Adolescents' access to quality reproductive health care, including family planning, is essential to their health, well-being, and future success. Yet too little is being done in humanitarian settings to meet this basic need. The Women's Refugee Commission and Save the Children, in partnership with the United Nations High Commissioner for Refugees and the United Nations Population Fund has documented the gaps in the humanitarian sector and outlined recommendations for donors, governments, and humanitarian and development organizations in a new report, "Adolescent Sexual and Reproductive Health Programs in Humanitarian Settings: An In-depth Look at Family Planning Services."
The need for action on reproductive health care for adolescents could not be more urgent or obvious. The statistics are striking. Two million girls under the age of 15 give birth every year. Adolescent girls have a higher risk of maternal mortality than any other age group. And half of sexual assaults are committed against girls younger than 15.
The sense of urgency is compounded in humanitarian settings. The disintegration of community and family structures weakens traditional protection mechanisms and alters behavioral patterns. As a result, child-bearing risks are extremely high, sexual violence and exploitation is pervasive and forced or early marriage is not uncommon.
There is growing recognition among humanitarian actors of these devastating consequences. But, as documented in our new report, greater understanding of this issue has not yet been matched by increased programming and funding for adolescents.
In researching our report, the WRC and Save the Children conducted a year-long mapping exercise that found only thirty-seven programs focusing on the sexual and reproductive health needs of 10 to 19 year olds had been implemented since 2009. Only 21 of these provided more than two methods of contraceptives. Funding patterns were equally bleak. A review of more than 2,600 health proposals in 101 humanitarian funding appeals from 2009 to 2012 revealed only 37 proposals that included any elements of adolescent sexual and reproductive health care. More than half of these have gone unfunded. The gaps in funding and programming at every phase of humanitarian response are sobering and urgently require increased attention and support from donors, policymakers and practitioners.
But in spite of the work that remains to be done, there are also some encouraging findings in our report. During the program mapping exercise, we were able to document multiple instances of notable practice in humanitarian settings that could serve as a guide for strengthening programming and significantly scaling up access to reproductive health care for adolescents.
The successful programs that we did find had common threads. They build community trust and support by engaging parents, teachers and community leaders. They engage adolescent themselves, not in tokenistic ways, but as full participants from the start in the assessments of need and in the design of programs. Successful programs are also responsive to the different needs of a diverse adolescent population that includes the married and unmarried; those in school and those who are not, and adolescents with disabilities. And we found that the more effective programs offer comprehensive sexual and reproductive health services at a single site or through a strong, functioning referral network.
Our report calls for humanitarian organizations to fully integrate adolescent reproductive health needs into the standard set of services immediately at the start of humanitarian response operations. This should be done in the health sector but also in child protection, education and gender-based violence programming. And donors must provide adequate funding for these programs.
Once the emergency situation stabilizes, we recommend that humanitarian organizations and donors sustain this work and building on the good practice that our study identified and on lessons learned from development settings. Finally, organizations implementing programs must use sex and age disaggregated data in their monitoring and evaluation in order to ensure that their programs are actually reaching adolescent girls.
Adolescent girls caught up in emergencies have the right to the same opportunities as all girls. To ensure they do, we need to scale up their access to reproductive health care. This will help delay first pregnancy, reduce maternal mortality, and increase the chances that adolescents, especially girls, will stay in school. Adolescents in these communities deserve to learn, to grow, and to realize their potential. The humanitarian community is positioned- and obligated to-help make that happen.