Adolescence

country are particularly serious, given that in the period2000–2009, around 47 per cent of Indian women aged20–24 were married by age 18. 10 Adolescent pregnancy isa regular consequence of child marriage, and underweightmothers have a higher risk of maternal death or morbidity.Obesity is a growing and serious concern in both industrializedcountries and the developing world. Data from asubset of 10 developing countries show that the percentageof girls aged 15–19 who are overweight (i.e., those with abody mass index above 25.0) ranges between 21 and 36per cent. 11 Among the OECD countries, the highestlevels of obesity in 2007 were found in the four southernEuropean countries of Greece, Italy, Spain and Portugal,together with the mainly Anglophone nations of Canada,the United Kingdom and the United States. 12Sexual and reproductive health mattersGirls are more likely to have engaged in early sex inadolescence but also less likely to use contraceptionInvesting in sexual and reproductive health knowledge andservices for early adolescents is critical for several reasons. Thefirst is that some adolescents are engaging in sexual relationsin early adolescence; international household survey data representativeof the developing world, excluding China, indicatethat around 11 per cent of females and 6 per cent of malesaged 15–19 claim to have had sex before the age of 15. 13Latin America and the Caribbean is the region with thehighest proportion of adolescent females claiming to havehad their sexual debut before age 15, at 22 per cent (thereare no equivalent figures for young men for this region).The lowest reported levels of sexual activity for both boysand girls under 15 occur in Asia. 14The second reason concerns the alarming and consistentdisparity in practice and knowledge of sexual and reproductivehealth between adolescent males and adolescentfemales. Adolescent males appear more likely to engageis risky sexual behaviour than adolescent females. In 19selected developing countries with available data, malesaged 15–19 were consistently more likely than females tohave engaged in higher-risk sex with non-marital, noncohabitingpartners in the preceding 12 months. The dataalso suggest, however, that boys are more likely than girlsto use a condom when they engage in such higher-risksex – despite the fact that girls are at greater risk of sexuallytransmitted infections, including HIV. These findingsunderscore the importance of making high-quality sexualand reproductive health services and knowledge availableto adolescent girls and boys alike from an early age. 15Early pregnancy, often as a consequence of earlymarriage, increases maternity risksThe third challenge is empowering adolescent girls inparticular with the knowledge of sexual and reproductivehealth, owing to the gender-related protection risks theyface in many countries and communities. Child marriage,often deemed by elders to protect girls – and, to a muchlesser extent, boys – from sexual predation, promiscuityand social ostracism, in fact makes children more likely tobe ignorant about health and more vulnerable to schooldropout. Many adolescent girls are required to marry early,and when they become pregnant, they face a much higherrisk of maternal mortality, as their bodies are not matureenough to cope with the experience.The younger a girl is when she becomes pregnant, whethershe is married or not, the greater the risks to her health. InLatin America, for example, a study shows that girls whogive birth before the age of 16 are three to four times timesmore likely to suffer maternal death than women in theirtwenties. Complications related to pregnancy and childbirthare among the leading causes of death worldwide foradolescent girls between the ages of 15 and 19. 16For girls, child marriage is also associated with an increasedrisk of sexually transmitted infections and unwanted pregnancies.Research suggests that adolescent pregnancy is relatedto factors beyond girls’ control. One study undertaken inOrellana, an Ecuadorian province in the Amazon basin,where nearly 40 per cent of girls aged 15–19 are or have beenpregnant, found that the pregnancies had much less to dowith choices made by the girls themselves than with structuralfactors such as sexual abuse, parental absence and poverty. 17Unsafe abortions pose high risks for adolescent girlsA further serious risk to health that arises as a consequence ofadolescent sexual activity is unsafe abortion, which directlycauses the deaths of many adolescent girls and injures manymore. A 2003 study by the World Health Organizationestimates that 14 per cent of all unsafe abortions that takeplace in the developing world – amounting to 2.5 millionthat year – involve adolescents under age 20. 18 Of the unsafeabortions that involve adolescents, most are conducted byuntrained practitioners and often take place in hazardouscircumstances and unhygienic conditions. 1922THE STATE OF THE WORLD’S CHILDREN 2011