But what is most exciting about the Addis Conference is a new focus on age. While family planning has largely been framed as an issue for adult women in the past, the needs of girls and youth are finally taking centre stage.
This matters because the unmet family planning needs of girls are alarming, yet often consigned to the ‘too hard’ basket. Around 18 million teen girls give birth every year, 95% of them in the developing world. Of these, 2 million are children under the age of 15 years. In all, 9 out of 10 adolescent births are to married girls who are less likely than their unmarried peers to use contraceptives – indeed an estimated 75% of adolescent pregnancies are planned. While the World Health Organisation estimates global adolescent fertility rates of 53 births per 1,000 women, this rate is almost double that in sub-Saharan Africa.
The cost of these teen pregnancies is staggering – physically, economically, socially – as highlighted in a 2012 ODI and Save the Children report. Teen pregnancy is the biggest killer of girls in the developing world, with the youngest girls – obviously – facing the greatest risks. Babies born to adolescents are 50% more likely to die in their first week of life than those born to women in their twenties.
Beyond its appalling human toll, maternal mortality threatens progress on a whole range of global goals: not only Millennium Development Goal No. 5 on maternal mortality, but all of the MDGs. As the infographic below for the Ethiopian Conference shows, the reverse is also true, with progress on maternal mortality enhancing progress across those same goals.
The World Bank has estimated that the lifetime opportunity costs related to adolescent pregnancy – measured by the young mother’s foregone annual income over a lifetime ranging from 1 percent of annual GDP in China to 30 percent of annual GDP in Uganda. In India alone, unmet family planning needs have been estimated to cost 12% or annual GDP or $400 billion. . Governments and donors are now recognising the social impact of early marriage, often putting an end to any semblance of self-determination for girls. As one married adolescent girl in Nepal commented during a recent DFID-funded ODI study on adolescent girls and social norms: ‘There is a lot of difference. When one is married, one cannot act on one’s own will. One is caught up in a kind of bondage, one is not free’.
One of the key messages at the Addis conference is about how governments and development partners can best invest in youth – especially their education, health and employment – to create a ‘demographic dividend’ (accelerated economic growth following a rapid decline in a country’s fertility and resulting changes in the population age structure). While the family planning field has focused more narrowly on public-health programming solutions in the past, there is now welcome attention on multi-sectoral approaches.
Where the debate is still missing a trick is the failure to link systematically to social-protection strategies and programmes – a growth industry within the international development sector, with cash transfer programmes alone reaching over 750 million people.
A World Bank cash transfer experiment targeting adolescent girls in Malawi has shown how regular cash stipends can expand girls’ schooling, as well as their sexual and reproductive health choices. More generally, cash transfer evaluation evidence highlights that in many contexts not only are school girls less likely to be seen as eligible for marriage than those who have already dropped out of school but cash transfers can reduce household level financial barriers to education, giving parents an incentive to keep their children in school while offsetting the costs of education.
Given that World Bank data from 49 countries show that early marriage rates are highest among the poorest people in every country, even small income improvements can reduce negative coping strategies such as early marriage and early pregnancy. Obviously cash alone is no silver bullet – the answer lies in twinning poverty reduction with other programmes and services – not only improved sexual and reproductive health services but also efforts to raise people’s awareness of their rights.
Hopefully, the links between early pregnancy and social protection can be made in the follow-up to the Conference, given that the recent UNFPAMotherhood in Childhood Report called for far more investment in partnerships across social protection to reach the poorest girls, families and communities more effectively.
It is encouraging that the importanceof young people – both girls and boys – is being recognised in Addis this week, not just for family planning but also for broader development progress. And the big ambitions on fast-tracking the demographic dividend are also welcome. That said, there are still some key gaps, including the need to harness synergies with social protection programming to reach the poorest and most vulnerable adolescents. If this gap is not filled, there is a very real risk that the worthy ambition of ‘full access, full choice’ will not be realised.