Youth Face Reproductive Health Risks -- October 1, 2000

Around the world, thousands of adolescent women die each year from complications due to an unplanned pregnancy. And in 18 African countries, a third of today’s 15-year-olds will become infected with HIV during their adult lives.

For developing-country adolescents to avoid unplanned pregnancies, disease and other serious reproductive health problems, they need accurate information and services, health experts say in the current issue of Family Health International’s Network, an international quarterly health bulletin.

Preventing HIV infections among adolescents is an excellent strategy for slowing the AIDS pandemic, says Dr. Ward Cates, Jr., president of FHI and an expert on sexually transmitted diseases (STDs). "Younger people are more likely to adopt and maintain safe sexual behaviors than are older people with well-established sexual habits, making youth excellent candidates for prevention efforts," he says. "Reducing adolescent infections will ultimately result in fewer infections among all age groups."

However, many interrelated and complex factors that put adolescents at risk of HIV and other STDs will not be changed easily or quickly, he and other experts say. In many settings, these include poor education, unemployment and poverty. Also, urbanization can disrupt family relationships, social networks and traditional mores, while generating more opportunity for sexual encounters.

An unplanned pregnancy is a serious reproductive health risk for many adolescent girls. In addition to disease and possibly death, other severe consequences for an unmarried adolescent with an unplanned pregnancy include expulsion from school, loss of a job or dishonor for her family and herself.

Because they are afraid, ashamed or desperate, many young women are willing to risk their lives to end an unplanned pregnancy. They seek an illegal abortion, often from an untrained person under unsafe conditions, or they try dangerous ways to induce an abortion themselves.

"Adolescents are more likely than adults to deny they are pregnant, not recognize the signs of pregnancy, delay decision-making and seek abortion later in the pregnancy, which puts them at greater risk," said Ashley Montague, a program associate for the U.S.-based Ipas, a reproductive health organization that concentrates on preventing unsafe abortions.

Clandestine abortion is associated with high rates of illness and death. Unsafe abortion can result in hemorrhage, infection and cuts or chemical burns. Treatment can require hospitalization, blood transfusions, antibiotics and other drugs.

Effective strategies and programs to protect the reproductive health of adolescents and young adults are needed in every country, but are especially urgent for youth in developing countries.

"Young adults need a basic understanding of how their bodies work and the reproductive health concerns they face, as can be provided through family life education," says Dr. Nancy Williamson, senior associate for Frontiers in Reproductive Health, a project of the Population Council, Tulane University and FHI to evaluate reproductive health programs, including programs for youth in Mexico, Bangladesh, Kenya and Senegal.

Youth need ways to develop stronger interpersonal skills in order to avoid unprotected sex, she says. They should know about specific health services available to them and how to obtain condoms and other contraceptives "They should be aware that the choices they make today could help or harm them and those they love, perhaps with lasting consequences," says Dr. Williamson.

She cautions, however, that reproductive health programs for adolescents should be carefully designed and evaluated before expanding on a large scale. Difficult decisions must be made about allocating limited resources wisely. Also, some programs reach youth long after they need the information rather than when the information is most crucial. Other programs may not deal with the most pressing concerns facing youth.

In general, research shows that family life education can result in young adults delaying first intercourse or, if they are already sexually active, in using contraception. Virtually all studies conclude that sex education does not lead to earlier or increased sexual activity.

"Youth are interested in sex because of biological reasons, hormones," says Dr. Cynthia Waszak, an FHI senior scientist who focuses on adolescent health. "Suggestions about sex in music, radio, advertisements, films and television reinforce that interest. Teenagers talk about sex and have questions about it. We should find ways to give youth the right information so they can make better, informed decisions about their sexual behavior."