Insight

Promising progress but more to do for adolescent girls’ health

Tristana Perez

by Tristana Perez

Development Impact Associate

A quarter of a century ago the landmark Beijing Declaration and Platform for Action set a visionary agenda for women’s and girls’ empowerment.

The Declaration highlighted 12 critical areas of concern, all of which remain as pressing today as they were in 1995. On health, the Declaration stated that:

The explicit recognition and reaffirmation of the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment” and committed countries to: “Ensure equal access to and equal treatment of women and men in education and health care…

Good health is critical for girls to achieve their potential. This International Day of the Girl Child we should celebrate progress on girls’ health over the past 25 years, but we must also look closely at the challenges girls, in particular those in adolescence, still face.

Adolescence is a critical period in a female’s life. Experiences between ages 10 and 19 can determine the future of families, communities and subsequent generations. Teenage girls living in low- and middle-income countries are less likely to engage with health services, more likely to experience early or forced marriage and pregnancy and have higher rates of HIV than boys of a similar age living in the same communities.

These health challenges reflect negative gender norms, such as society’s devaluation of girls, and lead to significant gender inequalities in health outcomes that impact millions of female lives.

In the 25 years since the Beijing Declaration, some progress has been made to improve girls’ health and to empower and educate them to make safer decisions about their bodies. This is reflected in declining rates of maternal mortality and of female genital mutilation[1], but there is still a long way to go. Here are three of my major concerns for the health of girls around the world:

Girls are less likely to access health services

Girls in low- and middle-income countries are less likely to engage with health services. Gender norms during puberty can restrict girls’ access to information and their ability to travel, which in turn influences their self-esteem and health-seeking behaviour[2]. The World Health Organization (WHO) reports that 52% of adolescent girls and young women from rural areas and 47% from urban areas in 28 countries in sub-Saharan Africa need approval from their husbands/family to make decisions about their own health care[3].

Even when programmes specifically target adolescents, boys are more likely to access and use the support provided[4].

Younger mothers and their babies face increased risks

Early pregnancy is risky for both mother and child. Every year, 12.8 million births occur amongst girls aged 15-19[5]. In 2016, pregnancy complications were the leading cause of death in girls aged 15-19 years globally[6]. Babies born to mothers under the age of 20 are more likely to die before turning five, have stunted growth, and be underweight or anaemic[7].

Poor nutrition exacerbates the issue. Girls aged 10-19 are disproportionately lacking in iron and at high risk of poor diet compared to boys[8]. Young mothers are less likely to have healthy babies if they are malnourished themselves. Nutritional deficits can lead to underweight babies or anaemia in pregnancy which can contribute to the risk of miscarriage, stillbirth, and premature birth[9].

Girls remain at much higher risk of acquiring HIV

Adolescent girls are disproportionately impacted by HIV and other sexually transmitted infections compared to boys. UNICEF reports that for every five adolescent boys living with HIV, there are seven girls[10]. Worryingly, of new infections in adolescents in the past year, 80% occurred among girls[11].

These gender differences are largely the result of early marriage or pre-marital sex between young girls and older partners, who are more likely to already be living with HIV[12]. WHO reports that every year, 12 million girls get married before turning 18[13]. In these relationships, adolescent girls are unlikely to have the power to negotiate safer sexual practices[14][15]. Girls also face a high risk of violence and abuse, both of which are significant factors that lead to increased risk of acquiring HIV[16].

Looking ahead

We can be encouraged by global progress on female empowerment and maternal mortality, particularly over the past two decades. However, the list above shows there is still a long way to go. The COVID-19 pandemic also threatens to undo much of the progress. The United Nations Population Fund (UNFPA) predicts there could be up to 7 million unintended pregnancies worldwide because of the COVID-19 pandemic, potentially leading to thousands of deaths from unsafe abortion and pregnancy complications[17]. There are also worrying reports of increased gender-based violence, compounded by lockdowns and restrictions that make it even more difficult to leave for a safer place[18].

Girls are affected by a range of social and economic factors that leave them vulnerable to poor health. In turn, this exacerbates existing gender inequalities. My hope on this International Day of the Girl Child is that we will work to quickly recover any gains lost to the pandemic and redouble our efforts to deliver on the ambitious plan set out in Beijing. We cannot wait another quarter of a century for change.

References

[1] https://www.who.int/news-room/detail/08-03-2020-women-s-health-and-rights-25-years-of-progress

[2] https://www.who.int/life-course/news/women-and-girls-health-across-life-course-top-facts/en/

[3] https://www.who.int/life-course/news/women-and-girls-health-across-life-course-top-facts/en/

[4] Temin, Miriam & Levine, Ruth. (2009). Start with a Girl A New Agenda for Global Health. esocialsciences.com, Working Papers. 26. https://www.cgdev.org/sites/default/files/1422899_file_Start_with_a_Girl_FINAL_0.pdf

[5] https://www.who.int/life-course/news/women-and-girls-health-across-life-course-top-facts/en/

[6] https://www.who.int/maternal_child_adolescent/data/causes-death-adolescents/en/

[7] Zabin, L. S., and K. Kiragu. 1998. “The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa.” Studies in Family Planning 29:210–32. Phipps, M. G., and M. Sowers. 2002. “Defining early adolescent childbearing.” American Journal of Public Health 92 (1): 125–28.

[8] Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks.

[9]  Gillespie, S. R. 1997. “Improving adolescent and maternal nutrition: an overview of benefits and options.” UNICEF Staff Working Papers, Nutrition Series.

[10] UNICEF. Children and AIDS. 2017 statistical update. New York: UNICEF; 2017

[11] https://data.unicef.org/resources/hiv-estimates-for-children-dashboard/

[12] K.G. Santhya & Shireen J. Jejeebhoy (2015) Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries, Global Public Health, 10:2, 189-221, DOI: 10.1080/17441692.2014.986169

[13] https://www.who.int/life-course/news/women-and-girls-health-across-life-course-top-facts/en/

[14] K.G. Santhya & Shireen J. Jejeebhoy (2015) Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries, Global Public Health, 10:2, 189-221, DOI: 10.1080/17441692.2014.986169

[15] Bruce, J. (2007). Girls left behind: Redirecting HIV interventions toward the most vulnerable. Promoting healthy, safe and productive transitions to adulthood, Brief No. 23. New York, NY: Population Council.

[16] Bruce, J. (2011). Violence against adolescent girls: A fundamental challenge to meaningful equality. New York, NY: Population Council and UN Adolescents Girls Task Force.

[17] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31679-2/fulltext

[18] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31679-2/fulltext