World Population Day: Stronger Health Systems for Stronger Teenage Girls

World Population Day: Stronger Health Systems for Stronger Teenage Girls

{Photo: MSH staff/Tanzania}Photo: MSH staff/Tanzania

Invest in teenage girls. Change the world.

Sylvia, age 16, knew little about HIV & AIDS or reproductive health when she started primary school. Now, she says: “I am not scared by the pressure from boys and other girls to engage in early sex, I know my rights and am determined to fulfill my vision of completing my education.” Sylvia is one of 485 girls in 6 eastern Ugandan schools who received integrated sexual and reproductive health and HIV information.

Today, July 11, we commemorate World Population Day 2016 and the midpoint toward reaching the Family Planning 2020 (FP2020) goal to ensure the right of 120 million additional women and girls to access contraception. More than half of the 7 billion people on earth are under the age of 30. Most of the FP2020 focus countries are in the very regions of the world where we find (a) the highest population of youth and (b) more marginalized and disenfranchised young people. In many of the world's poorest countries, people aged 15 to 29 will continue to comprise about half of the population for the next four decades.

As countries experience the demographic dividend, adolescents will enter their working years and will need to be healthy to be productive. Adolescents face unique health needs, from puberty to gender expectations, often compounded with reproductive and sexual health stigma and limited access to health information, services, and resources. Many youth have sex for the first time (by choice, pressure or forced), putting them at risk for early pregnancies and HIV and other sexually-transmitted infections. Late adolescence is also when common mental disorders and substance use disorders are most likely to emerge.

Adolescent girls face additional burdens: menstrual hygiene, early or forced marriage, fistula risk, economic interdependence, and more. Among sexually active women, the unmet need for contraception is highest among teenage girls ages 15 to 19.

How can the world meet the unique health needs of large numbers of adolescents -- especially with so many teens in resource-limited settings?

Design health systems to involve youth, positive youth development, and be responsive to youth needs.

  1. Support evidence-based and innovative service delivery of high-impact interventions and mainstreaming of youth-friendly services.
    Many younger women do not visit health facilities because they tend to be healthy and are afraid of stigma around sexuality. For some, the experience or fear of side effects and health risks are primary barriers to family planning use. Train health workers on counseling to ensure the right method is selected, side-effects are adequately explained, and any side-effects experienced by the clients are managed appropriately. Consider different service delivery models to creatively reach young people instead of brick-and-mortar health facilities. Facilitate peer groups and networks of young women users of contraceptives that support each other with information about how to manage and get help to address side effects. In Uganda, MSH trained youth champions to expand a network of youth advocates using Facebook, SMS, and other social media to communicate facts about reproductive health and family planning, eliminate myths, and promote demand for services.

  2. Integrate service delivery.
    Integrate youth-friendly family planning into maternal health, nutrition, HIV, Tuberculosis, or other interventions, to amplify health impact. Outreach events for hard-to-reach and underserved young people can provide services such as family planning, HIV counseling, and distribution of condoms and contraceptives for dual protection, antenatal care for young pregnant women including immunization, malaria treatment, and education on exclusive breastfeeding and nutrition.

  3. Develop leadership capacities of adolescents.
    Through community-based interventions and digital platforms such as YouthLeadGlobal, and eCourses, youth can develop leadership skills to align and mobilize communities and inspire peers to action. Successful programs enhance protective factors of young people and do not simply attempt to reduce risk. In northern Nigeria, teenage girls -- living amid threats of Boko Horam -- empowered themselves and their families and communities on sexual and reproductive health. In Peru, through a participatory community and citizenship process, 200 youth leaders reported that they boosted their knowledge of family planning while also improving their leadership skills, communication with their parents, and their self-esteem.

  4. Work with youth and communities to create a supportive environment for targeted youth interventions, and not just for health.
    In the midst of all the physical, emotional, and cognitive development, youth are also learning to be active members of society. Positive youth development must happen holistically, with interventions targeting employability, education, civic engagement as well as health. Nupur, a youth activist from Bangladesh, who spoke at the Gender 360 Summit last week said, “There aren’t many options offered to girls in my community to teach us about careers; most of the programs we find are trainings in tailoring or sewing. What if I want to learn about computers?” We need to listen to and partner with youth, so we know what issues are most important to them, support their initiatives, and tailor solutions to their needs.
  5. Institutionalize policies that support youth universal access to reproductive health and care.
    Set national standards that youth providers must follow. Stronger health systems can accelerate the impact of successful youth interventions and institutionalize effective policies and services packages that promote youth health and wellbeing. In Madagascar, for example, MSH is working with Advance Family Planning and government agencies to ensure that the renewal of the 1926 Reproductive Health Law contains language assuring access to family planning by adolescents is voted in by the end of this year.

We have an opportunity to meet the health needs of youth, if we deliberately invest in teenage girls as positive contributors to the world. As UN Secretary General Ban Ki Moon said, “the acronym SDG also stands for ‘Sustainable Development Generation’ and sustainability means engaging future generations today.”

Youth are our colleagues, leaders, and activists. We need to invest in, include, and support them now, so that they can grow into confident and informed adults, who will support the young after them.

Stronger health systems. Stronger teenage girls. Stronger world.

Astride Gilles contributed to this content. Kate Cho, MHS, is a technical advisor on family planning and reproductive health. Fabio Castaño, MD, MPH, is MSH's global technical lead for family planning and reproductive health.