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Improving Adolescent Sexual and Reproductive Health and Rights: Reflections on the Past 25 Years

      For the second time in five years, the supplement accompanying this issue of the Journal of Adolescent Health brings our attention to Adolescents' Sexual and Reproductive Health and Rights (ASRHR) throughout the world [
      • Chandra-Mouli V.
      • Svanemyr J.
      • Amin A.
      • et al.
      Twenty years after International Conference on Population and Development: Where are we with adolescent sexual and reproductive health and rights?.
      ,
      • Kabiru C.
      Adolescents' sexual and reproductive health and rights: What has been achieved in the 25 years since the 1994 International Conference on Population and Development and what remains to be done?.
      ,
      • Liang M.
      • Simelane S.
      • Fortuny Fillo G.
      • et al.
      The state of adolescent sexual and reproductive health.
      ,
      • Chandra-Mouli V.
      • Ferguson B.J.
      • Plesons M.
      • et al.
      The political, research, programmatic and social responses to adolescent sexual and reproductive health and rights in the 25 years since the International Conference on Population and Development.
      ,
      • Engel D.M.C.
      • Paul M.P.
      • Chalasani S.
      • et al.
      A package of essential sexual and reproductive health and rights interventions- what does it mean for adolescents?.
      ,
      • Plesons M.
      • Cole C.B.
      • Hainsworth G.
      • et al.
      Forward, together: A collaborative path to comprehensive adolescent sexual and reproductive health and rights in our time.
      ]. In a 2015 supplement, JAH documented the 20 years of progress since the 1994 International Conference on Population and Development, where the ASRHR were identified as essential not only for improving the health and well-being of adolescents but also that of the population of the world. In a commentary introducing the 2015 supplement, Venkatraman Chandra-Mouli et al. [
      • Chandra-Mouli V.
      • Svanemyr J.
      • Amin A.
      • et al.
      Twenty years after International Conference on Population and Development: Where are we with adolescent sexual and reproductive health and rights?.
      ] identified many areas of ASRHR that warranted further attention and outlined concerns that needed to be further addressed.
      The current supplement continues that previous work and outlines where we are now in the area of ASRHR and where we need to go to meet the challenges ahead.
      The four papers and editorial provide a comprehensive review of the progress that has been accomplished over 25 years in enhancing ASRHR. In the first paper, Liang et al. [
      • Liang M.
      • Simelane S.
      • Fortuny Fillo G.
      • et al.
      The state of adolescent sexual and reproductive health.
      ] provide analyses of the progress on key indicators of ASRHR, as well as social and economic determinants. The second paper, by Chandra-Mouli et al. [
      • Chandra-Mouli V.
      • Ferguson B.J.
      • Plesons M.
      • et al.
      The political, research, programmatic and social responses to adolescent sexual and reproductive health and rights in the 25 years since the International Conference on Population and Development.
      ], builds on the first and provides a review of policy and programmatic responses over the last 25 years by focusing on six areas of ASRHR: pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstruation. The final two papers, by Engel et al. and Plesons et al., offer guidance for how we might capitalize on the progress that we have made over the past 25 years [
      • Engel D.M.C.
      • Paul M.P.
      • Chalasani S.
      • et al.
      A package of essential sexual and reproductive health and rights interventions- what does it mean for adolescents?.
      ,
      • Plesons M.
      • Cole C.B.
      • Hainsworth G.
      • et al.
      Forward, together: A collaborative path to comprehensive adolescent sexual and reproductive health and rights in our time.
      ].
      The good news is that trend analysis of key ASRHR indicators at global, national, and subnational levels show that adolescent girls are more likely to marry later, delay their first sexual experience, and delay their first childbirth compared with 25 years ago. They are more likely to use contraceptives [
      • Liang M.
      • Simelane S.
      • Fortuny Fillo G.
      • et al.
      The state of adolescent sexual and reproductive health.
      ]. In addition to improvements in documented health outcomes, there have been significant investments in funding of programs and research targeting adolescents with growth of evidence-informed policies and guidelines on responsive ASRHR programming [
      • Chandra-Mouli V.
      • Ferguson B.J.
      • Plesons M.
      • et al.
      The political, research, programmatic and social responses to adolescent sexual and reproductive health and rights in the 25 years since the International Conference on Population and Development.
      ].
      Although these trend analyses provide optimism, in her editorial, Dr. Kabiru outlines several concerns [
      • Kabiru C.
      Adolescents' sexual and reproductive health and rights: What has been achieved in the 25 years since the 1994 International Conference on Population and Development and what remains to be done?.
      ]. First, there remain substantial inequalities across and within countries in key indicators of adolescent health [
      • Kabiru C.
      Adolescents' sexual and reproductive health and rights: What has been achieved in the 25 years since the 1994 International Conference on Population and Development and what remains to be done?.
      ]. Second, some indicators—such as intimate partner violence and reproductive cancers—have worsened [
      • Kabiru C.
      Adolescents' sexual and reproductive health and rights: What has been achieved in the 25 years since the 1994 International Conference on Population and Development and what remains to be done?.
      ]. Third, efforts to implement ASRHR policies and programs are impeded by extensive resistance to the provision of comprehensive ASRHR information and services to adolescents due to social norms and taboos around adolescents' sexuality [
      • Engel D.M.C.
      • Paul M.P.
      • Chalasani S.
      • et al.
      A package of essential sexual and reproductive health and rights interventions- what does it mean for adolescents?.
      ]. Fourth, the multiple factors that drive ASRHR demand complex programs that are often challenging to implement. Finally, an issue that remains largely underexamined in this supplement is the limited focus of ASRHR programming on adolescent boys [
      • Kabiru C.
      Adolescents' sexual and reproductive health and rights: What has been achieved in the 25 years since the 1994 International Conference on Population and Development and what remains to be done?.
      ].
      Of the papers in this supplement, Engel et al. takes special care to emphasize the critical importance of identifying adolescence as a unique period in the life course with specific implications for the implementation of an essential package of services for ASRHR interventions The paper's framework builds on the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights’ report and highlights five key principles: equity, quality, accountability, multisectorial engagement both within the health care system and the broader community, and meaningful engagement of adolescents [
      • Starrs A.M.
      • Ezeh A.C.
      • Barker G.
      • et al.
      Accelerate progress—sexual and reproductive health and rights for all: Report of the Guttmacher–Lancet Commission.
      ]. The paper provides a useful table for adolescent-specific considerations for the delivery of a package of essential ASRHR interventions.
      Plesons et al. [
      • Plesons M.
      • Cole C.B.
      • Hainsworth G.
      • et al.
      Forward, together: A collaborative path to comprehensive adolescent sexual and reproductive health and rights in our time.
      ] further raises the bar and outlines the challenges that hinder adolescent-responsive actions at the country level, identifying some of the opportunities that countries may leverage to overcome these challenges. These challenges include persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningful engagement of young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. Plesons et al. identify the following five key areas for action:
      • 1.
        Mobilize and make full use of political and social support for ASRHR policies and programs;
      • 2.
        Increase and make effective use of external and domestic funding for ASRHR;
      • 3.
        Develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR;
      • 4.
        Use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and
      • 5.
        Manage the implementation of ASRHR strategies at scale with quality and equity.
      In the closing comments of her editorial, Dr. Kabiru outlines the challenges to implementing a comprehensive approach to ASRHR. She emphasizes the importance of multisectoral collaboration to tackle the wider social and economic determinants of ASRHR, yet recognizes that countries need practical guidance and support to create, implement, and assess multisectorial programs. She calls out the Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation, a program that provides guidance for multisectoral programming at country level but also recognizes that many countries will need both technical and financial support to implement this guidance for programming on a sensitive topic such as ASRHR [
      • Chandra-Mouli V.
      • Svanemyr J.
      • Amin A.
      • et al.
      Twenty years after International Conference on Population and Development: Where are we with adolescent sexual and reproductive health and rights?.
      ,
      ].
      In supporting the publication of this supplement, the editorial staff here at the Journal of Adolescent Health hopes to call attention to the accomplishments that have been achieved in ASRHR over the past 25 years, as well as the opportunities to continue to improve the health and well-being of adolescents throughout the world.

      References

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        • et al.
        Twenty years after International Conference on Population and Development: Where are we with adolescent sexual and reproductive health and rights?.
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        A package of essential sexual and reproductive health and rights interventions- what does it mean for adolescents?.
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        • Cole C.B.
        • Hainsworth G.
        • et al.
        Forward, together: A collaborative path to comprehensive adolescent sexual and reproductive health and rights in our time.
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      1. Global accelerated action for the health of adolescents (AA-HA!): Guidance to support country implementation. World Health Organization, Geneva2017 (Available at:)
        https://bit.ly/2OXuTrx
        Date accessed: September 24, 2019

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