The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development

Abstract

Among the groundbreaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low-and middle-income countries in the 25 years since the ICPD in six areas central to ASRHdadolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time

“…For the first time, adolescent health is placed fully on numerous global, regional, and national agendas [1]. In 2016, to fulfill the mission of "leaving no one behind," the special needs of adolescents were recognized in both the SDGs and in the Global Strategy for Women's, Children's, and Adolescents' Health [5,6].…”

“…We have better data and evidence on ASRHR and therefore have a better understanding of adolescents' SRHR needs and effective (and ineffective) services and interventions [1]. We have confirmed the value of reaching general populations of adolescents with large-scale, multisectoral, multilevel ASRHR programs with meaningful engagement of young people in all steps of the process, while employing innovative and flexible models to meet the needs of the growing number of adolescents living in particularly difficult circumstances [1]. And we are starting to make progress in learning how to do so in different contexts and with different resource availability.…”

“…This supplement aims to contribute to this goal. Paper 1 provides an overview of the state of ASRHR in the 25 years since the ICPD, Paper 2 outlines how our political, programmatic, and social responses have evolved over the same time period, and Paper 3 sets out considerations for delivering a package of essential SRH services and interventions to meet the needs and preferences of adolescents [1,2,4]. This fourth paper concludes by reaffirming our vision for ASRHR, charting out emerging opportunities and persistent and new challenges that we must take into account, and proposing five priority actions that will need to be taken in the next 10 years to achieve significant progress toward the unfinished agenda for ASRHR.…”

Adolescents' Sexual and Reproductive Health and Rights: What Has Been Achieved in the 25 Years Since the 1994 International Conference on Population and Development and What Remains to Be Done?

“…The first paper by Liang et al [2] examines trends in key indicators of adolescents' SRHR and social and economic determinants of their SRHR during the 25 years since the ICPD. The second paper by Chandra-Mouli et al [3] complements the first and provides an overview of policy and programmatic responses over the last 25 years by focusing on six aspects of adolescents' SRHR: pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstruation.…”

“…Second, some indicators such as intimate partner violence and reproductive cancers have worsened [2]. Third, efforts to implement adolescent SRHR policies and programs are impeded by extensive resistance to the provision of comprehensive SRHR information and services to adolescents because of social norms and taboos around adolescents' sexuality [3]. Fourth, the multiple factors that drive adolescents' SRHR demand complex programs that are often challenging to implement.…”