Demystifying Data: A Guide to Using Evidence to Improve Young People’s Sexual Health and Rights

The sexual and reproductive health and rights of young people are a pressing concern everywhere in the world. The world’s 1.2 billion adolescents aged 10–19 account for 18% of the global population.1 While their situation differs across regions and countries, adolescents share basic rights pertaining to sexual and reproductive health, such as equality, privacy, dignity, freedom from harm and freedom to choose whether or not to marry. They also need information and services to support healthy decisionmaking related to sexuality and reproduction.

Adolescents’ needs vary depending on many factors: their stage of physical and emotional development, whether they are married, whether they have become mothers or fathers, whether they are sexually active, and what type of sexual activity and relationship they are engaged in. For example, an estimated one in four women aged 15–19 in the developing world is married or in union—that is, living with a partner.1 Marriage that takes place during adolescence is often not decided by the adolescents themselves, and young women in particular may lack power relative to older partners. Moreover, unmarried adolescents who engage in sexual activity typically face societal disapproval, which can prevent them from receiving the information and services that they need to protect their health.

Many women become mothers during their adolescent years: In 2012, an estimated 15 million babies worldwide were born to mothers aged 15–19.2 This is important in light of the fact that adolescents aged 15 and younger can have a somewhat higher risk of ill-health from pregnancy, and substantially higher risk of maternal death, compared with women who give birth in their early 20s.3 On average, only one-third of adolescents in developing countries who want to avoid pregnancy are using a
modern contraceptive method; the remaining two-thirds risk having unintended pregnancies and, sometimes, unsafe abortions.4 Unsafe abortion is most prevalent in developing countries and is common among young women; 41% of unsafe abortions occur among women aged 15–24.5 Also, the risk of sexually transmitted infections (STIs), including HIV, accompanies any sexual intercourse including oral and anal sex. Evidence suggests that those who are younger than 25 are more likely to be infected than those aged 25 and older.6 Although adolescents’ sexual activity is difficult to measure, the available data highlight young people’s urgent need for sexual and reproductive health information and services beginning from early adolescence.

Many barriers prevent young people from obtaining comprehensive information and quality services. Some key obstacles include poor in-school curricula, inadequate training of teachers and inadequate outreach to those who are not attending school. In addition, health care infrastructure is often weak, especially in poor and rural areas, and some providers exhibit judgmental attitudes about sexual activity among unmarried youth.

Sexual activity among young people is highly stigmatized and even criminalized in many countries. Marriage is often considered the only context in which it is permissible for young people to be sexually active. As a result, unmarried, sexually active young people are often denied access to sexual health services and information, either because of formal barriers or social taboos. Despite these prohibitions, many young people engage in sexual activity, driven by their curiosity and desire. This reality should be incorporated into any program or policy to improve the sexual well-being of adolescents and young people. Comprehensive sexuality education is an integral component of such efforts and critical to ensuring that young people are aware of the respect due to them as individuals. Without such education, young people are less likely to be aware of their rights and the ways in which established custom, tradition and law may infringe on those rights.

To this end, scientific evidence on the sexual and reproductive knowledge, attitudes, behaviors and health of young people can strengthen the work of health care
providers, educators and advocates as they work toward meeting young people’s needs for information, education and services. Reliable statistics based on nationally representative samples of youth also provide solid evidence for communicating with policymakers, community leaders and other stakeholders about young people’s sexual and reproductive health and rights. Such evidence is an important mechanism for giving legitimacy to the issues and strengthening the case for increasing attention to and resources for improving adolescent sexual health. Existing surveys do not measure all aspects of youth sexual and reproductive health and rights; the existing data on sexual rights are especially weak. The limitations of the data are described in each chapter where they appear, and the conclusion addresses some of these limitations by making recommendations for future research.