Adolescent Girls: The Missing Link in Child Survival and Maternal Health Programs

Failure to promote and protect the health, nutrition and development of adolescent girls contributes to high-risk adolescent pregnancies and HIV infection, and thus to high maternal and child morbidity and mortality. This paper presents the evidence to argue that greater investment in prevention of adolescent pregnancies and improved access to health and social services for adolescent mothers would significantly reduce maternal and child morbidity and mortality in developing countries. The sources for the paper include a literature review conducted for UNICEF on key factors in the increased risk of mortality and morbidity for adolescent mothers and their infants, and findings from eight child survival case studies in three world regions conducted for Plan International. In addition, five interviews with child survival and reproductive health specialists identify barriers related to vertical funding streams to integration of adolescent health interventions in maternal and child health programs, and suggest strategies to overcome these barriers.

Analysis of the service models of current child survival program models reveals that two major opportunities to prevent maternal, infant and child mortality are being missed when health-related millennium development goal (MDG) strategies fail to focus on adolescent girls' health and development. First, programs need to classify and treat adolescent pregnancies as high risk for both mother and child, and take actions to ensure proper nutrition and health care during pregnancy and access to obstetric services. Second, programs need to prevent adolescent high-risk unwanted pregnancies and HIV infection through advocacy and communications to delay early marriage and through attention to socio-cultural and financial barriers to access to contraceptive education and services. Finally, increasing girls' access to education post-puberty should be a central prevention strategy; continued schooling delays marriage and first births, and helps make girls less vulnerable to HIV and STDs.