U n i v e r s a l h e a l t h c o v e r a g e a n d c ommu n i c a b l e d i s e a s e s and poor access to health services. The overwhelming need to emphasise adolescent SRH in the SADC stems from the morbidity and mortality profile and underlying associated factors, which include high adolescent pregnancy rates, high adolescent mortality rates, unmet need for family planning, child marriage, lack of youth-friendly services and inadequate training of health care workers (HCWs). This article summarises the risk factors for poor adolescent SRH in SADC and provides key recommendations for optimal adolescent health. Risk factors for poor adolescent SRH Gender power inequities: Inequities contribute to early, unprotected sex and teenage pregnancy. Research from South Africa (SA) showed that adolescent girls who were prone to physical violence were at a higher risk of an unwanted pregnancy (Global Health Action, 2014). Child marriage: SSA has the highest percentage of married 15–19-year-olds with percentages in SADC ranging from four per cent in Swaziland and South Africa to 43 per cent in Mozambique (SAGPA, 2014). Child marriage contravenes international law and the Convention the Rights of the Child (CRC, 2003). Most countries in the SADC have set the minimum age for female marriage at 18 but some, including the Democratic Republic of Congo and Zimbabwe, have set it at 15 and 16, respectively (UNFPA, 2012). Mismatch between legislation/regulations and popular practice: In countries like Zambia and Botswana, the permissible age for medical procedure consent (18 and 21 years, respectively) is greater than the median age of females becoming sexually active (17 and 17.5 years, respectively); this legislation hinders adolescent access to key SRH services. In Seychelles, girls over the age of 15 years can consent to sexual intercourse, but it is illegal to provide contraception to a minor (SAGPA, 2014). Sexually active adolescents often settle on using condoms because they are unaware of other methods. Research from SA and Zimbabwe shows that only four to 16 per cent of HCWs provide other methods of contraception to adolescents (Morse et al., 2013). Unsafe abortions: The risk of adolescent maternal death is exacerbated by unsafe abortions. Since abortion is legal in only two SADC countries (South Africa and Zambia), women with unwanted pregnancies are forced to access this service illegally in other countries, risking post-abortion complications and death. In Seychelles, where abortion can only be performed to save the life of the woman, women under 20 years of age are more likely (86 per cent) to access unsafe abortions (SAGPA, 2014). Accessibility of adolescent-friendly services for SRH: Adolescents who attempt to access SRH services, including antenatal maternal care, HIV testing, services to prevent mother-tochild HIV transmission (PMTCT) and antiretroviral treatment, risk 1. Recognise adolescents as a unique population (separate from children and adults) 2. Review adolescent-related policies and laws to reduce mismatch between regulations and current behaviour. Policies and laws that prohibit adolescents from accessing SRH services should be discouraged. Laws on child marriage, termination of pregnancy and the minimum age to access basic services, such as contraception and treatment for STIs, should be reviewed. Policies should encourage pregnant adolescents or adolescent mothers to continue with their education and subsequently seek employment – this requires coherence between the health and education sectors of government 3. Intensify interventions that improve the position of women in society and the environment in which adolescents live. Adolescent behaviour change will not be sustained if their environment does not promote healthy behaviours. Interventions should target (i) adolescent males and females; (ii) other significant people in the adolescent’s environment (partners, parents, teachers, health and social service workers); (iii) organisations (schools, health services); (iv) social structures; and (v) the legal environment 4. Invest in parent education or orientation to improve family functioning, resilience and communication. All of these things are developmentally essential for optimal adolescent health. Community and faith-based organisations provide a simple platform to accomplish this in the SADC region, even though these have traditionally not been involved in adolescent health. A positive relationship between adolescents and their 54 Commonwealth Health Partnerships 2015 families, peers and communities has been shown to be protective and promote positive adolescent health outcomes (Viner et al., 2012) 5. Develop adolescent-friendly care within the health system. Each encounter with an adolescent is an opportunity to reduce their personal risk of early pregnancy or poor health outcome. Such care should provide adolescents with the motivation, skills, services and commodities of proven efficacy (condoms, contraception, antiretroviral drugs, HIV tests) to protect themselves 6. Expand adolescent health information to schools. Including SRH education as part of the school curriculum has been shown to decrease sexual risk and encourage sexual health among adolescents (Bearinger et al., 2007). SRH education should also be offered as a package that includes information on HIV, STIs, contraception and unintended pregnancy 7. Implement and evaluate innovative ways to distribute contraception and other health information to adolescents. These include mobile outreach programmes or task-shifting contraceptive provision to community-based providers. A review by Koon et al. suggests that the use of generalist or specialist adolescent community health workers could facilitate engagement with adolescents and promote uptake of adolescent health messages. The adoption of a youth peer provider model in Latin America, where youth peer providers under the age of 20 years are trained to provide condoms, oral contraceptive pills, emergency contraception, injectable contraceptives and SRH health information to their peers has had a high success rate (Tebbets et al., 2013) Priorities for improving adolescent SRH
Commonwealth Health Partnerships 2015
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