girls face a greater risk than their unmarried peers. Girls and women who trade sex for school fees, food, and other goods and forms of payment also face a higher risk.

Map 2.5 Adolescent Girls and Young Women have limited autonomy in their health care decisions, Page 40 Adolescent girls in the developing world encounter multiple barriers in obtaining appropriate health services and have limited autonomy in their health care decisions. Restrictive laws and policies may keep adolescent girls from services even where they exist. For example, some laws require written permission from a husband or parent in order to obtain contraception. Adolescents rarely have control over financial resources and may have limited transportation options, so services may be inaccessible because of costs and inconvenient location or hours.

Figure 1.1. Mother’s age is a risk factor for children's health problems, Page 12 Analysis of data on nearly 87,000 women in 76 countries found that when the first child is born to a young mother (12–20 years old), as compared to a mother of 24–26 years old, the child is at greater risk of dying before the age of five, being stunted, being underweight, and suffering from anemia. Delaying these births could mean fewer such health problems and fewer infant deaths. These analyses control for the effects of a range of other influences on babies’ health, including household wealth, mothers’ education level, and other factors, so the results isolate the effect of age.

Figure 2.4 Physical and/or sexual intimate-partner violence and non-partner sexual violence among adolescents 15–19, Page 34 A WHO Multi-country Study on Women’s Health and Domestic Violence documents widespread violence against women and girls and the particular risks adolescent girls face. Younger women are at higher risk of physical or sexual abuse than older ones, making this a critical health challenge for adolescent girls as well as young women. More than one-third of 15–19-year-olds reported physical and/or sexual abuse by their partner in the past 12 months. Non-partner sexual abuse was reported by between 1% and 27% of adolescents in the different sites.

Figure 2.3 Unmet need for contraception among married women by age and region, Page 28 Preventing unintended pregnancies with family planning would significantly bolster adolescent girls’ health. Despite recent gains in access to contraceptive services, young women’s unmet need for contraception continues to exceed that of older women. Multiple barriers impede girls’ access to contraception, including laws prohibiting or restricting young and/or unmarried girls’ contraceptive access or requiring permission from parents or husbands, and a prevalent belief that exposure to family planning information increases the propensity for young people to engage in sex.