08 October 2003

LONDON—Meeting adolescents' reproductive health needs is an urgent priority in the global fight against poverty and HIV/AIDS, emphasizes The State of World Population 2003 report by UNFPA, the United Nations Population Fund.

Neglect and under-funding of programmes enabling young people to avoid unwanted pregnancy, unsafe childbirth and sexually transmitted infections are undermining development and spreading HIV/AIDS; investment to correct this will be repaid many times over. These are key findings of UNFPA’s annual flagship report, launched here today by UNFPA Executive Director Thoraya Ahmed Obaid.

Some 1.2 billion people—one person in five—are between ages 10 and 19, the largest number of adolescents in history. Half of them are poor; one in four live in extreme poverty, on less than $1 a day. The report, subtitled, Making 1 Billion Count: Investing in Adolescents’ Health and Rights, examines their condition, in the context of changing social norms and lifestyles, including weakening of family support systems, amid globalization and urbanization.

In developing countries, some 82 million girls now between ages 10 and 17 will marry before their 18th birthday, disrupting their education and limiting their opportunities. Some 14 million teenagers, married and unmarried, give birth each year; many face serious pregnancy-related illnesses, and at least 5 million undergo unsafe abortion. Those aged 15 to 19 are twice as likely as women in their 20s to die in childbirth. But according to the report, unmet need for family planning among adolescents is twice as high as among the adult population.

While early marriage persists in many poor countries, the trend elsewhere is towards later marriage, lengthening the time unmarried adolescents are exposed to the risks of unwanted pregnancy and sexually transmitted infections. Poverty, unequal power relations, and social norms in many countries make it hard for many girls and young women to refuse unwanted relations, especially with older partners, or to protect themselves against pregnancy or infection.

HIV/AIDS has become a disease of the young, the report stresses, fuelled by poverty, gender inequality and a severe lack of information and services for prevention. Half of all new HIV infections, and at least a third of the more than 333 million new cases of curable sexually transmitted infections each year, occur in people aged 15 to 24. Yet, only a small percentage know they are infected, and a majority of young people are ignorant about how HIV is transmitted.

"There is a critical need for more education and increased access to youth-friendly reproductive health services," says Ms. Obaid. "Studies show that accurate information delivered at the right age within the appropriate context tends to encourage responsible behaviour."

The report provides country-specific examples of projects that combine life skills education, including sexuality education, and peer counselling with access to services, and often offer job skills training as well. Projects that are locally driven, culturally sensitive and involve youth at all stages have greater success, the report stresses. The integrated Geração Biz project in Mozambique, for example, reaches both students and out-of-school youth and was designed by young people. The number of adolescents visiting clinics for counselling and services increased more than 10-fold following the establishment of youth-friendly services in Maputo.

While such programmes have been shown to be highly effective in promoting healthier behaviour in adolescents—in Uganda, for example—they are under-funded and meet only a fraction of the need. The report notes that a study of 107 countries found that 44 did not include AIDS education in their curricula.

The report points out the high costs and social consequences of failing to adequately meet adolescents' reproductive health and rights. Countries that invest in education and health on a priority basis, it emphasizes, can benefit from falling fertility and a temporary rise in their working-age populations relative to dependents to boost development. Investment is needed now to take advantage of these future windows of opportunity, which will open in the next 20 years in some subregions, later in others.

"Investing in the well-being and ensuring the participation of the world's largest youth generation will yield benefits for generations to come," said Ms. Obaid. "By improving the prospects of young people, we improve the prospects of all."