Blogs
Globally, the population of adolescents (ages 10–19) with a high unmet need for sexual and reproductive health services is rapidly increasing. This leads to increased fertility, unintended pregnancies, and unsafe abortion rates, which is a challenge in many low- and middle-income countries (LMICs), where a third of all women become mothers during adolescence. Adolescent sexual and reproductive health and rights (ASRHR) is the ability for adolescents to have access to comprehensive sexuality education, essential sexual and reproductive health services, and autonomous decision-making power needed to protect their health. It can improve overall wellbeing and expand future educational and economic opportunities when supported.
The Adolescent Sexual and Reproductive Health and Rights Exemplars project (ASHER) was a two-year project in 2021–2023 aimed at examining the policies and programmes that have been successful in select LMICs in reducing high levels of unintended adolescent pregnancies, including prevention and management of these, and advancing ASRHR. The project also sought to determine how the lessons learned and best practices can be applied to improve SRHR outcomes for adolescents across geographies.
The ASHER project identified six countries from low- and middle-income regions of the world which had made tremendous progress in reducing unintended adolescent pregnancies as compared to their peers. The countries also known as exemplars in ASRHR are Cameroon, Ghana, Malawi and Rwanda in Africa, and Nepal and India in Asia. The African Institute for Development Policy (AFIDEP) led the research in five countries except India, which was led by the Gates Ventures office in India. Through the studies conducted, the following were established:
Nepal: Adolescent pregnancies rate had remained at a constant level of 18% from 2011 to 2016 but reduced to 14% on 2020. The pregnancy rate was higher among older adolescents of ages 18–19 years who were married. It was established that adolescents with higher education were less likely to get pregnant. When a policy and programme review was conducted to establish interventions that had led to such positive progress, it was noted that Nepal invested in sexuality education and youth-friendly health services. The country also implemented a national programme which trained 4,500 service providers and 1,516 health facilities on safe abortion between 2001 and 2022.
Rwanda: Pre-marital pregnancy among adolescents had reduced from 5.7% in 2000 to 2.4% in 2020 while marital pregnancy had increased from 1.3% to 3.1%. Adolescents with lower education or no education were more likely to get pregnant. Contrary to expectation, youth from urban areas had high rates of marital or pre-marital pregnancy as compared to those from rural areas. Rwanda has focused on creating youth corners and safe spaces for adolescents to access sexuality education and services. The country has also invested in community involvement and sexuality education in their academic curricula.
Cameroon: Adolescent pregnancy rate declined from 32% in 1998 to 22% in 2018, with a notable decline among married adolescents. Similar to other countries, adolescents with low education and from poor households were more likely to get pregnant before marriage. Cameroon integrated sexuality education and family life education in their curricula in 2007, targeting both in-school and out-of-school adolescents. The country has also employed a multisectoral approach to addressing ASRHR, set stands for youth-friendly health service delivery, and identified strategic funding mechanisms that focus on reproductive maternal, newborn, child and adolescent health as well as nutrition.
Ghana: Adolescent pregnancy is less prevalent among young adolescents aged 10–17 years but higher among older adolescents of 18–19 years. It is also higher among married adolescents than their unmarried counterparts. Similar to other exemplars, education and economic status play a significant role in reducing adolescent pregnancy. Aside from a good policy environment, Ghana has invested in digital counselling services targeting youth through mobile applications. The digital platforms provide information on SRHR and allow adolescents to ask questions in a safe environment without parental restriction or fear of cultural biases.
Malawi: Adolescent pregnancy in Malawi is higher among married youths as compared to their unmarried counterparts. It was noted that adolescent pregnancies were common in the Southern region as compared to the North and Central regions of the country. Adolescents with higher levels of education, particularly those who have attained secondary or higher levels, recorded lower rates of both pre-marital and marital pregnancies. In order to reduce adolescent pregnancies, the country has focused on implementing youth-friendly health services, school-based initiatives, household empowerment programmes, ending child marriages and a cross-sectoral approach to programme delivery.
A cost-benefit analysis was conducted to assess the feasibility of interventions that reduce unintended adolescent pregnancies. In line with the other analyses conducted, the cost-benefit analysis established that health system interventions such as youth-friendly health services and integrated health service delivery are the most beneficial and cost-effective measures of reducing unintended pregnancies among adolescents. It was also noted that community-led initiatives are the next best option when investing in adolescent SRHR.
In conclusion, the exemplary efforts of countries such as Cameroon, Ghana, India, Malawi, Nepal and Rwanda, underscore the importance of investing in comprehensive sexuality education, youth-friendly health services, and community engagement to address adolescents’ multifaceted challenges. By learning from these exemplars, policymakers, researchers and practitioners can glean valuable insights into successful approaches and leverage this knowledge to inform and strengthen ASRHR programmes globally.