Global Consultation on Child and Adolescent Health and Development -- Preparing The First Generation Of Adults In The New Century

Thank you for inviting me to participate in this global consultation on child and adolescent health and development. This is a topic that I care about very deeply. I have two daughters who are now adults and I remember very well when they were adolescents and helping to guide them through this passage to adulthood. Believe me it is not easy, for often we parents, are courageous in our minds but seem inept in action when it comes to our children. We are better at advising and counselling the children of our friends.

Providing reproductive health information and services to adolescents is a priority of the United Nations Population Fund (UNFPA) and today I will explain why, what we are doing, and how we work with our partners in the United Nations, in civil society, and governments and foundations to provide young people with the information and services they need to protect themselves and their futures.

Why adolescents and young people?

As we all know, adolescence is a unique stage in life and adolescents have unique perspectives and needs. Adolescents are no longer children and yet they are not yet adults. In our minds, they remain children and we tend to be overprotective. During adolescence, we establish our own identities and patterns of behaviour and prepare for the adult world and adult responsibilities. But for many adolescents today, the notion of adolescence as a time of opportunity for self-development, under safe and healthy conditions, could not be further from their reach. Many live in poverty or in especially difficult circumstances, with little access to knowledge and resources as well as services.

Both girls and boys face a complex mosaic of challenges and pressures. While boys may experience expanded participation in community and public life during adolescence, many girls find this can be a time of intensifying restrictions, with their freedom of movement severely limited and much fewer choices in their lives. In many situations, when talking about adolescents, we remain within the realm of the socially acceptable subjects, thus avoiding talking about their reproductive health, believing that by ignoring or not recognizing it, the tabooed issues would disappear. While in other circles, extreme emphasis is placed mainly on the sexuality of adolescents as if that is all there is. But the young people themselves remind us all the time, as we just heard, that they are much more than that- they are complete human beings with all the complex needs of people: physical, emotional, mental, spiritual and also sexual. They remind us that they are not only the future, as we say, but rather they are the present and we need to work with them now in dealing with their complete sets of needs in realistic and supportive ways.

Even at an institutional level, we, at UNFPA, know from experience that some institutions and governments are not comfortable speaking about reproductive health in general and for adolescents in particular. It further deprives organizations from financial support for implementing the mandate of International Conference on Population and Development (ICPD). Still, for us at UNFPA, adolescent reproductive health is a main concern of our programmes and, therefore, I will discuss it knowing that the other panels will tackle the other aspects of adolescent health, especially issues related to macro-economics.

In all cultures around the world, there is gender differentiation in our expectations of girls and boys. Girls are expected to be shy and timid and to refrain from sexual activity and not talk about it while boys are encouraged to experiment, to brag about it and even to be aggressive. Many young people of both sexes are ill-informed about sexual matters. And the consequences are dramatic.

In this context, we have to remember that many girls, and even boys, are married at a very early age and thus face additional conflicts as well as emotional and physical upheavals. When we talk about adolescents, we have one image- a single teenager, without real family responsibility; rarely do we think of a married teenager, especially for girls. This is type of thinking is translated operationally in the marginalization of the needs of married adolescents, thus depriving them from services specifically addressing their emotional, physical and reproductive health needs.

And the consequences of our own adult attitudes and prejudices are dramatic:

 

• An estimated 15 million adolescents give birth each year and a large proportion of these pregnancies are unwanted.
• Countless pregnant teenage girls are forced to drop out of school.
• Overall, one in every 10 births worldwide is to a teenage mother.
• In the least developed countries, 1 in 6 births is to a young woman aged 15-19.
• At least 1 in 10 abortions around the world occurs among women aged 15-19.
• More than 4 million adolescent girls undergo abortions every year, 40 per cent of which are performed under unsafe conditions.
• Each day, one-half a million young people are infected with a sexually transmitted disease.
• Of all age groups, the unmet need for contraception is greatest among sexually active young people.

In addition to the health risks of early pregnancy and the other risks associated with premature and unprotected sexual activity, teenagers now face the added risk of acquiring HIV/AIDS. Some 7,000 young people, including teenagers, are infected each and every day. In some countries in Africa, teenage girls are five times more likely to be infected with HIV than boys their same age. This is partly to do with biology and mostly to do with gender discrimination and poverty, and young women's lack of power to say NO to unsafe or unwanted sexual relations.

The sad reality is that, today, it is among adolescents, and adolescent girls in particular, that HIV infection is most rapidly spreading. And, yet, around the world, the majority of adolescents-whether they are married and unmarried, in school or out of school-lack access to sexual and reproductive health information, education and services. And this puts their health, their lives and their futures at risk.

In Africa, where HIV/AIDS has hit the hardest, millions of young women, who are highly vulnerable to infection, are dangerously ignorant about HIV/AIDS. According to United Nations Children's Fund, more than 70 per cent of adolescent girls aged 15 to 19 in Somalia and more than 40 per cent in Guinea-Bissau and Sierra Leone have never even heard of AIDS. In countries such as Kenya and Tanzania, more than 40 per cent of adolescent girls harbour serious misconceptions about how the virus is transmitted.

In another part of the world, Eastern Europe and Central Asia, HIV incidence is rising faster than anywhere else, and the epidemic is concentrated in young people, mostly injecting drug users. In a few parts of the region, as many as one-half the reported cases are in people younger than 20. In this region, unprecedented numbers of young people are not completing their secondary schooling. With jobs in short supply, many are at special risk of injecting drugs and resorting to sex work, which is causing HIV infection to rise.

Today we have the largest youth generation in history- more than 1 billion young people below 24 years old, and they constitute almost 60 per cent of the population in developing countries. In these countries, we see that globalization is creating new values in the younger generation that usually collide with the values and traditions of their parents.

In almost all countries, the topic of adolescent sexuality and reproductive health is politically and culturally sensitive. Around the world, UNFPA, along with sister agencies and partners, is intensifying efforts to find acceptable and effective ways to help young people protect their reproductive health and their futures. It is also trying to find ways to sensitize adults to the real needs of young people in this particular taboo area.

Working on health prevention with adolescents is critical to slowing the spread of AIDS. Today, in the African countries with the highest HIV prevalence rates, almost 50 per cent of today's 15 year olds could die of AIDS within the next 10 years. Working on health prevention with adolescents is also critical to slowing population momentum. It has been found that raising the mother's age at first birth from 18 to 23 could reduce population momentum by over 40 per cent.

It is also important to reach youth with reproductive health information because sexual and reproductive health behaviours at this stage in the life cycle tend to stay for the rest of life. We must also remember that today's adolescents are tomorrow's workers and leaders. So, we must unleash girls' potential for human development, support health prevention activities, help teenagers acquire good sexual and reproductive behaviours and develop positive life skills. If we miss this opportunity and neglect today's adolescents, the same problems we are struggling to deal with today will be with us tomorrow, only they will be bigger.

There can be no doubt that working in health prevention and adolescent and youth development will have an impact on poverty reduction, sustainable development, human rights, and population growth.

Actions in Support of Adolescents

UNFPA's action is guided by the goals of the International Conference on Population and Development and its five years review. The ICPD Programme of Action gave special attention to the condition of adolescents, including the health of adolescent mothers, HIV prevention, the gender equality dimension of reproductive health and rights, and balancing population and development dynamics.

UNFPA works for implementing the ICPD by defending girls' rights to later, informed and voluntary marriage. Today, unchosen marriage is perhaps the most widespread human rights violation in the adolescent age group. If present conditions prevail, 82 million of the girls currently aged 10-17 in the developing world will be married while still officially "children".

We work to implement ICPD Programme by protecting the reproductive health of married and unmarried adolescents and establishing positive health habits. Tragically, a picture of rapid increases in HIV among 15-25 year olds, especially girls, requires an immediate response. Of the more than 60 million people who have been infected with HIV in the past 20 years, about half have become infected between the ages of 15 and 24. With HIV/AIDS, unprotected sexual relations for girls, which has always been a rights and safety issue, has now become life threatening.

All over the world, adolescent girls and boys, married or unmarried, are clearly at risk of severe reproductive health problems and need continuing support including information, education and services to assist them in adopting safe, voluntary behaviours. Married adolescent girls are often under pressure to become pregnant and have virtually no strategies articulated at this point in their lives to protect themselves. Delaying age at marriage to at least 18, and offering frank and comprehensive information and services to adolescents about their sexual health, is a vital strategy to prevent STIs, HIV/AIDS, and unwanted pregnancy.

We also work to protect adolescent childbearing through pregnancy support services designed for the needs of younger mothers. One-half of the first-time mothers in the developing world are adolescents. They carry special risks for maternal mortality and morbidity, particularly among girls under 15. We support efforts aimed at increasing the age of first birth so that young mothers have more physical and social capabilities.

UNFPA bases its programmes on development-oriented, rights-affirming principles identifying young people as a resource, and acknowledging their rights. Young people are themselves agents of social change and instruments of their own empowerment. Respecting their ability and providing them with the environment and the tools to deal with their issues would make them genuine participants in their own development. The rights-and development-based approach has the ICPD and ICPD+5 as a point of departure. But this cannot be done without the involvement of adults from all sectors, including policy makers and decision makers, community gatekeepers, including parents, teachers, traditional and religious leaders, and service providers themselves.

Working in partnerships

Broad-based actors and cross-sectoral approaches are key. Issues of safety, social relationships, self-esteem, education, skill development and economic opportunities all figure into healthy adolescent development. Livelihood activities may be especially important in areas where girls are under economic pressure and must exchange sex for income or other valued resources in the absence of wage-earning work opportunities. Therefore, actions and plans that address adolescent health need to be extended to a broad, development-based approach that includes all sectors not just health but also education, livelihoods and vocational training, life skills, recreation and sports, arts, culture and media.

A little over a month ago, the UNFPA signed an agreement with AIESEC International, the largest global student organization, to collaborate on projects aimed at raising young people's awareness of critical issues related to population and development and reproductive health, including challenges related to HIV/AIDS pandemic.

Another partnership that I am particularly excited about is the African Youth Alliance for AIDS Prevention. The Alliance involves UNFPA, the non-governmental organizations, PATH and Pathfinder International, as equal partners and not as executing agency relationship. It also involves four African governments and local citizens' groups in the four countries. It is a new initiative and a new way of working together to upscale services. The African Youth Alliance is a five-year initiative to improve adolescent reproductive health and reduce the spread of HIV/AIDS in Botswana, Ghana, Tanzania and Uganda. Unprecedented in scale, the initiative, which is funded by the Bill and Melinda Gates Foundation, will serve as a model for other national youth programmes worldwide. Through the Alliance, young people are being educated about HIV prevention and provided with the necessary information, skills and support to protect their health.

Building partnerships has been a cornerstone of UNFPA's efforts worldwide. We work with an ever-expanding alliance of governments, NGOs, women's and youth groups, media organizations, and United Nations agencies, especially UNICEF and WHO. We also work with community and religious leaders of all faiths because they are active community mobilizers and well heard. One area of particular focus, which has been largely overlooked until very recently, is adolescent reproductive health services in crisis situations. In situations of conflict, in refugee camps, and after natural disasters, young people need information and services to meet their special needs, especially since sexual violence often increases in these emergency situations. That is why UNFPA is working very hard on this issue with partners to ensure that their needs are met in their time of need.

In our work, we strive to be culturally and gender sensitive. This is critical when it comes to reproductive health because the issues are sensitive and intertwined with gender and culture. This is true for HIV/AIDS, female genital cutting, family planning, and empowerment. If we do not take an approach that is sensitive to gender and culture, we will not be very effective.

Around the world, WHO, UNICEF and UNFPA, as well as other United Nations agencies, are partners in supporting adolescent programmes. Each agency is contributing with its comparative advantage to support programmes that cover all aspects of adolescents' lives in a comprehensive manner and, more importantly, to reduce gender disparities in health, social, and economic resources.

In particular, agencies are acknowledging the importance of working beyond the health sector, recognizing as critical the expectations that society puts on boys and girls during adolescence. This has also led to a growing recognition of the great diversity of needs among adolescents in the developing world.

Finally, we have to recognize that adolescent behaviour mirrors that of adults and is shaped by their social and cultural environments, including families, communities, schools, media, popular culture and public opinion. Rather than focusing solely on reducing risk factors for morbidity and mortality, new approaches need to look at helping adolescents, particularly disadvantaged girls, to overcome obstacles, to meet new social demands, to build opportunities for self-development under safe and healthy conditions. Teenagers today need support to succeed as the first generation of adults in the twenty-first century.

Thank you