On International Day of the Girl Child, we are reminded of the importance of addressing the health needs of young women and girls. In 2013, maternal disorders were the fourth leading cause of death for young girls ages 15-19, largely due to the high prevalence of early pregnancy, unsafe sex and child marriage. The Journal of Adolescent Health recently released a set of systematic reviews examining interventions aimed at improving the sexual and reproductive health of adolescents in low- and middle-income countries (LMICs).
Approximately 11% of infants around the globe are born to adolescent girls ages 15-19, and nearly all of these births occur in LMICs. About one in five girls living in low-resource settings becomes pregnant before she turns 18 years old, which can have devastating implications for her health and wellbeing. Adolescent pregnancy is associated with an increased likelihood of contracting sexually-transmitted infections (STIs), undergoing an unsafe abortion, dropping out of school, experiencing mental health issues and developing life-threatening childbirth-related complications.
A review of 21 interventions designed to prevent unintended and repeat adolescent pregnancy in LMICs found that conditional and unconditional cash transfer programs were generally the most successful for preventing pregnancy. Interestingly, a program in Malawi found a reduction in adolescent pregnancy among families who received unconditional cash transfers, but not among families who received cash transfers conditional upon school attendance. Programs that provided contraception directly to young people were generally the most successful for increasing contraceptive use. However, very few interventions resulted in decreased sexual activity or delayed sexual debut.
Young people, and young girls in particular, are especially vulnerable to acquiring STIs. Developing countries carry the largest burden of global STIs, which are associated with negative health consequences that can last well into adulthood. Every year, about 228,000 adolescent girls around the world, many of whom live in sub-Saharan Africa, are infected with HIV. Girls are also 3-4 times more likely than boys to be diagnosed with chlamydia.
A review of 21 interventions designed to prevent STIs among adolescents in LMICs found mixed results for a number of different interventions including educational programs, life-skills trainings, mass media campaigns and cash transfers. Overall, mass media campaigns seemed to be the most effective for reducing risky sexual behavior. Some behaviors were easier to modify than others: while 12 out of 17 interventions aimed at increasing condom use were successful, only 1 out of 4 interventions designed to decrease transactional sex was successful.
Child marriage is a violation of human rights that disproportionately affects young girls. In 2014, about one in ten girls was married before age 15, and about one in three was married before age 18. Girls living in South Asia and sub-Saharan Africa are at greatest risk of becoming child brides and also of dropping out of school, suffering from intimate partner violence including sexual coercion and having an adolescent pregnancy.
A review of 11 interventions designed to prevent child marriage in LMICs found that only six had at least some positive impact on reducing the prevalence of child marriage or increasing the age of marriage. Interventions that focused on reducing financial burdens on families with young girls, either with cash transfers or assistance with paying school fees, were the most common approach and also the most successful.
A community-based approach
Comparing the effectiveness of interventions that employ different strategies and are implemented in diverse global settings is difficult. The most successful interventions often take inter-sectoral, multi-faceted approaches to improving the sexual and reproductive health of adolescents. Involving local adolescents in the development and implementation of programs designed to serve them is a key strategy for maximizing impact. The community-based approach to research and programming is a powerful tool for ensuring that interventions are appropriate in local contexts and for empowering young people to invest in themselves and their futures.
Read about “Act Now for Adolescents”, a knowledge summary from the Partnership for Maternal, Newborn & Child Health.
Hear another perspective on adolescent sexual and reproductive health from Patrick Mwesigye, Founder/CEO of the Uganda Youth and Adolescents Health Forum.
Check out another systematic review of interventions designed to improve global adolescent sexual and reproductive health.
Learn more about global adolescent health from the World Health Organization.