Globally adolescent girls in low and middle-income countries continue to face unmet needs when it comes to their sexual and reproductive health, according to a report published by the Guttmacher Institute. Two-thirds of sexually active adolescent women worldwide do not have access to contraceptives – this unmet need contributes to higher risks of HIV, unintended pregnancies, and unsafe abortions, says the report.
With 95% of the 13m births globally among young women aged 15-19 occurring in developing countries each year, protecting adolescents’ sexual and reproductive health is critical to achieving development goals, including reducing poverty, the report says. Complications during pregnancy and childbirth are the second leading cause of death among adolescent girls globally, and babies born to adolescents face significantly higher risks of pre-term birth, low birth weight, malformations and other complications, the report notes.
Aids-related deaths among young women aged 15-19 are increasing, with women in this age group in sub-Saharan Africa facing an HIV prevalence twice that of young men in the same age group. “This increase likely reflects a lack of commitment to providing testing and treatment services specifically for young people,” the report says. In a third of all African countries and in half of countries in West Africa, fewer than 50% of adolescent women know of a place to get a test, the report says. Fewer than 50% of adolescents know where to obtain a condom in one-third of African countries.
“More adolescent women, particularly those at high risk for HIV, need access to HIV testing outside the context of pregnancy-related care,” the report says. “Testing offers an opportunity for health providers to link young people living with HIV to appropriate care and treatment, including services to prevent mother-to-child transmission.”
This report draws on national survey data from 70 developing countries to provide an overview of adolescent women’s needs for and use of sexual and reproductive health services. The proportion of recent births to mothers younger than age 20 that are unplanned is particularly high – more than half – in most Latin American and Caribbean countries. In a third of countries in Africa, more than 40% of such births are unplanned. Levels are lower in Asian countries, typically within the range of 10–20%.
Adolescent women who have an unmet need for contraception report that their main reasons for non-use of a contraceptive method are infrequent sex and not being married. A number of other factors, such as lack of access, health concerns and worry about side effects, are also important. A minority of sexually active adolescent women who have an STI or STI symptoms seek care in a health facility.
Adolescent women in Africa and Asia are more likely than those in Latin America and the Caribbean to either receive no treatment at all or to obtain care from a source other than a health facility. Compared with older women, adolescents are more likely to seek abortions from untrained providers or to have a self-induced abortion. They also tend to take longer to recognise their pregnancies and consequently have abortions at later gestations, and they know less about their rights concerning abortion and post-abortion care.
While the proportion of women giving birth before age 20 who receive some antenatal care from a skilled provider is generally high (more than 75%) across all three regions, far smaller proportions received antenatal care early in their pregnancy or made the recommended minimum of four antenatal visits.