The State of Adolescent Sexual and Reproductive Health

Featured Journal Content

Journal of Adolescent Health
December 2019 Volume 65, Issue 6, Supplement, S1-S62
https://www.jahonline.org/issue/S1054-139X(19)X0005-1
Adolescent Sexual and Reproductive Health and Rights: Progress in the 25 Years Since the International Conference on Population and Development and Prospects for the Next 25 years
Edited by Caroline W. Kabiru
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Review Articles
The State of Adolescent Sexual and Reproductive Health
Mengjia Liang, Sandile Simelane, Guillem Fortuny Fillo, Satvika Chalasani, Katherine Weny, Pablo Salazar Canelos, Lorna Jenkins, Ann-Beth Moller, Venkatraman Chandra-Mouli, Lale Say, Kristien Michielsen, Danielle Marie Claire Engel, Rachel Snow
S3–S15
Published in issue: December 2019
Abstract
In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents’ lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development
Venkatraman Chandra-Mouli, B. Jane Ferguson, Marina Plesons, Mandira Paul, Satvika Chalasani, Avni Amin, Christina Pallitto, Marni Sommers, Ruben Avila, Kalisito Va Eceéce Biaukula, Scheherazade Husain, Eglé Janušonytė, Aditi Mukherji, Ali Ihsan Nergiz, Gogontlejang Phaladi, Chelsey Porter, Josephine Sauvarin, Alma Virginia Camacho-Huber, Sunil Mehra, Sonja Caffe, Kristien Michielsen, David Anthony Ross, Ilya Zhukov, Linda Gail Bekker, Connie L. Celum, Robyn Dayton, Annabel Erulkar, Ellen Travers, Joar Svanemyr, Nankali Maksud, Lina Digolo-Nyagah, Nafissatou J. Diop, Pema Lhaki, Kamal Adhikari, Teresa Mahon, Maja Manzenski Hansen, Meghan Greeley, Joanna Herat, Danielle Marie Claire Engel
S16–S40
Published in issue: December 2019
Abstract
Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH—adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD’s contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD’s Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time
Marina Plesons, Claire B. Cole, Gwyn Hainsworth, Ruben Avila, Kalisito Va Eceéce Biaukula, Scheherazade Husain, Eglė Janušonytė, Aditi Mukherji, Ali Ihsan Nergiz, Gogontlejang Phaladi, B. Jane Ferguson, Anandita Philipose, Bruce Dick, Cate Lane, Joanna Herat, Danielle Marie Claire Engel, Sally Beadle, Brendan Hayes, Venkatraman Chandra-Mouli
S51–S62
Abstract
The 1994 International Conference on Population and Development established a basis for the advancement of adolescent sexual and reproductive health and rights (ASRHR) that endures today. Twenty-five years later, our vision for the future warrants reflection based on a clear understanding of the opportunities and challenges before us. Inclusion of adolescents on global, regional, and national agendas; increased investment in ASRHR policies and programs; renewed commitments to universal health coverage; increased school enrollment; and advances in technology are all critical opportunities we can and must leverage to catalyze progress for adolescents. At the same time, a range of significant challenges remain, have newly emerged, or can be seen on the horizon, including persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningfully engaging adolescents and young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. To achieve as much progress toward our vision for ASRHR as possible, the global ASRHR community must take strategic and specific steps in the next 10 years within five areas for action: (1) mobilize and make full use of political and social support for ASRHR policies and programs; (2) increase and make effective use of external and domestic funding for ASRHR; (3) develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR; (4) use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and (5) manage the implementation of ASRHR strategies at scale with quality and equity.