Despite their fundamental importance, programs and policies for young people remain lacking. The needs of young people are often only recognized when it is too late: when they become pregnant, need abortions, or are infected with HIV or other STDS. Services — if provided — are delivered through conventional Maternal Child Health/Family Planning (MCH/FP) programs which are not specifically geared toward younger age groups.
It is time to end the cultural and policy silence surrounding young people's health and prevent young women and men's problems before they start. Young people comprise almost 30% of the world population, and are growing in number. By 2020, 87% of young people will be living in developing countries. A large percentage of these young people will be sexually active, not use adequate contraception, and suffer disproportionately from reproductive health problems including pregnancy-related complications, HIV/AIDS and STDS, and female genital mutilation (FGM).
Ensuring the reproductive health of young people makes social and economic sense: Health complications related to STDS, abortion, or teenage pregnancy can place a substantial burden on individual welfare and scarce government resources. Adolescent childbearing can lead to economic setbacks for young people, their communities, and the national economy. If adequate public investments are not made in the health of the younger generation, these personal and societal costs will only increase.
RISKS TO GOOD HEALTH
Low mortality rates among young people have falsely labeled them as a healthy age group. This traditional health indicator — often used by health planners, policymakers, researchers, and program staff — grossly underestimates that young people are disproportionately affected by reproductive health problems and ignores the future costs of morbidity.
High Prevalence of Sexual Activity
The majority of young people are sexually experienced by age 20. Much of this sexual activity takes place within marriage; however premarital sexual activity is common, varying among gender and within countries and regions.
Among unmarried adolescents, very few use contraception at first intercourse. Contraceptive use among married adolescents is lower in Sub-Saharan Africa than among unmarried teens. In Latin America, trends are variable. Little information exists about the contraceptive practices of unmarried youth in Asia. Whether married or not, young people who engage in sexual intercourse without contraception are at risk of adverse health effects.
Low Contraceptive Use
Although knowledge of contraception among young people is increasing, contraceptive use remains low among married and unmarried young women and men.
Increasing STD/HIV/AIDS infections
Sexually transmitted diseases are most common in youth ages 15-24. Incidence rates are higher among young women than men in countries where STDs are a major health problem.
In many developing countries up to 60% of all new HIV infections are among 15-24 year-olds. Approximately one-half of all people infected with HIV are under age 25. The majority of new infections will occur among young women.
Increasing Adolescent Pregnancies
Fertility rates for all women, including adolescents, are declining. However, growing population sizes will lead to an increase in adolescent births in many regions of the world. In Sub-Saharan Africa, for example, an approximate 23% increase in adolescent births is predicted for 1995-2020.
Unwanted Pregnancy and Pregnancy-Related Complications
Pregnancy in adolescence carries a relatively high risk of death or long-term complications.
Pregnant teens are more likely to suffer from malnutrition, pregnancy-induced hypertension, and eclampsia than women over age 20. In addition, an immature birth canal may prolong labor, increase the risk of vesicovaginal fistula, cause permanent damage to bladder and bowels and to the infant's brain, or lead to death of mother and child.
Young mothers, ages 15-19, are twice as likely to die of pregnancy-related causes than women ages 20-24. The risk of death may be five times higher for girls ages 10-14 than for women 20-24.
Infant Mortality and Morbidity
The mortality and morbidity rates of infants of young mothers are higher than for older mothers.
Abortion Complications
Young women suffer disproportionately from abortion complications.
Teenagers are more likely than older women to have clandestine or illegal abortions because of legal, social and financial reasons. Estimates of abortions performed on teenage women range from 1 to 4.4 million. Data from 13 studies in seven Sub-Saharan African countries show that adolescents comprised 39-72% of all cases of abortion-related complications. Female Genital Mutilation
85-115 million girls and women have undergone FGM. Two million or more girls undergo FGM each year. FGM is most often practiced in 26 African countries (including the Middle East), a few Asian countries, and is increasingly practiced in Europe, Canada, Australia and the US.
BARRIERS TO GOOD HEALTH
Why do young people disproportionately suffer from reproductive health problems?
Lack of Information:
Many young people lack knowledge and have misleading information about sexual issues.
Lack of Access:
Legal barriers often prohibit or limit provision of information or services to young people. Financial and geographic barriers prevent many young people from paying for services or being able to access clinics.
Cultural and Social Restrictions:
Unequal power relations and sexual coercion between boys and girls and older men and girls often prevent girls from negotiating the timing of sex and contraceptive usage. Attitudes toward sex, particularly premarital sex, often result in the restriction of information and access to services for young people. Low levels of female education lead to less reproductive decision-making power and earlier childbearing among many young women.
RECOMMENDATIONS FOR ACTION:
SOCIAL & ECONOMIC CONSEQUENCES
Ensuring young people's reproductive health is not solely the responsibility of the health sector, but also that of the education, poverty, and population sectors.
Young People's Health is a Population Issue:
Young people represent a large and growing population group.
Associated with the demographic transition is an absolute and relative increase in the population of older people. Investments in the human capital of youth are necessary to build a healthy workforce that can support and ensure the welfare of the elderly population.
Young People's Health is an Education Issue:
The health of young people has a direct impact on their educational potentials. Schoolgirls who become pregnant are either forced to leave school, risk unsafe abortions to avoid leaving school, and are prevented from returning to school after giving birth, because they have to take care of their child. Young women who become pregnant at an early age, therefore, achieve lower levels of education than women who delay childbearing until their 20s. "Investing in the second decade of life should be part of regular business at each level of the development community." This was the message delivered by the Population Council in a World Bank workshop on adolescent health. Neglecting young people's health will reduce or negate the benefits of past government expenditures in child survival, childhood communicable diseases, and education as well as curtail future economic and social development.
Despite their fundamental importance, programs and policies for young people remain lacking. The needs of young people are often only recognized when it is too late: when they become pregnant, need abortions, or are infected with HIV or other STDS. Services — if provided — are delivered through conventional Maternal Child Health/Family Planning (MCH/FP) programs which are not specifically geared toward younger age groups.
It is time to end the cultural and policy silence surrounding young people's health and prevent young women and men's problems before they start. Young people comprise almost 30% of the world population, and are growing in number. By 2020, 87% of young people will be living in developing countries. A large percentage of these young people will be sexually active, not use adequate contraception, and suffer disproportionately from reproductive health problems including pregnancy-related complications, HIV/AIDS and STDS, and female genital mutilation (FGM).
Ensuring the reproductive health of young people makes social and economic sense: Health complications related to STDS, abortion, or teenage pregnancy can place a substantial burden on individual welfare and scarce government resources. Adolescent childbearing can lead to economic setbacks for young people, their communities, and the national economy. If adequate public investments are not made in the health of the younger generation, these personal and societal costs will only increase.
Young People's Health is a Poverty Issue:
Improving young people's health is critical to the goal of poverty reduction: Young people comprise an increasing percentage of the workforce, are the workforce of the future, and contribute to the economic production in the home through paid and unpaid work.
Obstructed labor, HIV infection, and chlamydia infection rank among the leading ten causes of disability-adjusted life years (DALYs) lost among young people ages 10-24 living in developing regions
Future Directions:
ln planning future health, population, education, and poverty projects, Bank staff must recognize that:
ways of shaping investments in young people's health should be discussed within and among sectors; opportunities for collaboration must be created among Bank projects; on a country level, health programs for youth should be integrated and mainstreamed with other national plans.
*WHO defines young people as persons in the 10-24 years age group, combining adolescents ages 10-19 and youth ages 15-24.
How ever in INTERNATIONAL YOUTH DEVELOPMENT FORUM IYDF we have adopted the defition of the age group 15-35.
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