Elsevier

The Lancet

Volume 369, Issue 9568, 7–13 April 2007, Pages 1220-1231
The Lancet

Series
Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential

https://doi.org/10.1016/S0140-6736(07)60367-5Get rights and content

Summary

Worldwide, societal shifts and behavioural patterns exacerbated by unique developmental vulnerabilities create a confluence of factors that place today's adolescents at heightened risks for poor health outcomes. Country-level data show that continued investment in effective prevention and treatment strategies is essential to protect adolescents' sexual and reproductive health. Whereas strategies must be tailored to the developmental needs of this age group and their social contexts, effective approaches are multifaceted. All adolescents need access to quality youth-friendly services provided by clinicians trained to work with this population. Sex education programmes should offer accurate, comprehensive information while building skills for negotiating sexual behaviours. Girls and boys also need equal access to youth development programmes that connect them with supportive adults and with educational and economic opportunities. Although progress has been made since the 1994 International Conference on Population and Development, adolescents continue to be disproportionately burdened by threats to their sexual and reproductive health.

Section snippets

Sexual behaviours and use of contraceptives

The timing of first sexual intercourse and the context in which it occurs both have health implications. In some parts of the world, for instance in North Africa and parts of Asia, most sexual activity reported even 10–15 years ago takes place within the context of marriage.13 With the gap between age at first sexual intercourse and age at marriage widening in many developing countries, more people are sexually active before marriage than in the past.14 A study from 2000 with data from 14

Birth and abortion rates

National health statistics typically include rates of birth (as opposed to pregnancy rates) for 15–19-year-olds (table 2).6, 38, 39, 40, 41 In the developing world, birth registration rates differ widely; thus, data from some developing countries in table 2 represent a best estimate.

In sub-Saharan Africa, the average birth rate (for most recent year available) per 1000 girls aged 15–19 years is 143, varying from 37 in Mauritius to 229 in Guinea.6, 39 This rate is high compared with the

STIs including HIV/AIDS

WHO has estimated that 340 million new cases of curable STIs—syphilis, gonorrhoea, chlamydia, and trichomoniasis—occur every year. The largest number of new infections occurred in south and southeast Asia, followed by sub-Saharan Africa, Latin America, and the Caribbean. Data from epidemiological surveys show that within countries and between countries in the same region, the prevalence and incidence of STIs can vary widely, between urban and rural populations and even similar population

Strategies for prevention and health promotion

Despite the vastly differing patterns of sexual health behaviours and outcomes and the great diversity in the life situations that determine adolescents' reproductive health pathways, common elements comprise prevention and health promotion worldwide.54, 55 As noted by Wellings and colleagues9 in the recent Lancet series on sexual and reproductive health, “…no general approach to sexual-health promotion will work everywhere, and no single-component intervention will work anywhere”. We present

Worldwide outlooks for improving adolescents' sexual and reproductive health

The goals of the 1994 International Conference on Population and Development in Cairo recognised reproductive rights as among fundamental human rights and put universal access to safe, affordable, and effective reproductive health care on the international agenda for the two following decades.86 Sexual and reproductive rights refers to the rights of individuals, who are free of coercion, to the highest attainable standard of sexual health, and a satisfying and safe sexual life, and to be able

The next steps

Although there are signs of progress, continued worldwide investment is needed to prevent early pregnancy, STIs, and the spread of HIV in adolescents. Evidence provides consistent direction as to the next steps towards these goals.

All strategies designed for adolescents must be tailored to the unique developmental needs of young people and to the contexts and cultures in which they live. Health providers, teachers, and programme leaders all need specific knowledge and skills to assess and

Search strategy and selection criteria

This article was based on a review of publications focused on the reproductive health of adolescents, including studies in peer-reviewed journals (eg, on evaluation of clinical or sex education programmes), reviews analysing sets of such studies, and monographs, mainly from globally-focused health and development organisations such as the Joint United Nations Programme on HIV/AIDS, WHO, Family Health International, the United Nations Population Fund, The Guttmacher Institute, the UN

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