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The Reproductive and Sexual Health of Adolescent Girls in Low and Middle Income Countries


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There are over 600 million girls (aged 10 to 19) in the world today; more than 500 million of them live in low and middle-income countries.[1] Although girls are half the youth population, little attention has been given to the specific challenges facing adolescent girls as they develop into adult members of society.[2] Further, gender inequality persists in communities around the world, marginalizing adolescent girls and challenging their opportunities for a better present and future. Society has a responsibility to invest in adolescent girls’ education, health, safety, economic security, and citizenship in order to ensure an environment where girls can exercise their rights, prosper, and help uplift their communities and nations. 

More girls than ever are completing primary school but secondary school completion still lags in spite of contributions to economic development. 

  • Out of the world’s 130 million out-of-school youth, 70 percent are girls.[3]
  • In the least developed countries, one third of young women aged 15-24 cannot read.[4]
  • The share of girls in the total number of out-of-school children in South and West Africa fell from two-thirds in 2000 to less than one-half in 2012.[5]
  • Progress in South and West Asia has been especially notable for girls since 2000, when nearly three in five out-of-school children were female, compared to less than one-half in 2012.[5]
  • In some countries such as Nepal, Guatemala, and Vietnam, the percentage of poorest girls who had completed primary education was higher in 2010 than the national average in 2000. For example, in Cambodia, only 11% of the poorest girls had completed primary school in 2000, but 43% of the poorest quintile of girls had completed primary school by 2010.[5]
  • However, secondary school completion among girls is still relatively rare in the poorest countries of the world.[23] While there is considerable variation in secondary school completion across Africa, in most countries within the region, well below 50 percent of girls complete school and in some countries, the number is less than 5 percent.

Adolescent girls face a number of sexual and reproductive health challenges, including maternal death, HIV, and complications with pregnancies. 

  • Girls (aged 15-19) account for 11 percent of all births and around 14 percent of all maternal deaths, with around 50,000 girls dying from maternal causes annually.[4]
  • Complications during pregnancy and childbirth are the second leading cause of death for 15-19 year-old girls globally, after suicide.[7]
  • In 2013, almost 60% of all new HIV infections among young people aged 15–24 occurred among adolescent girls and young women.[8]
  • In sub-Saharan Africa, 76 percent of the young people aged 15-24 living with HIV are female.[9]
  • In many settings, marriage also represents an increased risk of HIV infection. A study in Kenya and Zambia found that married adolescent girls had rates of HIV that were 50% higher than those girls who were unmarried and sexually active; those elevated rates of infection were associated with more frequent intercourse, virtually no condom use, and older partners who were more likely to be HIV-positive.[10]

The safety of girls is of concern due to their increased risk of sexual assault, harmful traditional practices, and human trafficking.

  • The World Health Organization estimates that some 150 million adolescent girls experience forced sex or other forms of sexual violence in a single year.[11]
  • Adolescent girls are vulnerable to violence within marriage, including sexual violence. In the Democratic Republic of Congo, 70 percent of girls (aged 15-19) who have ever been married reported having experienced violence at the hands of a current or former spouse.[4]
  • More than 125 million girls and women have undergone female genital  mutilation/cutting in the 29 countries in Africa and Middle East.[12]
  • One woman dies every hour due to dowry related reasons. In 2012, there were 8,233 dowry deaths in India.[13]
  • Of every 3 children trafficked, 2 are girls.[14]

Adolescent girls face limited economic security due to lack of access to bank services and property.

  • Women and girls comprise half of the world’s population but own only one percent of the wealth.[15]
  • Some 75 percent of the world’s women cannot get bank loans because they have unpaid or insecure jobs and are not entitled to property ownership.[15]
  • Women produce between 60 and 80 percent of the world’s agricultural product, yet they own less than 5 percent of the world’s titled land.[16]
  • When girls and young women are able to choose to delay marriage and have planned pregnancies, their per capita income and savings increase which results in national income growth.[3]

Lack of citizenship and legal rights restrict adolescent girls’ ability to become full members of society.

  • Even though most countries do have birth registration laws, every year 51,000,000 children under age 5 are not registered at birth, most of whom are girls. Without the ability to gain employment and identification in these sectors, women and girls are confined to the home and left unpaid and often invisible members of society.[17]
  • One third of the world’s girls are married before the age of 18.[18]
  • In 146 countries, state or customary laws allow girls younger than 18 to marry with the consent of parents: in 52 countries, girls under age 15 can marry with parental consent. In contrast, 18 is the legal age for marriage without consent among males in 180 countries. The lack of gender equality in the legal age of marriage reinforces the social norm that it is acceptable for girls to marry earlier than boys.[11]
  • One girl in 10 has a child before the age of 15 in Bangladesh, Chad, Guinea, Mali, Mozambique and Niger.[11]

There are tremendous economic benefits to investing in adolescent girls.

  • Every year of schooling increases a girl’s individual earning power by 10 to 20 percent, while the return on secondary education is even higher, in the 15 to 25 percent range.[3]
  • If all girls completed secondary school in Kenya, they would add US$27 billion to the economy over their lifetimes.[19]
  • Globally, estimates show that closing the gender gap in employment rates between women and men would increase the global GDP by up to 5.4 percent.[20]
  • Investing US$8.1 billion a year in voluntary family planning would reduce unintended pregnancies by more than 66 percent, prevent 30 percent of maternal deaths, avert 20 percent of newborn deaths, and reduce unsafe abortion by 40 percent.[21]

Advocates for adolescent girls are making progress. 

  • In nine countries within Asia and Africa, a program devoted to girls’ formal secondary education has enrolled over 13,500 girls in school. The program offers a number of education enhancements for girls including gender-responsive teacher training, mentoring, academic support, infrastructural support to provide safety and security, life skills, and for a small number of the neediest girls, some material support.[22]
  • In Bangladesh, a group has incorporated microcredit into its programs for adolescent girls. The Employment and Livelihood for Adolescents program provides a basic loan to young women ages 14-25 years. The program scaled up rapidly in 5 years to include more than 300,000 members.[20]
  • In Nicaragua, a project seeks to empower girls aged 10-14 and reduce barriers to their sexual and reproductive health by building friendships and providing them with safe environments in which to discuss their problems. The project activities include a soap opera, and all-girls soccer team, and regular gatherings at community centers and churches for discussions among mothers, teachers, and girls themselves. An evaluation found increased knowledge of sexual and reproductive health among girls and their mothers, as well as changes in behavior in many girls.[23]

Written by Lizzy Menstell, member of Advocates for Youth’s International Youth Leadership Council; and Nicole Cheetham, MHS, Director of International Youth Health and Rights Division.

Advocates for Youth © 2015


1. World Population Day 2013 Focuses on Adolescent Pregnancy. United Nations Population Fund Web site. http://www.unfpa.org/public/home/news/pid/14426  July 11, 2013. Accessed October 24, 2014 

2 The World Bank. Measuring the Economic Gain of Investing in Girls http://www.girleffect.org/resources/2011/8/measuring-the-economic-gain-of-investing-in-girls/  August 2011. Accessed October 23, 2014

3. United Nations Foundation. Why Invest in Adolescent Girls. http://www.clintonglobalinitiative.org/ourmeetings/PDF/actionareas/Why_Invest_in_Adolescent_Girls.pdf Accessed October 27, 2014 

4. The United Nations Children’s Fund. Progress for Children, a report card on Adolescents. http://www.unicef.org/publications/files/Progress_for_Children_-_No._10_EN_04232012.pdf.  April 2012. Accessed October 17, 2014.

5.   United Nations Educational, Scientific and Cultural Organization. Progress in getting all children to school stalls but some countries show the way forward. http://unesdoc.unesco.org/images/0022/002281/228184E.pdf. June 2014. Accessed October 24. 

6. Population Council. New Lessons: The Power of Educating Adolescent Girls. http://www.girleffect.org/resources/2009/10/new-lessons-the-power-of-educating-adolescent-girls/ 2009.  Accessed October 23, 2014. 

7. WHO calls for stronger focus on adolescent health. World Health Organization Web site.  http://www.who.int/mediacentre/news/releases/2014/focus-adolescent-health/en/ May 14, 2014. Accessed October 24. 

8. Joint United Nations Program on HIV/AIDS. The Gap Report.http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/unaidspublication/2014/UNAIDS_Gap_report_en.pdf. Updated September 2014. Accessed October 20, 2014

9.  Promoting Gender Equity: The Gender Dimensions of the AIDS Epidemic. United Nations Population Fund Web site. http://www.unfpa.org/gender/aids.htm Assessed October 24, 2014.

10. Erulkar A, Muthengi E. Evalution of Berhane Hewan: A Program to Delay Child Marriage in Rural Ethiopia. Guttmacher Institute. March 2009; 35(1) http://www.guttmacher.org/pubs/journals/3500609.html Accessed October 24, 2014. 

11. United Nations Population Fund. Motherhood in Childhood: facing the challenge of adolescent pregnancy. http://www.unfpa.org/webdav/site/global/shared/swp2013/EN-SWOP2013-final.pdf. 2013. Accessed October 17, 2014.

12. Female genital mutilation. World Health Organization Web site. http://www.who.int/mediacentre/factsheets/fs241/en/. Updated February 2014. Accessed October 24, 2014. 

13. National Crime Records Bureau. Crime against Women. http://ncrb.nic.in/CD-CII2012/cii-2012/Chapter%205.pdf. 2012. Accessed October 24, 2014.  

14. United Nations Office on Drugs and Crime. Global Report on Trafficking in Persons. http://www.unodc.org/documents/data-and-analysis/glotip/Trafficking_in_Persons_2012_web.pdf. 2012. Accessed October 24, 2014. 

15. Gender and Poverty Reduction. United Nations Development Program Web site. http://www.undp.org/content/undp/en/home/ourwork/povertyreduction/focus_areas/focus_gender_and_poverty/. 2014. Accessed October 27, 2014. 

16. Plan International. Economic Security Strategy 2010-2015: Promoting the Economic Rights of Children and Young People. http://plan-international.org/files/global/publications/about-plan/economic-strategy-2015. May 2012.  Accessed October 27, 2014 

17. Federal Bill. Girls Count Act of 2013. https://www.govtrack.us/congress/bills/113/hr3398/text. Introduced October 30, 2013. Accessed October 27, 2014. 

18. Child Marriage Facts and Figures. International Center for Research on Women.  http://www.icrw.org/child-marriage-facts-and-figures. 2013. Accessed October 27, 2014. 

19. The Girl Effect. Smarter Economics: Investing in girls. http://www.girleffect.org/resources/2011/8/smarter-economics/. January 2011. Accessed October 27, 2014. 

20.  Adolescent Girls’ Advocacy & Leadership Initiative. Economic Empowerment Strategies for Adolescent Girls. http://www.letgirlslead.org/assets/pdfs/AGALI-Economic-Empowerment-Report-2013-.pdf.  Accessed October 24, 2014 .

21. Women Deliver. Invest in Family Planning and Reproductive Health. http://www.womendeliver.org/assets/Infographic_FamilyPlanning_FINAL.pdf. 2013. Accessed October 27, 2014. 

22. The Girl Effect. Education for Girls: Alternative Pathways to Girls’ Empowerment. http://www.girleffect.org/resources/2013/3/education-for-girls-alternative-pathways-to-girls-empowerment/ February 2013. Accessed October 23, 2014 

23. The United Nations Children’s Fund. Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood. http://www.unicef.org/publications/files/Opportunity_in_Crisis-Report_EN_052711.pdf. June 2011. Assessed October 27, 2014. 

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