Reproductive Health Matters submission to the Committee on the Rights of the Child General Comment on the Rights of Adolescents, March 31st 2015
Adolescent girls around the world are disproportionately impacted by the unmet need for contraception[i]; unsafe abortion[ii], maternal morbidity and mortality[iii]. These risks can be caused or exacerbated by female genital mutilation, early marriage, sexual exploitation, gender-based violence and transactional sex. Meanwhile male and female adolescents make up a rapidly growing share of people living with HIV worldwide[iv]. Adolescents who identify as lesbian, gay, bisexual or transgender are more likely to experience discrimination in health services and high-risk behaviours associated with social stigma; and are at increased risk of depression and suicidality[v]. Laws which restrict access to services on the basis of age place children and young people at additional risk, denying them access to essential information, advice and treatment[vi].
Reproductive Health Matters (RHM) provides a platform for the dissemination of knowledge and evidence on Sexual and Reproductive Health and Rights (SRHR) globally. It has a special focus on bringing neglected issues to light, and giving a voice to those with expertise in legal, policy, and clinical aspects. Through its peer reviewed journal, RHM supports policy makers and programme service providers with high-quality research and evidence on how to improve quality, access and uptake of sexual and reproductive health services. Reproductive Health Matters further contributes to the generation of solid evidence, by encouraging and supporting those working on the ground, particularly those in low and middle-income countries, to publish cutting edge research on obstacles and success in making change happen. RHM keeps advocates and readers abreast of progress (or regress) in the field by providing critical analysis of policy and practice at global and local level.
RHM has routinely published research on the specific SRHR needs of adolescents and we would like to draw the attention of the Committee on the Rights of the Child to evidence published by RHM (links to relevant papers below) to inform the development of evidence-based guidance to states.
The evidence we have published provides four overarching messages which we hope will inform the Committee’s work.
i) The sexual and reproductive rights and health of adolescents need to be urgently addressed as a matter of human rights and public health; so that adolescents can realise their entitlement to the highest possible attainment of mental and physical health, and in order that they can fully participate in and contribute to their communities as they transition into adulthood.
ii) Adolescents have the right and the need to access good quality, evidence-based information and education about gender, sexuality, sexual rights and sexual and reproductive health.
Education should address prevention of STIs/HIV and pregnancy, abortion and maternity, but must not focus solely on risk. It should also:
• acknowledge and destigmatise the diversity of gender identities and human sexuality;
• promote safe and consenting relationships, and address gender-based violence;
• equip young people to communicate about their sexuality and sexual health with partners, parents, and professionals;
• inform about, and help to create demand for, local sexual health services.
iii) Adolescents have the right and need to access good quality sexual and reproductive health services which :
• are informed by evidence about adolescent behavior and risk;
• recognise their specific needs and their evolving capacity to make decisions about their bodies and their lives;
• are accessible in location, hours and cost;
• which respect their right to confidentiality and privacy;
• which aim to tackle stigma;
• which are gender-sensitive, and acknowledge and cater to the different needs of young people in relation to their sexual identities, and sexual behavior;
• and which provide services across STI/HIV and pregnancy prevention, safe abortion and maternity services .
iv) These rights and needs are largely not being met because the voices of adolescents and the experience of professionals on the ground who work with them are not heard by policy-makers. There is a lack of understanding of adolescent development, behavior and needs, a lack of resourcing, more generalised problems with health service delivery; and a lack of political will to challenge conservative opposition to addressing adolescent sexual health, and to providing services for unmarried adolescents.
RHM would like to draw particular attention to:
evidence that laws which restrict access to sexual and reproductive health services on the basis of age, increase risks for young people,
the need for civil society organisations, educators and health providers to work with governments to promote understanding and acceptance of adolescent sexuality and sexual health needs as a reality – across diverse cultural and religious contexts,
the need for investment in gender-sensitive and age-disaggregated research and wider dissemination of findings that shed light on the unique SRHR needs of adolescent girls and boys, as well as the specific challenges for transgender youth,
the need for a protective legal environment that allows young people to exercise their sexual and reproductive rights, and in which they are empowered to express gender identity and sexual orientation without the fear of stigma, violence or coercion,
the need to explore the risks and opportunities that new technologies provide for health promotion, education and service provision for adolescents,
the need to involve adolescents in identifying the barriers to accessing existing services; and in designing new services to meet their needs,
the need to ensure that health programmes whether for STI/HIV, pregnancy prevention, abortion or safe maternity are rights-based and respect the bodily autonomy, decision-making capacity and confidentiality of adolescents.
All RHM papers on adolescent sexuality, sexual and reproductive rights and health are in our key topics here.
[i] Rosen, J. Position paper on mainstreaming adolescent pregnancy in efforts to make pregnancy safer. World Bank
[ii] World Health Organization. Unsafe Abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. World Health Organization: Geneva, 2011.
[iii] Making Pregnancy Safer: Adolescent Pregnancy. World Health Organization: Geneva 2008.
[iv] Turning the tide against AIDS will require more concentrated focus on adolescents and young people. Unicef, January 2015 www.data.unicef.org/hiv-aids/adolescents-young-people [last accessed 30/03/2015]
[v] Recommendations for Promoting the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Adolescents: A Position Paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health 52 (2013) 506-510
[vi] Yarrow E, Anderson K, et al. Can a restrictive law serve a protective purpose? The impact of age-restrictive laws on young people’s access to sexual and reproductive health services. Reproductive Health Matters 2014;22(44):148-156.