Married and unmarried girls have multiple, interlinked health needs. These need to be met in a comprehensive, multi-sectoral way. Successful approaches combine demand generation - at the community and individual level – with youth-friendly sexual and reproductive health care provision.
Adolescent girls need accurate information on sexual and reproductive health and rights (SRHR). This can be provided through comprehensive sexuality education (CSE) and outreach campaigns delivered in and beyond schools, including through safe spaces and girls clubs. Girls should also be referred to service delivery points where they can access the health care they need. CSE should be age-appropriate and go beyond biology to include teaching on sexual orientation, pleasurable experiences, bodily autonomy, healthy relationships, menstrual and bodily hygiene, contraception methods and how to avoid sexually transmitted infections.
Gender and power are key issues in sexual and reproductive health education. Research shows that sexuality and HIV education which explicitly addresses gender and power is five times more likely to reduce rates of pregnancy and sexually transmitted infections as those that do not.
Girls are often not the decision-makers when it comes to their own health, so it is critical to work with communities, including parents and other gatekeepers. Evidence shows that girls clubs which also engage with parents and other family and community members are more likely to achieve behaviour change – beyond attitude changes – such as reductions in violence and child marriage.
Girls face multiple barriers to accessing sexual and reproductive health care. This is often due to the attitudes of providers, who can be judgemental about adolescent sexual activity or unfamiliar with the laws and policies on adolescents’ rights to health care. Health care providers should be continuously trained on the rights of adolescents to access sexual and reproductive health care, whether they are married or not. They also need training on how to interact with adolescents, including counselling and communication skills. Legal and policy barriers that prevent adolescents from accessing sexual and reproductive health care – on the grounds of their age, sex, marital status, or the number of children they have – should also be removed.
Health care providers need training on the particular risks posed by adolescent pregnancy. As adolescent girls face specific risks during pregnancy and childbirth, maternal and neonatal health care providers should be trained on the additional complications that pregnant adolescents may face, including during the post-partum period.
Community members and health care providers should be trained on gender-based violence. Medical professionals and teachers should be able to provide referrals to appropriate legal, social or child protection mechanisms.
- Svanemyr J, et. al., 2015, Creating an Enabling Environment for Adolescent Sexual and Reproductive Health: A Framework and Promising Approaches, Journal of Adolescent Health, Volume 56, Issue 1, Supplement, January 2015, Pages S7–S14.
- Marie Stopes International, 2018, Global Impact Report 2017:
- UNESCO, 2018, International technical guidance on sexuality education, an evidence-informed approach, revised edition, UNESCO, Paris, France
- Haberland, N, 2015, The Case for Addressing Gender and Power in Sexuality and HIV Education: A Comprehensive Review of Evaluation Studies, International Perspectives on Sexual and Reproductive Health, 41(1):31–42, doi: 10.1363/4103115.
- Marcus, R., et. al., 2017,GAGE Rigorous Review Girls’ clubs, life skills programmes and girls’ wellbeing outcomes