Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?
Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?
Adolescent sexual and reproductive health (ASRH) continues to be a major public health challenge in sub-Saharan Africa where child marriage, adolescent childbearing, HIV transmission and low coverage of modern contraceptives are common in many countries. The evidence is still limited on inequalities in ASRH by gender, education, urban–rural residence and household wealth for many critical areas of sexual initiation, fertility, marriage, HIV, condom use and use of modern contraceptives for family planning. We conducted a review of published literature, a synthesis of national representative Demographic and Health Surveys data for 33 countries in sub-Saharan Africa, and analyses of recent trends of 10 countries with surveys in around 2004, 2010 and 2015. Our analysis demonstrates major inequalities and uneven progress in many key ASRH indicators within sub-Saharan Africa. Gender gaps are large with little evidence of change in gaps in age at sexual debut and first marriage, resulting in adolescent girls remaining particularly vulnerable to poor sexual health outcomes. There are also major and persistent inequalities in ASRH indicators by education, urban–rural residence and economic status of the household which need to be addressed to make progress towards the goal of equity as part of the sustainable development goals and universal health coverage. These persistent inequalities suggest the need for multisectoral approaches, which address the structural issues underlying poor ASRH, such as education, poverty, gender-based violence and lack of economic opportunity.
health policy, public Health
Melesse, Dessalegn
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Matua, Martin
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Choudhury, Allysha
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Wado, Yohannes
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Faye, Cheikh
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Neal, Sarah
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Boerma, Ties
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26 January 2020
Melesse, Dessalegn
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Matua, Martin
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Choudhury, Allysha
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Wado, Yohannes
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Faye, Cheikh
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Neal, Sarah
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Boerma, Ties
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Melesse, Dessalegn, Matua, Martin, Choudhury, Allysha, Wado, Yohannes, Faye, Cheikh, Neal, Sarah and Boerma, Ties
(2020)
Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?
BMJ Global Health, 5 (1), [e002231].
(doi:10.1136/bmjgh-2019-002231).
Abstract
Adolescent sexual and reproductive health (ASRH) continues to be a major public health challenge in sub-Saharan Africa where child marriage, adolescent childbearing, HIV transmission and low coverage of modern contraceptives are common in many countries. The evidence is still limited on inequalities in ASRH by gender, education, urban–rural residence and household wealth for many critical areas of sexual initiation, fertility, marriage, HIV, condom use and use of modern contraceptives for family planning. We conducted a review of published literature, a synthesis of national representative Demographic and Health Surveys data for 33 countries in sub-Saharan Africa, and analyses of recent trends of 10 countries with surveys in around 2004, 2010 and 2015. Our analysis demonstrates major inequalities and uneven progress in many key ASRH indicators within sub-Saharan Africa. Gender gaps are large with little evidence of change in gaps in age at sexual debut and first marriage, resulting in adolescent girls remaining particularly vulnerable to poor sexual health outcomes. There are also major and persistent inequalities in ASRH indicators by education, urban–rural residence and economic status of the household which need to be addressed to make progress towards the goal of equity as part of the sustainable development goals and universal health coverage. These persistent inequalities suggest the need for multisectoral approaches, which address the structural issues underlying poor ASRH, such as education, poverty, gender-based violence and lack of economic opportunity.
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Adolescent sexual and reproductive health in sub-Saharan Africa
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Accepted/In Press date: 18 December 2019
Published date: 26 January 2020
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Funding Information:
Contributors DYM and TB conceived the framework of the paper and prepared a first draft of the article. DYM, TB and SN further developed the paper in the second stage. DYM, MKKM and AC performed data analyses and synthesised results with the support from other authors through discussions with country participants as part of a Countdown to 2030 for Women’s, Children’s and Adolescents’ Health analysis workshop on adolescent sexual and reproductive health, 24 to 27 June 2019, Addis Ababa, Ethiopia. All authors critically reviewed the draft, contributed to the finalisation and approved the final manuscript. funding Funding was provided by the Bill & Melinda Gates Foundation through a grant to the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health. Funding for an analysis workshop with country participants was provided by a collaboration with the Canadian Partnership for Women’s and Children Health (CanWACH) and Global Affairs Canada.
Funding Information:
which peer reviewed, edited and made the decisions to publish. Open access fees are funded by the Bill & Melinda Gates Foundation and PMNCH.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
health policy, public Health
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Local EPrints ID: 437801
URI: http://eprints.soton.ac.uk/id/eprint/437801
ISSN: 2059-7908
PURE UUID: ed491754-74a8-4252-aaf8-bc0469b5ac8f
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Date deposited: 17 Feb 2020 17:32
Last modified: 17 Mar 2024 03:19
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Contributors
Author:
Dessalegn Melesse
Author:
Martin Matua
Author:
Allysha Choudhury
Author:
Yohannes Wado
Author:
Cheikh Faye
Author:
Ties Boerma
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