Adolescence is a period of increased risk-taking and therefore susceptibility to behavioural problems at the time of puberty and new concerns about reproductive health. Female adolescents, compared to their male counterparts, face disproportionate health concerns following puberty; foremost among these are too-early pregnancy and frequent childbearing. Male adolescents, for their part, often lack a sense of shared responsibility for sexual and reproductive matters and respect for reproductive choices. This helps perpetuate traditions in many developing countries that encourage early marriage followed quickly by a first and subsequent births. Even where these influences are waning, lack of sexual and contraceptive knowledge, along with difficulty in obtaining contraceptives, results in continued early childbearing among adolescents.

Adding to the challenge is the sheer magnitude of the numbers: more than half the population in developing countries is under 25. The 10-24 year-old population in these countries is estimated at 1.3 billion, and growing; by 2025, this number is expected to rise by some 400 million.

These are among the many reasons why adolescent reproductive health is a priority concern of UNFPA. And, although a relatively new and sensitive area, there is good evidence that information and service programmes for adolescents, both male and female, result in improved health of young people, improved health of young mothers when they bear children, better birth outcomes and health of infants, enhanced socio-economic potential for young women, and slowed population growth.

UNFPA's entry into the area of adolescent reproductive health occurred at a time when adolescents were largely neglected in policies and programmes. Today, this is changing. The reproductive health needs of adolescents are, by necessity, becoming a priority concern in an increasing number of countries. There is also increased interest among United Nations development partners, donors and NGOs.

UNFPA support for activities targeted at adolescents has expanded dramatically in the last decade. So has the scope of UNFPA programmes, from an early emphasis on education to a broader array of information, outreach, advocacy, and service programmes, many of them involving adolescents in both programme design and implementation. Moreover, the findings and recommendations of a recent thematic evaluation have given direction to the latest cycle of UNFPA-funded programmes and projects and are serving as an important tool for advocating strengthened government action to address adolescent reproductive health needs.

Such strengthened action is needed in all regions, as the majority of adolescents still do not have access to information and education on sexuality, reproduction, and sexual and reproductive health and rights. Nor do they have access to preventive and curative services. Providing adolescents with access to such information, education and services is thus the main challenge for future programmes.

Country-level implementation. Adolescent reproductive health is increasingly becoming a government priority. A few examples may help illustrate this, as well as the nature and impact of UNFPA assistance in this area.

The Islamic Republic of Iran is a good case in point, and with good cause: some 40 per cent of its population is under 15 years of age. The Government has used many different channels to raise awareness among adolescents on issues related to reproductive health and family planning. These include public health outlets, Parent-Teacher Associations, and NGOs, among others. In August, the Government convened the "First National Workshop on Adolescents' Health", marking the beginning of a series of nationwide activities. The workshop discussed a questionnaire that had been prepared by the Department of Family Health of the Ministry of Health and Medical Education and decided to conduct a study on adolescent reproductive health in three pilot provinces, with a view to developing specific policies and programmes. In a related activity, the Family Planning Association of Iran, an affiliate of the International Planned Parenthood Federation (IPPF), is working on linking adolescent reproductive health with the teachings of Islam in order to make it more acceptable to the Iranian people.

The UNFPA-supported subregional programme in the Caribbean is another positive example. It emphasizes adolescent reproductive health and rights as one of its two substantive themes, moving away from past emphasis on providing services to women-in-union only to a more integrated and inclusive approach. The programme is focused on providing access to, and delivery of, services through a coalition of government, NGO, youth and community-based organizations. The programme is designed as a truly subregional operation, targeting adolescents and young people for special attention in all countries in the subregion and making use of pilot testing and training in countries where such an integrated approach is new.

Adolescent reproductive health is also a priority concern in Nicaragua. UNFPA support to the first national Centre for Adolescent Reproductive Health in Managua has enabled the Centre to provide health care to a large number of pregnant adolescents primarily from poor urban areas, as well as information materials and training to NGOs working in this field. As a result, over 7,000 adolescents and youth of both sexes, in a spectrum ranging from university students to gang members, have been trained in reproductive and sexual health issues. In addition, a special training module has been developed in collaboration with the Nicaraguan Communal Movement, resulting in the creation of rural Health Brigades throughout the countryside with a large number of promoters of reproductive health for adolescents.

Recognition of the importance of adolescent reproductive health also made inroads in countries in which such issues are particularly sensitive. In Gabon, for example, a special meeting at the National Assembly in April provided a unique forum to discuss the main reproductive health problems facing Gabonese youth today. Among the issues discussed at the meeting, which was attended by the President of the National Assembly and some 60 parliamentarians (about half the total in the Assembly), were the increase in the rate of abortion among teenage girls and the need for an educational system that would enable teenagers to manage their sexuality and offer them appropriate counselling and training to get a successful start in life. World Population Day also provided an opportunity to convene the country's First National Forum of NGOs on Adolescent Reproductive Health. About 200 people took part in the event, representing some 30 NGOs. The opening ceremony was attended by the spouse of the Gabonese President and by the Minister of Public Health. The National Forum lasted three days and produced the Declaration of Libreville containing recommendations on such issues as reproductive health and services, policies and laws, and religious, cultural and societal concerns.

Global and regional support. Adolescent reproductive health received considerable attention at the regional and global levels. For example, to promote policy development and programme delivery, UNFPA, together with WHO and UNICEF, issued a statement on Action for Adolescent Health: Towards a Common Agenda, which originated from a joint study group. The common agenda is designed to provide a framework for accelerated joint programming for adolescent health at the country level.

UNFPA also produced two important publications promoting reproductive health care for adolescents. One, a joint publication with IPPF entitled Generation 97: What Young People Say about Sexual and Reproductive Health, presents the results of a survey of over 600 young people in 54 countries on such issues as friendship, love and relationships, sexuality, contraception, pregnancy and parenthood, and risk behaviour. The other, UNFPA and Adolescents, uses plain language to look into such issues as programming for adolescent reproductive health and the use of strategic alliances.

UNFPA worked closely with a number of NGOs in promoting the reproductive health of special groups of adolescents, including refugees. With the Fund's support, the World Association of Girl Guides and Girl Scouts and Family Health International began work in three countries with a view to developing a methodology to promote the health of adolescent girls, including reproductive health, that can be applied to the refugee work of girl guide associations throughout the world. UNFPA convened a regional meeting in San Jose, Costa Rica, 1-3 December, bringing together more than 150 high-level representatives from governmental and non-governmental sectors, as well as the international development community, to examine progress made at the country level and to articulate a regional commitment to improving the reproductive and sexual health of young people in Latin America. The participants emphasized the need to provide counselling and services specially suited to adolescents and made numerous action-oriented recommendations in such areas as public policy, information and services, and strategic partnerships.

The concerns of youth and reproductive health in countries in transition were the subject of a European regional meeting, which met 23-25 June in Copenhagen. The meeting, which was organized by UNFPA and the Government of Denmark in cooperation with the WHO Regional Office for Europe, brought together some 70 representatives from NGOs and relevant government departments from the countries of Central and Eastern Europe, the Commonwealth of Independent States and the Baltic States to share their experiences in dealing with adolescent reproductive and sexual health issues. The participants highlighted the seriousness and urgency of the problems that young people face and proposed major strategies to address the specific needs of youth in the region. The recommendations that emanated from the meeting will guide UNFPA in its future assistance to these countries.

The Fund co-sponsored, with the United Nations Division for the Advancement of Women (UNDAW), UNICEF and the Economic Commission for Africa, an Expert Group Meeting on Adolescent Girls and Their Rights, in Addis Ababa in October. The meeting made a number of recommendations that had far-reaching implications for adolescent girls in terms of creating an enabling environment, providing reproductive health services, and identifying special groups of adolescent girls who need attention. UNFPA also co-sponsored the Second World Congress on Family Law and the Rights of Children and Youth, which was held in San Francisco in May. The Congress, attended by some 500 participants from over 50 countries, adopted a resolution stating that all couples and individuals, including adolescents, should have access to reproductive health information and services.

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