Improving access to sexual reproductive health services for adolescents

Author: Shebana Alqaseer, Technical Advisor for Adolescent Sexual and Reproductive Health, Save the Children Philippines, and Shubha Kamana Mandal, Technical Manager – Health and Nutrition, Save the Children Nepal

The importance of supporting adolescent sexual and reproductive health and rights (SRHR) cannot be overstated. The Global Adolescent Forum, which took place last week, was an example of young people and advocates coming together to sound the alarm for adolescent well-being.

It is time for governments, leaders and policy makers to address the pressing issues affecting our young people

Our goal is clear: to ensure that every single adolescent has access to comprehensive information, high-quality services and genuine support for their SRHR.

In some countries, such as Nepal and the Philippines, deep-rooted cultural norms mean that adolescents face barriers to accessing services or information about reproductive health and reproductive health. and reproductive reproductive and reproductive reproductive and reproductive reproductive, reproductive and reproductive reproductive and reproductive reproductive and reproductive reproductive and reproductive reproductive, reproductive and reproductive reproductive and reproductive reproductive and reproductive reproductive, reproductive and reproductive reproductive and reproductive reproductive and health In Nepal, where a a fifth of the population are adolescents, discussions about adolescent reproductive and reproductive health and reproductive health are often considered taboo. This is just one of the multiple challenges faced by adolescents, which include gender inequality, lack of education and information about reproductive and reproductive health and reproductive health, and limited access to health services. These challenges contribute to high rates of child, early and forced marriage; unwanted pregnancy; sexual coercion; violence by an intimate partner; and sexually transmitted infections (STIs), including HIV.

in Nepal, 14% adolescent girls experience pregnancy between the ages of 15 and 19, rising to 19.8% in Madhesh province. Worryingly, 8.8% of girls and boys aged 10-14 and 26.6% of girls and boys aged 15-17 are currently married in Madhesh, which is higher than the national average. Nepal Although national policies in 2000 and 2019 prioritized adolescent SRHR, there have been few concrete actions to address these challenges.

Adolescents in the Philippines have similar challenges, with one out of every ten births for girls under 19 years old. Every hour, adolescent mothers give birth to a total of 24 babies more than 200,000 births per year. As a majority Catholic nation, deep-rooted cultural and religious norms make discussions of adolescent sexuality and SRHR taboo. These norms have been ingrained in society for generations and their impact is deeply felt, perpetuating stigma and shame around these key topics. Consequently, adolescents in the Philippines are denied the full exercise of their sexual and reproductive rights, leaving them without adequate support systems to successfully navigate the challenges of adolescence.

Engaging the entire community in the Philippines

There is an urgent need to address adolescent pregnancy and create a safe and supportive environment where young people can access information, services and support related to sexual and reproductive health and wellness. To address this, Save the Children Philippines has adopted a socio-ecological model that recognizes that adolescents, their families, their communities, and local government units and agencies are critical to achieving results for adolescent SRHR. Adolescents do not exist in isolation; they are an integral part of the family, which is why it is important to include parents and caregivers in discussions about reproductive and reproductive reproductive health and rights.

An adolescent girl talks about adolescent problems to local government officials in the Philippines.

Realizing the multiple, intertwined impact of early and unwanted pregnancies, Heart, 15, talks about how she participates in outreach programs to raise awareness.

“We gather young people and take turns talking to them about different topics. We usually talk to children of our age, around 13-16 years old. And since I attended a Save the Children seminar where they talked about ways to prevent teenage pregnancy, I came up with the idea to convince children to study hard and avoid marriage when they are young.” Heart explains.

Save the Children believes that families must be equipped with the knowledge and skills necessary to provide guidance and support to young people. Save the Children’s Reduction Early Teenager Pregnancy (REAP) Project in the Philippines is working to improve access to information about reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive and reproductive reproductive and reproductive and reproductive reproductive and reproductive and reproductive reproductive and reproductive and reproductive and reproductive and reproductive, reproductive and reproductive and health information communication skills among their parents. This approach led to a 28% increase in the number of new family planning users among young mothers aged 15 to 19. Save the Children continue equip parenting advocates with vital knowledge and skills participate in open discussions about adolescent development, adolescent reproductive health, and positive discipline strategies.

Mirma Madrona, Program Manager of Save the Children Philippines, expressed the importance of support systems for adolescents:

“It is important that adolescents have the support system they need to help them reach their full potential. Working with adolescents motivates me to constantly learn and work to be a support system that respects, fulfills and protects their rights.”

Consultations with parents of adolescents

In addition to working with parents of adolescents, Save the Children Philippines works to engage adolescents, men and community leaders in the promotion and protection of adolescent rights. This not only details behavior change, but also focuses advocacy on policy change. Working with like-minded civil society and women’s rights organizations in the Philippines, Save the Children was instrumental in advocating for the Adolescent Pregnancy Prevention Bill in Congress, which seeks to provide adolescents with access to reproductive and reproductive rights products and services, strengthen comprehensive sexuality education and establish social protection mechanisms for parents of adolescents and their children. This bill will help remove barriers for parents of teenagers, including those related to health, education and economic support.

Improving SRHR knowledge among adolescents, families and health care providers in Nepal

Save the Children Nepal works with adolescents, boys and girls, families, communities and the health system to support the Government of Nepal in improving reproductive and adolescent health and ensuring universal access to reproductive and reproductive health and health services. To expand adolescent-friendly health services, we strengthened the capacity of health workers, expanded access to necessary equipment, and supported the development and use of communication and counseling materials.

Furthermore, Save the Children adopted a new approach that ensures the participation of adolescents in improving the quality of health services. To complement the system strengthening work, Save the Children Nepal and our local partners also work with adolescents and their families to increase their knowledge and acceptance of services and to develop enabling environments for adolescents within their families and communities.

Married and unmarried adolescent girls are included through Save the Children’s Healthy Transition curriculum. The curriculum supports married adolescents in parenthood and trains them to take better care of themselves and their children. Healthy Transitions offers bimonthly small group meetings for enrolled adolescent girls and uses a participatory, comprehensive curriculum focused on maternal and newborn health, marriage, gender roles, family planning, mental health, self-efficacy, and financial literacy. Until 2019–20 assessment the first cohort of young women to complete one year of the Healthy Transitions curriculum found an increase in current use of modern contraceptive methods (from 26% to 33%) among married young people, as well as decreased support for statements about gender inequality.

The Healthy Transitions curriculum is currently being implemented in 31 groups in Sarlahi and Mahottari districts of Nepal, and the adolescent girls involved in this group are experiencing drastic changes in their knowledge and practice. Girls who were once participants now lead these sessions. These interventions aim to reduce early marriage and pregnancy, contributing to the reduction of maternal and newborn morbidity and mortality, and helping adolescent girls continue their education so they can achieve their ambitions.

Earlier, we could not understand our sexual and reproductive health even though it is in our curriculum. The teachers would suggest that we read the chapter on our own and also feel ashamed to talk openly with the teacher in the presence of a male classmate. But now after joining a Healthy Transitions session, we’ve learned about our own bodies and can confidently talk about our problems in a group.” Sharda* enrolled in Healthy Transitions session, Nepal

Adolescent girls discuss SRHR issues during a Healthy Transitions session.

Mother and sister of an adolescent girl (left) participating in Healthy Transitions. Her mom feels good about it and her little sister benefits too.

Work together now to ensure a brighter future for adolescents

Leaders must understand that access to reproductive health and reproductive health is not just about health care, but about ensuring that every young person in the world can reach their full potential. It is a matter of social justice, empowerment and transformation. We must work together to ensure a brighter future for adolescents and write a new story where they can grow, learn and thrive in an environment of support, understanding and opportunity.

Early and unintended adolescent pregnancies have reached a critical point, requiring a comprehensive response that not only challenges deep-rooted cultural and religious norms and prejudices, but also aims to change behavior and mindsets. The way forward brings challenges, but through our joint efforts, there remains hope, supported by the progress we and other like-minded organizations have made so far, for a more inclusive, informed and empowered generation of adolescents.

The photo at the top of the page shows Nisha* (right), 13, with a kid’s club colleague at a rally against child marriage in their village in Nepal (photo: Suzanne Lee / Save the Children).

*We have changed the names of Sharda and Nisha to protect them.

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