How are adolescent women affected? While data in developed
countries show that early childbearing does not in itself result in more frequent or
serious obstetrical complications,2 in countries where so many
other systems for preserving the health of mothers and children are inadequate, early
childbearing is associated with considerable danger. WHO describes two studies—one in
Bangladesh and another in Nigeria—that highlight the impact of age on maternal
mortality. The maternal mortality ratio (MMR) among young women in Bangladesh (aged 15 to
19 and 10 to 14, respectively) was two to five times that of their counterparts aged 20 to
24. In Nigeria, the MMR was 2.5 times higher for 16-year-olds than for women aged 20 to
24. And for Nigerian girls under 15 years, the MMR was seven times that of their 20 to
24-year-old counterparts.3 Compounding the risks, some African
adolescents suffer from consequences of genital mutilation that make delivery more
difficult. Adolescent women are also at high risk from certain STDs including HIV/AIDS. In
addition, adolescent women in Africa experience a disproportionate number of both
spontaneous and induced abortions.4, 5
Why are adolescents at risk? The physical and maturational
changes of adolescence can lead young people to make reckless choices. Psychological
research has revealed that adolescents—who often feel the need for attention from
peers as they gain independence from parents—are willing to take risks as they
experiment to define their own identity.6 In addition,
adolescents are often unable to express how the emotional and physical changes they are
experiencing are affecting them. This also puts them at risk. Parents and elders say they
don’t understand adolescent behavior—but often neither do the teenagers. And,
when adolescents are told by adults to behave in a way that contradicts the behaviors they
observe in their elders, these young people may lose trust in adults. Parents are the
primary educators of their children; however, parents often feel uneasy with this role
when dealing with questions of sex and reproductive health. Adolescents want to
communicate with their parents and elders and to obtain information from them—and
they are more likely to do so when they are treated with respect and without judgment.
Many adolescents are ignorant of their reproductive health needs; yet, even when they are
aware of these needs, they often discover that services are not accessible to
them—which perpetuates their risk.
Adolescents
in the Central African Republic. Are these happy and healthy young women at risk
for unintended pregnancy and its consequences?
Are family planning services appropriate for adolescents?
Because many African societies encourage marriage and fertility at an early age, some
leaders feel that family planning services are not appropriate for this population.
Services are still associated with greater sexual freedom. Extensive research in the
United States, however, shows that programs that teach young people about contraceptives
and make them available do not cause adolescents to start sex earlier than they would
otherwise. In some cases, programs help delay the onset of sex.7
In designing acceptable programs oriented to adolescents, the real and immediate needs of
a particular adolescent population must form the basis for any intervention.8
What are the consequences of lack of access to reproductive health services
for Africa’s adolescent population? In every country of the region,
newspapers have published numerous stories of tragedy befalling young women and men.9 Some reports portray devastating results when traditional village
lifestyles are exposed to urban problems (e.g, young domestic workers return from the city
infected with the HIV virus and spread this disease within their community). Other news
stories warn of the dangers of urban life (e.g., easy access to drugs and exposure to
media images that glorify high-risk sexual behavior). Often, the adolescents portrayed are
not married and may have left the traditional way of life. Lack of financial resources may
push young men and women along more dangerous routes: that of exchanging sex for money,
unsafe abortion, infanticide or even suicide.10, 11
These news stories can be valuable in starting dialogues about the needs of adolescents in
local African communities.
Linking Adolescent Reproductive Health Education with Services
Adolescent reproductive health programs should seek to link reproductive health
education with access to a range of services that respond to each young client’s
specific needs. For example, sexually inactive teens may need to know where they can get
guidance about or protection from unwanted sexual advances; whereas, sexually active young
people, particularly the unmarried, need counseling in how to choose and where to obtain
an effective contraceptive to avoid unintended pregnancy, unsafe abortion and STDs.6
So far in Africa, efforts have been twofold. Under the leadership of the United Nations
Population Fund (UNFPA), many countries have developed and introduced Family Life
Education (FLE) curricula in schools. Sometimes, however, FLE programs may respond to
pressures that cause them to dilute the sexuality education material and, thus, lose their
impact on adolescent reproductive health. Nongovernmental organizations (NGOs) or youth or
women’s associations in almost every country have launched innovative projects. For
example, many NGO peer-to-peer programs have demonstrated success in reaching adolescents
with education, information and condoms. Indeed, these peer education programs are often
the only means of reaching out-of-school teenagers. In some cases, innovations by NGOs
have inspired Ministries of Health to replicate NGO models. For the most part, however,
the public sector in health has not yet developed comprehensive services to improve the
reproductive health of adolescents, though service providers may see a limited number of
adolescents in their practices and clinics. Nor has any project scaled up to cover more
than a small proportion of the total adolescent population in need.
It will take time before societies, local communities, and parents of adolescents
accept that adolescence is a time when it is normal to take an interest in sex and even
experiment. Perhaps, when we learn to communicate openly about sexuality and reinforce
efforts to clarify values and develop a positive self-image, we will have made the most
progress in protecting the reproductive health of young and old alike.
2Makinson C. 1985. The health consequences of teenage
fertility. Family Planning Perspectives 17(3): 132–139.
3AbouZhar C and E Royston. (eds). 1991. Maternal
Mortality; A Global Factbook. WHO: Geneva, Switzerland.
4Noble J, J Cover and M Yamagishita. 1996. The
World’s Youth 1996. Population Reference Bureau: Washington, DC, USA.
5Kinoti SN et al. 1995. Monograph on Complications of
Unsafe Abortion in Africa. Reproductive Health Programme of the Commonwealth Regional
Health Community Secretariat for East, Central and Southern Africa. JHPIEGO Corporation:
Baltimore, Maryland, USA.
6McCauley AP et al. 1995. Meeting the needs of young
adults. Population Reports. Series J: Family Planning Programs. (41): 1–43.
7 Kirby D. 1994. School-based programs to reduce
sexual risk-taking behaviors: Sexuality and HIV/AIDS education, health clinics and condom
availability programs. (Unpublished)
8 Njau W, S Radeny and R Muganda (eds). 1992. A
Summary of the Proceedings of the First Inter-Africa Conference on Adolescent Health.
Center for the Study of Adolescence: Nairobi, Kenya.
9 Les Jeunes en danger; Résultats d’une étude
régionale dans cinq pays de l’Afrique de l’Ouest (Youth in danger; Results of a
regional study in 5 West African countries). 1996. CERPOD: Bamako, Mali.
10 Diadhiou F. 1990. L’adolescente gère mal sa
fécondité. Incertitude et quête de soi dans une société en transition (The adolescent
manages her fertility badly. Insecurity and pursuit of self in a society in transition).
Pop Sahel (13): 12–13.
11 Senanayake P and M Ladjali. 1994. Adolescent
health: Changing needs. International Journal of Gynecology & Obstetrics 46(2):
137–143.
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