Partnering with Very Young Adolescents (VYA) to Improve Sexual & Reproductive Health

and it is my pleasure to welcome you to the why I a’s first webinar you may have noticed that we change the name of this webinar from investing when it counts partnering with voas to improve SRH to simply partnering with very young adolescents to improve sexual and reproductive health we did this to avoid confusion with a soon to be updated population council publication on vui a’s titled investing when it counts which will be published this summer in addition to our first webinar the vya allow alliance is also excited to launch the vya clearinghouse toolkit on k for help more on this later in the webinar so what is the very young adolescents alliance it is an alliance of four founding members to include Georgetown University’s Institute for Reproductive Health Save the Children plan international USA and dsw for the purpose of raising awareness of the importance of the y a’s testing innovative programs and making program practices tools and guidelines widely accessible today we will have five speakers who will be presenting on five different topics on vayase our first speaker will be dr. Bob bloom dr. bloom is the william h gate senior professor and chair of the department of populations family and reproductive health at Johns Hopkins Bloomberg School of Public Health he is a leading authority and Adolescent Health sexuality and healthcare issues dr bloom will be speaking to us on why adolescents a conceptual framework for understanding be why ace dr. bloom morning or good afternoon to everyone good evening where I am and to my colleagues niiice um it’s a pleasure to be here I’d like to set the context for this webinar so when we look at a young adolescents some a few statistics that are worth pointing out first of all we see that the vast majority of young adolescents as is true for adolescence in general live in low and middle income countries over eighty-five percent um we know that there are very specific vulnerabilities that young adolescents in particularly young adolescent girls have for example um two million young adolescents get pregnant that’s girls under the age of 15 get pregnant every year the vast majority 90 plus percent occurs in marriage so uh this is a significant issue and a significant issue of worldwide it’s disproportionate in some countries like Bangladesh Brazil the DRC the Opia India Nigeria where these are particularly salient issues it’s also worth noting um that um there are some positive trends and that is that we have seen a reduction when you look over a 30 to 40 year period of time both in early marriage and in early pregnancy um that said this is and remains a global issue and a child marriage remains a very very significant issue just to put it a bit more in context um uh in sub-saharan Africa um more than a third of 10 to 14 year old girls live with neither a mother or father in the household thirty percent are working in sub-saharan Africa and Asia about a quarter in Latin America about a sixth so uh um being out of school excuse me and her and um working almost always in

the informal economy is a significant issue we know from research that about fifteen percent of young adolescents of engage in sexual intercourse in sub-saharan Africa and about a third in North America of Latin America and the Caribbean in Europe so early sexual debut is also a significant issue so it’s with that as a backdrop that I just want to share a way of thinking about some of the issues at a multi level of framework some of what we know and some of what we think so I’m starting with a national level we there see that laws that relate to family planning and family planning access I do have significant impact many of the other laws or what I would refer to is enabling context so laws for example that protect young people against early marriage laws that protect against gender-based violence there is not good evidence one way or another that these laws have profound effects but they do set the political stage and set the context that is very important the second slate uh we when we look more proximally at the context in which young people live at the community level there we begin to see many more direct effect so um the norms and laws of the community and when I say laws in that context i’m talking about informal laws um do have a direct effect on child marriage they have a direct effect on school going even if schools are accessible I the cultural and religious norms of the community I have a great extent an impact on what happens to the outcomes for young people and so when we think about effective programs that improve outcomes for very young adolescents there’s um some good evidence that engaging the community I is um really critical as a framework in the context more proximal to the individual closer our school and peers and family and we know that school is a protective in many important ways we know that young people who attend school I do better the world bank has shown that for every year a young girl is in school from the seventh grade on her risk of adolescent pregnancy decreases by seven percent it’s compounded each year um so keeping girls in school makes a very significant difference we also know that schools can be a source of vulnerability for young people both because of gender-based violence that they can experience in the school setting and on the way to and from school but that said overall school remains a highly protective in environment and as a strategy that improves the health as well as the social well-being of young people matriculation and engagement are protected and when I think of engagement I’m really talking about the opportunities to engage with an adult uh in school where there’s both caring and expectations for school achievement while among the topic of engagement in

school achievement um the evidence is overwhelming from around the world that family expectations and parental expectations I have a huge huge impact on the outcomes Rebecca is going to talk in a few minutes and Rebecca you said something a quote from the pile or a SEP slogan from Nepal that just rings in my ears about this issue and that is that there are those who say educating a daughter is like watering your neighbor’s garden there’s no payoff in it but the reality and the evidence is so much to the contrary that there’s huge payoff of in it so parental expectations for school participation school enrollment school achievement I have again a very real impacts delay marriage reducing licks of HIV and sexually transmitted infections as well as pregnancy all of these factors are filtered to the individual in the individuals vulnerability and so we know that the age of physical maturation makes a difference one of the things that we are seeing to out the world is that the age of puberty is declining in low and middle income countries it’s declining primarily because of improved nutrition and sanitation in high-income countries it’s occurring because of environmental toxins it’s increased exposure to light through a computer screen time in mechanisms such as that and so we see um these various forces and factors playing out with a decreasing of pubertal age we also know that this is a period of time when both the area of the brain that controls more sophisticated thinking the prefrontal cortex and the part that regulates emotions begin to develop and the emotional area develops before the other parts of the brain and the before the prefrontal cortex and what that means in fact is that adolescence in particularly young adolescents are much more sensitive to awards than to punishment the evidence is strong that punitive approaches to adolescents in early adolescence has less impact than it does in childhood and adulthood but using a rewards-based approach has more impact so I present this is just a framework to think about a very young adolescents let me turn it back to you I look forward to the rest the dialogue you thank you dr. bloom thank you dr. bloom moving on to our next speaker is dr Rebecca Lundgren from Georgetown University’s Institute of reproductive health dr. Lundgren is the deputy director and director of research at the Institute for Reproductive Health Georgetown University where she applies her 25 years plus of implementation implementation science experience to the challenge of developing and testing effective scalable programs for very young adolescents Rebecca will speak to us on the topic of developmental assets and sexual and reproductive health among vayase the case of northern Uganda Rebecca right pleasure to be with you to be with all of you this morning and my esteemed panelists colleagues and friends bob has given a very compelling discussion about the various domains that influence boys and girls as I grow up into adults in fact there is growing recognition to the best way to achieve our vision of young people with healthy sexual relationships is to support adolescent positive development sometimes called developmental assets from a very early age there’s however there’s very little empirical evidence of the linkages between these developmental assets and

sexual and reproductive health outcomes so the study that I’m going to share with you today was designed to provide some evidence on the linkage between assets and sexual and reproductive health outcomes among this very young age group the study was conducted by irh in collaboration with the search Institute and it took place in northern Uganda last year so let’s talk a little bit about develops no assets it’s a little bit of a mouthful but it simply refers to those valuable resources that young people have within themselves and also the context around them which are key to their well-being and healthy development one of the ways that we measure developmental assets is a developed developmental assets profile or called the dap which was developed by the search Institute and has been tested and used in a number of settings around the world the dap measures eight broad categories of assets and these are divided into external and internal assets the external assets are those that are provided by people only on persons context like the ones that bob was mentioning the family the community of the school or their peers those that you can see here on the first column to your left and then we also have the four other assets which are considered their internal strings which those are things related to their values and beliefs that young people have within themselves assets can also be understood in terms of the ecological context in which they’re built and you see those on the far right where you can see some categories that roughly correspond to the circles at Bob just presented so we look at the personal social family school and community assets which is in the world of the DAP we just rearranged some of the questions and the items into different categories to look at context looking at this internal and external assets gives us a really nice tool for looking at Adolescent well-being from a holistic point of view this slide here shows you some of the a number of sample items from the depth organized by the asset scale and the context feel that it belongs to together these are grouped together to measure a larger constructs what’s important for you to know is that in the case of our work in northern Uganda and everywhere the death is applied it must go through a very rigorous adaptation and testing process to make sure that these items are culture culturally relevant while remaining true to the original tested assets framework so we did a went through a under the adaptation and testing process which included translation back translation focused goods and two pilots of the tools so since we were of course wanting to look at the linkage between these assets as measured by the dap with sexual and reproductive health we also had to come up with indicators that would be appropriate for this age group so that some of these indicators are indicated here on the slide and as you can see they range from knowledge and attitudes to supportive relationships access to service and intention to delay sex or use condoms as many of you know developing sexual and reproductive health indicators for this age group is not easy and you may wonder whether or not more questions about sex or condom use or other kinds of behaviors that were typically interested in in our field so the reason why is that during the pilot only three of the boys interviewed even admitted to having a girlfriend and one of them had had to have ever had sex so we focused for this particular population we focused adapt on and other indicators and not so much on sexual behaviors that of course could be different in different settings so let’s look a little bit at the results and see what we found see we were eager to find out if there was some kind of empirical measurable link between these outcomes and developmental assets so the data that i’ll be presenting is based on the depth scales and subscales so it’s important for you to know without the laboring the point that the revised scales worked well in this setting and you can see some data on the reliabilities here on this slide so this slide shows us kind of an overview of what we learned so where did the young adolescents that we interviewed fall on on the death so you can see about sixty percent of the youth are represented in the hot to highest levels which we call thriving or adequate and those are represented by I guess the blue and purple slices on the left of your pie however a third of the youth they’ve fall into the category of vulnerable and seven percent in towns there’s there

were no significant differences by sex I’m not on this indicator so I’m not presenting it broken down by boys and girls one thing I forgot to mention earlier that this setting took the study took place in kind of the urban gulu in northern Uganda so these are not the most rural children their kids who are living in in pretty much an urban area but in the setting of a kind of remote northern Uganda so this slide here shows a comparison of the sexual and reproductive health outcomes between girls and boys girls are the light blue and boys of the dark blue bars and what you’ll see here is that girls are more likely than boys to have most sexual and reproductive health outcomes in other words the girls are doing better on sexual and reproductive health almost a quarter of the girls as compared to only twelve percent of the boys for example reported having a supportive relationship similarly 70 sorry seventy-two percent of girls reported accurate knowledge of humor t as compared to only about half of the voice so let’s go on and look at our hypothesis our question was the linkages between these developmental assets and sexual and reproductive health so this slide shows the results for use with adequate and thriving liberal levels and what we see is that they had better odds than other youth in three of the five outcomes sexual and reproductive health outcomes that we’re measuring so they were more likely youth who are adequate or thriving in terms of assets were more likely to have accurate accurate HIV knowledge believe they can access services and intend to delay sex until marriage or use condoms so this slide is looking at just those youth with thriving assets so those are youth who are doing the best of our sample and what we can see here is that they had better odds than all of the other youth in achieving four out of the five outcomes so on this side you can see that more likely to have accurate condom knowledge HIV knowledge and more likely to have supportive relationships so what does this mean for programs that’s really the bottom line so the results of the study tell us that addressing the vulnerabilities or boys as well as girls is important to improving sexual and reproductive health in our field we often neglect boys in our work because of the overwhelming needs that we see in the lives of young girls yet these results suggest that fewer boys have supportive relationships adequate information and access to services than their female peers in order also in order to lay the foundation for healthy and sexual reproductive lives it’s time to really think outside of this sexual and reproductive health box of programming we need to think about programs and build those assets that you need to successfully navigate puberty that’s not a surprise for those of you listening who are involved in other health areas but it’s something that we and the sexual and reproductive health area have neglected I think so we can do that we can address and build positive sets by improving the ability of parents and adults to support girls and boys by expanding our rights base programming to engage young people actively in their communities you know build their life skills and and conduct activities to link children with supportive adults that’s a quick snapshot of our results and we’ll be sharing with you a brief that has further information for those of you who are interested you can go and look learn more about the study thank you very much Thank You Rebecca moving on dr. Chandra scientists at the World Health Organization’s Department of reproductive health and research will be our next speaker at waho dr. Chandra focuses on building the epidemiologic and evidence stayed around adolescent sexual and reproductive health and translating that research into well conceived and well-managed policies and program dr. Chandra will speak to us on menstrual stigma why does it matter dr Chandra greetings from the viewer chill it’s a pleasure to be part of this group and part of this discussion in my brief presentation I’m going to talk about men’s true stigma does it exist and does it matter I look at the merriam-webster externally for a definition of the term stigma and the dictionary defines stigma

as a set of negative beliefs and attitudes that a group or a community or an entire society have about something the dictionary also says that these beliefs and attitudes are often unfair clearly this is in the context of men stood stigma next so does it exist working with the Sheila Patel and Manny summer we’ve just completed a systematic review of the knowledge and understanding of men our menstrual hygiene and menstrual health among adolescent girls in low and middle income countries we’ve submitted it to the journal of adolescent health this review identified 110 papers or so from a number of developing countries over 40 developing countries 40 low and middle-income countries and in a nutshell there is stigma is an enormous amount of stigma for various reasons and one is because of the discomfort with it being associated with sexuality and reproduction it’s very difficult for many people many groups many communities many societies to talk about anything related to sexuality and reproduction now this is not just low and middle-income countries this is not just Asian African and Latin American countries there are still many high-income countries in North America and Western Europe where school-based sexuality education is not statutory and this stems from the same discomfort the second point there is there a stigma because girls themselves feel unable to manage their periods effectively so there is the sense of shame I don’t have access to mental products and so I use a newspaper or dried leaves or I don’t have under ways to to wear and to keep the menstrual products in and so the shame is associated with the fact that I am constantly worried whether I’m smelling or and spotting and this is something that comes up again and again in the papers describing men are clear menstruation and adolescent girls I’m from India and in in South Asia especially but not only the stigma is associated with menstruation and menstrual blood being seen as dirty and so you hear the word pollution and dirt and the word is gust in in in the discussions in the discourse and that translates into action that’s my next slide but just to summarize that an enormous amount of stigma associated with it for a variety of reasons now does it matter it does matter because because of the stigma girl in South Asia girls in the Arab world are often not allowed to pray not allowed to enter the kitchen and cook not a lot of sleeping offense not allowed to touch any male member of the family because they may be they may pollute the person so that hinders their ability to carry out everyday activities there’s a another huge issue about schools not having functional toilets and girls not being able to go to school because of that I was struggling with whether that is a result of stigma or not but it clearly is because of lack of investment and lack of respect and attention to girls means but there are two other issues you know that hindering the ability of girls to carry out everyday activities is important but it doesn’t kill like maternal mortality or

HIV so why is it a public health issue it’s a public health issue for two reasons if weakens girls self-esteem and self-confidence what we say increasingly is that self-esteem is the basis of good health good development and this is reinforces what Rebecca said in her presentation feeling good about oneself so you know not knowing whether your periods are going to come today or next week not knowing whether you can manage your periods not knowing whether you can take an exam which is next week because you don’t know whether you’re idiots will come absolutely must destroy good sense of control and competence and you hear that message again and again in papers describing this area the next point is speculation at this stage but if a girl is told verbally and non-verbally that you know menstral Feynman’s / discomfort as part of a large and that she shouldn’t talk about it to anyone in some papers you read that no male member of the family is meant to know that you have your periods although everyone knows you have your PBS um so that must be and hinder a girl’s healthcare seeking now and in the future how many surprised then that women seek care for cervical cancer or a breast lump late I want to come back to my second point about weakening self-esteem and self-confidence in my next slide could I please have the next slide this wonderful book the teen years explain publix by Johns Hopkins Bloomberg School of Public Health talks about Korra sex and you know it comes back again and again as you will see two points made by professor bloom and professor Lundgren that you know you need you’ve competence confidence connections with people and institutions a sense of right and wrong the sense of caring we talk about these as the core assets that we need to help adolescents develop as they make their transition from childhood through adolescence into adulthood and I’ve highlighted two points in red and that’s competence and confidence as I said earlier not knowing whether they can manage the idiots not knowing that they can take charge of themselves is extremely important to one sense of incompetents or lack of control and lack of confidence you you hear so much in adolescence about the different confidence that girls have whether this is entirely because of menstruation is not clear at all but clearly for girls and low and middle-income countries it must contribute to it my next and last slide please so menstrual stigma exists menstrual stigma affects girls lives now and we believe in the future and it’s because of the reasons we have described earlier but lack of attention to girls needs that problems is a widespread issue and it affects many issues violins access to contraception so many other issues so those need to be well educated about menstruation girls need to grow and develop in a context that sees menstruation is healthy and positive not shameful and dirty that’s really the central message in this discussion on stigma the others are about access to the products and services they need to manage themselves well to be cared for and supported by their families when they have their periods and to be able to consult a competent and caring health worker when they have problems so that wraps up my presentation so I I think in

the early adolescent period when he run workshops my last point is that when we run workshops for health workers on adolescent his doctors midwives nurses often in their 40s and 50s he start by asking people to write down one memory from their adolescence which is etched in their minds which they’ll never forget they do it on a card and put it face down on a table in front of them and when we cluster the cards in wherever we are in the world you find six or seven cards about my periods I had materials I didn’t know what was going on I was scared to death it was sort of I thought I was going to die I saw a doctor the doctor was not sympathetic I started spotting in class and there were giggles behind me I didn’t know what was going on this is a huge issue and something that we have to deal with and for me an oxen wh 0 this is front and center of the head thank you thank you dr. Chandra next on our panelist is brad turner brad is the adolescent reproductive health advisor at saved the children he is an international public health specialist with over 15 years experience focusing on adolescent sexual and reproductive health why we will while we will focus today on a project related to girls menstrual hygiene management brad has a strong passion for bringing boys and men into the sexual and reproductive health dialogue today brad will cover the topic private sector investment in menstrual hygiene right thank you so much and greetings from Save the Children us Wow while I wait for my slides to come up I just want to say how happy I am to be here and how pleased I am I think I see over 130 participants calling in today so thank you so much for listening in as noted i will follow right on the same topic that Chandra just presented on and talk about a partnership with the private sector to address some of these needs around menstrual stigma community expectations on how adolescent girls and boys should act and how they should be envisioning their life trajectories are often quite strong and dictated often with limited roles and opportunities for girls providing support and education for very young adolescents is one way to level this playing field Save the Children has a global commitment to improving the lives of girls and women by addressing gender inequities and engaging men and boys in an effort that will improve community norms in support of children’s well-being we assert that one of the most fascinating times of life to do this work and one of the most important is during this early puberty in early adolescent ears changing perceptions paradigms and opportunities early is key to influencing lifelong opportunities and related decision-making I might need help moving my slides thank you this is a behbeh from Ethiopia look how happy and carefree she is remember those days when you were 11 years old and you felt you could achieve all your hopes and dreams I wonder what you would write down on that card if you’re in that workshop with dr. Chandra around your greatest memory the sad reality for so many children is that when they hit early adolescence many of their life opportunities are cut short because of restrictive social and gender norms abeba is on the verge of her first menstruation but does not know what to expect or what is about to happen because no one has ever talked to her about the changes she’s about to experience and little does she know but that this transition to adulthood has triggered her parents to begin negotiations with another family arranging her marriage one of the key drivers for her parents pursuit of an arranged marriage is financial insecurity they can’t afford her they believe marriage and dependency on another family will afford her a better life and protect her for abeba early adolescence and puberty will quickly propel her into the adult world of marriage pregnancy and motherhood there reality for a behbeh and her family is that none of them know how to shift the pendulum so a bedless life chances are

something that she can influence and change I’d say the children we work to slow this progression into adulthood down just a bit taking a step back and providing very young adolescents their parents and their teachers the tools they need to transition and help very young adolescent girls transition through puberty confident healthy and informed so what kind of tools do we offer health education financial literacy empowerment training through sports classroom engagement and literacy so we’re going to you know dive into the squirmish topic for some which is menstruation management as this is one example of several ways that we empower girls and I think Chandra highlighted nicely why we should start with this because of that stigma and the effect on girls girls ability to manage menses in school affects the quality and enjoyment of girls education poor mental hygiene management in schools causes worry and humiliation contributes to absenteeism and leads to poor performance in school moreover as girls transition through puberty and feel shame about their body changes their lack of confidence becomes increasingly visible this affects their entire adolescent experience for the public eye we don’t really need to always call this minstrel management it depends on context you’re working in you can call it empowering young women but I push you to remember that in the developing world what a hurdle this is this this issue of menstrual management menstrual hygiene management and consider the value of quitting your programs and the girls you serve with proper latrines the basic health and hygiene education to ensure that girls know how this transition will impact their future their family’s future and their life choices and preventing early and unplanned pregnancy next I got the next slide things so to help drive our agenda on Mental Hygiene management Save the Children has partnered with Procter & Gamble’s always brand who for the last 30 years has been championing girls puberty transition and helps girls have access to information find the support they need and to gain confidence Procter & Gamble now reaches 65 countries through more than 500,000 education professionals for 17 to 20 million girls each year helping girls gain confidence is core to their brand anyone who’s watched the the American Super Bowl this year might have seen a greats Procter & Gamble commercial about running like a girl where they effectively and emotionally broke down gender norms and expectations of girls in front of 40 million American viewers while showing girls that they can do anything they put their minds to it for those of you not in the US and I think it’s the majority of you on the call I think if you just google run like a girl P&G this this video will come up on youtube so through Save the Children and UNESCO and local partners Procter & Gamble continues this mission in developing countries so more and more girls will know what is happening to them when they start puberty and have access to menstrual pads were available we were hoping to have a colleague from Procter & Gamble do this presentation but then they were not able to join us so this is why I’m showing a little bit around to Procter & Gamble’s framework and their their achievements so Save the Children has been a proud partnership partner of Procter & Gamble’s always in Tampax brands since around 2008 we’ve partnered on a project called protecting futures in Ethiopia South Africa and Nepal where we have trained teachers and girl leaders on delivering puberty education we’ve built girl-friendly latrines at schools so girls would feel safe and comfortable while menstruating at school and and every day to be honest and introduce girls to the full range of menstrual hygiene management products of El available to them in their in their markets through the project we were we also were able to develop really nice educational products like well think on one slide ahead so like this poster you see here on on the left this was written in local languages in all three countries and distributed to the girls and it just had nice inspirational messages on one side that they could hang on their wall and then on the other side had information about puberty and menstruation we’ve also developed puberty workbooks for boys and girls and now are adapting them throughout the global Save the Children movement and I’m happy to share examples

of these from Nepal Malawi and Uganda and we also have a colleague at Columbia University Marnie summer she has developed puberty work bricks as well in about five or six countries and we can direct you to her website we’ve also expanded our partnership with Procter & Gamble and are now including menstrual hygiene management into our school health and nutrition programs in China Nigeria and Mexico for us this is a really big opportunity for scale-up both for save the children and procter and gamble because one it’s working directly through the school’s on a school health and nutrition platform which we have very institutionalized through our work and most ministries of Health also have school health and nutrition directors within the ministry of education so it becomes a really nice way to drive some of these issues up through the policy level like Procter & Gamble Save the Children has experienced the pleasure of watching girls gain the confidence in themselves at a time when so many girls that are becoming self conscious of their body changes and start to drop out of school to hear these two girls say that this is information they will talk to their daughters about when they become mothers is already breaking down the long-standing taboos that exists around the world and in their communities this is the type of shared results and partnerships we seek with our private donors there they’re winning strategies that have shared value for both of our brands that would be to save the children brand and and in this case Procter & Gamble’s brands so this was the the part of the webinar where we wanted to show you a video we made on this protecting features project in Nepal Ethiopia and unfortunately we realized too late that showing the video wouldn’t be very effective on this platform so what I would love for everyone to do is pull out a pen it’s a three minute video so instead of spending three minutes watching it I want to take 30 seconds for you all to write down the URL and it would be great for you to watch this after after the webinar I’m also typing in at box a longer URL which I’m not going to make you write down but you can cut and paste it and that will bring you to our website it’s a microsite all around this Procter & Gamble protecting futures partnership and there’s some videos there so as a few concluding remarks Save the Children strategically invest in very young adolescents and we recognize the critical importance of this transformative time when girls likes opportunities can be determined and their course to adulthood shapes when properly supported girls can stay in school delay marriage and childbirth acquire strong life and livelihood skills and safely grow into healthy and educated women who make powerful positive contributions to their families and communities but when girls received little or no supports life options narrow as opportunities are replaced by dropping out of school early marriage early childbirth and perpetuating a cycle of poverty so it save the children we are already reaching these children through education empowerment health and livelihood programs in over 20 countries our biggest challenge now and and it’s an opportunity that we have is currently testing testing out multi-sector platform and programming all together in one package for very young adolescents with the goal of improving sexual reproductive health educational attainment and well-being as very young adolescents grow up through older adolescents and this is really where we’re seeking our biggest partnership opportunities for the moment is looking beyond single pneumatic areas but doing a much more comprehensive package of child protection education and health for younger adolescents to support these transitions thank you so much for listening in and I’ll hand it back to the moderator Thank You Brad moving on to our last speaker sattika chalasani technical specialist at unfpa michalis ani works on the sexual and reproductive health and rights of adolescence and youth with a particular focus on the poorest adolescent girls michalis ani will speak to us today on childhood and motherhood the need to invest in V Y A’s Thank You Danielle and thank you everyone for listening in today I would like to quickly talk about adolescent pregnancy bringing it around full circle to where dr. Bluhm started this morning

and how investing in very young adolescents can support their safe transitions to adulthood including in marriage and childbearing you’ve already seen some data presented by dr. bloom and some of my data repeats what he has said however I think it’s an important point and so I would like to know that in more than 30 countries 10% of more of adolescents have had sexual intercourse by age 15 that means that adolescents transition early to sexual activity in some countries like me share those rates are as high as twenty six percent in measure of course most stuff it is within the context of marriage and you actually see this very rapid cohort progression into marriage where by age 15 while you have about eleven percent married this is women 22-24 married by age 15 about eleven percent by the time you get to age 18 three short years later you have three times the number of girls who have entered into a marriage or a union so there’s very early and rapid transitions into marriage and childbearing in many countries around the the transitions into marriage and childbearing the important point to note is this distinction about sexual initiation before marriage and after marriage the UN Population division has a study in which the compile data for about 36 countries mostly African and Latin American and from that data you see that in 22 of the 36 countries sexual initiation is actually more common before marriage than it is within marriage however I would like to know that data on this sequencing of these activities it does rely on date reporting which is not always of the best quality and there is a certain simultaneity or jointness of decisions in in activities related to a 22 sex and marriage and childbearing and it’s hard to kind of sequence these out even though we do try to do this with surveys that being said you know given that sexual initiation does happen before marriage in many places around the world most childbearing does happen within marriage Union as dr. bloom said this morning that’s 90% or nine in ten adolescent birds happen within the context of a marriage or union and adolescent child bearing as he noted while it’s been declining it’s still very high about nineteen percent of young women in developing countries give birth before age 18 that’s 7.3 million births a year of which very young adolescents those under 15 actually contribute to millions that’s more than a quarter and just a different way of slicing the data that’s about 20,000 girls each day giving birth before the age of 18 there’s also significant differentials between countries if you look at the regional estimates on adolescent birth rates the world average is 50 words per thousand women 15 to 19 in the least developed countries it’s about 113 words per thousand women in the more developed countries it’s 21 that’s a differential of five to six times between these two regions the issue with the early transitions to sexual activity marriage and childbearing is that a lot of these are unintended and unsafe we know that a lot of sexual initiation is actually forced or coerced in high adolescent birthrate countries about thirty percent of birds to women under age eight under age 20 are unintended that’s the median of course when we say unintended because these are young adolescents and they do want to have children at some point in their life most of the unintended birds are actually mistimed rather than unwanted 3.2 million unsafe abortions occur each year among girls 15 to 19 we don’t have very good data on abortions among 10 to 14 year olds and there is 70,000 adolescent deaths annually from complications related to pregnancy and childbirth as a new wh old report from last year shows it’s the second cause of death among females 15 to 19 so the point of showing that data was to

show that there are these early transitions rapid transitions many of them with serious consequences and they’re unsafe and unintended we do have some theoretical frameworks for understanding how young is too young for these transitions because adolescents do have to make these transitions at some point and you can look at the physical physiological maturation of the body as one criteria cognitive capacity for making safe informed involuntary decisions and institutionalize concepts of old enough as reflected in legal frameworks and international standards and if you use those three criteria and you look at the timing of transitions and the context of those transitions from DHS data which tell you something but not everything about these transitions the conclusion is that boys and girls aged 14 and younger are universally too young to make safe and consensual transitions so what we understand from theory is is borne out by the data that we see and we we know from large quantitative studies but also qualitative studies around the context of these transitions so what will it take to ensure that these transitions happen when adolescents are old enough and when they want them to occur it will mean we have to empower girls with information skills and support networks including comprehensive sexuality education we have to enhance the accessibility and quality of formal schooling for girls including conditional cash transfers their families must have economic support and incentives including unconditional cash transfers we must make available quality affordable health services including general preventive services for younger adolescents and contraceptives HIV testing counseling and treatment maternal health services for older adolescent we also need to ensure that the laws on minimum age of marriage are set to 18 and that access to SRH services is non-discriminatory and there’s no there’s no restrictions based on age or marital status early adolescence to reiterate the whole purpose of this webinar is critical globally thirty-two percent of girls of lower secondary school age are out of school what this means is that primary school completion transitioned secondary school these occur around the same age as puberty as as when puberty hits and investing in girls before puberty and school dropout occur is key all of the interventions that I talked about in the previous slide these need to happen earlier and earlier as early as we can let our our our conscience and our programs allow them to happen and so I would like to conclude there by saying that we know a lot about the transitions adolescents make especially in the domain of SRH and we know that we need to make preventive investments in very young adolescents to ensure that these transitions are safe and consensual thank you thank you said Vika and thank you to all of our speakers today so what’s next as I mentioned earlier we would like to take this opportunity to launch the cape or health dy8 Clearinghouse toolkit this toolkit is for program managers educators health workers advocates researchers and policymakers committed to making a difference in the lives of very young adolescents girls and boys between the ages of 10 and 14 the tool kit offers resources which address the unique developmental cognitive and social opportunities and challenges facing this age group it provides links to examples of successful programs research results curricula advocacy materials and other resources useful for working with bya in addition the voi a is planning to do another webinar and in the next four to six months we welcome your clueless to learn in here out about anh vui A’s after this webinar we will be sending out a short survey only about four questions asking for your ideas and on topics that you would like to see for future webinars tomorrow who will be sending a follow-up email with resources reference to I know some of you have asked about this referenced in today’s

presentations along with the link to the toolkit I just mentioned on behalf of the vui a alliance I would like to thank you for joining us today for our first webinar and we look forward to having you join our future webinars so please stay tuned and we look forward to our next time thank you