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Humanitarian response must focus on adolescent sexual health needs – report

Source: Fri, 14 Jun 2013 12:55 GMT
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Earthquake survivors stand next to a makeshift tent at the Cite Soleil in Port-au-Prince, February 2010. REUTERS/Eliana Aponte
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NEW YORK (Thomson Reuters Foundation) – Humanitarian organisations must prioritise the sexual and reproductive health needs of displaced adolescents at the earliest opportunity in a crisis to protect young people from sexual violence, sexually transmitted diseases and early pregnancy, a report has found.

While relief agencies focus on providing food, water and shelter for refugees in emergencies, the sexual and reproductive health needs of young people, particularly vulnerable girls, too often sit at the bottom of the check list – or don’t feature on the list at all, said the report by the Women’s Refugee Commission and Save the Children.

“The report calls for humanitarian organisations to integrate adolescent reproductive health services at the very beginning of any emergency response,” said Sarah Costa, executive director of the Women’s Refugee Commission, speaking on a panel on Thursday at the United Nations, where the report was presented.

Entitled Adolescent Sexual and Reproductive Health Programs in Humanitarian Settings: An In-depth Look at Family Planning Services, the report catalogues the results of a year-long study, done in partnership with the United Nations High Commissioner for Refugees (UNHCR) and the United Nations Population Fund (UNFPA).

On the basis of its findings, it recommends that governments, donors and humanitarian and development organisations effectively address the sexual and reproductive health risks for adolescents in crisis situations by scaling up services in emergencies and by investing in this area. 

The price of not doing – of neglecting adolescent sexual and reproductive health (SRH) – is high, panel members said, particularly in a world with burgeoning and chronic refugee populations due to conflict and natural disaster.

“Young people are not only an important subgroup, but in many conflict and post-conflict zones, they are the majority of the population,” said Babatunde Osotimehin, UNFPA executive director, adding that in conflict zones like Liberia, Sudan and Afghanistan two-thirds of the population are under 25.

But “we give low priority to these people” and their need for SRH services “continue to be overlooked in humanitarian interventions,” he said. This is partly because “we don’t have a systematic data collection system that tells us who is where and what we should look out for.”

Not only are adolescents a large segment of the population of many developing countries, but adolescent girls are among the most vulnerable to sexual violence, rape, early marriage, unsafe abortions and sexually transmitted diseases in humanitarian crisis situations where family structures may be shattered and risk-taking behaviour elevated, the report said.

Globally, 16 million girls between the ages of 15 and 19 and 2 million girls under 15 give birth every year. Adolescent girls are at the highest risk of dying from pregnancy, with pregnancy-related deaths twice as high for girls aged 15 to 19 and five times higher for girls under 15 than for women over 20, according to the report.

If adolescent SRH were addressed, the results would include delays in first pregnancies, a reduction in maternal mortality and more girls staying in school, Costa said, noting such services are core to achieving the health-related Millennium Development Goals.

But the study of adolescent SRH programmes in humanitarian settings painted a discouraging picture.

“There’s a dearth of these adolescent reproductive health programmes,” said Sandra Krause, reproductive health programme director at the Women’s Refugee Commission.

The report noted that:

  • Only 37 programmes focused on the SRH needs of adolescents aged 10 to 19 in humanitarian settings
  • Only 21 programmes offered at least two methods of contraception
  • Proposals for funding of adolescent SRH programmes in humanitarian settings accounted for less than 3.5 percent of all health proposals per year
  • The majority of those proposals have gone unfunded.

Of the 21 programmes that offered at least two methods of contraception, the report identified three as being “effective” in their delivery of SRH services by demonstrating enhanced use of contraceptives and researchers visited them as case studies: Profamilia in Colombia, the Adolescent Reproductive Health Network in Thailand and the Straight Talk Foundation in northern Uganda.

The report found that these successful programmes share some key traits, including:

  • Securing community trust and adult support
  • Engaging adolescent participation early on following an emergency
  • Responding to the needs of diverse adolescent groups, including those who are married and unmarried, those in-school and out-of-school and those with disabilities
  • Having a qualified and dedicated staff with ongoing training
  • Integrating services at one location, i.e. a one-stop shop for SRH services
  • Offering flexible outreach strategies as well as budgets for transportation to reach adolescents in remote or insecure areas.

The report's overarching recommendation was: “There is an urgent need to scale up services for Adolescent Sexual and Reproductive health (ASRH) in humanitarian settings from acute emergency through protracted crises and development. Investing in ASRH may help delay first pregnancy, reduce maternal death, improve health outcomes, contribute to broad development and reduce poverty.”

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