Even before the COVID-19 pandemic, global health programs and institutions failed to fully serve the sexual and reproductive health needs of young people in low- and middle-income countries, leading to critical gaps in information and services. The pandemic is now taking a disproportionate toll on this population, as they find themselves cut off from educational opportunities, at greater risk of human rights violations and with reduced access to health care, all of which could have multigenerational implications. New Guttmacher Institute estimates illustrate the devastating impact the pandemic could have on young people’s sexual and reproductive health and rights if policymakers do not take swift action.
An Already Dire Situation
Young people in low- and middle-income countries have experienced persistent inequities in sexual and reproductive health and rights for generations. And now, preexisting gaps are growing in new and harmful ways because of the COVID-19 pandemic, leaving people who already had the fewest resources and options in an even more precarious situation. According to Guttmacher data from 2019, 43% of sexually active adolescent women aged 15–19 who want to avoid a pregnancy are not using a modern form of contraception (e.g., hormonal pills, IUDs, condoms). This results in 10 million unintended pregnancies each year and 5.7 million abortions, the majority of which occur in unsafe conditions. Out of the 12 million adolescents who give birth each year, nearly four million do not deliver in a health facility, leaving them without access to skilled care for routine deliveries and newborn care, as well as for obstetric complications.
Embedded in these global statistics are the stories of individual young people and the barriers they face when seeking care. For example, young people in Uganda who were interviewed about their experiences accessing family planning services reported challenges in receiving high-quality, respectful care from providers. One young woman in Kabale, a district in the Western region of the country, expressed concerns about confidentiality and the stigma associated with seeking sexual and reproductive health care, saying, "They spread rumors and if they know you, they can tell your parents when you go to access family planning services." Such a lack of confidentiality undermines the provider-patient relationship and may discourage young people from seeking services, even if they are in desperate need of care.
Programmatic snapshots from youth advocacy organizations echo these concerns and suggest policymakers’ broader lack of attention to adolescents’ diverse health needs. The International Youth Alliance for Family Planning has been monitoring a number of health facilities in Kampala, Uganda and has reported that even prior to the pandemic, there were shortages of family planning supplies and the costs were often out of reach for young people. Some public health centers, even those positioned to serve university students, provided limited contraceptive methods or counseling, which undermined young people’s ability to make informed and voluntary decisions to protect their health. These individual stories point to an insufficient, patchwork approach to fulfilling adolescents’ sexual and reproductive health needs in low- and middle-income countries.
Potential Negative Effects of the Pandemic
In order to get a clearer picture of the potential effects of the pandemic on adolescents’ sexual and reproductive health outcomes, a research team at the Guttmacher Institute looked at a range of possible declines in care for 132 low- and middle-income countries due to COVID-19 disruptions. These new estimates illustrate the potentially devastating impact a decline of 12–25% in essential sexual and reproductive health care—including contraceptive services, maternal care and abortion—could have on adolescents’ health outcomes (see Methods section below for more information). We found that for 15–19-year-olds:
- A 12% average decline in modern contraceptive use would result in an additional 734,000 unintended pregnancies.
- A 25% average decline in essential pregnancy-related care would result in an additional 134,000 major obstetric complications and an additional 3,400 maternal deaths.
- A 23% shift in abortions from safe to unsafe would lead to an additional 491,000 unsafe abortions.
There are a range of pandemic-related issues that could lead to these and other detrimental effects on adolescents’ sexual and reproductive health and rights. First, lockdown measures are disrupting contraceptive supply chains and the ability to travel to health facilities, putting young people at greater risk of unintended pregnancy by reducing their access to information and contraceptive services. Second, school closures are leading to reduced access to sexual and reproductive health supplies and information for adolescents, including critical interventions offered in school settings, such as comprehensive sexuality education. Third, the economic crisis has driven increases in gender-based violence, child marriage and other rights violations that threaten young people’s health and well-being.
Finally, it is important to acknowledge that adolescents are not a homogenous group; the pandemic poses unique challenges for marginalized groups, including young people who identify as LGBTQ+, those who are unhoused, those living with disabilities, and those who are migrants, refugees or living in humanitarian settings.
Averting Future Harm
The confluence of social and economic disruptions and the subsequent erosion of adolescents’ human rights require a coordinated and multifaceted response to ensure their sexual and reproductive health needs and rights are not further sidelined. It is critical that policymakers not divert allocated funds away from adolescent sexual and reproductive health care and instead invest in comprehensive, adolescent-focused services.
For only $1 per person per year in low- and middle-income countries, all adolescents in need could receive essential sexual and reproductive health care, including modern contraception, maternal and newborn care, and abortion care. This amount is just 59 cents more per person than the current costs for what are insufficient levels of care.
But action must go beyond funding. Policymakers need to prioritize sexual and reproductive health care that meets young people’s needs, both during and after the pandemic. Specifically, they must:
- Define and promote sexual and reproductive health care—including safe abortion, contraception and maternal care—as essential, particularly for young people. This would allow adolescents to travel for services, even in areas under stay-at-home orders or with travel restrictions, without fear of legal consequences.
- Address supply issues by shoring up supply chains to avoid stock-outs, making contraceptives available without a prescription, and facilitating multimonth dispensing of contraceptives.
- Repeal restrictive policies such as parental consent requirements, which pose an even greater burden during the pandemic.
- Ensure frequent updating and dissemination of information on the availability of sexual and reproductive health care at public and private facilities.
- Leverage young people’s use of digital platforms to promote telehealth options that make care available to patients in their own homes.
- Address the unique needs of vulnerable and marginalized adolescent populations, such as those who are unhoused, those with disabilities, those who are migrants, refugees or living in humanitarian settings, and those who identify as LGBTQ+.
In order for these actions to be successful both during the pandemic and beyond, young people must be meaningfully engaged in their design, implementation, monitoring and evaluation. Also, services must be affordable, nondiscriminatory, medically accurate, and developmentally and culturally appropriate. By prioritizing young people’s diverse sexual and reproductive health needs and ensuring that they are at the forefront in identifying effective solutions, policymakers can prevent these harms to young people and strengthen our collective future.
We used data from Adding It Up: Investing in Sexual and Reproductive Health 2019 to estimate the impact of potential declines in sexual and reproductive health service coverage levels in 132 low- and middle-income countries. Details on the health interventions included and approach to estimating impact can be found in Adding It Up: Investing in Sexual and Reproductive Health 2019—Methodology Report.
Our assumptions of service coverage declines draw from existing modeling studies on the impact of the COVID-19 pandemic on sexual and reproductive health outcomes. We drew from Dasgupta, Kantorová and Ueffing (2020) for the percentage declines in use for each contraceptive method, which followed and annualized the assumptions of service disruption in the public sector medium scenario of the United Nations Population Fund (2020). For pregnancy-related care, we used the coverage reductions assumed in the Roberton et al. (2020) medium scenario (scenario 2). For the reduction in access to safe abortion services, we used the childbirth care coverage reduction (23.1%) in scenario 2 of Roberton et al., assuming a similar lack of access to facilities and providers for people seeking safe abortions.
Alan Jarandilla Nuñez and Sandra Nabulega work with the International Youth Alliance for Family Planning, which aims to provide universal access to high-quality family planning and sexual and reproductive health and rights services and information for all youth, girls, and women, no matter where they are from.
This article was made possible by UK Aid from the UK Government and a grant from the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the donors.