Sexual & Reproductive Health

© 2011 Tanzeel Ur Rehman / Cover Asia Press, Courtesy of PhotoshareYoung people face a greater risk of unplanned pregnancy now than ever. Girls are beginning to menstruate younger, and young people are waiting longer to marry; as a result, there is a growing window of time during which premarital sex and pregnancy can occur. On average, one-third of women in developing countries give birth before age 20; a large proportion of these pregnancies are unplanned. Each year, between two million and four million adolescents undergo clandestine or unsterile abortion. Moreover, teen mothers are twice as likely as older women to die of pregnancy-related causes, and their own children are at higher risk of illness and death.

All contraceptive methods are safe for young people, although permanent methods such as vasectomy and female sterilization are not recommended. Yet many people lack access to contraception and related information; in fact, young people have the highest levels of unmet need for family planning of any population.

Access to Contraception is Important to Youth Reproductive Health

  • Early and unwanted pregnancy is detrimental to the health and socioeconomic status of young people and their children.
  • About 11 percent of all births in low- and middle-income countries are to young women between ages 15 and 19. Many of these 13 million young women are giving birth before their bodies have fully matured.
  • Young mothers are at increased risk of complications such as vaginal tears, obstructed labor, fistulae, excessive bleeding, and infection during and after childbirth. Young mothers are also at higher risk of preterm birth and of having low birth weight babies.
  • For both physiological and social reasons, women between the ages of 15 and 19 are twice as likely to die in childbirth as those in their twenties. Girls younger than 15 are five times as likely to die as those in their twenties.
  • Infants born to young mothers are more likely to die and suffer from disease than those born to older women.
  • Helping young people prevent unwanted pregnancy is the best way to prevent unsafe abortions.

Key Areas for Policy Action

Many of the same policy actions that would help to make contraception available to women and men more generally also apply to contraceptive access for young people. Countries should undertake the following key policy actions that are especially important in improving access for young people:

  • Promote abstinence while recognizing the contraceptive needs of sexually active youth. Abstinence is a primary means of preventing unwanted pregnancy. However, policy should acknowledge that sexually active youth need increased contraceptive access and options.
  • Promote laws and policies that reduce pregnancy-related death and illness. These include laws that promote young women's access to reproductive health care and information and that protect young women's health such as prohibition against early marriage.
  • Ensure that youth have access to a wide range of contraception. Nearly all contraceptive methods are appropriate for adolescents. Law, policy, and clinical guidelines should reflect international consensus on the safety and appropriateness of contraceptive methods, so that health workers have clear guidance to advise and prescribe appropriately to young people based on sound medical criteria.
  • Eliminate restrictions based on social status (for example, denying contraceptives to unmarried adolescents) or based on unfounded medical criteria.
  • Allow minors to consent to use of contraception without adult approval or notification. Policies requiring adult consent unnecessarily restrict access to contraception.
  • Ensure that young people have access to comprehensive, youth-focused information about contraceptive options, through schools and other channels.
  • Promote dual protection against unintended pregnancy and STIs.
  • Address the role of emergency contraception as a backup to failure of condoms and other contraceptives.
  • Support youth-friendly services that train health workers to address the special concerns of young people, that maintain confidentiality and privacy, and that are accessible and affordable to young people.
  • Emphasize open discussion and promotion of condoms and allow schools to provide condoms and other contraceptives, as appropriate.

The State of Policy Making

A growing number of policies promote access to contraception for young people. Still, in several countries, formal and informal policy barriers limit such access. Often such policy language regarding young people can be found within national population policies, Ministry of Health policies, and guidelines and the policies and guidelines of nongovernmental organizations.