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State of World Population 2003: Investing in Adolescents' Health and Rights

The recently released State of World Population 2003: Investing in Adolescents' Health and Rights report by the United Nations Population Fund (UNFPA)examines the challenges and risks faced by the younger generation, all of which have a direct bearing on their physical, emotional and mental well-being

State of World Population 2003: Investing in Adolescents' Health and Rights begins with the statement that, today, millions of adolescents and young people face problems of early marriage and childbearing, incomplete education and the very serious threat of HIV/AIDS. Some facts and figures:

  • Half of all new HIV infections occur in people within the age-group 15-24.
  • A young person is infected with HIV every 14 seconds; they (increasingly women) account for nearly half of new cases of HIV infection worldwide.
  • More than 13 million children under the age of 15 have lost one or both parents to AIDS.
  • Some 14 million women and girls between the ages of 15 and 19 -- both married and unmarried -- give birth every year.
  • In some countries, in spite of legislation against early marriage, girls are married before they turn 18. These include 60% in Nepal, 76% in Niger and 50% in India.
  • According to one regional estimate, between 1 and 2 million men and women are trafficked annually.
  • A majority of trafficking cases are reported from Asia. Over 225,000 people are from South East Asia and an additional 150,000 from South Asia.

State of World Population 2003: Investing in Adolescents' Health and Rights emphasises the fact that greater scope for knowledge, opportunities, choices and participation of young people would enable them to lead healthy and productive lives. Also, help them contribute to their communities and to a more stable and prosperous world.

In the framework of human rights certain rights are particularly meant for adolescents and the youth, claims the report. It reiterates the need for gender equality and the rights to education and health, including reproductive and sexual health information and services appropriate to age, capacity and circumstance.

Promoting healthy patterns of sexual behaviour

The report highlights the importance of promoting healthy sexual behaviour to reduce adolescent pregnancies and halt the spread of HIV/AIDS. It points out that the traditional `silent' attitude towards sex should be given up and young people should be provided with age-appropriate information about their sexuality and how to engage in responsible sexual behaviour, including abstinence.

School programmes on sexual and reproductive health have the potential to reach large numbers of youth, at least in countries where most young people attend school.

The report acknowledges the contribution of Myrada, an NGO in southern India, which has organised a number of children's groups to address the problems of child marriage and bonded labour.

One district in Rajasthan, in northern India, has conducted a public education campaign encouraging families to prolong engagements -- often entered into when girls are seven or eight years old -- before marriages are consummated and the brides move into the grooms' home.

Providing opportunities for girls to continue their education, or earn money, is another strategy to delay marriage and also expand life skills and choices. A number of Indian states have developed long-term investment programmes that offer young women money or gifts when they complete a certain level of schooling before getting married.

In Bangladesh, a secondary school scholarship programme for girls, requiring the commitment that girls remain unmarried through to the 10th standard final examination, proved so successful that the government has expanded it to the national level. The programme had an immediate effect in delaying marriage. In targeted areas, female enrolment in the programme more than doubled between 1994 and 2001.

According to State of World Population 2003: Investing in Adolescents' Health and Rights, a number of innovative methods have been used to deliver and reinforce health messages to various audiences, following the International Conference on Population and Development (ICPD) in 1994.

With the decline in fertility rates, the report adds, the proportion of working population (15-60 years) increases relative to that of the so-called `dependent' ages (0-15 years and 60 years and over). This opens up a `demographic window'. Referring to countries like Thailand and the Republic of Korea, the report says that with appropriate investments in health and education and economic policies and governance, countries can mobilise the potential of their young and launch an economic and social transformation. The demographic window closes as the age and dependency of the population increases once more.

Adolescent reproductive health and poverty

Stressing the fact that an estimated 238 million young people -- almost one in four -- face the constraints of extreme poverty, the report emphasises the need for poverty reduction in addressing adolescent reproductive health needs.

It quotes a World Bank study of 72 countries which showed that both low per capita income and high income inequality were linked to high national HIV infection rates; a $2,000 increase in per capita income was associated with a 4% reduction in infections.

According to the report, differences in adolescent fertility are driven by many factors including life opportunities, access to services, provider attitudes, socio-cultural expectations, gender inequality, educational aspirations and economic levels. Poor young women are likely to marry early. In the wealthiest 20% of the population, marriage before age 18 is relatively rare.

Adolescent girls more at risk

The report draws attention to appalling violations of the health and human rights of women. Adolescent girls are especially at risk from unprotected sexual activity.

In India, the picture is dismal -- an estimated two in five sex workers are below the age of 18. According to one regional estimation, between 1-2 million men and women are trafficked annually, most of them from Asia. Over 225,000 originate in South East Asia and an additional 150,000 in South Asia.

Quoting studies from India, Jamaica, Mali, the United Republic of Tanzania and Zimbabwe, the report reveals that about 20%-30% of adolescent girls had experienced some form of sexual violence. In Asia and Eastern Europe, girls as young as 13 are trafficked as `mail order brides'.

The report warns that gross sexual violation of adolescent girls harms their reproductive and sexual health. A woman's risk of infection during unprotected sexual relations is two to four times higher than that of men. Pregnancy is a leading cause of death among young women aged 15 to 19 worldwide, with complications during childbirth and unsafe abortions being the major factors.

Young women aged between 15 and 19 years account for at least one fourth of the estimated 20 million unsafe abortions performed each year, resulting in some 78,000 deaths.

Reproductive health services

After the 1994 ICPD, the UNFPA report claims, there have been a number of initiatives to provide suitable sexual and reproductive health services in response to increased awareness and the special needs and rights of the youth. Many of these have been pioneered by family planning associations and non-governmental organisations.

One such example is the Kidavri Network for Adolescent Skills in India, a network of seven diverse NGOs, with assistance from community contributions, international NGOs and foundations, bilateral aid agencies and United Nations programmes including UNFPA, that produces a newsletter, holds periodic strategy meetings and facilitates the exchange of knowledge and skills.

In 2000, India approved a population policy containing provisions for sexuality education and services for adolescents.

Citing results from a study conducted in India, the report states that marriage does not always protect young women against HIV infection. A study done at a STI (sexually transmitted infections) clinic in Pune, Maharashtra, found that 25% of the 4,000 women attending the clinic were infected with a sexually transmitted infection and 14% were HIV positive. Among the 93% who were married, 91% had only one partner, their husbands.

Survey results worldwide

Surveys from 40 countries indicate that more than half of young people have misconceptions about how HIV is transmitted. In the Ukraine, while 100% of adolescent females knew about AIDS, only 21% knew of the three main methods of prevention. In Somalia, only 26% of adolescent females had heard of AIDS, and only 1% knew how to protect themselves.

In Botswana, where one in three people lives with HIV/AIDS, virtually all young people had heard of AIDS and more than 75% knew of the three primary means of protection. Still, 62% of girls had at least one major misconception about how HIV is transmitted.

In Nepal, where half of the country's 50,000 injecting drug users are aged between 16 and 25 years, the incidence of HIV among drug users climbed from 2% in 1995 to nearly 50% in 1998.

Tuberculosis is the leading cause of death among AIDS patients worldwide. One-third of all AIDS patients are infected with the disease. Those with HIV are much more likely than others -- 800 times, by some estimates -- of developing active tuberculosis.

In Kenya, the prevalence of both HIV and tuberculosis doubled between 1990 and 1996.

Highlighting countries like Brazil, Jamaica, Senegal, Thailand and Uganda, the report says that these countries understood the seriousness of HIV/AIDS more than a decade ago and were successful, to some extent, in preventing the spread of the virus. Other governments have only recently woken up to the seriousness of the crisis. In India, the report says, the prime minister has urged parliament to consider HIV/AIDS as the most severe public health problem facing the country today.

The returns on preventing the spread of HIV among young people are high in terms of the cost of arrested development, lost agricultural output, excess training to provide for personnel losses, health facility overloads, treatment (wherever available) and care. The economic benefits of a single averted case of HIV/AIDS are estimated to be $34,600 for a poor country with annual per capita earnings of $1,000 per year.

Emphasising the government's role in curbing the spread of HIV/AIDS, the report stresses the need to give priority to international development goals and commitments towards young people. At the 1994 ICPD, the international community pledged to meet one-third of the cost of population and reproductive health services in developing countries. The amount was estimated to reach $18.5 billion by 2005.

The report regrets the fact that international contributions towards the fight against HIV/AIDS are declining. In 2001, the total expenditure was $9.6 billion. Of this, international assistance added up to $2.5 billion (about a quarter of the total), less than half of what was committed for 2000.

HIV/AIDS is spreading fastest in sub-Saharan Africa, where an estimated 8.6 million young people (67% female) are living with HIV/AIDS. In Botswana, South Africa and Zimbabwe, an estimated 60% of boys now 15 years old will eventually become infected. HIV is also spreading rapidly in South Asia where an estimated 1.1 million youth are infected (62% female). East and South East Asia have an estimated 740,000 young people living with HIV/AIDS, half of whom are female. Given China's large population and rising incidence of HIV, the number of youth with HIV/AIDS here is likely to grow considerably.

An estimated 160,000 youth (41% female) were reported infected in the Middle East and North Africa in 2001. Although surveillance systems in this region have improved over the past few years, this may be a low estimate.

Community support in fighting the AIDS menace

The UNFPA report points out that even though countries around the world had developed their own policies and laws to fight the spread of HIV/AIDS, implementation has been slow and difficult. Programmes addressing restrictive social norms and promoting behavioural changes require advocacy efforts to gain the active involvement of communities and reflect local concerns, values and priorities.

For the successful implementation of preventive measures, and to ascertain the rights and needs of adolescents, young people should be involved in creating and implementing policies and programmes.

The Convention on the Rights of the Child (CRC), the report says, formally acknowledges children's rights, not just their need for protection. Article 12 insists on the `visibility' of children in their own right, and states that children and young people have the right to express an opinion, and to have that opinion taken into account, on any matter affecting them.

Implementing the CRC requires a shift in how people conceive of adult-child relationships, as children are more often seen as requiring protection and guidance rather than being able to offer any worthy inputs.

(InfoChange News & Features, October 2003)