Adolescents number approximately 1.2 billion, are similarly distributed by sex, and represent 18% of the global population. This group is concentrated (88%) in low- and middle-income countries. Although according to the Convention on the Rights of the Child, any human being under the age of 18 is a child, in many regions their rights are systematically violated and, in a situation of total vulnerability, they are forced to adopt adult behaviors and roles early, depriving them of a stage key in their development and, in many cases, conditioning the rest of their lives.
Adolescence has been considered a period of life in which you enjoy good health. This perception, added to the limited political voice of adolescents in front of other groups, has made them historically marginalized in the global health and development agenda. Although their mortality can be considered low, 1.5 million adolescents die each year from preventable causes or avoidablesuch as traffic accidents, HIV, suicide, respiratory diseases, and interpersonal violence. They are data that show that they are a group with specific needs. On the other hand, most of the determinants of their health are outside the health sector. This adds complexity and demands greater coordination between sectors, until now very marginal, but necessary to move forward.
Without minimizing aspects that affect adolescent boys in a greater proportion (violence, traffic accidents, child labor …), the impact of issues that affect girls (such as child marriage and adolescent pregnancy) have led to the failure to achieve the Millennium Development Goals (MDGs) has not been recognized by the governments of low- and middle-income countries, nor by the other actors involved.
This is especially evident in the case of ODM5 (improve maternal health), the furthest behind of all. Adolescents are estimated to contribute 70,000 to the total number of maternal deaths, with deaths from causes related to pregnancy and childbirth the second leading cause of death for the group of girls aged 15-19 years overall. At the same time, the data indicate that adolescent girls, especially unmarried ones, are the age group with the least access to contraception.
In turn, adolescent pregnancy has serious social consequences: it limits the possibility of continuing education, with the consequent negative impact on the income level and personal autonomy of adolescent mothers, which in turn has repercussions on health and on the educational level of your children. Finally, it also puts adolescent girls at higher risk of contracting Sexually Transmitted Infections and HIV.
However, with early marriage and adolescent pregnancy being such determinants of underdevelopment, when we analyze trends in recent years the conclusions are discouraging: progress in all regions has been scant and slow. More than 60 countries have prevalences of child or forced marriage of 20% or higher that have remained constant in the last decade. And teen pregnancy levels have also been stable since the 1990s.
Health inequities, that is, unjust and avoidable differences in health, are not alien to this population group either. Among adolescent girls there are great variations motivated by socioeconomic, gender, ethnic or geographical differences. An example: the adolescent fertility rate, that is, the number of births per 1,000 women between 15 and 19 years of age ranges between 1 and 299, depending on the countries). Where there are no fluctuations is in the trends, which are always the same: adolescents from rural areas, without education or with the lowest levels, and from the poorest quintiles are the most affected by adolescent pregnancy, compared to those in the area. urban, with secondary or higher education or in the richest quintiles of the population.
What can we expect in this new stage?
Adolescents have for the first time achieved visibility and a space of their own in the Sustainable Development Agenda adopted in September. The TO has crept into acronyms and major strategies. They have been recognized as a group with specific risks, rights and needs. Finally, a goal includes the elimination of child, forced or early marriage. It is a better framework from which to advocate for a greater allocation of resources and for the design of policies and programs with a focus on human rights, pro-equality and with greater integration between sectors. On the other hand, while there is only one specific health goal (SDG3), most of the other goals are closely related to it (SDG1: Poverty reduction and social protection, SDG2: Food security and nutrition, SDG4: Education, SDG5: Sexual and reproductive health and rights, sexual violence, child marriage, female genital mutilation, SDG8: Economic growth, or SDG10: Reduction of inequality).
In any case, addressing the needs of the fifth of the population of developing countries, which contributes to the 35% of the global disease burden, is an indispensable requirement for a true sustainable development. If confirmed, it would be the best way to make up for this historical omission to today’s adolescents who were born precisely around the declaration of the MDGs in 2000 and to subsequent generations.
Anna Lucas is coordinator of the Maternal, Child and Reproductive Health Initiative of the Barcelona Institute of Global Health (ISGlobal).