Adolescent Reproductive Health: The Challenge and Benefits of Delaying Sex
There are 1.2 billion adolescents (ages 10 to 19) in the world today, accounting for 17 percent of the global population. They are the largest youth cohort in history, and 90 percent live in the developing world. Within that broad age group, very young adolescents (ages 10 to 14) often fall through the cracks of international development work, especially when it comes to health, and reproductive health in particular.
“We’ve been reluctant to really directly reach out to very young adolescents because we fear community backlash or we don’t really know how to work with very young adolescents,” said Cate Lane, USAID’s youth health advisor, speaking at the Wilson Center on August 28.
Lane, along with Laurette Cucuzza, the senior technical advisor for reproductive health at CEDPA, and Gene Roehlkepartain, president of child advocacy group Search Institute, discussed the challenges and benefits of working with 10- to 14-year-olds on sensitive but important sexual and reproductive health issues.
An Overlooked Age Group
“Adolescents are often lumped into groups, such as 10 to 19, or 15 to 24, but there are vast differences between adolescents of different ages,” said Cucuzza. Programs that ignore those differences, she continued, “often miss the windows of opportunity for early and nuanced approaches that can have lasting effects and provide protection from a myriad of health risks that contribute to high maternal and child mortality and morbidity.”
One reason why sexual and reproductive health work often bypasses the younger adolescent group, according to Lane, is the concern that “if you talk about sex, and you talk about sexuality, then the young people are going to want to go out and experiment.”
But, she continued, “we know from the research around comprehensive sexuality education that that’s really not true. That if you provide young people with comprehensive sexuality education they’re more likely to delay, they’re more likely to use contraception, they have fewer partners.”
Developmental Assets: A Framework for Engagement
Because of their age and social and cultural norms that may complicate sexual and reproductive health efforts, figuring out how to best to target very young adolescents can be difficult. Roehlkepartain advocated a “positive development” approach – one that builds on so-called “developmental assets,” or characteristics, both in adolescents and in their communities, that support healthy personal development.
Through extensive survey-based research in the United States (currently being expanded internationally), Search Institute has identified 40 of these assets, ranging from having family and community support to valuing delayed sexual debuts. Encouraging these assets can lead to a cycle of positive development for adolescents, said Roehlkepartain. Based on the institute’s U.S.-based work, youth with more developmental assets are less likely to engage in or support risky behavior, like violence, drinking, or sexual activity.
Most recently, Search Institute surveyed adolescents in Bangladesh, Honduras, Jordan, and Rwanda to assess correlations between asset levels and health, violence prevention, livelihood development, education, and civic engagement. The results suggest that developmental assets are universally applicable.
“Even with very different populations in each country, we’re finding similar patterns of asset levels. And that…doesn’t vary much by age, gender, or city or village. So it seems to be a fairly stable measure across a wide variety of young people,” said Roehlkepartain.
The Necessity of an Integrated Approach
Because of the impact developmental assets can have on a range of behaviors across cultures, Roehlkepartain likened their impact to preventive programming. “We think that focusing on identifying and building the strengths in young people complements the efforts to prevent the problems” that so many youth programs target, like health, education, and workforce development, he said.
CEDPA’s on-the-ground work in India, Nepal, Nigeria, and South Africa shows the importance of cross-cutting interventions that empower youth and create supporting environments for addressing sexual and reproductive health. For example, reproductive health programming in India’s Jharkhand state included “intensive advocacy with parents, media, and communities from the outset,” and was able to survive even as comparable programs in other states were coming under increasing criticism, Cucuzza said.
In Nigeria’s Akwa Ibom state, where “HIV prevalence is high, primary school attendance is low, and poverty is rampant,” village chiefs worked alongside religious and women leaders to create an integrated approach, teaching adolescents vocational skills, providing sexual and reproductive education, and improving primary school attendance, she said.
There is a tendency to only deal with “positive development” – empowering youth and strengthening preventive behaviors and norms – once more pressing, immediate problems have been tackled, said Roehlkepartain. But “what we’re learning in developing contexts, which I think is true for this country as well, is that by paying attention to developing and empowering children and youth in all walks of life…is part of what lifts them up.”
“It’s not just waiting until they’ve got everything else solved,” he said. “It all goes together.”
Pursuing positive development could hold promise for USAID and the myriad goals it has relating to the health and wellbeing of young people, said Lane.
“If we are to really achieve USAID’s goals of reducing high-risk pregnancies, unsafe abortions, HIV, reducing maternal mortality, improving child survival, increasing the use of contraception, stabilizing population growth,” she said, “we really have to understand how we instill and sustain positive behaviors among this group of very young adolescents instead of trying to change those negative and often entrenched behaviors when people are older.”
Photo Credit: Sean Peoples.