ADVOCATES FOR YOUTH

The Facts

The Sexual and Reproductive Health of Youth: A Global Snapshot

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At the beginning of the new millennium, about 1.7 billion people —more than a quarter of the world's population—were between the ages of 10 and 24, 86 percent living in less developed countries.¹ Worldwide, many youth have had sexual intercourse and are at risk of sexually transmitted infections (STIs), including HIV, or of involvement in unintended pregnancy. Research based reproductive health programs can provide youth with the information, support, and services they need to make responsible decisions about their sexual health.

Sexual Activity among Teens Varies by Region.

• Premarital sexual intercourse is common and appears to be on the rise in all regions of the world.¹ Young people everywhere reach puberty earlier and marry later than in the past. As a result, youth are sexually mature for a longer period of time prior to marriage.²
• Youth's degree of sexual experience varies across regions, but is generally consistent within regions. Studies of female youth suggest that two to 11 percent of Asian women have had sexual intercourse by age 18; 12 to 44 percent of Latin American women by age 16; and 45 to 52 percent of sub-Saharan African women by age 19.³ In developed countries, most young women have had sex prior to age 20—67 percent in France, 79 percent in Great Britain, and 71 percent in the United States.⁴
• Among male youth, studies suggest that 24 to 75 percent of Asian men have had sex by age 18; 44 to 66 percent of Latin American men by age 16; and 45 to 73 percent of sub-Saharan African men by age 17.³ In developed countries, most young men have had sex prior to age 20—83 percent in France, 85 percent in Great Britain, and 81 percent in the United States.⁴
• Studies indicate same-sex sexual behavior among males throughout the world—among 13 percent of literate males in Lambayeque, Peru; 10 percent of males attending night school in Lima, Peru; six percent of university males in Dumaguete City, the Philippines; and 10 percent of STI clinic attendees in New Dehli, India.³ In the United States, between 10 and 14 percent of males report having had sex with another male.⁵ Forty percent of these men report the same-sex sexual behavior as occurring before age 18, and not since.⁶
• Youth's sexual activity is not always consensual. Some countries—such as Bangladesh, Brazil, and Thailand—report that many children are forced into prostitution.¹ In the United States, studies suggest that about one in three young girls and one in six young boys may have experienced at least one sexually abusive episode before adulthood.⁷

Adolescent Pregnancy and Childbearing Is a Major Concern.

• Adolescent pregnancy and childbearing are associated with a range of outcomes detrimental to teens' health, including complications of pregnancy, illegal or unsafe abortion, and death, especially in less developed nations.⁸ When compared to women in their mid-twenties, women under age 15 are at 25 times greater risk of dying from complications related to pregnancy or childbirth; 15- to 19-year-old women are at twice the risk.⁹
• Although rates of adolescent childbearing are declining in many countries, 15 million women ages 15 to 19 give birth every year, 13 million in less developed countries.^1,2 Overall, 33 percent of women from less developed countries give birth before the age of 20—varying from eight percent in East Asia to 55 percent in West Africa.¹
• In developed countries, up to 10 percent of women give birth by age 20, except in the United States, where up to 19 percent give birth by age 20.¹
• Worldwide, mostly as a result of unintended pregnancy, nearly four and a half million adolescents undergo abortion each year; 40 percent occur under unsafe conditions.⁹

Contraceptive Knowledge and Use Vary by Region.

• While over 90 percent of teenage women in most countries in Asia, North Africa and the Near East, and Latin American and the Caribbean knew at least one contraceptive method, in sub-Saharan Africa knowledge levels were generally lower. Teens who had not yet had sex were the least knowledgeable about contraception in every country except Nigeria.⁸
• While knowledge of contraception may be widespread, relatively few teenage women in most countries use contraceptives. Two percent of sexually active young women in Niger, Rwanda, and Senegal reported using contraception; 23 percent in Cameroon; one percent in the Philippines; 34 percent in Indonesia; and less than 11 percent throughout Latin America and the Caribbean.⁸ In some developed countries, most sexually experienced teenage women use hormonal contraception and/or condoms: 88 percent in France; 92 percent in Great Britain; and 75 percent in the United States.⁴

Barriers to Adolescent Sexual and Reproductive Health Remain.

• In most countries, adolescents face significant barriers to using contraception. Service-related barriers include incorrect or inadequate information, difficulty in traveling to and obtaining services, cost, and fear that their confidentiality will be violated.^1,2,8,10
• Personal barriers that especially deter young women from accessing and using contraception include fear that their parents will find out, difficulty negotiating condom use with male partners, fear of violence from their partner, and concerns about side effects.^1,10,11
• Social, cultural, and economic factors also greatly influence young people's ability to protect themselves from unwanted pregnancy and STIs, including HIV. Mass media, materialism, migration and/or urbanization may increase both the desire and opportunity for sexual activity, and many youth feel strong peer group pressure to engage in sexual intercourse.¹ Some cultures may promote early sexual intercourse by expecting women to marry and begin childbearing at an early age.¹¹

Effective Programs Include Important Components.

Around the world, effective programs improve sexual health and promote healthy sexual decisions among young people. The following components are often included in effective programs:

• Accurate information and age-appropriate services that focus on behaviors ^2,10,12
• Youth-friendly, confidential contraceptive services²
• Culturally appropriate information and services²
• Gender-specific information and services that address young women's needs and pay attention to their less than equal power status in many relationships¹³
• Services geared specifically to the sexual health needs of young men²
• Peer education and outreach²
• Activities to build skills in communication and negotiation^2,10,12
• Meaningful involvement by youth in programs' design and operation¹⁴
• Involvement of parents and other community members.¹⁴

Many effective programs also provide integrated services to create an empowering environment for young people and to address their multiple needs.

References

1. Boyd A. The World's Youth 2000. Washington, DC: Population Reference Bureau, 2000.
2. James-Traore T et al. Advancing Young Adult Reproductive Health: Actions for the Next Decade: End of Program Report. Washington, DC: FOCUS on Young Adults, 2001.
3. Brown AD et al. Sexual Relations among Young People in Developing Countries: Evidence from WHO Case Studies. Geneva: World Health Organization, 2001.
4. Darroch JE et al. Differences in teenage pregnancy rates among five developed countries: the role of sexual activity and contraceptive use. Fam Plann Perspectives 2001; 33:244-50+.
5. American Association for World Health. AIDS: All Men Make a Difference! Washington, DC: The Association, 2000.
6. Michael RT et al. Sex in America: A Definitive Survey. Boston: Little, Brown & Co, 1994.
7. Eng TR, Butler WT, ed. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press, 1997.
8. Blanc AK, Way, AA. Sexual behavior and contraceptive knowledge and use among adolescents in developing countries. Studies in Family Planning 1998; 29:106-16.
9. United Nations Population Fund. Fast Facts: Young People and Demographic Trends. New York: UNFPA, 2000. [http://www.unfpa.org/adolescents/facts.htm]
10. Senderowitz J. Reproductive Health Programs for Young Adults: Health Facility Programs. Washington, DC: FOCUS on Young Adults, 1998.
11. Alan Guttmacher Institute. Into a New World: Young Women's Sexual and Reproductive Lives. New York: The Institute, 1998.
12. Centers for Disease Control & Prevention. HIV Prevention Saves Lives. Atlanta, GA: The Centers, 2002.
13. Centers for Disease Control & Prevention. HIV/AIDS among US Women: Minority and Young Women at Continuing Risk. Atlanta, GA: The Centers, 2002.
14. James-Traore TA. Developmentally Based Interventions and Strategies: Promoting Reproductive Health and Reducing Risk among Adolescents. [FOCUS Tool Series, 4] Washington, DC: FOCUS on Young Adults, 2001.

Written by Andrés Meléndez Salgado and Nicole Cheetham
January 2003 © Advocates for Youth

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