UNFPA Quality Assurance of RH Commodities

1. Trends in Family Planning and Maternal Health of Youthin Africa East and Southern Africa Regional Office (ESARO) Presented at the International Conference on Family Planning in Addis Ababa, Ethiopia Youth Pre-Conference, 10 November 2013 UNFPA Quality Assurance of RH Commodities

2. Outline • Investing in Heath Programmes for Adolescent and Young People: Attaining the Demographic Dividend in Africa • Status of Young People (HIV, unintended pregnancy, unsafe abortion, child marriage) and Trends (unmet need for FP, TFR, CPR) • Programmes for Adolescent and Young People • Addressing child marriage (Lessons from Ethiopia) • Conclusion and Recommendations

3. 10 facts about adolescent pregnancy The lifetime opportunity cost related to adolescent pregnancy—measured by the mother’s foregone annual income over her lifetime—ranges from 1 per cent of annual GDP (or $124 billion), in China to 30 per cent of annual GDP (or $15 billion), in Uganda.

4. Sub-Saharan Africa yet to reap a Demographic Dividend • Some countries making progress • Indicators in ESA reached higher levels (population, health and education) vs. western and central Africa • Africa’s GDP had an annual average growth rate of 5.2% in the last 10 years (1),but health and education continue to challenge economic growth • The region's high population growth rates (average of 2.5% per year) have greatly slowed per capita economic gains. More than 70% of Africans still live on less than $2 a day • Accelerated economic growth is needed to reduce inequality and poverty, and improve people's lives across Africa

5. Need for a dramatic and rapid demographic transition • Today 43% of SSA’s population is under 15 • Youth can be a great force for economic and political change, but sheer numbers do not themselves signify that a DD is imminent • Accelerated economic growth of the DD remains a possibility for many African nations, but countries must prioritize strategic investments to lower fertility and child mortality,and the accompanying shift in the age structure

6. FP, Education and targeted investments are crucial to DD • Countries must address their extremely young age structure through FP, education, skills building, employment schemes and other investments that contribute to smaller and healthier families, they will not achieve their full potential for economic growth that comes through a demographic dividend. • Countries need to make investments that lead to having a smaller dependent (adolescent) population and a larger working-age population.

7. Status of Young People • Young people aged 10-24 make up 1/3 of the total population of Sub Saharan Africa • Expected to almost double to 281 million by 2050. YET • Every hour, 50 young people (aged 15-24) become infected with HIV. That’s 430,000 new HIV infections per year – most of them among young women • Less than 40% of young people have adequate HIV prevention knowledge • Teenage pregnancy rates still remain high. By age 17, 1 in 5 young women in 6 countries have started child bearing, which poses a significant risk to their health

8. At a glance •16 million adolescent girls between 15 and 19 become mothers every year • Adolescent pregnancies are the leading causes of death among adolescent girls ages 15-19 (leading causes of deaths in ESA : MM and HIV ) • Despite progress, adolescent pregnancy continues to increase in some regions of the developing world OMS

9. Consequences of adolescent pregnancy brings detrimental social and economic consequences for a girl, her family, her community and her nation puts new-borns at risk (higher risks for the baby with younger mothers) 15% of all unsafe abortions in are among adolescent girls aged 15-19 years reinforces the vicious cycle of poverty and ill health:Adolescent mothers in many places leave or are made to leave school, and are less likely than their peers to develop vocational skills. OMS

10. Child Marriage in SS Africa Young women married by age 15 Young women married by age 18 Source: PRB/UNFPA based on DHS data

11. Married by Age 18, Cameroon Married by Age 18: Proportion of women aged 20 to 24 married by age 18.Source: ICF Macro, Demographic and Health Surveys; UNICEF, Multiple Indicator Cluster Surveys UNFPA PRP Adolescent and Young People 2012 Status Report

12. Married by Age 18, Ethiopia Married by Age 18: Proportion of women aged 20 to 24 married by age 18.Source: ICF Macro, Demographic and Health Surveys; UNICEF, Multiple Indicator Cluster Surveys UNFPA PRP Adolescent and Young People 2012 Status Report

13. Married by Age 18, Cote d’Ivoire Married by Age 18: Proportion of women aged 20 to 24 married by age 18.Source: ICF Macro, Demographic and Health Surveys; UNICEF, Multiple Indicator Cluster Surveys UNFPA PRP Adolescent and Young People 2012 Status Report

14. Married by Age 18, Democratic Republic of Congo Married by Age 18: Proportion of women aged 20 to 24 married by age 18.Source: ICF Macro, Demographic and Health Surveys; UNICEF, Multiple Indicator Cluster Surveys UNFPA PRP Adolescent and Young People 2012 Status Report

15. Married by Age 18, Mozambique Married by Age 18: Proportion of women aged 20 to 24 married by age 18.Source: ICF Macro, Demographic and Health Surveys; UNICEF, Multiple Indicator Cluster Surveys UNFPA PRP Adolescent and Young People 2012 Status Report

16. Married by Age 18, Niger Married by Age 18: Proportion of women aged 20 to 24 married by age 18.Source: ICF Macro, Demographic and Health Surveys; UNICEF, Multiple Indicator Cluster Surveys UNFPA PRP Adolescent and Young People 2012 Status Report

17. Trends in CPR for young women15 – 24 years in Southern Africa Source: IPPF ARO & AFIDEP: Enhancing progress towards universal access to RH in Southern Africa, 2011

18. Unmet Need for family planning among currently married women (two most recent DHS surveys from 2006-2011) ICF International, 2012. MEASURE DHS STAT compiler - http://www.statcompiler.com - February 18 2013.

19. Adolescent Fertility Rates • At that current rate of decrease, it would take sub-Saharan Africa nearly a half-century to reach Europe's current level of teenage childbearing of 19! Source: UNESCO Diagnostic Report based on World Bank: World Development Indicators

20. Trends in Family Planning in six selected countries Source: Chart produced based on data from UNFPA, 2012

21. Youth Sexual Behaviour and Contraceptive use Chart produced based on tabulations by Prata et al, 2013

22. Sexual and Reproductive Health Services Condom use amongst young people aged 15-24 generally low and inconsistent • Regional average: 34% of females, 45% of males • Range: Namibia 74% - Madagascar 3% • Condom supply in the region is extremely limited with only 9 condoms per man per year made available through donor support. Education on condom use for young people is gaining acceptance but still inadequate

23. Adolescence: a time for investment Investing in adolescents is crucial to reaching global health targets Adolescents need comprehensive, accurate and developmentally appropriate sexuality education More needs to be done to strengthen health sector capacity to provide adolescent- centered services National governments have the authority and the responsibility to address social and cultural barriers in the provision of adolescent sexual and reproductive health education and services Actions are needed at each of these levels by different sectors and Adolescents too have key roles to play ONU JOEY O’LOUGHLIN

24. Outcome 1 Reduce marriage before age 18 • Policy-Level Actions • Prohibit child marriage • Educate communities • Harmonize and enforce laws • Individual, Family & Community-Level Actions • Inform and empower girls • Keep girls in school • Influence cultural norms that support child marriage through community empowerment UNFPA

26. Outcome 2 Create understanding and support to reduce pregnancy before the age of 20 years • Policy-Level Actions • Support pregnancy prevention programmes among adolescents • Individual, Family & Community-Level Actions • Provide comprehensive Sexuality Education to adolescent girls and boys in and out of school and SRH services • Build community support for preventing early pregnancy JOEY O’LOUGHLIN

27. Outcome 3 Increase use of contraception • Policy-Level Actions • Legislate access to contraceptive information and integrated HIV/SRH services • Reduce the cost of contraceptives to adolescents (conditional recommendation) • Individual, Family & Community-Level Actions • Educate adolescents about contraceptive use • Build community support for contraceptive provision to adolescents • Skills for adolescents to obtain contraceptive services WHO

28. Outcome 4 Reduce coerced sex Policy-Level Actions • Prohibit coerced sex Individual, Family & Community-Level Actions • Empower girls to resist coerced sex • Influence social norms that condone coerced sex • Engage men and boys to critically assess gender norms UN

29. Outcome 5 Reduce unsafe abortion Policy-Level Actions • Enable access to safe abortion and post-abortion services for adolescents • INDIVIDUAL, FAMILY, & COMMUNITY-LEVEL ACTIONS • Inform adolescents about dangers of unsafe abortion • Inform adolescents about where they can obtain safe abortion services, where legal • Increase community awareness of the dangers of unsafe abortion • Health system-Level Actions • Provide access to safe abortion services where legal and post abortion care • Identify and remove barriers to safe abortion services and/or post abortion care UN

30. Outcome 6 Increase use of skilled antenatal, childbirth, and postpartum care POLICY-LEVEL ACTIONS • Expand access to skilled antenatal, childbirth, and postnatal care • Expand access to Basic and Comprehensive Emergency Obstetric Care • Individual, Family, & Community-Level Actions • Inform adolescents and community members about the importance of skilled antenatal and childbirth care • Health system-Level Actions • Ensure that adolescents, families, and communities are well prepared for birth and birth-related emergencies • Be sensitive and responsive to the needs of young mothers and mothers-to-be WHO

31. Reduction of Child marriage in Ethiopia - BerhaneHewan(‘Light for Eve’) • 2004 program started implementation in the Amhara region, Ethiopia. • girls aged 10-14 years were three times more likely to be in school • 98% of girls 10-14 years old were attending school after the intervention (from compared to 71% at baseline) • 90% less likely to be married • the proportion of ever-married young girls decreased from 10% at baseline to 2% at the end. • Since 2004, the model has expanded and reached over 10,000 girls in 12 communities. • A scaling-up process is currently testing the program component of delaying marriage among unmarried girls in Ethiopia, Kenya, Tanzania and Uganda.

32. Recommendations (1) • Strengthen youth leadership and participation and Invest in new and social media to reach adolescents and young people with CSE and link them to services • Initiate and scale up CSE during primary school educationto reach most adolescents before puberty, before most become sexually active and before the risk of HIV transmission or unintended pregnancy increases

33. Recommendations (2) • Maximise the protective effect of education through Education for All by keeping adolescents and young people in school • Integrate and scale up youth-friendly HIV and SRH servicesto improve access and uptake. • Ensure that health servicesare youth friendly, non-judgemental and confidential and reach adolescents and young people when they need it most

34. Acknowledgements Based on various publications: • a report jointly produced by Guttmacher institute and UNFPA on “Adding It Up: Costs and Benefits of Contraceptive Services” • Dr. Matthews Mathai’s paper: Addressing Early Pregnancy and Poor Reproductive Outcomes in Africa’ • 2013 Partners and Inter Agency report (UNESCO/UNAIDS/UNICEF/UNFPA: Young People Today, Time to Act Now) • 2013 SWOP Launch Source: http://unfpa.org/webdav/site/global/shared/documents/Reproductive%20Health/Fact%20Sheets/AIU_2012_Estimates%20Factsheet_ENGLISH.pdf

35. Thank you