Around the world, about 16 million girls aged 15-19 give birth each year. In developing countries, out of 100 girls, 19 give birth by age 18 and 3 give birth before age 15. Complications from pregnancy and child birth are the leading cause of death among girls in this age group, especially in developing countries. Pregnancy jeopardizes the rights, health, education and potential of far too many adolescent girls, robbing them of a better future. Actions must be taken to prevent “children having children”, as we are commemorating World Population Day 2013 which focuses on adolescent pregnancy.
There are over 600 million girls in the world today; more than 500 million of them live in developing countries. Millions of teenage girls across the world are, or will be, practicing unsafe sex, and far too many lack access to information, contraceptives and basic education in the fundamentals of sexual and reproductive health. If young people are able to receive age-appropriate and comprehensive sexuality education, they will develop the knowledge and skills they need to protect their health throughout their lives. If young people can access good quality youth-friendly sexual and reproductive services, they will be able to make informed choices to keep them healthy. The opportunities and choices girls have during adolescence will enable them to begin adulthood as empowered and active citizens.
We must note that adolescent pregnancy is an important development issue that goes beyond health aspects of young people. It is deeply rooted in poverty, high levels of income inequality, violence, the practice of child and forced marriage in some countries, lack of education, and the failure of systems and institutions to protect the rights of young people. Related to this but highly determinant are the unequal power relations between adolescent girls and their male partners in male dominated societies.
With changing social values, young people in China are exposed to increasing reproductive health risks, including unsafe sex, unplanned pregnancies and sexually transmitted infections including HIV. A UNFPA-supported national survey on access and utilization of sexual and reproductive health services by unmarried youth aged 15-24 showed that even though the majority of unmarried youth are open to having sex before marriage, only a very small portion of them—less than 5 per cent, are well informed about reproductive health. Less than 15 per cent had correct knowledge about preventing HIV infection. The survey showed 4 out of 100 unmarried girls aged 15-24 become pregnant, and almost 90 per cent of these pregnancies would result in abortion. The number of unintended pregnancies before marriage is relatively low and the average age of marriage is relatively high compared to many other countries. However, it is to be expected that Chinese youth now and the Chinese youth of the future will experience sexuality in a different manner than their parents. Population dynamics such as massive domestic migration and the persistently high skewed sex ratio at birth have intensified the need to improve sexual and reproductive health services for the young people.
China’s family planning services have traditionally focused on married couples, not unmarried youth. Such practice needs to change to respond to the challenges young people are facing now. A network must be formed among ministries of education, health, family planning as well as youth leagues, women’s groups, and the business sector to provide services and information on sexual and reproductive health to young people, especially out-of-school youth, and youth affected by migration, including left-behind youth.
Adolescents and young people stand at the center of the solution. In order to support effective policy making and improvement of information and service provision to respond to the emerging challenges, more reliable data should be generated to understand the needs of the young people better. When identifying the needs of young people and how the gaps in information and health can be closed, young people must be consulted and involved. Policy makers and service providers must form partnership with young people and work hand-in-hand in closing the existing gaps.
Underlying all of these efforts is the notion that the dignity and human rights of young people, especially adolescent girls must be respected, protected and fulfilled. Every young girl, regardless of where she lives, or her economic circumstances, has the right to fulfill her potential. Today, too many girls are denied that right. We can change that, and we must.
The author is Arie Hoekman, the United Nations Population Fund (UNFPA) Representative to China.
