A New Agenda for Global Health: Focusing on the Health and Education of Adolescent Girls Will Lead to Enormous Benefits for Developing Countries and Will Accelerate the Achievement of Many International Health and Development Goals

Article excerpt

Much of the frustration that permeates efforts to improve the lives of people in the developing world springs from the fact that the commonly identified roots of the problem are factors that are difficult to change. But one fundamental cause of the social and economic hardships in the developing world can be addressed: the poor health and limited education of adolescent girls.

As a partial glimpse into the hardships that girls face, consider the burdens of their older counterparts. Women's challenges take different forms across regions, countries, and socio-economic classes, although there are similarities, especially their exposure to discrimination, violence, and poverty. Women comprise two-thirds of the 759 million adults lacking basic literacy skills. Women's job options are more limited and less remunerated than those for men. More than half a million girls and women die in childbirth every year, often without the benefit of health services and skilled assistance. And all too often, women do not have a voice in the important decisions affecting their lives and those of their children, households, and communities.

To take their rightful place as drivers of economic growth and a healthier tomorrow, women need to be better prepared during their years preceding adulthood--the crossroads of adolescence. Adolescence is a period of risk and opportunity, with lifelong effects on the future of girls and their families. Indeed, the size and strength of tomorrow's labor force will be shaped by the health of today's girls, along with their education. It is during adolescence that girls establish patterns of sexual behavior, diet, exercise, tobacco use, and schooling that profoundly affect their lifelong health. And health problems experienced during adolescence, such as sexually transmitted infections, anemia, and gender-based violence, can have long-term consequences.

Most girls are still reachable during early adolescence, when they are 10 to 14 years old, through institutions such as families, schools, and for some, workplaces. When girls are reached during this phase, their behavioral patterns can be shaped to protect their health as well as the health of their future children.

But just as the opportunities are clear, the threats to girls' health and well-being are numerous and are linked to fundamental injustices present in many societies. A general guide for how to overcome these injustices is emerging from evidence gathered from the actions of a variety of international organizations. National leaders now need to evaluate, support, and expand the lessons that have been learned in order to make a real difference for girls.

Litany of problems

Most girls enter adolescence healthy, but social and biological forces make them vulnerable to illness and disability. What happens during the eight or nine years following puberty (roughly between the ages of 10 and 19) can have long-term consequences.

In many communities across the developing world, most girls steer clear of health services from the age of their last immunization until their first pregnancy. The reasons are many. Girls often lack the financial means and autonomy to seek care when they need it and tend to be even more uninformed than boys about their bodies, ways to maintain their health, and the health services available. The health sector rarely orients services in the way adolescents need them to be: non-judgmental, confidential, and easily accessible. Surveys reveal that even youth-oriented programs, such as youth centers and peer-based programs, often fail to reach the most vulnerable girls. A risky adolescence is the result.

The conditions that girls face during adolescence and the decisions (often involuntary) that they make can affect not only themselves but also can have drastic implications for the health status of their future children. Unhealthy mothers pass on poor health to their children, and young mothers are even more likely than older mothers to pass on poor health to their babies. …