By Shebana Alqaseer, Adolescent Sexual and Reproductive Health Technical Adviser, Save the Children Philippines, and Shubha Kamana Mandal, Technical Manager - Health and Nutrition, Save the Children Nepal
The importance of upholding adolescent sexual and reproductive health and rights (SRHR) cannot be overstated. The Global Forum for Adolescents, which took place last week, was an exemplary moment of young people and advocates coming together to sound the alarm for adolescent well-being.
It is time for governments, leaders, and policy-makers to step up to address the pressing issues that impact our young people
Our goal is clear: Ensuring that every single adolescent has access to comprehensive information, high-quality services and genuine support for their SRHR.
In some countries, such as Nepal and the Philippines, deeply embedded cultural norms mean that adolescents face hurdles accessing SRHR services or information. In Nepal, where a fifth of the population are adolescents, discussions on adolescent SRHR are often considered taboo. This is just one of the multifaceted challenges faced by adolescents, which also include gender inequality, lack of education and information on SRHR, and limited access to healthcare services. These challenges contribute to high rates of child, early and forced marriage; unintended pregnancy; sexual coercion; intimate partner violence; and sexually transmitted infections (STIs), including HIV.
In Nepal, 14% of adolescent girls experience pregnancy between the ages of 15–19, which rises to 19.8% in the Madhesh province. Worryingly, 8.8% of girls and boys aged 10–14 years, and 26.6% of girls and boys aged 15–17 are currently married in Madhesh, which is higher than the national average. Although Nepal has prioritised adolescent SRHR in national policies in 2000 and 2019, tangible actions to address these challenges have been scarce.
Adolescents in the Philippines have similar challenges, with one in every ten births being to girls younger than 19 years old. There are 24 babies born to adolescent mothers every hour, totalling more than 200,000 births annually. As a predominantly Catholic nation, deeply rooted cultural and religious norms render discussions about adolescent sexuality and SRHR taboo. These norms have been ingrained in society for generations, and their impact is deeply felt, perpetuating stigma and shame around these crucial topics. Consequently, adolescents in the Philippines are denied the full realisation of their sexual and reproductive rights, leaving them without adequate support systems to successfully navigate the challenges of adolescence.
Involving the whole community in the Philippines
There is a pressing need to address adolescent pregnancies and to create a safe and enabling environment where young people can access information, services and support concerning SRHR. To respond to this, Save the Children Philippines has adopted a socio-ecological model recognising that adolescents, their families, their communities, and local government units and agencies are all essential to achieving results for adolescents’ SRHR. Adolescents do not exist in isolation; they are an integral part of families, which is why it is important to involve parents and caregivers in discussions about SRHR.
Understanding the multiple, intersecting impact of early and unintended pregnancies, Heart, a 15-year-old, shares how she takes part in outreach programmes to raise awareness. “We gather the youth and take turns speaking to them about different topics. We usually talk to children our age, about 13–16 years old. And because I have attended a seminar from Save the Children where they talked about ways to prevent pregnancy among adolescents, I got this idea to convince the children to study hard and to avoid getting married while they are young,” Heart explains.
Save the Children believes that families must be equipped with the knowledge and skills needed to provide guidance and support to young people. Save the Children’s Reducing Early Adolescent Pregnancy (REAP) Project in the Philippines works to improve access to SRHR information and services for adolescents by building communication skills among their parents. This approach led to a 28% increase in the number of new family planning users among young mothers aged 15 to 19 years old. Save the Children continues to equip parenting advocates with vital knowledge and skills to engage in open discussions on adolescent development, adolescent reproductive health and positive discipline strategies.
Mirma Madrona, a programme officer at Save the Children Philippines, expressed the importance of support systems for adolescents:
“It’s important that adolescents have the support system they need to help them achieve their full potential. Working for and with adolescents motivates me to continuously learn and work to be the support system that respects, fulfils, and protects their rights.”
In addition to working with the parents of adolescents, Save the Children Philippines works to engage adolescent boys, men and community leaders to promote and protect the rights of adolescents. This not only entails changing behaviour, but also focusing advocacy to change policies. Working with like-minded civil society and women’s rights organisations in the Philippines, Save the Children was instrumental in advocating for the Adolescent Pregnancy Prevention Bill in Congress, which seeks to allow adolescent access to SRHR commodities and services, strengthen comprehensive sexuality education, and establish social protection mechanisms for adolescent parents and their children. This Bill will help remove barriers for adolescent parents, including those related to health, education, and economic support.
Improving SRHR knowledge among adolescents, families and health care providers in Nepal
Save the Children Nepal has been working with adolescent boys and girls, families, communities, and the health system to support the Government of Nepal to improve adolescent SRHR and ensure universal access to SRHR services. To scale-up adolescent-friendly health services, we have strengthened the capacity of health workers, expanded access to necessary equipment, and supported development and use of communication and counseling materials.
Further, Save the Children has adopted a new approach which ensures participation of adolescents in improving the quality of health services. To complement the systems strengthening work, Save the Children Nepal and our local partners, are also working with adolescents and their families to increase their knowledge and acceptance of services and develop a favorable environment for adolescents within their families and communities.
Married and unmarried adolescent girls are engaged through Save the Children’s Healthy Transition curriculum. The curriculum supports married adolescents in parenthood and equips them to take better care of themselves and their children. Healthy Transitions offers bi-monthly, small group sessions for enrolled adolescent girls, and uses a participatory, comprehensive curriculum focused on maternal and newborn health, marriage, gender roles, family planning, mental health, self-efficacy and financial literacy. A 2019–20 evaluation of the first cohort of young women to complete a year of the Healthy Transitions curriculum found an increase in current use of modern contraceptive methods (from 26% to 33%) among married young people as well decreased support of unequal gender attitude statements.
The Healthy Transitions curriculum is currently implemented in 31 groups in the Sarlahi and Mahottari district of Nepal, and adolescent girls engaged in this group are experiencing drastic changes in their knowledge and practices. Girls who were once participants are now facilitating these sessions. These interventions aim to reduce early marriage and pregnancy, contributing to decreased maternal and neonatal morbidity and deaths, and help adolescent girls to continue their education to be able to achieve their ambitions.
“We have not been able to understand about our sexual and reproductive health earlier though it is in our curriculum. Teachers would suggest reading the chapter ourselves and we also feel shy to discuss openly with teacher in presence of male colleague in the class. But now after joining Healthy Transitions session, we learned about our own body and can confidently discuss about our problems in the group.” Shardha* enrolled at a Healthy Transitions session, Nepal
Adolescent girls discussing SRHR issues during Healthy Transitions session.
The mother and sister of an adolescent girl (left) who is participating in Healthy Transitions. Her mum feels good about it and her younger sister is also benefiting.
Work together now to ensure a brighter future for adolescents
Leaders must realise that access to SRHR is not just a matter of health care, it is a matter of ensuring that every young person in the world can realise their full potential. It is a matter of social justice, empowerment and transformation. We must work together to ensure a brighter future for adolescents and write a new narrative where they can grow, learn, and thrive in an environment of support, understanding and opportunity.
Early and unintended adolescent pregnancies have reached a critical juncture, demanding a comprehensive response that not only challenges deep-seated cultural and religious norms and prejudices, but also aims to shift behaviour and mindsets. The path forward has challenges, but through our collective efforts, there remains hope, bolstered by the progress we and other like-minded advocates and organisations have made so far, for a more inclusive, informed and empowered generation of adolescents.
Photo at top of the page shows Nisha* (right), age 13, with a fellow children's club member at a rally against child marriage in their village in Nepal (photo: Suzanne Lee / Save the Children).
* We've changed Sharda and Nisha''s names to help keep them safe.
