Child marriage

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The rippling economic impacts of child marriage

By Suzanne Petroni, LancetYouth Commissioner, Senior Director, Global Health Youth and Development, ICRW and Quentin Wodon, Adviser, Education Sector, World Bank

child marriage

Globally, more than 700 million women alive today married before the age of 18. Each year, 15 million additional girls are married as children, the vast majority of them in developing countries. Child marriage is widely considered a violation of human rights, and it is also a major impediment to gender equality. It profoundly affects the opportunities not only of child brides, but also of their children. And, as a study we issued this week concludes, it has significant economic implications as well.

Every day, we learn more about the drivers of child marriage in different contexts and the ways in which to help end this harmful practice. But to date, we have had only limited information on the negative impacts of the practice across countries, and very little understanding of its economic costs.

The International Center for Research on Women (ICRW) and the World Bank have been collaborating on a multi-year research project to assess these impacts and costs. We looked at the impacts of child marriage on early childbearing, fertility, contraceptive use, intimate partner violence, educational attainment, earnings in adulthood, and decision-making ability within the household, among other outcomes. We also considered impacts on the children of child brides, including, for example, their risk of being stunted and of dying before age five.

Our collaboration, supported by the Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation and the Global Partnership for Education, concludes that child marriage imposes very significant social and economic costs, not only at the individual level, but also for societies and for the intergenerational transmission of poverty.

child marriage23We unveiled our findings at the World Bank’s headquarters in Washington, DC. Our study finds that child marriage could cost developing countries trillions of dollars by 2030 — the year by which the UN, through its Sustainable Development Goals (SDGs), calls for the elimination of the practice.

By far the largest economic cost related to child marriage is from its impact on fertility and population growth. By contributing to larger families and, in turn, population growth, child marriage delays the demographic dividend that can come from reduced fertility and investments in education. The associated cost could run in the trillions of dollars globally (in purchasing power parity) between now and 2030.

Other costs are substantial as well. By 2030, countries could see tens of billions of dollars in benefits from the reduction that ending child marriage would bring in stunting and child mortality.

Ending child marriage would also have tremendous positive effects on girls’ education, which in turn would bring many additional benefits. Increased educational attainment for girls contributes to women having fewer children later in life, increases their lifetime expected earnings, improves household income, reduces their likelihood of experiencing intimate partner violence and increases their ability to make decisions. In relation to earnings, our study shows that the interruption of education as a result of child marriage reduces the earnings of child brides in adulthood by 9 percent on average, which has negative impacts for households and national economies.

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To ground these figures at the country level, consider this:

In Niger, the country with the highest prevalence of child marriage in the world, eliminating child marriage in 2015 would have led by the year 2030 to annual benefits of up to $1.7 billion in additional welfare, $327 million in savings to the education budget, $34 million through reduced infant mortality, and $8 million through reduced child stunting. In addition, earnings today are $188 million below what they could have been without child marriage, and these losses would grow over time if child marriages continue. Altogether, failing to end child marriage would cost the country billions of dollars, with the impact falling disproportionately on the poor.

Findings from the study demonstrate that child marriage is not only a social issue, it is very much an economic issue. We hope that by demonstrating these economic costs, we will be able to foster broader investments to end this harmful practice and ensure that all girls have access to the opportunities and the futures that they deserve.

This blog was originally posted on Medium and on the World Bank blog. For more insights about the Economic Impacts of Child Marriage, visit website.

Self-harm 20 years on

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Twenty-year outcomes in adolescents who self-harm show worrying levels of substance abuse

7515771442_5bec2aa61b_oAn Australian study by researchers from the Murdoch Children’s Research Institute (MCRI) that followed a sample of almost 2000 Victorian school children from the age of 14 until the age of 35 found that social disadvantage, anxiety, and licit and illicit substance use (in particular cannabis), were all more common in participants who had reported self-harm during adolescence.

The longitudinal study, the Victorian Adolescent Health Cohort Study, was the first in the world to document health-related outcomes in people in their 30s who had self-harmed during their adolescence. Until now, very little has been known about the longer-term health and social outcomes of adolescents who self-harm.

Published in the brand new Lancet Child and Adolescent Health journal, the study found the following common elements:

  • People who self-harmed as teenagers were more than twice as likely to be weekly cannabis users at age 35
  • Anxiety, drug use, and social disadvantage were more common at age 35 among participants who had self-harmed during their teenage years. While most of these associations can be explained by things like mental health problems during adolescence and substance use during adolescence, adolescent self-harm was strongly and independently associated with using cannabis on a weekly basis at age 35 years
  • Self-harm during the adolescent years is a marker for distress and not just a ‘passing phase’

The findings suggest that adolescents who self-harm are more likely to experience a wide range of psychosocial problems later in life, said the study’s lead author, Dr Rohan Borschmann from MCRI.

15582255270_eb0ff87cb4_o“Adolescent self-harm should be viewed as a conspicuous marker of emotional and behavioural problems that are associated with poor life outcomes,” Dr Borschmann said.

The study found that anxiety, drug use, and social disadvantage were more common at age 35 among participants who had self-harmed during their teenage years.

“While most of this can be explained partly by things like mental health during adolescence and substance use during adolescence, adolescent self-harm was strongly and independently associated with using cannabis on a weekly basis at age 35 years,” Dr Borschmann said.

Interventions during adolescence which address multiple risk-taking behaviours are likely to be more successful in helping this vulnerable group adjust to adult life.

Coherent policy approaches need to be implemented that focus on reducing the prevalence of common underlying population-based risk factors (eg harmful alcohol consumption and antisocial behaviour) and, to maximise the effectiveness of such policies, a response from multiple sectors, including the education, health, and community sectors, is required.


Lancet Commission Chair, Prof George Patton is the principle investigator and data custodian of the Victoria Health Cohort Study. Dr Rohan Borschmann (Centre for Adolescent Health, MCRI, Melbourne) led the writing of the paper and Denise Becker, Carolyn Coffey, Elizabeth Spry, Margarita Moreno-Betancur, Paul Moran, Prof George Patton all contributed to the writing of the paper.

Evidence gap maps and ASRH

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You’re invited to the YouthPower Learning Webinar:

                          What do we know?                          Evidence gap maps regarding adolescent sexual and reproductive health and related transferable skills programming in LMICs

The Gender and Positive Youth Development (PYD) Community of Practice invites you to its upcoming webinar on evidence gap maps (EGM), regarding the effects of adolescent sexual and reproductive health (ASRH) and related transferable skills programming in low- and middle-income countries (LMICs). The webinar will be hosted on July 12 from 10:00 to 11:00 am EST.


Register here!


In the past couple of years, the International Imperative for Impact Evaluation (3ie) has developed evidence gap maps to facilitate access to evidence and prioritize investment in research related to youth and transferable skills (YTS) and adolescent sexual and reproductive health (ASRH).

Mario Picon, 3ie’s Senior Evaluation Specialist, will provide an overview of two recent 3ie evidence gap maps focused on youth sexual and reproductive health programming, as well as the intersection with transferable skills.

  1. Adolescent Sexual and Reproductive Health Evidence Gap Map
  2. Youth and Transferable Skills Evidence Gap Map

The presentation will provide:

  • A brief explanation of 3ie’s EGM objectives and process,
  • A summary of the two relevant EGMs, and
  • Recommendations on how stakeholders, such as ASRH program funders, implementers, researchers, and youth support organizations, can use the EGMs in programming and planning.

The presentation will be followed by a discussion on how these products can help inform ASRH programming and research investment.

To participate virtually  on the day of the event, click on the following link and enter as a guest: https://youthpower.adobeconnect.com/gender/

To learn more about the event, speaker, and agenda, visit the event webpage here.

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Global Adolescent Conference

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Missed attending this years Global Adolescent Health Conference in Ottawa? You can relive every moment of the conference via the CanWaCH YouTube Channel. All sessions – keynotes, plenaries and breakouts – are available to watch here.

Below you will find direct links to sessions that our Commissioners presented.

Using Accountability to Advocate for Adolescents
What are the ingredients needed to develop functional accountability mechanisms that monitor, review and act against organizational, global and national commitments? This interactive session will provide participants with resources to help build stronger advocacy and accountability mechanisms, including highlighting an innovative program of data collection from youth themselves through UNICEF’s U report.

Moderator: Prof. George Patton, Chair, Lancet Commission on Adolescent Health and Wellbeing and University of Melbourne, Australia

  • Dr. Zulfiqar Bhutta, Co-Director & Inaugural Robert Harding Chair, SickKids Centre for Global Child Health and Founding Director, Centre for Excellence in Women and Child Health, Aga Khan University
  • Caroline Riseboro, President & CEO, Plan International Canada
  • Marion Cosquer, UNICEF’s U Report Youth Participant, France

Session Presentation

Mental Health for Adolescents: A Call to Action
Mental health issues are the leading causes of death and disability in youth globally. New knowledge from neuroscience and public health is transforming our understanding of why most mental health problems affect youth. This knowledge forms the foundation for an evidence based approach to preventing mental health problems through an inter-sectoral approach, with young people at the heart of the agenda.

  • Dr. Vikram Patel, Professor of Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School

Session Presentation

How do we pay for this? Financing Adolescent Health
This interactive discussion will address actions needed to secure equitable, gender responsive investments for adolescent health. It will present recent findings that support a positive return on investments for adolescent health, discuss how to pay for the SDG and EWEC targets, and look at financing on development through both the funding arm of the Global Strategy, the Global Financing Facility, and complimentary and parallel financing mechanisms which will be important to address financing gaps in humanitarian and fragile settings.

Moderator: Julia Sánchez, President & CEO, Canadian Council for International Co-operation (CCIC)

  • Ambassador Marc-André Blanchard, Canada’s Permanent Representative to the United Nations
  • Prof. George Patton, Chair, Lancet Commission on Adolescent Health and Wellbeing and University of Melbourne, Australia
  • Mariam Claeson, Director, Global Financing Facility
  • Dr. Emanuele Capobianco, Deputy Executive Director, Partnership for Maternal, Newborn and Child Health

Session Presentation

The Coalition

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The Coalition of Centres in Global Child Health (The Coalition) is a global network of expert individuals and academic centres and institutions that have explicitly expressed commitment to a collectively-developed set of principles and plans of advancing global child health. Members of The Coalition will have the opportunity to collaborate and communicate with their peers from around the world via symposia, workshops, and other forums. Two of our very own Commissioners are involved, Dr Zulfiqar Bhutta (Chair, The Coalition of Centres in Global Child Health) and Prof Susan Sawyer.

Their vision, collaborating to inform and advance global child health through providing a platform for academic centres to collaborate. The Coalition website is now live. The website is designed to serve as a place where Coalition partners can exchange knowledge and easily access the latest resources in global child health, curated by expert members of The Coalition Steering Committee.  These materials are broken into focus areas for ease of reference.

Youth! IAAH needs you

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IAAH World Congress on Adolescent Health

“Looking for youth and young professionals”

The International Association for Adolescent Health (IAAH) 11th World Congress on Adolescent Health will be organised from October 26-28, 2017 in New Delhi, India. The Congress is hosted by the Public Health Foundation of India (PHFI) and MAMTA Health Institute for Mother and Child with the support of the Ministry of Health and Family Welfare, Government of India (MoHFW). The theme of the 2017 Congress is “Investing in Adolescent Health-the Future is Now”.

Young people are a global force to reckon with and this will be reflected in the Congress by ensuring that youth and young professionals are central to the Congress planning and programme. Young participants in the broad age ranges of 15-18 years (adolescents); 19-24 years (youth) and 25-30 (young professionals) from schools, colleges and professional universities from across the world are encouraged to participate in the Congress with the following objectives:
(a) build their capacities in essential research and advocacy skills through mentorship opportunities and
(b) provide a platform to young stakeholders to voice their health priorities and engage in scientific and policy-oriented discussions on adolescent health.

Youth applications for the IAAH Adolescent Health Congress are now open and the deadline for submission is May 31, 2017. Limited scholarships are available for youth from LMICs.


Youth: Register here


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The Lancet’s New Journal

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The Lancet Child & Adolescent Health: a call for papers for a new journal

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Building on the foundations of The Lancet‘s sustained commitment to publishing the best in research around the world, including clinical paediatric research and global child health, it is exciting to see The Lancet announce the launch of a new journal — The Lancet Child & Adolescent Health.

The Lancet Child & Adolescent Health will publish research Articles, Comments, Correspondence, Clinical Pictures, Editorials, Reviews, and Viewpoints. They are inviting submissions that effect clinical practice or public health across the life course from the fetal period through to young adulthood at 24 years.

The new editor of The Lancet Child & Adolescent Health is Ms Jane Godsland. We are delighted that three of the Lancet Commissioners, Professors Susan Sawyer, Rima Afifi and Zulfikar Bhutta have been invited to join the international advisory board. It is also pleasing that a US trainee in adolescent health and medicine, Dr Jason Nagata, is also on the board.

The journal offers a fast-track publication process by which original research can be published online within 4–8 weeks from submission. Randomised trials that strengthen the evidence base for disease treatment will be given priority, but we also welcome any studies that have the potential to change or challenge clinical or public health practices.

For The Lancet Child & Adolescent Health see http://www.lancet.com/child-adolescent

Poor kids hit puberty sooner

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Poor kids hit puberty sooner and risk a lifetime of health problems

Shape-shifting bodies. Cracking voices. Hairs sprouting in new places. Puberty marks a dramatic period of change for young people. New research shows children who grow up in poor homes enter puberty early.

Not only do they experience more emotional, behavioural and social problems compared to their peers, early puberty puts them at risk of a range of health issues for the rest of their lives.

The research, published yesterday in the journal Pediatrics, adds to a body of work showing the cumulative effect of adversity in childhood can have lifelong physical, mental and behavioural repercussions. However, the reason why these disadvantaged children enter puberty early remains unclear. And work is continuing to pinpoint factors that trigger the cascade of hormones that mark this critical period of development.

What is puberty?

Puberty is an inherently awkward transition in which a child’s body matures to allow reproduction. In girls, it typically begins with breast development between the ages of eight and 13 and ends with menarche, or the first period. In boys, puberty begins between ages nine and 14, on average, starting with growth of the sexual organs and wrapping up with facial hair and a deepened voice.

But changes at puberty are not all physical. Puberty also triggers rapid biological and social change, and increasing risk for psychological health problems, like depression and anxiety, substance use and abuse, self-harm and eating disorders.

We still don’t know exactly what triggers the cascade of hormone secretions that, over time, produces these tell-tale changes. And “What triggers puberty?” was one of the 125 questions posed in Science magazine’s 125th anniversary edition in 2005 that still remains unanswered today.

In particular, we still don’t know exactly what causes some children to enter puberty earlier than others, although there have been many factors linked to early puberty. These include childhood obesity, being born small for gestational age and exposure to environmental chemicals. Other researchers have linked early puberty with living with a stepfather or having experienced stressful life events, such as childhood maltreatment and abuse.

What we did

Previous studies looking into social impacts on the timing of puberty have had mixed results. While one Indian study found poor girls started their periods later than normal, a UK study found girls who grew up the poorest were twice as likely to have started their periods earlier than the richest.

So, we carried out the first study of its kind in Australia to see how cumulative exposure to social disadvantage affected the age children entered puberty. We asked parents of 3,700 children in the Growing Up in Australia Study to report signs of their children’s puberty at age eight to nine, and then again at ten to 11. Signs included: a growth spurt, pubic hair and skin changes; breast growth and menstruation in girls; and voice deepening and facial hair in boys.

We then compared the family’s socioeconomic position – as measured by their parent’s annual income, education and employment – of those who started puberty early with others who started on time.

At ten to 11 years old, about 19% of boys and 21% of girls were classified in the early puberty group. In other words, they had entered puberty earlier compared to their counterparts.

Boys from very disadvantaged homes had a four-fold increase in the rate of early puberty, while girls’ risk increased nearly two-fold compared with kids that came from the richest families.

How could this happen?

Research on the biology of stress shows how major adversity, like extreme poverty, can permanently set the body’s stress response to high alert, affecting the brain’s circuits. This might, in turn, influence how reproductive hormones are regulated, so affecting the timing and trajectory of puberty.

Another body of research suggests the social environment can influence so-called epigenetic changes in our genes. These changes might affect the regulation of genes involved in reproductive development, switching some on or off sooner than usual.

Another theory is that in the face of hardship – for instance, economic disadvantage, harsh physical environment, the absence of a father – children may be programmed to start the reproductive process earlier to ensure their genes are passed on to the next generation.

Yet, we still don’t know exactly how poverty or disadvantage triggers early puberty.

Why this matters

What we do know, however, is early puberty is linked with a range of health issues. For instance, in girls, it’s linked with emotional, behavioural and social problems during adolescence including: depressive disorders, substance disorders, eating disorders and earlier-than-usual displays of sexuality.

Early puberty also affects people’s health far beyond their teenage years. It places them at a greater risk of developing obesity, reproductive cancers and cardiometabolic diseases (diabetes, heart disease or stroke) in later life.

Written by Associate Professor Ying Sun

This article was originally posted on The Conversation.


The lead author on the study is Associate Professor Ying Sun, a visiting researcher at The Centre for Adolescent Health, Murdoch Children’s Research Institute (MCRI) based at Anhui Medical University, China. The other co-authors are Commissioners Prof George Patton, Dr Peter Azzopardi, as well as Professor Melissa Wake, and Dr Fiona Mensah.

What is the Global AA-HA! Guidance?

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On Tuesday 16 May, we were thrilled to see the launch of the Global Accelerated Action for the Health of Adolescents (AA-HA!). The launch event took place at the Global Adolescent Health Conference, Ottawa, Canada and was hosted by the Canadian Partnership for Women and Children’s Health (CanWaCH), along with Every Woman Every Child (EWEC), the Partnership for Maternal, Newborn and Child Health (PMNCH) and WHO.

Screenshot 2017-05-18 11.12.31What is the Global AA-HA! Guidance?

Simply put, the Global AA-HA! Guidance aims to assist governments in deciding what they plan to do – and how they plan to do it – as they respond to the health needs of adolescents in their countries.

It is intended as a reference document for national-level policy-makers and programme managers to assist them in planning, implementing, monitoring and evaluation of adolescent health programmes.

The Guidance summarises the main arguments for investing in adolescent health, and details the key steps from understanding the country’s epidemiological profile, undertaking a landscape analysis to clarify what is already been done and by whom, conducting a consultative process for setting priorities, to planning, implementing, monitoring and evaluating national adolescent health programmes. It also includes key research priorities and case studies to illustrate that what is being recommended can be done, and in some cases has already been done.

Global AA-HA! Guidance has 6 overarching messages

1. Approach

The AA-HA! guidance provides a systematic approach for understanding adolescent health needs, prioritising these in the country context and planning, monitoring and evaluating adolescent health programmes.

2. Prevention

More than 3000 adolescents die every day from largely preventable causes such as unintentional injuries; violence; sexual and reproductive health problems, including HIV; communicable diseases such as acute respiratory infections and diarrhoea; noncommunicable diseases, poor nutrition and lack of physical activity; and mental health, substance use and suicide. Even more suffer from ill health due to these causes. Although much research is still needed, effective interventions are available for countries to ACT NOW.

3. Priority setting

The nature, scale and impact of adolescent health needs vary between countries, between age groups and between the two sexes. Funds are limited, and governments should prioritise their actions according to the disease and injury risk factor profiles of their adolescent population, as well as the cost-effectiveness of the interventions. Adolescent health needs intensify in humanitarian and fragile settings.

4. Leadership

Strong leadership at the highest level of government should foster implementation of adolescent-responsive policies and programmes. To accelerate progress for adolescent health, countries should consider institutionalizing national adolescent health programmes. Through the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), globally agreed targets related to adolescent health exist, along with indicators to monitor progress towards these. Age and sex disaggregation of data will be essential.

5. Yields from investing in adolescent health span across generations

There is a pressing need for increased investment in adolescent health programmes, to improve adolescent health and survival in the short term, for their future health as adults, and for the next generation. This is a matter of urgency if we want to curb the epidemic of noncommunicable diseases, to sustain and reap the health and social benefits from the recent impressive gains in child health, and ultimately to have THRIVING and peaceful societies.

6. Together

WITH adolescents, FOR adolescents. Adolescents have particular health needs related to their rapid physical, sexual, social and emotional development and to the specific roles that they play in societies. Treating them as old children or young adults does not work. National development policies, programmes and plans should be informed by adolescents’ particular health related needs, and the best way to achieve this is to develop and implement these programmes with adolescents.

Whole-of-government. To achieve the Sustainable Development Goal targets, the health and other sectors need to normalise attention to adolescents’ needs in all aspects of their work. An Adolescent Health in All Policies* (AHiAP) approach should be practised in policy formulation, implementation, monitoring and evaluation.

*AHiAP is an approach to public policies across sectors that systematically takes into account the implications of decisions for adolescent health, avoids harmful effects and seeks synergies – in order to improve adolescent health and health equity. It is a strategy that facilitates the formulation of adolescent-responsive public policies in all sectors, and not just within the health sector.Screenshot 2017-05-18 13.25.45

Adolescent participation

Countries should ensure that adolescents’ expectations and perspectives are included in national programming processes. Adolescent leadership and participation should be institutionalized and actively supported during the design, implementation, monitoring and evaluation of adolescent health programmes. Furthermore, respecting adolescents’ views regarding their health care ensures that more adolescents will seek services and remain engaged in accessing them.

From a developmental perspective, the engagement of adolescents enhances adolescent-adult relationships, develops adolescent leadership skills, motivation and self-esteem, and enables them to develop the competencies and the confidence they need to play an active, positive and pro-social role in society.

Resources

 

Launch of the AA-HA!

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Global Accelerated Action for the Health of Adolescents (AA-HA!)

The Lancet Commission on Adolescent Health and Wellbeing is excited to support the launch of the Global AA-HA! Guidance. Commission Chair Professor Patton and Commission lead Prof Ross will be at WHO launch at the Global Adolescent Health Conference, Ottawa, Canada on 16-17 May 2017. The event is hosted by the Canadian Partnership for Women and Children’s Health (CanWaCH), along with Every Woman Every Child (EWEC), the Partnership for Maternal, Newborn and Child Health (PMNCH) and WHO.


More than 3000 adolescents die every day, totalling 1.2 million deaths a year, from largely preventable causes, according to a new report from the World Health Organization (WHO) and partners. In 2015, nearly two thirds, some 855,000 10 to 19-year-olds died in low- and middle-income countries of the African and South-East Asia Regions. Road traffic injuries, lower respiratory infections and suicide are the biggest causes of death among adolescents.

Most of these deaths can be prevented with good health services, education and social support. But in many cases, adolescents who suffer from mental health disorders, substance use or poor nutrition cannot obtain critical prevention and care services – either because the services do not exist, or because they do not know about them.

In addition, many behaviours that impact health later in life, such as physical inactivity, poor diet, and risky sexual health behaviours, begin in adolescence.

“Adolescents have been entirely absent from national health plans for decades,” says Dr Flavia Bustreo, Assistant Director-General, WHO. “Relatively small investments focused on adolescents now will not only result in healthy and empowered adults who thrive and contribute positively to their communities, but it will also result in healthier future generations, yielding enourmous returns.”

Data in the report, Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation, reveal stark differences in causes of death when separating the adolescent group by age (younger adolescents aged 10-14 years and older ones aged 15-19) and by sex. The report also includes the range of interventions – from seat-belt laws to comprehensive sexuality education – that countries can take to improve their health and well-being and dramatically cut unnecessary deaths.

Top 5 causes of death for adolescents 10-19 years 

Total #deaths
1. Road injury 115,302
2. Lower respiratory infections  72,655
3. Self-harm  67,149
4. Diarrhoeal diseases  63,575
5. Drowning  57,125

Road injuries top cause of death of adolescents, disproportionately affecting boys
In 2015, road injuries were the leading cause of adolescent death among 10 to 19-year-olds, resulting in approximately 115,000 adolescent deaths. Older adolescent boys aged 15 to 19 years experienced the greatest burden. Most young people killed in road crashes are vulnerable road users such as pedestrians, cyclists and motorcyclists.

However, differences between regions are stark. Looking only at low- and middle-income countries in Africa, communicable diseases such as HIV/AIDS, lower respiratory infections, meningitis and diarrhoeal diseases are bigger causes of death among adolescents than road injuries.

Lower respiratory infections and pregnancy complications take toll on girls’ health
The picture for girls differs greatly. The leading cause of death for younger adolescent girls aged 10-14 years are lower respiratory infections, such as pneumonia, often a result of indoor air pollution from cooking with dirty fuels. Pregnancy complications, such as haemorrhage, sepsis, obstructed labour and complications from unsafe abortions, are the top cause of death among 15 to 19-year-old girls.

Adolescents are at very high risk of self-harm and suicide
Suicide and accidental death from self-harm were the third cause of adolescent mortality in 2015, resulting in an estimated 67 000 deaths. Self-harm largely occurs among older adolescents, and globally it is the second leading cause of death for older adolescent girls. It is the leading or second cause of adolescent death in Europe and South-East Asia.

Top 5 causes of death for adolescent males and female, 10-19 years

Males #deaths Females #deaths
1. Road traffic injury 88,590 1. Lower respiratory infections 36,637
2. Interpersonal violence 42,277 2. Self-harm 32,499
3. Drowning 40,847 3. Diarrhoeal diseases 32,194
4. Lower respiratory infections 36,018 4. Maternal conditions 28,886
5. Self-harm 34,650 5. Road traffic injury 26,712

A vulnerable population in humanitarian and fragile settings
Adolescent health needs intensify in humanitarian and fragile settings. Young people often take on adult responsibilities, including caring for siblings or working, and may be compelled to drop out of school, marry early or engage in transactional sex to meet their basic survival needs. As a result, they suffer malnutrition, unintentional injuries, pregnancies, diarrhoeal diseases, sexual violence, sexually-transmitted diseases and mental health issues.

Interventions to improve adolescent health
“Improving the way health systems serve adolescents is just one part of improving their health,” says Dr Anthony Costello, Director, Maternal, Newborn, Child and Adolescent Health, WHO. “Parents, families and communities are extremely important, as they have the greatest potential to positively influence adolescent behaviour and health.”

The AA-HA! Guidance recommends interventions across sectors, including comprehensive sexuality education in schools; higher age limits for alcohol consumption; mandating seat-belts and helmets through laws; reducing access to and misuse of firearms; reducing indoor air pollution through cleaner cooking fuels; and increasing access to safe water, sanitation and hygiene. It also provides detailed explanations of how countries can deliver these interventions with adolescent health programmes.

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The AA-HA! Guidance was produced by WHO in collaboration with UNAIDS, UNESCO, UNFPA, UNICEF, UN Women, World Bank, the Every Woman, Every Child initiative and The Partnership for Maternal, Newborn , Child & Adolescent Health.

The document will be launched at the Global Adolescent Health Conference: Unleashing the Power of a Generation on 16 May in Ottawa, Canada.

The report helps countries implement the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) by providing comprehensive information needed to decide what to do for adolescent health, and how to do it. The Global Strategy, which was launched in 2015 to support the Sustainable Development Goals (SDGs), provides an opportunity to improve adolescent health and to respond more effectively to adolescents’ needs.

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