STRENGTHENING HEALTH SYSTEMS THROUGH EVIDENCE IN ASIA AND THE PACIFIC background. Adolescents (aged 10 to ... reproducti
Women’s and Children’s Health Knowledge Hub policy brief
COMPASS June 2011
Improving adolescent reproductive health – the importance of quality data Natalie Gray1,2, Peter Azzopardi1,3, Elissa Kennedy1, Mick Creati1,2,3, Elise Willersdorf1 1 3
Centre for International Health, Burnet Institute; 2 Department of Epidemiology and Preventive Medicine, Monash University; Centre for Adolescent Health, Royal Children’s Hospital, Melbourne
Key Messages
Background
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Adolescents suffer a disproportionate burden of reproductive mortality and morbidity, and also face unique barriers to accessing reproductive health information and services.
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Quality data on adolescents’ reproductive health outcomes, risk and protective behaviours, and access to and utilization of information and services are essential for the development of evidence-based policies and programs.
Adolescents (aged 10 to 19 years) undergo rapid development characterized by an increasing physical capacity to be sexually active, but a less than fully developed psychological and emotional capacity to assess the unintended consequences of sexual activity and negotiate safe and consensual sex. Adolescents also experience unique barriers to accessing reproductive health information and care, and are unlikely to benefit from reproductive health interventions targeted at the overall population. As a result, adolescents experience a disproportionate burden of poor reproductive health outcomes including sexually transmitted infections (STIs) and unintended pregnancies.
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DHS and MICS surveys commonly relied upon by policymakers and programmers are limited in their capacity to provide these data due to the omission of important cohorts and indicators, and failure to report data disaggregated by age. A review of DHS and MICS sampling strategies, and a consideration of alternative data collection strategies, are warranted.
Pregnancy has significant implications for adolescents. Girls aged 15-19 are twice as likely to die from pregnancy-related causes as women in their twenties; girls aged 10-14 are five times more likely to die. Globally, maternal mortality is the most common cause of death amongst adolescents aged 15-19 years. Babies born to adolescent mothers are also at a higher risk of death in their first month of life.1,2 Adolescent pregnancy also has socio-economic consequences, with pregnant girls in much of Asia and the Pacific being forced to leave school. This reduction in their educational attainment reduces their livelihood opportunities, increases their dependence on their husbands and families, and is correlated with poorer health outcomes for themselves and their children. Developing evidence-based policies and programs to improve adolescent reproductive health requires quality data on adolescents’ reproductive health outcomes, health-risk and protective behaviours, and access to and utilization of health information and services. In most developing countries, policymakers and program designers rely on data collected by two national-level household surveys: the Demographic and Health Survey (DHS) and UNICEF’s Multiple Indicator Cluster Survey (MICS). Both surveys collect and report reproductive health indicators, and have gained reputations for being accurate and representative. However, the extent to which they report outcomes for adolescents had not previously been determined.
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Women’s and Children’s Health Knowledge Hub policy brief
Research findings A mapping of 128 indicators relevant to adolescent reproductive health was undertaken using the DHS and MICS reports from nine countries: Bangladesh, Cambodia, Indonesia, Papua New Guinea, Philippines, Solomon Islands, Timor-Leste, Vanuatu and Vietnam.3 The mapping found that DHS and MICS have limited capacity to provide data to inform evidence-based adolescent reproductive health policy and programs for three main reasons: •
Omission of important cohorts. The sampling strategy selected by DHS and MICS in most countries excludes unmarried women and all males. Adolescents aged 10-14 are omitted in all countries.
Unmarried women, males and adolescents under 15 are all at risk of poor reproductive health outcomes, and there is evidence that reproductive health information is most effective prior to the commencement of sexual activity. This lack of data is a missed opportunity to develop evidence-based policies and programs for these cohorts of adolescents.
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Omission of important indicators. DHS and MICS exclude data on indicators relevant to adolescents including the direct and indirect causes of maternal mortality, prevalence and causes of maternal morbidity, nutritional status prior to and during pregnancy, diagnosis and treatment of STIs, and abortion and post-abortion complications.
DHS and MICS do, however, provide valuable data on contraceptive prevalence, exposure to family planning information and services, and access to general health services; all of which are reported disaggregated by age. These are of direct relevance to policy and programs aimed at promoting healthy sexual decisionmaking among adolescents, delaying first pregnancy, increasing birth spacing, and empowering young women to choose when to commence childbearing and how many children to have.
Policy Recommendations •
Recognise that adolescents have different reproductive health needs to adults, and that adolescent-specific data are required to inform evidence-based policy and programs.
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Advocate for a review of DHS and MICS sampling strategies, including a cost effectiveness study of including unmarried women, males, and adolescents under 15.
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Advocate for the inclusion in DHS and MICS of a minimum set of indicators relevant to adolescent reproductive health.
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Increase investment in the development of methods for collecting reliable data on causes of maternal mortality and morbidity.
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Examine the potential for collecting data on omitted cohorts and indicators through separate surveys or strengthening of routine health information systems.
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Assess the cost-effectiveness of routinely reporting all relevant indicators disaggregated by age versus the development of specific adolescent-focused reports targeted at policymakers and programmers.
Failure to report disaggregated data. Data relating to nearly 30% of reproductive health indicators are not agedisaggregated in DHS and MICS reports. For those indicators that are age-disaggregated, further disaggregation by marital status, urban/rural location, education level and wealth quintile is not undertaken. This reduces the capacity of reported data to identify at-risk groups and inform targeted policy and programs.
For further information and resources see: www.wchknowledgehub.com.au
References WHO. Adolescent pregnancy: unmet needs and undone deeds. Geneva: World Health Organisation. 2006.
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Patton G, Coffey C, Sawyer S et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009; 374(9693): 881-892
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Gray N, Azzopardi P, Kennedy E, Creati M, Willersdorf E. Improving adolescent reproductive health in Asia and the Pacific: do we have the data? A review of DHS and MICS surveys in nine countries. Accepted, Asia Pacific Journal of Public Health.
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A strategic partnerships initiative funded by the Australian Agency for International Development
This document is an output from a strategic partnerships initiative funded by AusAID. The views and opinions expressed in this document are those of the authors and do not necessarily reflect the views of AusAID or the Australian Government.
