Against the backdrop of the Millennium Development Goals (MDGs) and other international commitments to reduce poverty and improve sexual and reproductive health outcomes among adolescents, together with the social context of adolescents in the global community, efforts to effectively address adolescent health outcomes present complex challenges. While some trends in adolescent health and social outcomes have improved over the past three decades, including school enrolment and retention, early marriage and early pregnancy (5), disparities in many adolescent health outcomes persist by age, income, gender, region and other sociocultural factors. Adolescents are a diverse group of people whose capacities and needs differ by age, sex, living arrangements, area of residence, level of education, and by their status in terms of marriage, childbearing and employment. These differences must be addressed when attempting to improve and maintain their health and development.
Adolescents are a critical target population with regard to influencing global public health outcomes. Young people below 25 years of age represent almost 50% of the world's population. Furthermore, nearly 85% of the world's adolescent population lives in developing countries (6). In a number of countries in sub-Saharan Africa, population below 15 years of age is five times greater than the population over 55 years of age (5). This subset of the world's population is often disproportionately affected by social and economic inequities that characterize the development landscape. This makes them more vulnerable to poor health outcomes, especially outcomes related to sexual and reproductive health.
Determinants and consequences of early pregnancy
Key determinants of adolescent pregnancy include early marriage, sexual coercion and lack of access to and use of contraception. Consequences of early pregnancy can include morbidity and mortality attributable to low access to skilled antenatal, childbirth and postnatal care as well as unsafe abortions (7). Structural inequities and the social environment place certain groups of adolescents at risk of engaging in behaviours that jeopardize healthy transitions to adulthood. For example, poor adolescents are less likely to complete their schooling (8). Consequently, they often have less access to health information, since sexual and reproductive health education (to the extent that it takes place) is often provided to students in the higher grades. Over the past 15 years, fertility rate among the poorest adolescents in many countries has increased (9), and adolescent girls from the poorest fifth of the population are four times more likely to become pregnant than those in the richest fifth.
Adolescence represents a key stage in development and a critical opportunity for ensuring successful transition to adulthood. Poor sexual and reproductive health outcomes can often be traced to adolescence, when most people become sexually active (7). Educational achievement, life skills and decision-making around sexual behaviour and childbearing have profound effects on the lives of adolescents as well as their families, communities and society.
The role and approach of WHO
WHO has articulated both a definition of health and the importance of a supportive legislative and regulatory framework. Implicit in the framework of WHO's definition of health are the right to be informed about and to have access to safe, effective, affordable and acceptable methods of fertility regulation, the right of access to appropriate health care services that enable women to go safely through pregnancy and childbirth, and the right for couples to have the best chance of having healthy children.
WHO's Global reproductive health strategy emphasizes the importance of legislative and regulatory frameworks that support and facilitate universal and equitable access to sexual and reproductive health services. It notes that it may often be necessary to remove existing legal and policy barriers that impede the use of life-saving interventions and other necessary services. Political, legal and regulatory environments are key determinants of accessibility to, and availability and quality of health services. Further, the human rights to participation and non-discrimination are essential to the process of developing supportive laws and policies.
