Globally, 16 million girls aged 15-19 years and two million girls under age 15 give birth every year. In the poorest regions of the world, this translates to roughly one in three girls bearing children by the age of 18.
Adolescent girls are at the highest risk of maternal death: the risk of pregnancy-related death is twice as high for girls aged 15-19 and five times higher for girls aged 10-14 compared to women in their twenties.
In humanitarian settings, child-bearing risks are compounded for adolescents, due to increased exposure to forced sex, and reduced availability of and sensitivity to adolescent sexual and reproductive health services. At the same time, adolescents in humanitarian settings will have similar needs and desire for sexual and reproductive health information and services as their peers in non-crisis settings.
Although adolescent sexual and reproductive health is receiving more attention in humanitarian settings, there is little documentation of progress to date, or of programs that effectively integrate SRH services, including family planning, for this age group.
To address this gap, the Women's Refugee Commission and Save the Children—in partnership with the United Nations High Commissioner for Refugees (UNHCR) and the United Nations Population Fund (UNFPA)—undertook a year-long exercise to map existing adolescent sexual and reproductive health programs that have been implemented since 2009 and document good practices. Findings and recommendations are summarized in our joint report: Adolescent Sexual and Reproductive Health Programs in Humanitarian Settings: An In-depth Look at Family Planning Services.
We accomplished our work through a practitioner survey and humanitarian funding analyses; key informant interviews; and collection of good practice case studies. The survey reached 1,200 individuals through various listservs.
Based on the more than 200 responses we found that:
--A mere 37 programs focused on the SRH needs of 10- to 19-year-olds in humanitarian settings since 2009.
--Only 21 of these programs offered at least two methods of contraception.
--Of the programs that offered at least two methods of contraception, none were in acute onset emergency settings.
--Proposals for adolescent sexual and reproductive health through humanitarian funding streams constituted less than 3.5% of all health proposals per year.
--The majority of these proposals have gone unfunded.
Despite this lack of programming, promising practices for ASRH in humanitarian settings exist. Three programs among the 21 programs offering at least two methods of contraception were identified to be “effective” in their delivery of SRH services by demonstrating enhanced contraceptive uptake: Profamilia in Colombia, the Adolescent Reproductive Health Network in Thailand and Straight Talk Foundation in northern Uganda.
Additionally, several programs show noteable approaches, including utilizing a consortium model to address the needs of this population; providing ASRH services within school-based programs; working with urban displaced populations; and incorporating ASRH into disaster risk reduction activities. Successful programs have secured community and adolescent involvement; are responsive to the different needs of adolescent sub-populations; and provide holistic and multi-sectoral services.
There is an urgent need to scale up services for ASRH in humanitarian settings from acute emergency through protracted crises and development. Investing in ASRH may help delay first pregnancy, reduce maternal death, improve health outcomes, contribute to broad development goals and reduce poverty.