Make full SRHR for young women a priority

Young women in Sub-Saharan Africa need the full range of sexual and reproductive health care, writes Heather Boonstra, Director of Public Policy, Guttmacher Institute.

As thousands of young people from around the world join advocates, scientists, policymakers, journalists and health care providers at the 21st International AIDS Conference in Durban this week, the fact that HIV disproportionately affects adolescent and young women is sure to be frequently cited. Almost half of all new HIV infections among women in Sub-Saharan Africa occur among those aged 15–24 years. Like young people everywhere, adolescents in Sub-Saharan Africa need honest, complete information about sexual health and access to confidential sexual and reproductive health care services to better protect themselves.


Evidence sheds light on young women’s needs for sexual and reproductive health information and services in developing regions around the globe and in Sub-Saharan Africa, specifically.

In developing regions worldwide:

  • Adolescent women aged 15–19 will have an estimated 21 million pregnancies in 2016, of which about 12 million will result in a birth.
  • An estimated 17,000 young women die from complications of pregnancy or childbirth each year.

In Sub-Saharan Africa:

  • Among adolescent women aged 15–19, 11.3 million are sexually active and do not want a child for at least two years. About a third of these women (3.6 million) are using a modern contraceptive method to avoid unintended pregnancy, but the other 7.7 million currently have an unmet need for modern contraception.
  • Nearly half of pregnancies among women aged 15–19 are unintended, and almost half of these end in abortion. Most of these abortions occur in countries where the procedure is illegal and performed under clandestine and often unsafe conditions.
  • If all adolescent women in the region who need modern contraceptives were to use them, unintended pregnancies would drop by 2.7 million per year, resulting in 1.1 million fewer unplanned births, as well as 1.3 million fewer abortions, almost all of which would have been unsafe.

These interconnected challenges and risks facing adolescent women call for a coordinated effort to ensure that all young people get medically accurate sexual and reproductive health information and confidential health care services. To meet adolescents’ needs, programme planners and policymakers must work to provide high-quality, comprehensive sex education and contraceptive counselling and services to help young women overcome barriers to contraceptive use and to protect their rights to voluntary, informed and confidential contraceptive choice.

Educators and health care workers must make a concerted effort to dispel myths about HIV and to provide medically accurate information and services for preventing HIV and other STIs, including access to male and female condoms. Young women also need more and better options to protect themselves. Multipurpose prevention technologies — products in development that simultaneously protect against unintended pregnancy, HIV and other STIs — hold great promise, but more investment is needed to make them a reality.

Finally, young women who experience unintended pregnancies must receive non-judgmental, comprehensive care regardless of whether or not they decide to remain pregnant. Those who continue their pregnancies should be educated on the value of obtaining professional antenatal care, and those who decide to end their pregnancies should have access to safe abortion services.

Cost and lack of confidentiality are the biggest barriers that adolescents in developing countries face in obtaining safe abortion services. To encourage adolescents to seek out safe and legal care, it is critical to offer abortion and post-abortion care services at an affordable cost or free of charge, and to involve parents, guardians and spouses only with the patient’s consent. Contraceptive counselling and method provision should also be included as part of comprehensive post-abortion services.

No society or country — in Sub-Saharan Africa or globally — can afford to neglect young women’s sexual and reproductive health. Young people have a right to sexual and reproductive health care that meets the full range of their needs, from comprehensive sex education to contraceptive care, from HIV prevention and treatment to safe abortion care.

Greater investments are necessary, not only to improve adolescent women’s health, but also to strengthen families and communities, and ultimately to help countries achieve their development goals. The global community — including policymakers, programme planners, advocates and donors — has an obligation to support medically accurate information and proven programmes to help young people around the world keep themselves safe and healthy well into the future.