UNFPAState of World Population 2003
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State of World Population
Overview of Adolescent Life
Gender Inequality and Reproductive Health
HIV/AIDS and Adolescents
Promoting Healthier Behavior
Meeting Reproductive Health Services Needs
Comprehensive Programmes for Adolescents
Giving Priority to Adolescents
Sources for Boxes
Graphs and Tables


Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7


1 Research methodologies are increasingly including measures of the personal characteristics of adolescents, their family situations and community characteristics and norms.

2 The United Nations Theme Group on HIV/AIDS in China. 2002. HIV/AIDS: China’s Titanic Peril. 2001 Update of the AIDS Situation and Needs Assessment Report. Beijing, China: UNAIDS.

3 Monitoring the AIDS Pandemic (MAP) Network. 2001. “The Status and Trends of HIV/AIDS/STI Epidemics in Asia and the Pacific”. Report presented at the MAP Meeting in Melbourne, Australia, 4 October 2001.

4 Rosen, J. 2001. Formulating and Implementing National Youth Policy: Lessons from Bolivia and the Dominican Republic. Washington, D.C.: FOCUS on Young Adults, Pathfinder International.

5 Greene, M., et al. 2002. In this Generation: Sexual & Reproductive Health Policies for a Youthful World. Washington, D.C.: Population Action International.

6 Ministry of Health. 2002. National Standards and Guidelines for Reproductive Health Care Services. Hanoi: Ministry of Health, Government of Viet Nam.

7 UNFPA. 1999. Annual Report 1999. New York: UNFPA.

8 Kiragu, K., et al. 1998. Adolescent Reproductive Health Needs in Kenya: A Communication Response Evaluation of The Kenya Initiatives Project. Baltimore, Maryland: Population Communication Services, John Hopkins University.

9 United Nations. 1989. Convention on the Rights of the Child: General Assembly Resolution 25(XLIV): 44th Session: Supplement No. 49, (A/RES/44/25, reprinted in 28 I.L.M. 1448): opened for signature 26 January 1990, paragraph 29.1(b); United Nations. 1979. Convention on the Elimination of All Forms of Discrimination against Women: Adopted and Opened for Signature, Ratification and Accession by General Assembly Resolution 34/180 of 18 December 1979, article 10c. New York: United Nations; United Nations. 1993. Vienna Declaration and Programme of Action: World Conference on Human Rights (A/CONF.157/24), paragraph 18. New York: United Nations; United Nations. 1995. Population and Development, vol. 1: Programme of Action adopted at the International Conference on Population and Development: Cairo, 5-13 September 1994, Principle 10, paragraphs 4.3(c), 4.12, 4.16(a, b), 4.17, 4.29, 7.39, 7.48 and11.16. New York: Department of Economic and Social Information and Policy Analysis, United Nations; United Nations. 1996. The Beijing Declaration and the Platform for Action: Fourth World Conference on Women: Beijing, China: 4-15 September 1995 (DPI/1766/Wom), paragraphs 83(i), 107(e), 125(e), 126(b), 227, 230(f), 231c, 233(c, d, f, g) and 278(b, c). New York: Department of Public Information, United Nations; United Nations. 1999. Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development (A/S-21/5/Add.1), paragraphs 3 and 40. New York: United Nations; and United Nations. 2000. Resolution Adopted by the General Assembly: S-23/3: Further Actions and Initiatives to Implement the Beijing Declaration and Platform for Action (A/RES/S-23/3), paragraph 99(a). New York: United Nations.

10 United Nations 1995, paragraphs 7.38, 12.13, 12.14, 12.20, 12.22; United Nations 1996, paragraphs 109(d, and f), 206(a, b, i, and j), and 231e; and United Nations 1999, paragraphs 5, 37.

11 United Nations 1989, paragraph 3.1; United Nations 1995, paragraphs 6.7(b) and 7.21; United Nations 1996, paragraphs 107(e), 110(a, and e),111(a), and 267; United Nations 1999, paragraphs 21(b), 40, 42, 45, 52(b), and 73(c); and United Nations 2000, paragraphs 72(g), and 79(f).

12 United Nations 1979, paragraphs 7(c), and 14.2(a); United Nations 1995, paragraphs 4.3(b), 4.4(a), 7.9, 7.18, 15.8, 15.9, and 15.10; United Nations 1996, paragraphs 106(s), 108(a, and j), 233(f), and 295; and United Nations 2000, paragraphs 51, 52(c), 76, and 81.

13 United Nations 1989, paragraphs 12.1, and 13; United Nations 1995, paragraphs 6.15, 7.43, 7.47, and 11.20; United Nations 1996, paragraphs 111(b), and 284(a, and b); United Nations 1999, paragraphs 21(b), 73(c), 83, and 90; United Nations 2000, paragraphs 79(f), and 95(b, and c).

14 Senderowitz, J. 2000. “A Review of Program Approaches to Adolescent Reproductive Health.” Poptech Assignment. No. 2000.176. Arlington, Virginia: Population Technical Assistance Project.

15 Chibbamulilo, P. 1997. A Report on the Mini-Participatory Learning and Action (PLA) Exercise for the JSI/SEATS Programme in Zambia. Lusaka, Zambia: Family Planning Service Expansion and Technical Support Project, John Snow International.

16 MacLean, A. 1999. Sewing a Better Future: A Report of Discussions with Young Garment Factory Workers about Life, Work and Sexual Health. Washington, D.C.: CARE International, Cambodia, and FOCUS on Young Adults.

17 Cheetham, N., R. Thiombiano, and S. Ky. 2003. “Community Participation to Improve Youth Sexual and Reproductive Health in Burkina Faso.” Unpublished project summary. Washington, D.C.: Advocates for Youth.

18 Khan, S. A., and M. Ahmed. 2001. “BRAC, Bangladesh: Community Mobilization to Support Adolescent Development.” FOCUS Project Highlights. Washington, D.C.: FOCUS on Young Adults, Pathfinder International. Web site: www.pathfind.org/pf/pubs/ focus/Project%20Highlights/BRAC.htm, accessed 6 January 2003.

19 Micklewright, J. 2002. “Social Exclusion and Children: A European View for a US Debate.” Innocenti Working Papers. No. 90. Florence, Italy: Innocenti Research Centre, UNICEF.

20 Lansdown, G. 2001. Promoting Children’s Participation in Democratic Decision- Making. UNICEF Insight No. 6. Florence, Italy: Innocenti Research Center, UNICEF. Web site: www.unicef-icdc.org/publications/pdf/insight6.pdf, accessed 19 April 2003.

21 Cornwall, A., and A. Welbourn (eds.). 2002. Realizing Rights: Transforming Approaches to Sexual and Reproductive Well-being. London: Zed Books.

22 See: UNICEF. 2002. The State of the World’s Children 2002: Leadership (Sales No. E.02.XX.1). New York: UNICEF.

23 Faulkner, K., and J. Knott. 2002. “Institutionalising Youth Participation in a Large International Organisation: Experiences from the International Planned Parenthood Federation.” Ch. 2 in Cornwall and Welbourn 2002.

24 Lansdown 2001.

25 Ibid.

26 See: UNESCO. n.d. “Who is Who: Directory of International Youth-led/ Youth-serving Organisations.” Paris: UNESCO. Web site: www.unesco.org/ youth/ONGRepertoire.htm, accessed 8 June 2003.

27 Russell, J., and X. Solórzano. 2001. Adolescent and Youth Policy: The Experiences of Colombia, Dominican Republic and Nicaragua. Washington, D.C.: Adolescent Health and Development, PAHO, WHO.

28 See web site: www.elige.org.mx/Quienes_somos.htm, accessed 20 January 2003.

29 TakingItGlobal Projects: Network of Young Women Activitists against Violence against Women. See web site: http://projects.takingitglobal.org/ genderviolence, accessed 20 January 2003.

30 The Youth Coalition, Ottawa, Ontario, Canada. Web site: www.youthcoalition.org, accessed 20 January 2003.

31 For example, the costs of an HIV/AIDS preventive education programme in country with low prevalence may be high relative to the immediate benefits. However, the risk of spread in an uninformed population is greatly increased with enormous potential consequences.

32 Costs are not the same as expenditures. Administrative costs, private costs and opportunity costs are often omitted from analyses. Modes of financing (e.g., transfers) are variously, and often improperly, accounted. See: Knowles, and J. Behrman. 2003. Background paper (edited version March 2003) the Expert Meeting on Assessing the Economic Benefit of Investing in Youth in Developing Countries, National Research Council, Washington, D.C., 15 October 2003.

33 Correia, M., and W. Cunningham, W. 2003. Caribbean Youth Development: Issues and Policy Directions. Washington, D.C.: The World Bank; and Cunningham, W. 2003. Presentation at the Expert Meeting on Assessing the Economic Benefit of Investing in Youth in Developing Countries, National Research Council, Washington, D.C., 15 October 2003.

34 It is easier to estimate social than private costs as the latter component inputs and their prices vary.

35 The financial costs include child support payments, the publicly paid health costs for the mother and child, government transfers for aid to poor families and to foster care. Economic costs include tax revenues foregone by lowered future income of the mother and the child, administrative resources diverted to providing social services, lost benefits from alternative uses of health care funds, economic costs of increases in crime related to reduced education and employment prospects and other reduced contributions to society by the child and adolescent mother. For additional references and details, see: Correia and Cunningham 2003; and Cunningham 2003. Variations in social services provided and income levels (and the portion directed to child support) account for the differences in national estimates.

36 Buvinic, M. 1998. “The Costs of Adolescent Childbearing: Evidence from Chile, Barbados, Guatemala and Mexico.” Studies in Family Planning 29(2): 201-209.

37 The biological father is less likely to be present and more of the women are living as boarders outside their own or their parents’ home. Unlike in the United States (see: Buvinic 1998 for references), future marital chances are not affected. The pattern of extended single-motherhood for young mothers does not hold in these Latin American settings.

38 In Mexico, two thirds of adolescent mothers were children of women who were themselves adolescent mothers.

39 Population-based surveys would be the most reliable, though costly, method. Most information comes from measures at antenatal centres but young mothers may be less likely to use them.

40 Cited in: Knowles and Behrman 2003, p. 41. This estimate contains a significant time discount for a gain of 34.6 disability-adjusted life years that are realized 5-8 years after infection.

41 Marseille, E., P. B. Hoffman, and J. G. Kahn. 2002. “HIV Prevention before HAART in Sub-Saharan Africa.” The Lancet. 2002 359(9320): 1851-1856.

42 This point was forcefully argued by P. Piot, D. Zewdie, and T. Türmen (2003. “HIV/AIDS Prevention and Treatment.” The Lancet 360[9326]: 86) in their rejoinder to the Marseille, Hoffman and Khan 2002 article.

43 Benefits included saved disability adjusted life years, reductions in secondary infections of partners of the averted case and reduced annual medical care costs.

44 Marek, T., and J.M. Del Rosso, T. 1996. Class Action: Improving School Performance in the Developing World through Better Health and Nutrition. Washington, D.C.: The World Bank. Cited in: Knowles and Behrman 2003.

45 WHO. 1996. “Research to Improve Implementation and Effectiveness of School Health Programmes,” (WHO/HPR/HEP/96.3). Geneva: WHO. Cited in: Knowles and Behrman 2003. The reviews show high returns (in the area of 18-20:1) to anti-smoking interventions, consistent with the high rates of prevalence and associated long-term mortality and morbidity.

46 This is the upper range of estimates for needs to meet the education-related Millennium Development Goals and is based on applying normative investment standards related to national GNP. A range of estimates from $2.4 billion, including UNICEF’s estimate of $9.1 billion, is noted. See: Devarajan, S. 2002. “External Finance and the Millennium Development Goals.” Presentation at the International Seminar, “Latin America and the Caribbean: Challenges before the Millennium Development Goals,” organized by the Inter-American Development Bank, Economic Commission for Latin America and the Caribbean, the World Bank, and UNDP, Washington, D.C., 10-11 June 2002.

47 The plausible range of estimates of returns, depending on assumptions about annual discount rates and component returns, was from 2.77 to 25.63 times the costs. See: Knowles and Behrman 2003, Ch. 6.

48 The uncertainty in this estimate was considerably higher; the range was 8.14 to 1,764.

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