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Guttmacher Institute

Guttmacher Institute. New evidence on adolescent sexual and reproductive health in Sub-Saharan Africa. Guttmacher Mission. Mission: Advance sexual and reproductive health worldwide through social science research, policy analysis and public education

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Guttmacher Institute

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  1. Guttmacher Institute New evidence on adolescent sexual and reproductive health in Sub-Saharan Africa

  2. Guttmacher Mission • Mission: Advance sexual and reproductive health worldwide through social science research, policy analysis and public education • Program: A unique combination of policy-relevant research and evidence-based advocacy • Approach: Partnership with national institutions to build capacity and ensure local ownership of findings

  3. About the Guttmacher Institute • Founded in 1968 • Based in NY and DC • $12 million budget • Domestic and international programs • Wide range of issues • Abortion; contraception; adolescents; HIV

  4. Scientific and Policy Publications • Perspectives on Sexual and Reproductive Health • International Family Planning Perspectives • Guttmacher Policy Review • Occasional Reports and Monographs • www.guttmacher.org

  5. New and Forthcoming Research Findings • Adolescent sexual & reproductive health • With partners in Kenya, Ghana, Burkina Faso,Malawi, Uganda, Nicaragua, Honduras, Guatemala, Costa Rica • Forthcoming: With partners in India, Nigeria & Mexico

  6. New and Forthcoming Research Findings • Global & regional estimates of abortion • With WHO

  7. New and Forthcoming Research Findings • Incidence, causes & costs of unsafe abortion • With partners in Nigeria, Uganda, Guatemala & the Philippines & with Population Council in Pakistan • Forthcoming: with Population Council, incidence estimates for Mexico and with Ipas in Ethiopia and Burkina Faso; with UNFPA new cost studies in Pakistan, Mexico and Ethiopia

  8. New and Forthcoming Research Findings • Understanding unmet need for contraception • Analysis of DHS surveys in 55 developing countries • Trends in maternal mortality • Forthcoming: Analysis of existing data in India, Mexico & Nigeria

  9. Learning from Young People about HIV and Pregnancy Prevention in Sub-Saharan Africa

  10. Project Objectives • Provide new evidence on the unmet sexual and reproductive health needs of adolescents • Use the new evidence to mobilize political support for policy and program change • Increase the capacity of African partners to do policy-relevant research and evidence-based advocacy

  11. African Research Partners • Institut Supérieur des Sciences de la Population, Burkina Faso • University of Cape Coast, Ghana • Centre for Social Research, Malawi • Makerere Institute of Social Research, Uganda • African Population and Health Research Center, Kenya

  12. About the African Population and Health Research Center (APHRC) • An international organization committed to conducting high quality and policy-relevant research on population and health issues facing sub-Saharan Africa • APHRC’s mission is to promote the wellbeing of Africans through policy relevant research on population and health issues

  13. APHRC Core Programs RESEARCH Generation and Synthesis of Scientific Knowledge Urbanization Population Dynamics Health Education POLICY ENGAGEMENT Engage policymakers in research Inform policy & programs Promote positive change Stimulate new thinking STRENGTHENING RESEARCH CAPACITY Fellowships Training workshops Support to universities

  14. African Communications Partners • Initiative Privée et Communautaire de Lutte Contre le VIH/SIDA, Burkina Faso • Planned Parenthood Association of Ghana • Youth Net and Counseling, Malawi • Panos Eastern Africa, Uganda • African Population and Health Research Center, Kenya

  15. Key Findings • Very young teens are sexually aware and most older teens are sexually active, usually before marriage • Less than half get any kind of sex education • Contraceptive education that begins in secondary school comes too late • Adolescents are concerned, but have too little information about pregnancy or HIV prevention to protect themselves

  16. Key Findings (cont.) • Abstinence-until-marriage is not a message that resonates with adolescents • Adolescents want information and services from professional sources • Both cost and embarrassment are barriers to services • Condom use is fairly widespred • Unintended pregnancy is a more immediate concern than HIV

  17. The reality is thatyoung people are or will soon be sexually active

  18. Few girls under 15 report having had sex, but many are sexually aware % of 12-14 year old females

  19. The same is true for young boys % of 12-14 year old males

  20. Adolescence is a time when changes in sexual activity happen fast % of 20-24 year olds who had sex by certain ages

  21. Most young women become sexually active by choice

  22. Early mandatory sex education is critical

  23. At most half of 15-19 year olds received any sex education at school

  24. Young people support sex education % of 12-14 year olds * Ever attended school †Know of AIDS

  25. Detailed knowledge of HIV prevention is low % of 15-19 year old males and females

  26. Cost and embarrassment are major barriers to services

  27. Young people prefer clinics and hospitals for contraception % distribution of 15-19 year olds who ever had sex

  28. Fear or embarrassment is the main barrier to getting contraception (Uganda) Male Female % reporting barrier among 12-19 year olds who had sex in last 12 months

  29. Lack of confidentialityand cost are main barriers AT CLINICS: “When you stay for a while like this, [the] consult medical officer saying ‘Eh! Those having gonorrhea whatever, there!’ The way you know, so you stand amongst many people, so you feel embarrassed.” [Malawi, urban, female] WITH FAMILY AND OTHER PEOPLE: “The only problem here is money. If you have the money you can go to the hospital without the knowledge of your house people.” [Ghana, rural, male]

  30. Pregnancy is at least as important a concern as HIV

  31. Young women use the male condom to prevent pregnancy more so than HIV % of females 15-19 who had sex in the last 12 months and used a condom

  32. Unwanted and mistimed pregnancies are a major problem 7.9 million pregnancies Pregnancy outcomes for adolescents aged 15-19 in Sub-Saharan Africa

  33. Many adolescents report that they have close friends who tried to end a pregnancy % of 15-19 year olds

  34. Less than half of young men use condoms consistently % of 15-19 year old males

  35. Research to Action

  36. Recommendations

  37. Because African adolescents are or soon will be sexually active: • Fund comprehensive programs that accept the reality of adolescent sexuality, promote abstinence for younger teens and work to de-stigmatize sexual activity among older unmarried adolescents. • Provide a counterweight to pressures from the United States to emphasize only abstinence-until-marriage and restrict condom availability.

  38. Because early sex education is critical: • Start in primary school and make it universal • Mobilize community and moderate faith-based groups • Include more detailed information on pregnancy and STI/HIV prevention, including condom demonstrations • Encourage delayed sexual debut for younger adolescents

  39. Because cost and embarrassment are barriers to services: • Make services for adolescents very low cost or free • Ensure confidential and non-judgmental services • Expand existing health facilities to meet the needs of the most vulnerable youth

  40. Because pregnancy prevention is at least as important a concern as HIV: • Promote condoms for pregnancy prevention, not just HIV prevention • Integrate family planning and HIV prevention efforts so that both are addressed in any setting • Build on current levels of adolescent condom use by improving correct and consistent use

  41. Because Washington is an “evidence-free zone” • Progressive governments must continue to: • Shore up support for sexual health within multilateral organizations • Use donor coordination mechanisms within countries to support good policies • Move quickly to address contraceptive shortfalls

  42. Hope on the Horizon • Waning influence of religious conservatives • Return of evidence-based U.S. policies • 2008 U.S. national elections • Importance of European governments

  43. This presentation was supported in part by the Gates Foundation, the Rockefeller Foundation and U.S. National Institute of Child Health and Human Development For more information, visit www.guttmacher.org

  44. Early Childbearing and Sexual Risk Behaviors among Young in El Salvador, Guatemala, Honduras and Nicaragua

  45. Why study youth in Central America? • Substantial and growing segment of the population • Highest adolescent fertility of all Latin America • High unmet need for contraceptives • High levels of risks for STIs/HIV

  46. Adolescent childbearing in focus countries is the highest in all of Latin America

  47. Significant proportions of adolescents have had sex % men/women aged 15-19 who had sexualintercourse

  48. Rural adolescent women are more likely to have had sex than their urban counterparts… % women aged 15-19 who had sexual intercourse

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