Path finder
Content
April 2011
A Smart Investment:
Integrating Sexual and Reproductive Health into Multisectoral Youth Programs
There are an astounding 3 billion people under the age of 25 alive today, 1.8 billion of whom are between 10 and 24 years of age. These young people—the majority of whom live in less developed countries—are facing remarkably high rates of early marriage, unintended pregnancy, sexually transmitted infections, HIV, and maternal mortality and morbidity, as well as severely limited access to jobs, education, and political participation. While today’s young people are confronting formidable challenges, they also have the capacity to effect enormous change in the world, reducing poverty and helping build more just and prosperous societies.
It is imperative that we direct more development resources toward young people, who constitute the fastest growing segment of the population in many countries.1 Recent US government initiatives such as the appointment of key State Department and USAID staff to oversee youth portfolios and the Global Health Initiative’s increased emphasis on women, girls, and gender equality, are encouraging developments. Nevertheless, if investments are to reap real, lasting rewards, we must place much more importance on young people and prioritize efforts that support their advancement. Multisectoral programs for youth—programs which acknowledge that young people’s problems are interconnected and require a holistic approach—are attracting widespread recognition and praise as a smart strategy for making the most of foreign assistance dollars. These programs engage two or more of the sectors that are central to young people as they transition into adulthood: health, education, livelihoods, and civic engagement. In multisectoral programs, each intervention plays a role in improving outcomes in the other sectors—just as the problems young people face are intertwined, so too are their solutions.
3
Billion Reasons
If multisectoral youth programs are to reach their full potential, they must include a strong sexual and reproductive health component. Programs to prevent early marriage, unintended pregnancy, HIV, and other sexually transmitted infections not only improve young people’s health, but also result in noteworthy gains in education, livelihoods, and civic engagement. As illustrated by this graphic, young people’s journey to adulthood is fraught with difficulties and their sexual and reproductive health needs must be met for investments in other sectors to be beneficial. Only then can young people stay the course and fully contribute to the economic and social development of their communities.
SEXUAL AND REPRODUCTIVE HEALTH Critical to a Successful, Healthy Journey through Life
prevent HIV infection and are more likely to use condoms. 5 Education and sexual and reproductive health are interdependent and the prospects for mutually beneficial
An estimated 2.2 million unintended pregnancies occur
outcomes of integrated programming are limitless.
Unintended Pregnancy
Approximately 10% of African girls
do not attend school during menstruation or drop out due to the lack of clean and private sanitation facilities.1
Menstrual Hygiene
annually among adolescents in sub-Saharan Africa, curtailing participation in education and economic opportunities. 3
Given that young people’s ability to build vocational skills, enter the labor force, and become economically empowered is closely tied to their sexual and reproductive health
LIVE
LI
HO
O
status,6 livelihoods programs, too, should
DS
SRH
be implemented in tandem with sexual and reproductive health interventions. If young people are sick, burdened by early marriage
SRH
ED
A UC
T
N IO
SRH
The close relationship between education and sexual and reproductive health has been studied extensively, and there are numerous examples of how the two are mutually reinforcing. Data from the Demographic and Health Surveys show that 20 percent of girls in Africa drop out of school because of early marriage and pregnancy. Many additional adolescent girls leave school when they begin menstruating due to a lack of hygiene products and separate latrines. Programs that help young people delay marriage, avoid pregnancy, and maintain menstrual hygiene can help increase school enrollment, particularly among girls. As the graphic demonstrates, investing in education certainly increases young people’s chances of completing successful journeys through life, but neglecting sexual and reproductive health issues in education programs renders them less effective, squandering valuable resources and doing a disservice to the young people these programs are meant to benefit. Investing in sexual and reproductive health programming increases returns on education investments, and the opposite also holds true. For example, initiatives to expand opportunities for youth to pursue secondary education may have an impact on their sexual and reproductive health. According to the Demographic and Health Surveys, in many sub-Saharan African countries the more educated the adolescent, the more likely she is to use contraception to avoid unintended pregnancy, and the less likely she is to have ever been pregnant. 3 A 100-country World Bank study found that for every four years
2
1) UN World Water Assessment Programme. “UN World Water Development Report: Water for people, water for life.” Paris, New York and Oxford: UNESCO and Berghahn Books, 2003. 2) Population Reference Bureau. “The World’s Women and Girls 2011 Data Sheet.” New York: Population Reference Bureau, 2011. 3) Guttmacher Institute. “Facts on the Sexual and Reproductive Health of Adolescent Women in the Developing World, In Brief.” New York: Guttmacher Institute and IPPF, 2010. 4) UNAIDS. “UNAIDS Report on the Global AIDS Epidemic 2010: Epidemiology slides.” Geneva: UNAIDS, 2010.
EN CIVIC
GA
M GE
E
NT
SRH
and childbearing, or die prematurely—after all, youth account for 41 percent of new HIV infections each year7 and AIDS kills primarily and AIDS kills primarily young and middle-aged adults during their
35% of girls marry by 18
Early Marriage
in less developed countries, impacting educational attainment.2
41% of new HIV infections are among young people aged 15-24.
peak productive years—resources devoted to building sustainable livelihoods are ill used. In short, without a sexual and reproductive health component, livelihoods programs are undermined and young people may be forced to deviate from their desired path through life. Conversely, when initiatives to expand economic opportunities for young women and empower them to control their
HIV and AIDS
Without treatment this can undermine educational, economic, and civic engagement.4
finances are paired with sexual and reproductive health efforts, they can reduce social isolation, remove incentives for early marriage, and improve their ability to negotiate safer sexual practices, including using contraception to prevent unintended pregnancy and condoms to prevent HIV and other sexually transmitted infections. 8 Sexual and reproductive health interventions also have the potential to improve outcomes for youth in the arena of civic engagement. Peer education programs that train young people to teach their peers about healthy sexual and reproductive choices have a positive impact on young peer educators’ sense of commitment and accountability to their communities. These kinds of programs help build young people’s self-confidence, commitment to service to others, and problem-solving, communication, and leadership skills—all essential components of civic engagement. Programs that enable youth to improve their own and their peers’ sexual and reproductive health impart transferable skills and convictions that can improve outcomes in all other sectors. In the same way, multisectoral programs that aim to increase civic engagement among young people can improve sexual and reproductive health. Improving young people’s ability to participate in civil society and strengthening their sense of citizenship can enhance their self-efficacy and may reduce the likelihood that they will practice high risk behaviors.9 Moreover, civically engaged young people with a strong sense of agency can be powerful advocates for their sexual and reproductive health needs and rights.
Neglecting sexual and reproductive health issues in education programs renders them less effective, squandering valuable resources and doing a disservice to the young people these programs are meant to benefit.
2
of education that girls complete, fertility rates drop by roughly one birth.4 Young people with more education are also more likely to know that condoms can
A Smart Investment | Pathfinder International
3
Healthy, empowered youth are productive, influential members of their communities and are well poised to take the reins and lead the way to a more vibrant, thriving future. The largest generation of young people in history is preparing to enter young adulthood and, at the same time, our development resources are limited. At this undeniably
photo: INDIA Karl Grobl
3B R
illion easons
about the campaign
For three decades, Pathfinder International has implemented youth programs in more than 30 countries around the world. Through its 3 Billion Reasons Billion Reasons campaign, Pathfinder is drawing greater attention to the need to invest in the world’s 3 billion people under the age of 25—the largest generation in history. Their sheer numbers can be either one of our greatest challenges or greatest opportunities. Pathfinder believes they are opportunities. Pathfinder believes our greatest greatest opportunity. they are our opportunity.
challenging moment in time, it is more important than ever to invest
in youth and to invest wisely, implementing programs with the greatest potential for success. Without a doubt, multisectoral programs for youth with a strong sexual and reproductive health component are the way forward. Healthier young people are more likely to continue their education, find sources of income, have healthy children, support their families, and become active, engaged citizens. Furthermore, over the long term these investments dramatically increase worker productivity and a country’s GDP, and advance the growth of democracy and good governance. Strategic investment in building young people’s capacity now will yield great economic returns for years to come, not only bettering individual lives, but also contributing to poverty reduction on a larger scale.10 Simply put, we cannot afford not to invest in the sexual and reproductive health of young people. The US government is increasingly recognizing the need to direct resources toward youth, and young people themselves are demanding multisectoral programs that address all elements of their complex lives, including their sexual and reproductive health.11 This document highlights just a few examples of the many ways that positive sexual and reproductive health outcomes are linked to positive outcomes in other essential development sectors. We must not miss the opportunity to make smart, responsible investments in sustainable, effective programs to maximize returns and best serve the world’s young people.
This paper was developed and produced with the support of the Summit Foundation.
references
1. UNFPA. The Case for Investing in Young People as Part of a National Poverty Reduction Strategy. New York: UNFPA, 2010. 2. Lloyd CB, Mensch BS. “Marriage and Childbirth as Factors in Dropping out from School: An Analysis of DHS Data from subSaharan Africa,” in Population Studies, 62(1):1–13, (2008). 3. Khan S, Vinod M. Youth Reproductive and Sexual Health: DHS Comparative Reports. Calverton, MD: Macro International Inc., 19 August 2008. 4. Klasen, Stephan. “Does Gender Inequality Reduce Growth and Development?—Evidence from Cross-Country Regressions.” PRR Gender and Development Working Paper Series No. 7. Washington, DC: World Bank, 1999. 5. World Bank. World Development Report 2007: Development and the Next Generation. Washington, DC: World Bank, 2007. 6. Esim S, et al. Making it Work: Linking Youth Reproductive Health and Livelihood. Washington, DC: International Center for Research on Women, 2001. 7. UNAIDS. UNAIDS Report on the Global AIDS Epidemic 2010: Epidemiology Slides. Geneva: UNAIDS, 2010. 8. Lukas, Terri. Reducing Adolescent Girls’ Vulnerability to HIV Infection: Examining Microfinance and Sustainable Livelihood Approaches, A Literature and Program Review. Washington, DC: Health Policy Initiative, Task Order 1, Futures Group, 2008. 9. Manney J, Stroud S, Sofer, G. Youth Civic Engagement as a Strategy for US Foreign Aid and Policy. Innovations in Civic Partnership White Paper. January 2010. 10. UNFPA. The Case for Investing in Young People as Part of a National Poverty Reduction Strategy, 2010. 11. Esim S, et al. Making it Work, 2001.
9 Galen Street, Suite 217 Watertown, MA 02472, USA Phone: 1-617-924-7200 www.pathfinder.org
WWW.PATHFINDER.ORG
0411/250
A Smart Investment:
Integrating Sexual and Reproductive Health into Multisectoral Youth Programs
There are an astounding 3 billion people under the age of 25 alive today, 1.8 billion of whom are between 10 and 24 years of age. These young people—the majority of whom live in less developed countries—are facing remarkably high rates of early marriage, unintended pregnancy, sexually transmitted infections, HIV, and maternal mortality and morbidity, as well as severely limited access to jobs, education, and political participation. While today’s young people are confronting formidable challenges, they also have the capacity to effect enormous change in the world, reducing poverty and helping build more just and prosperous societies.
It is imperative that we direct more development resources toward young people, who constitute the fastest growing segment of the population in many countries.1 Recent US government initiatives such as the appointment of key State Department and USAID staff to oversee youth portfolios and the Global Health Initiative’s increased emphasis on women, girls, and gender equality, are encouraging developments. Nevertheless, if investments are to reap real, lasting rewards, we must place much more importance on young people and prioritize efforts that support their advancement. Multisectoral programs for youth—programs which acknowledge that young people’s problems are interconnected and require a holistic approach—are attracting widespread recognition and praise as a smart strategy for making the most of foreign assistance dollars. These programs engage two or more of the sectors that are central to young people as they transition into adulthood: health, education, livelihoods, and civic engagement. In multisectoral programs, each intervention plays a role in improving outcomes in the other sectors—just as the problems young people face are intertwined, so too are their solutions.
3
Billion Reasons
If multisectoral youth programs are to reach their full potential, they must include a strong sexual and reproductive health component. Programs to prevent early marriage, unintended pregnancy, HIV, and other sexually transmitted infections not only improve young people’s health, but also result in noteworthy gains in education, livelihoods, and civic engagement. As illustrated by this graphic, young people’s journey to adulthood is fraught with difficulties and their sexual and reproductive health needs must be met for investments in other sectors to be beneficial. Only then can young people stay the course and fully contribute to the economic and social development of their communities.
SEXUAL AND REPRODUCTIVE HEALTH Critical to a Successful, Healthy Journey through Life
prevent HIV infection and are more likely to use condoms. 5 Education and sexual and reproductive health are interdependent and the prospects for mutually beneficial
An estimated 2.2 million unintended pregnancies occur
outcomes of integrated programming are limitless.
Unintended Pregnancy
Approximately 10% of African girls
do not attend school during menstruation or drop out due to the lack of clean and private sanitation facilities.1
Menstrual Hygiene
annually among adolescents in sub-Saharan Africa, curtailing participation in education and economic opportunities. 3
Given that young people’s ability to build vocational skills, enter the labor force, and become economically empowered is closely tied to their sexual and reproductive health
LIVE
LI
HO
O
status,6 livelihoods programs, too, should
DS
SRH
be implemented in tandem with sexual and reproductive health interventions. If young people are sick, burdened by early marriage
SRH
ED
A UC
T
N IO
SRH
The close relationship between education and sexual and reproductive health has been studied extensively, and there are numerous examples of how the two are mutually reinforcing. Data from the Demographic and Health Surveys show that 20 percent of girls in Africa drop out of school because of early marriage and pregnancy. Many additional adolescent girls leave school when they begin menstruating due to a lack of hygiene products and separate latrines. Programs that help young people delay marriage, avoid pregnancy, and maintain menstrual hygiene can help increase school enrollment, particularly among girls. As the graphic demonstrates, investing in education certainly increases young people’s chances of completing successful journeys through life, but neglecting sexual and reproductive health issues in education programs renders them less effective, squandering valuable resources and doing a disservice to the young people these programs are meant to benefit. Investing in sexual and reproductive health programming increases returns on education investments, and the opposite also holds true. For example, initiatives to expand opportunities for youth to pursue secondary education may have an impact on their sexual and reproductive health. According to the Demographic and Health Surveys, in many sub-Saharan African countries the more educated the adolescent, the more likely she is to use contraception to avoid unintended pregnancy, and the less likely she is to have ever been pregnant. 3 A 100-country World Bank study found that for every four years
2
1) UN World Water Assessment Programme. “UN World Water Development Report: Water for people, water for life.” Paris, New York and Oxford: UNESCO and Berghahn Books, 2003. 2) Population Reference Bureau. “The World’s Women and Girls 2011 Data Sheet.” New York: Population Reference Bureau, 2011. 3) Guttmacher Institute. “Facts on the Sexual and Reproductive Health of Adolescent Women in the Developing World, In Brief.” New York: Guttmacher Institute and IPPF, 2010. 4) UNAIDS. “UNAIDS Report on the Global AIDS Epidemic 2010: Epidemiology slides.” Geneva: UNAIDS, 2010.
EN CIVIC
GA
M GE
E
NT
SRH
and childbearing, or die prematurely—after all, youth account for 41 percent of new HIV infections each year7 and AIDS kills primarily and AIDS kills primarily young and middle-aged adults during their
35% of girls marry by 18
Early Marriage
in less developed countries, impacting educational attainment.2
41% of new HIV infections are among young people aged 15-24.
peak productive years—resources devoted to building sustainable livelihoods are ill used. In short, without a sexual and reproductive health component, livelihoods programs are undermined and young people may be forced to deviate from their desired path through life. Conversely, when initiatives to expand economic opportunities for young women and empower them to control their
HIV and AIDS
Without treatment this can undermine educational, economic, and civic engagement.4
finances are paired with sexual and reproductive health efforts, they can reduce social isolation, remove incentives for early marriage, and improve their ability to negotiate safer sexual practices, including using contraception to prevent unintended pregnancy and condoms to prevent HIV and other sexually transmitted infections. 8 Sexual and reproductive health interventions also have the potential to improve outcomes for youth in the arena of civic engagement. Peer education programs that train young people to teach their peers about healthy sexual and reproductive choices have a positive impact on young peer educators’ sense of commitment and accountability to their communities. These kinds of programs help build young people’s self-confidence, commitment to service to others, and problem-solving, communication, and leadership skills—all essential components of civic engagement. Programs that enable youth to improve their own and their peers’ sexual and reproductive health impart transferable skills and convictions that can improve outcomes in all other sectors. In the same way, multisectoral programs that aim to increase civic engagement among young people can improve sexual and reproductive health. Improving young people’s ability to participate in civil society and strengthening their sense of citizenship can enhance their self-efficacy and may reduce the likelihood that they will practice high risk behaviors.9 Moreover, civically engaged young people with a strong sense of agency can be powerful advocates for their sexual and reproductive health needs and rights.
Neglecting sexual and reproductive health issues in education programs renders them less effective, squandering valuable resources and doing a disservice to the young people these programs are meant to benefit.
2
of education that girls complete, fertility rates drop by roughly one birth.4 Young people with more education are also more likely to know that condoms can
A Smart Investment | Pathfinder International
3
Healthy, empowered youth are productive, influential members of their communities and are well poised to take the reins and lead the way to a more vibrant, thriving future. The largest generation of young people in history is preparing to enter young adulthood and, at the same time, our development resources are limited. At this undeniably
photo: INDIA Karl Grobl
3B R
illion easons
about the campaign
For three decades, Pathfinder International has implemented youth programs in more than 30 countries around the world. Through its 3 Billion Reasons Billion Reasons campaign, Pathfinder is drawing greater attention to the need to invest in the world’s 3 billion people under the age of 25—the largest generation in history. Their sheer numbers can be either one of our greatest challenges or greatest opportunities. Pathfinder believes they are opportunities. Pathfinder believes our greatest greatest opportunity. they are our opportunity.
challenging moment in time, it is more important than ever to invest
in youth and to invest wisely, implementing programs with the greatest potential for success. Without a doubt, multisectoral programs for youth with a strong sexual and reproductive health component are the way forward. Healthier young people are more likely to continue their education, find sources of income, have healthy children, support their families, and become active, engaged citizens. Furthermore, over the long term these investments dramatically increase worker productivity and a country’s GDP, and advance the growth of democracy and good governance. Strategic investment in building young people’s capacity now will yield great economic returns for years to come, not only bettering individual lives, but also contributing to poverty reduction on a larger scale.10 Simply put, we cannot afford not to invest in the sexual and reproductive health of young people. The US government is increasingly recognizing the need to direct resources toward youth, and young people themselves are demanding multisectoral programs that address all elements of their complex lives, including their sexual and reproductive health.11 This document highlights just a few examples of the many ways that positive sexual and reproductive health outcomes are linked to positive outcomes in other essential development sectors. We must not miss the opportunity to make smart, responsible investments in sustainable, effective programs to maximize returns and best serve the world’s young people.
This paper was developed and produced with the support of the Summit Foundation.
references
1. UNFPA. The Case for Investing in Young People as Part of a National Poverty Reduction Strategy. New York: UNFPA, 2010. 2. Lloyd CB, Mensch BS. “Marriage and Childbirth as Factors in Dropping out from School: An Analysis of DHS Data from subSaharan Africa,” in Population Studies, 62(1):1–13, (2008). 3. Khan S, Vinod M. Youth Reproductive and Sexual Health: DHS Comparative Reports. Calverton, MD: Macro International Inc., 19 August 2008. 4. Klasen, Stephan. “Does Gender Inequality Reduce Growth and Development?—Evidence from Cross-Country Regressions.” PRR Gender and Development Working Paper Series No. 7. Washington, DC: World Bank, 1999. 5. World Bank. World Development Report 2007: Development and the Next Generation. Washington, DC: World Bank, 2007. 6. Esim S, et al. Making it Work: Linking Youth Reproductive Health and Livelihood. Washington, DC: International Center for Research on Women, 2001. 7. UNAIDS. UNAIDS Report on the Global AIDS Epidemic 2010: Epidemiology Slides. Geneva: UNAIDS, 2010. 8. Lukas, Terri. Reducing Adolescent Girls’ Vulnerability to HIV Infection: Examining Microfinance and Sustainable Livelihood Approaches, A Literature and Program Review. Washington, DC: Health Policy Initiative, Task Order 1, Futures Group, 2008. 9. Manney J, Stroud S, Sofer, G. Youth Civic Engagement as a Strategy for US Foreign Aid and Policy. Innovations in Civic Partnership White Paper. January 2010. 10. UNFPA. The Case for Investing in Young People as Part of a National Poverty Reduction Strategy, 2010. 11. Esim S, et al. Making it Work, 2001.
9 Galen Street, Suite 217 Watertown, MA 02472, USA Phone: 1-617-924-7200 www.pathfinder.org
WWW.PATHFINDER.ORG
0411/250
