Introduction

Nearly half of all people are under 25. Over a billion are young people between the ages of 15 and 24, the parents of the next generation. Their decisions about education, sexual relationships, marriage, and childbirth will have an enormous impact on their lives and, in turn, on their communities and nations.

Young women and men face many risks – unwanted pregnancy, HIV/AIDS and other sexually transmitted diseases, sexual exploitation and alienation – yet they receive inadequate information, guidance and services to help them negotiate the difficult passage to adulthood. Ignoring these issues incurs a high cost in ill health, wasted opportunities and social disruption.

More than 14 million adolescents give birth each year, and a large proportion of these pregnancies are unwanted. Countless girls drop out of school each day because of pregnancy. Half a million young people acquire a sexually transmitted disease each year. Each minute, six more young people become infected with the HIV virus, which causes AIDS.

In many countries, the topic of adolescent sexuality and reproductive health is politically and culturally sensitive; as a result, reproductive health information and services do not reach most youth. However, some 55 countries have taken policy and programme measures to address the health needs of adolescents. Given the high level of demand, the United Nations Population Fund is intensifying efforts to find acceptable and effective ways to help young people protect their reproductive health and their futures.

During 1999, UNFPA worked closely with the World Population Foundation and the Dutch Youth Council to organize The Hague Youth Forum, which took place 5-7 February, just before The Hague Forum. The event was attended by more than 100 young people from all regions and resulted in numerous recommendations on how to address their sexual and reproductive health needs. About a quarter of the youth who participated in the forum also took part in the 21st Special Session of the United Nations General Assembly.

Using a joint strategy developed with the World Health Organization (WHO) and UNICEF, the Fund worked during the year to document experiences in adolescent reproductive health care in various countries. We found that some success is being achieved in introducing sexuality education and other emerging issues – such as human rights, harmful practices, and violence – into education programmes and in strengthening teacher training, parent education and community outreach. Reviews of UNFPA country programmes reveal that considerable efforts have been made, with some notable successes, to bring "health to youth". The review also found that much remains to be done.

Developing countries in all parts of the world face serious challenges in addressing adolescent reproductive and sexual health needs. Studies show that accurate information encourages responsible sexual behaviour, including abstinence, among adolescents.

Many young people are confronted with the possibility of pregnancy and HIV/ AIDS, yet they lack information and services to protect themselves. In Viet Nam, for example, while adolescents make up only 12 to 14 per cent of the population, they account for 25 per cent of abortions and 50 per cent of HIV infections. In Mongolia, a government health survey found that many sexually active female adolescents knew little about reproductive health and contraception and were at high risk of abortion and miscarriage. Fifty-four per cent of the Mongolian adolescents interviewed expressed the desire to learn about reproductive health in school.

In Georgia, while the overall abortion rate has declined considerably since independence, the rate for females aged 15-24 has risen by approximately one third, with about 20 per cent of abortions followed by complications. As with many other countries in the region, the wide reliance on abortion to end unwanted pregnancies is partly due to limited access to youth-friendly services in both the public and private sectors. Sexuality education is not offered in schools in Georgia, and information simply does not reach young people.

This situation is repeated in many countries. In the Philippines, according to a survey conducted in 1999, up to 74 per cent of sexually active adolescents were not using contraception, but the majority admitted that they were not willing or ready to become parents. In Bolivia, 30 per cent of all women are mothers by the age of 19. Raising the average mother's age at first birth from 18 to 23 would reduce population momentum by over 40 per cent. 

The spread of HIV/AIDS has highlighted the risks posed by the lack of reproductive health information and services for young people. Approximately half of all people who acquire HIV become infected before they turn 25 and typically die before their 35th birthday. The disease is wiping out years of progress, robbing nations of their most productive workers and children of their parents. Left behind are more than 11 million AIDS orphans. 

In hard-hit countries, AIDS is taking a disproportionate toll on young women who are becoming infected by older men. In Namibia, for instance, government figures show that most of the women testing HIV-positive are in their early 20s, while most men are in their mid-30s. In rural Uganda, there are six young women who are HIV positive for every one infected young man. 

To address these challenges, UNFPA is working to provide greater access to youth-friendly information and services and to advocate for policies that recognize the rights of young people and promote their reproductive health. A key focus of the Fund's work in adolescent reproductive health is the prevention of HIV infection. In all areas of its work with adolescents, UNFPA works to ensure the participation of young people themselves in the planning, implementation and evaluation of policies and programmes. It also works to address gender issues that affect reproductive health and behaviour. 

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