Poverty Threatens Youth Reproductive Health

• Youth ages 15 to 24 years old constitute 25 percent of the global working-age population, but account for 44 percent of the unemployed.
• Studies of female sex workers show that a large majority of them are under the age of 25. Poor household conditions often force young women to engage in sex work, which increases their risk of HIV infection.
• Poverty and inadequate health care systems compound the vulnerability of young women to maternal morbidity and mortality. Every minute, a woman somewhere dies in pregnancy or childbirth. This adds up to 1,400 women a day—529,000 a year—dying from pregnancy-related complications. Young mothers are at higher risk of serious complica­tions during pregnancy and childbirth because their bodies often have not yet fully matured.
• Poverty and reproductive health are intricately related. Poverty is associated with high-risk behaviors, such as transactional and coerced sex. These behaviors put young women at risk of unintended pregnancy, HIV, and sexually transmitted infections (STIs).
• Globally, HIV is spreading most rapidly among young people between the ages of 15 and 24. Half of new infections worldwide occur in this age group. In sub-Saharan Africa, 75 percent of all new HIV infections occur among young women and girls ages 15 to 24.
• Great disparities exist between adolescents from high- and low-income families for indicators including age at marriage, skilled attendance at birth, nutrition, contraceptive use, and knowledge of HIV.

Sustainable Livelihoods

Attention is now being focused on how sustainable livelihoods can help young people achieve improved health outcomes and lead empowered and productive lives. Sustainable livelihood programs seek to create long-lasting solutions to poverty by empowering their target population with knowledge, skills, and a means of generating income.The programs are varied in their focus, approach, and target audience, although many do the following:

• Provide youth with opportunities to earn income.
• Offer financial services and related on-the-job training.
• Develop institutions, alliances, and networks for youth to advance their economic interests.
• Promote policy and social changes that improve young people's livelihood prospects.

Youth livelihood programs can improve YRH by preventing exploitation of young people, linking young people with RH and HIV information and services, and reducing risky behavior. Most programs are small-scale, community-based interventions that reflect the specific context and needs of their target population.

Key Areas for Policy Action

By highlighting inequities in health access and outcomes, advocates and policymakers can enrich the understanding of the links between poverty and poor reproductive health. Such analyses can also influence decisions on how countries can set priorities for spending in ways that reduce poverty, while also achieving national health goals, including reductions in maternal and child deaths. To encourage action, countries should develop policies that do the following:

• Take youth into account as a special population when diagnosing and assessing poverty. Accurately assessing poverty in a given community requires attention to vulnerable or at-risk groups, such as youth, who are much more likely than older people to lack access to health care.
• Promote approaches to providing young women with technical skills and advocate for greater income-generating opportunities in their communities. Labor force participation and employment issues are among the most pressing in most countries worldwide.
• Ensure that youth have access to reproductive health services and supplies. This is crucial in achieving the Millennium Development Goals and improving health in low-and middle-income countries.
• Stress the multisectoral impact of YRH interventions. Linking reproductive health with actions in other sectors, particularly education and employment, strengthens the case for investment in youth. Programs that support girls’ education and literacy have ancillary benefits, such as increasing women’s employment opportunities, discouraging early childbearing, decreasing school dropout rates, and reducing malnutrition.
• Stress the interrelatedness of HIV/AIDS, poverty and reproductive health needs when adapting and implementing policy. Due to unequal power relationships between women and men in many countries, women are often unable to take actions to prevent pregnancy or HIV. As a result, an estimated 630,000 newborns are infected with HIV during pregnancy each year.
• Involve men in sexual and reproductive health as clients, partners, and agents of social change. Male involvement is crucial to promoting women’s health and alleviating poverty and malnutrition.

Youth participation in the policy making process, as well as in program planning, design, and implementation, is critical to the ability of sustainable livelihoods policy and programming to improve the reproductive health outcomes and socioeconomic status of young people.

The State of Policymaking

In recent years, international development agencies including the United Nations and World Bank have increased their attention to the link between poverty reduction and YRH. In addition, some countries’ national policies include language reflecting the importance of this linkage. Several national poverty reduction strategies include specific youth reproductive actions for poverty reduction within their overall frameworks. For example, Nicaragua’s 2005 National Development Plan identifies adolescents as a priority group for reproductive health services, and its policy matrix and action plan specifies a line item for a campaign to reduce teen pregnancy. However, despite the progress in addressing the link between reproductive health and poverty reduction, recent reviews have concluded that countries need to do much more to tie these poverty reduction strategies to specific monitoring objectives and budget outlays.