About 1.5 billion of the world’s people are 10-24-year-olds, 70% of whom live in developing countries. In many developing countries, this age-group makes up about one-third of the population. Given the sheer size of this generation, it will have a tremendous effect on the future of our world. These young people are growing up and entering their reproductive years in a time of rapid change that presents unprecedented opportunities and challenges. This issue, as the overview explains in greater detail, explores the challenges of improving and protecting adolescent reproductive health and the ways in which communities, parents and interventions can help young people negotiate them. At its core are three articles that began as presentations at “Investing in Young People’s Health and Development: Research That Improves Policies and Programs,” a conference held in Abuja, Nigeria, in 2008.
The lead research article, by Ann Blanc and colleagues, uses Demographic and Health Survey (DHS) data from 40 developing countries with multiple surveys to explore adolescents’ contraceptive use and discontinuation and compare them with those of older women [see article]. The proportion of married or unmarried sexually active adolescents practicing contraception increased more quickly than that of older women over the last two decades. However, adolescents also had higher rates of discontinuation and method failure. The authors note that the rising number of young people, coupled with increases in contraceptive use, are likely to challenge the preparedness, capacity and resources of existing family planning programs and providers.
Ann Biddlecom and colleagues use nationally representative data for Burkina Faso, Ghana, Malawi and Uganda to examine the relationship of parental connectedness, monitoring and communication to sexual activity and contraceptive use among unmarried 15-19-year-olds [see article]. Overall, reported levels of parental monitoring were moderate to high, while levels of parent-adolescent communication about sexual issues were universally low. In all four countries, adolescent males who reported low monitoring had an elevated risk of having had sex in the last year, as did their female counterparts in three countries. Communication about sex was positively associated with sexual activity among males in Malawi and females in Uganda, as well as with contraceptive use among females in Ghana and both males and females in Uganda. The authors caution that, given the cross-sectional data, the direction of these associations is unknown.
Despite restrictive social norms, some unmarried youth in India engage in romantic and sexual partnerships. According to authors Jaya and Michelle Hindin, who surveyed more than 1,000 unmarried 15-19-year-olds living in economically disadvantaged neighborhoods of Delhi, stricter norms for females than for males are reflected in the young people’s reports on their attitudes and experiences [see article]. Females were more likely to believe that only married people should have a sexual relationship, while males were more likely to justify such a relationship if the partners were in love or used a reliable contraceptive. Males were more likely than females to report that they had friends of the opposite sex, that they had ever been interested in someone of the opposite sex and that they had ever had sex. Among respondents who said they had been interested in a member of the opposite sex, males were more likely than females to try to find out more about the person or to request a friend or relative to act as a go-between.
Also in This Issue
• The circumstances in which young people first have sex can affect their future sexual behaviors and their risk of negative outcomes, including HIV infection [see article]. In analyses of nationally representative data from more than 7,000 sexually active 15-24-year-old South Africans, Audrey Pettifor and colleagues found that, compared with respondents who first had sex at age 15 or older, males with an earlier sexual debut were more likely to have had an older first partner, and that their female counterparts were more likely to have had an older first partner and to have been forced to have sex by that partner. For males, nonuse of condoms at first sex was associated with early coital debut and forced sex. Compared with females who began to have sex at age 15 or later and whose first partner had never forced them to have sex, the likelihood of nonuse was higher among those who had had an early debut and whose first partner had never forced them to have sex and among those with a later debut and forced sex.
• With nearly half of women in Nicaragua giving birth before age 20, the country has one of the highest adolescent fertility rates in the world. Using DHS data on more than 3,000 15-19-year-old females, Katherine Lion and colleagues found that, when place of residence, level of education and degree of wealth were accounted for, having first had sex before age 15 increased the risk of having an earlier first birth, while having first had sex after age 15 decreased it [see article]. In a multivariate logistic regression analysis including only sexually experienced respondents, the odds of currently using a modern contraceptive method were elevated among adolescents with a partner (regardless of whether or not they were married or cohabiting) and those who had given birth. The odds were decreased among those who lacked health care autonomy and those who wanted a baby within two years.