Adolescents Sexual and Reproductive Health and Rights in East and Southern Africa

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SADC Parliamentary Dialogue on Child Marriage Laws

Maja Manzenski Hansen and Renata Tallarico UNFPA East and Southern Africa Regional Office

1. Overview of the situation of ASRHR in the East and Southern Africa region, including linkages between:

• Maternal mortality • • • • Early and unintended pregnancy Child marriage HIV Sexual and gender based violence

2. Key challenges 3. A framework for action 4. UNFPA response to ASRHR and child marriage

   Globally, 70,000 adolescents die annually from causes related to pregnancy and child birth – 1/3 of these occur in sub-Saharan Africa.

Pregnancy related complications and HIV remain the leading causes of death among girls aged 15-19 in sub-Saharan Africa.

• • • 14 per cent of maternal deaths in Africa are the result of unsafe abortions.

5.5 million unsafe abortions in sub-Saharan Africa, including 2.52 million in East and Southern Africa. Women under the age of 25 account for 60 per cent of these. Up to 70 per cent of all women who receive treatment for complications of abortions are under 20 years old.

 • The risk of maternal death for mothers under 18 in low and middle-income countries is double that of older females.

Girls under 14 years are five times more likely to die from complications in pregnancy and child birth.

 Young adolescents face significantly higher risk of maternal morbidity, including obstetric fistulae.

 o Early pregnancy also put newborns at risk of morbidity and mortality Higher risks for the baby with younger mothers).

 Despite progress, adolescent pregnancy rates in East and Southern Africa remain among the world’s highest with a regional average of 108.2 births per 1,000 girls aged 15-19 years compared to the developing world average of 52.4 per 1,000 births.  1 in 4 women age 20 to 24 report a birth before age 18 in the ESA region and in 7 countries the proportion is even higher.

 Up to 9 of 10 pregnancies among adolescent girls take place within a union or marriage.

Source: UNFPA, State of World Population, 2013

Adolescent birth rates (Births per 1,000 girls aged 15-19) Source:

Latest DHS, AIS or MICS

• Overall decline in a majority of countries, but recent increases in some countries, incl. Angola, DRC, Lesotho, Namibia, and Zimbabwe.

• • • • • Direct factors: Age; Physical immaturity; Complications of unsafe abortion; Lack of access to routine and emergency obstetric care from skilled providers; HIV and AIDS.

• • • • • • • • Other contributing/indirect factors: Poverty; Malnutrition; Lack of education; Child marriage Low status of girls and women; Sexual violence and coercion; Restricted access to contraception, information and age-appropriate sexuality education; Under investment in adolescent girl’s human capital.

Despite some progress, most countries in sub-Saharan Africa are failing to meet the needs for family planning/contraception among women and especially adolescent girls.

Source: Two/three most recent DHS/MICs in the countries with highest adolescent pregnancy rates

Global: More than 1/3 of women aged 20-24 in the developing world were married or in union before age 18 in the period 2000 – 2011 12 per cent of them were married or in union before age 15 Regional: 28 of 41 countries worldwide with child marriage prevalence of 30 per cent or more are located in sub-Saharan Africa 40% of women in sub-Saharan Africa were married before aged 18 West and Central Africa: 41 per cent - 6.2 million young girls Ranges from 75 per cent (Niger) to 18 percent (Cape Verde) East and Southern Africa: 34 per cent - 7.0 million young girls Ranges from 50 per cent (Malawi) to 6 percent (South Africa)

Source:

UNFPA database using DHS, MICS and other household surveys .

Married girls are often under pressure to become pregnant immediately or soon after marriage, although they are still children themselves and know little about sex or reproduction.

Sources: UNFPA State of the World Population, 20013 using the latest DHS, MICS , UNICEF State of the World’s Children, 2013

• Wide variations in the prevalence of child marriage are found within countries. • Girls who are poor, have little or no education and live in rural areas are more likely to marry or enter into union before age 18. Source: Mozambique DHS 2011, Prepared by Population and Development Branch, Technical Division, UNFPA

Although 35 countries in Africa have adopted laws on the minimum legal age of marriage, many families and girls themselves may not know that these laws exists, and their enforcement is often lax. In many countries there are also loop holes that impede protection.

DRC Madagascar Malawi Mozambique Legal Age of Marriage for Women and Men, Selected Countries Without parental consent With parental consent Women Men Women Men 17 18 18 18 20 18 18 18 15 N/A 15 16 18 N/A 15 16 Uganda United Republic of Tanzania 18 18 18 18 16 14 N/A 14 Zambia 21 21 N/A N/A Zimbabwe 16 18 N/A N/A Compiled by the United Nations Statistics Division (and supplemented by data from the periodic country reports to the Committee on the Elimination of All Forms of Discrimination against Women (CEDAW), and data published by United Nations, Department of Economic and Social Affairs, Population Division (2011). World Fertility Policies 2011

What to expect if the current trends continue?

If the current trends of child marriage are to continue, worldwide, 150 million girls will be married in the next decade.

This translates into an average of 15.0 million girls who will marry every year or one girl every second. In East and Southern Africa, the number will increase from at least 7.0 million annually in 2010 to 7.4 million in 2020 and 8.0 million in 2030.

   Globally, there are about 380 000 new HIV infections among adolescent girls and young women (10–24) every year.

Globally, 15% of women living with HIV are aged 15–24, of whom 80% live in sub Saharan Africa.

In some high-burden countries in East and Southern Africa, the HIV prevalence amongst adolescent girls is more than double that of adolescent men.

 Adolescents (10–19 years) is the only age group in which AIDS deaths have risen between 2001 and 2013.

 In sub-Saharan Africa: • • • • • Women acquire HIV five to seven years earlier than men Only 15% of young women aged 15–24 are aware of their HIV status Only 26% of adolescent girls possess comprehensive and correct knowledge about HIV, compared with 36% of adolescent boys. Among girls aged 15–19 who reported having multiple sexual partners in the past 12 months, only 36% reported that they used a condom the last time they had sex.

Relationships between young women and older male partners are common and associated with unsafe sexual behaviour and low condom use.

 Increasing evidence to establish linkages between child marriage and HIV, including from Zambia, Uganda and Kenya.

• Percentage of ever-married women who have experienced spousal physical or sexual violence by their current or most recent husband or partner in the past 12 months, by age.

Source:

Demographic and Health Survey data, countries with available data in sub-Saharan Africa

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 In some settings in sub-Saharan Africa, up to 45% of adolescent girls report that their first sexual experience was forced.

   Over half of adolescent girls and young women who are married in sub-Saharan countries with available data do not have the final say regarding their own health care. Girls who marry before 18 are more likely to experience domestic violence than their peers who marry later.

Young women who experience intimate partner violence are 50% more likely to acquire HIV than women who have not.

Source:

Multi-country study on women’s health and domestic violence against women. Geneva: World Health Organization

 • • • Laws and policies Contradictions between constitutional and customary laws, especially in relation to child marriage. Laws and policies that govern the age of consent for HIV testing, treatment and access to sexual and reproductive health services.

Enforcement of laws protecting young girls from child marriage, gender based violence, FGM and other harmful traditional practices.

 • • Financial Resources available for implementation of national adolescent reproductive health or related policies.

Efforts - and resources – to prevent adolescent pregnancy typically focus on girls aged 15-19. Yet, the girls with the greatest vulnerabilities, and who face the greatest risk of complications and deaths from pregnancy and child birth are 14 or younger.

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 • • • • Institutional/service level Institutionalization of comprehensive sexuality education, including for marginalized and vulnerable adolescents (out-of-school youth, YPLHIV, adolescent living in slums, disabled people, LGBTI etc.).

Access to integrated, safe, effective, affordable and quality SRH/HIV services, incl. prevention, contraception, HCT, counseling, and HIV treatment for youth. Availability and access to comprehensive MNCH services, including antenatal, postnatal and neonatal care for adolescent mothers and their newborns.

Social protection mechanisms, mentorship and livelihood programmes for young mothers and vulnerable adolescents.

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  • • • • Community /individual Traditional beliefs, values and norms.

Harmful practices. Knowledge and condom use/contraceptive use Multiple sexual partners and other risk behaviors.

• • • Data and evidence Documentation of best practices and evidence generation.

Availability of data, especially for unmarried youth and very young adolescent aged 10-14.

Civil, marriage and birth registration systems  • Participation in planning, implementation and M&E Involvement and engagement of adolescents and young people, including adolescents girls, in policy making, planning and M&E  M&E and accountability systems 21

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Reduce marriage before age 18

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Harmonize and enforce laws, protocols and policies related to ASRHR/HIV and child marriage

• • • Inform and empower girls Keep girls in school Influence cultural norms that support child marriage and harmful practices through sensitization of communities and religious leaders

Reduce HIV and early and unintended pregnancies

• Provide Comprehensive Sexuality Education to adolescent girls and boys - in and out of school /key populations • Enhance access and quality of HIV and early pregnancy prevention programmes • • Build community and education sector support for prevention of HIV and early pregnancies Improve access to youth friendly, integrated SRH/HIV services

Increase use of contraception

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Legislate access to contraceptive information and commodities

Reduce the cost of contraceptives to adolescents Educate adolescents about contraceptive use Build community support for contraceptive provision to adolescents Improve access to contraceptive services Skills for adolescents to obtain contraceptive services

• • • •

Reduce sexual and gender based violence and harmful practices Put in place and enforce laws that prohibit sexual and gender based violence and harmful practices

• • Empower girls to resist coerced sex and gender based violence Influence social norms that condone coerced sex and gender based violence • Engage men and boys to critically assess gender norms

Reduce unsafe abortion

Enable access to safe abortion and post abortion services for adolescents • Inform adolescents about dangers of unsafe abortion • Increase community awareness of the dangers of unsafe abortion

Increase use of skilled antenatal, childbirth, and postpartum care

• Be sensitive and responsive to the needs of young mothers and mothers-to-be Inform adolescents and community members about the importance of skilled antenatal and childbirth care Expand access to skilled antenatal, childbirth, and postnatal care, including Basic and Comprehensive Emergency Obstetric Care 24

 Advocacy and support for implementation of the AU and national campaigns to end child marriage (ongoing)  Regional assessment of ASRHR laws and policies (ongoing)  Data for development, incl. secondary analysis of census, DHS,MICS etc. to identify and target geographic “hotspots” – areas with high proportions and numbers of girls at risk of child marriage (ongoing)  Support for implementation of multi-sectoral adolescent girls and child marriage programmes in high-prevalence countries (community engagement, CSE, health services/commodities, information, social protection and asset building) (ongoing)  Capacity building for REC parliamentarians and national partners/member states (2015)  Intervention/operational research for evidence generation (planned for 2015/2016)

 UNFPA will undertake a comprehensive assessment with compilation, review and analysis of national laws and policy provisions related to ASRHR in the Eastern and Southern Africa Region;  The study will inform the development of a standardized regional framework/protocol for harmonized AYP national laws and policies and support national partners in realizing enabling legal and health system environments for adolescents sexual and reproductive health and rights, including HIV-prevention.

 The study will be undertaken by Business Enterprises at University of Pretoria (Pty)  1.

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The objectives of the study are the following: To compile a full synopsis of laws and policy provisions relating to adolescents’ and young people’s SRH Rights, including HIV-prevention; To undertake an exhaustive analysis of the information obtained, including status of implementation, monitoring and evaluation of the relevant laws and policies in the East and Southern Africa Region; To document good practices, lessons learned at the national and/or regional level and the development of recommendations for SADC and EAC; To compile short case studies of young people’s experiences on how policies and laws are affecting their access to SRH and HIV services in select countries in the East and Southern Africa Region; and Finally, to develop a draft regional framework /protocol that takes into consideration regional and global commitments, and which is to be presented to SADC, EAC, IGAD and their member states for validation and endorsement.

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The study will be mainly focus on the following areas: Ages of consent to sexual activity; Ages of consent to marriage; Criminalization of consensual sexual activity among children; Ages of consent to medical treatment, including treatment for HIV and access to contraceptive aids; Reproductive health services including termination of pregnancy; Provision of education on sexuality and sexual health; Sexual diversity; National AIDS plans with focus on addressing stigma and discrimination; Criminalization of HIV/AIDS transmission; Forced sterilization; Harmful cultural practices; Protection for victims of sexual abuse; Gender specific legal protection; Sexual offences framework, including sexual abuse in schools and laws criminalizing consensual sex.

Thank you

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