The unmet need of adolescents
When we speak about the universal access to contraceptive services and the huge unmet need for family planning services that exists in the world today, the first image that comes to mind is that of poor women in Africa. Indeed, Africa’s unmet need for contraception is much higher than in other regions (Slide 1) and, in most countries, poor women have a much higher rate of unmet need (Slide 2). What is frequently forgotten though is that we are speaking mostly about young women’s unmet need. From any angle we look, young women are at the greatest disadvantage in terms of access to needed services: in Africa and everywhere in the world. A much larger proportion of young women have unmet need in most regions (Slide 3); and a large proportion of women who have unmet need are young. In addition, 2.5 million of adolescents worldwide have an unsafe abortion annually. These facts should give us reason enough for much greater attention to young women. There are, however, three other reasons that are equally or more compelling.
The first is purely demographic: early childbearing is very common (with an estimated 14,300,000 births to adolescents,i) and contributes to population momentum the neglected component of population growth, as Bongaarts has called our attention quite a while ago. His projections have shown that an exclusive focus on fertility decline is misguided because postponement of childbearing affects momentum which has a significant contribution to the rate of growth and the absolute numbers resulting from it (Slide 4). Those of us coming from a rights-based perspective do not feel very comfortable discussing the demographic issues at hand because of the risk of using “population control” to justify coercive policies. An estimated 818,000,000 women desire to limit childbearing;ii and the fact that this is a huge number of women creates a win-win situation, where fulfilling their needs brings about a demographic bonus – not an insignificant consideration in a world increasingly pressured by environmental concerns. In short, getting to a slower rate of growth can be achieved without trampling on individual rights. Quite the opposite: it is better achieved by fulfilling young women’s right to information, to health services, and to autonomy regarding the decision on whether and when to have children.
The second reason why we should pay more attention to young women’s unmet need is that fulfilling their needs has proved more difficult than is the case with older women. Throughout the world, where fertility has declined substantially among women above 30 years of age, the same has not always happened among younger women (Slide 5) despite similar desires to space and limit births. In fact, in Latin America the proportion of adolescents who have become mothers has actually increased in 14 and decreased in only 3 of the 17 countries studied, even when the adolescent fertility rate has slightly decreased due to the fact that there was a decrease in second births (Slide 6).
The explanation for this intractability of unmet need among adolescents rests on a host of different social conditions in different countries. In many societies, lack of educational opportunities and economic inequalities offer few attractive options to girls other than motherhood. This is especially true for girls living in poverty (Slide 7). A substantial proportion of adolescent mothers declare that their pregnancy was desired even though this proportion seems to be decreasing –at least in the countries in Latin America (slide 8). But an equally substantive proportion –both married and unmarried– wanted to postpone or avoid pregnancy.
The third and related reason for greater attention to the unmet need of adolescents is that a pervading factor that affects both wanted and unwanted pregnancies of adolescents in most societies is the basic question of young people’s sexual rights.
This might be surprising because when we think of unmet need the first thing that comes to mind is supply of contraceptives and availability of services. And indeed, they are basic. Without contraceptives, women of any age will – by and large – be unable to realize their own desire to avoid a pregnancy. The same applies to young women as well. Married and unmarried adolescents alike need information and access to contraceptive methods so that they can avoid a pregnancy they do not want. But young women face deep social and psychological barriers that older women normally do not face. And they all have their roots in the denial of young women’s sexual rights.
In most societies there is a deep resistance to recognize young people as subject of rights, and an equally strong denial of the recognition of them as sexual beings. The deadly combination of these entrenched values takes different shapes and forms in different cultures and different societies. While in some places young women are forced into early marriages with the expectation that they produce sons whether or not they want it, in others good girls are still expected to remain virgins until marriage no matter how late that might occur.
Even in societies where the enforcement of virginity taboos is rapidly eroding or no longer prevails, still very little public policy support exists for programs that address young people’s sexuality in a non-judgmental way. Good quality comprehensive sexuality education is very rarely available in schools, much less for the millions of adolescents who are out of school. Rigorous studies have shown that comprehensive sexuality education works but resources for its large-scale implementation are far from the top of the agenda, even for those trying to address unmet need. Youth friendly services remain a boutique endeavor.
Equally or perhaps even more damaging is the other side of the coin: the feeling of lack of entitlement to education and services among young women. The lack of society’s recognition of their sexual rights and the absence of public policies to fulfill those rights makes it inconceivable for many of them to use services that might be available and used by older women.
So, what is the advocate for meeting the unmet need to do? Push for continuing strong endorsement of the Millennium Development Goal 5 b at all relevant international fora? Yes. Keep adolescent fertility as the most important indicator among those related to 5b? Yes. Advocate for resources earmarked to young women’s services and education? Yes. Advocate for gender-sensitive comprehensive sexuality education in schools? Yes. Support policies to empower young women economically? Absolutely! Support the right to abortion for women of all ages? Of course! But above all, promote the sexual rights of young women, their full recognition as rights bearers, according to their evolving capacity.