Sexual and reproductive health of young people
With the global number of 1.2 billion adolescents aged 10-19 years and 1.8 billion young people aged 10-24 years in 2005,1 health and human rights advocates, researchers, policy makers, programme managers and national and international development specialists are becoming increasingly sensitive to the special needs of this large and critically important group. Yet, the observation made in the Programme of Action of the 1994 International Population Conference on Population and Development (ICPD) that "the reproductive health needs of adolescents as a group have been largely ignored to date by existing reproductive health services" still remains mostly applicable. The sexual and reproductive health needs of adolescents differ from those of adults and remain poorly understood and inadequately served in much of the developing world. This neglect has major implications, since reproductive and sexual behaviours formed in adolescence have far reaching consequences for the lives of young people as they develop, and later on. Their sexual and reproductive health also have implications for the societies they live in. Adolescence is a period of transition marked with biological, psychological and social changes. Adolescents in the contemporary world are undergoing such changes at a time when societies are themselves going through profound social and economic transformations.
Despite the importance of understanding and addressing sexual and reproductive health needs of adolescents, there continues to be a dearth of scientific information on the needs and perspectives of adolescents and young people, especially in developing countries. The 2007 World Development Report on Development and the Next Generation, focussing on young people, noted that "One of the biggest challenges in writing this [World Development] Report was that the evidence base was uneven".2 To address this knowledge gap, UNDP/UNFPA/WHO/World Bank Special Programme of Research, development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR) at the World Health Organization (WHO) launched in 1998 a research initiative on Adolescent Sexual and Reproductive Health (ASRH). In response to the Call for Proposals and Concept papers, 240 submissions were received and reviewed by the Specialist Panel for Social Science and Operations Research. Over 70 investigators were encouraged to further develop their proposals and research workshops were held in Bangkok, Nairobi, and Gramado for investigators from Asia, Africa, and Latin America and the Caribbean, respectively. A total of 45 studies were supported in 28 developing countries as part of the ASRH initiative and its follow-up. Although a number of priority topics were identified, based on the review of literature, research investigators were encouraged to submit proposals of relevance in the local context and of high potential for policy and programmatic impact. As a result, a broad range of topics were covered in ASRH studies, including, among other topics, formation of partnerships, sexual relationships, gender influences, and how adolescents deal with the dual risks of unwanted pregnancy and sexually transmitted infections; risk behaviours, perceptions and practices; correlates and consequences of early and unwanted pregnancy; sexual coercion; and health seeking behaviours and constraints adolescents face in acquiring care and information.
Over 150 million young people reside in countries of Latin America. The ASRH initiative supported 13 projects in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Paraguay, and Peru). Most of the studies covered sexual attitudes, risk behaviours and their determinants (Brazil, Colombia, Cuba, Mexico, Paraguay and Peru). Other topics included dual protection (Colombia), unwanted pregnancy and its consequences (Brazil), health seeking behaviour, quality of care and providers' perspectives (Argentina and Brazil), and assessment of peer education on sexual and reproductive health (Chile). Dissemination of research results from these studies is an important component of efforts to address the sexual and reproductive health needs of adolescents.
This issue of Salud Pública de México includes four papers highlighting critical findings. The paper by Kate Kostrzewa provides an overview of sexual and reproductive health of young people in Latin America and synthesizes findings from selected case studies. The paper highlights the policy implications of findings as well as topics for future research. The paper by Ariel Miño-Worobiej explores the influence of gender roles and traditional norms on sexual and reproductive health of adolescents. The third paper, by Dalia Szulik and her colleagues, examines the perspectives of obstetricians and gynaecologists in Argentina on family planning and induced abortion. The fourth paper, by Cecilia McCallum and Ana Paula dos Reis, covers the users and providers perspectives on quality of care in childbirth in a public maternity hospital in Salvador, Brazil. The studies together provide a glimpse of many critical findings emerging from these and other studies supported by WHO as part of the ASRH research initiative. They also highlight the interventions to address sexual and reproductive health needs of young people, taking into account their perspectives. These studies also point to the future directions of research by identifying the gaps in knowledge that still persist.
We gratefully acknowledge the financial support received from the Ford Foundation for the research workshop held in Cuernavaca, Mexico, where papers from studies in Latin America were originally presented and reviewed and for support to the publication of the set of papers. We are also grateful to Deborah Billings, Verónica Kaune, Sarah Bott, Edith Pantelides, Duncan Pedersen, Armando Seuc, and John Townsend for providing scientific and technical advice and to Shireen Jejeebhoy for assisting with the launch of the ASRH initiative and for guiding it through its implementation. Finally, we thank Kate Kostrzewa for editing the papers and for overseeing the publication process; Nicky Sabatini-Fox for the administrative support and the Editor and staff of Salud Pública de México for their interest and assistance.
Iqbal H Shah,(1)
Ondina Fachel Leal,(2)
1. United Nations. World Population Prospects: The 2004 Revision, Volume II: Sex and Age Distribution of the World Population. 2005. New York: United Nations.
2. The World Bank. World report 2007: Development and the Next Generation. 2007. Washington DC: The World Bank.