Education Health | United Nations Population Fund

The Promise of Education

Imagine the first day of school for an adolescent girl in rural, sub-Saharan Africa. Let’s call this girl Adah, and now, let’s imagine what the start of a new year of school is like for her. The excitement. The newness. The opportunity to return again for more education. To learn! For Adah, it is the most exciting time of her year.

What makes this year particularly special for Adah and her community is that it is the first year young girls are able to continue their education at the secondary school level. Things in her community are moving slowly, however, so while there is a state commitment for young girls to access secondary education, not all girls her age will be attending this next level of school. Right now, only a select group of girls with high enough grades were chosen this first year. Still, this is an exciting step forward. Transitioning from childhood to adolescence is never easy for any young girl, but Adah feels new confidence in herself and her capabilities. She is the first of the five girls in her family to go to secondary school.

Adah has two brothers and four sisters. While she is very close to her older sisters, their daily lives are very different. They have husbands and children. Life has never been easy, but now positive changes are emerging within their community and the impact is slowly starting to be felt.

“Girls with a primary education are twice as likely to marry or enter into union as those with a secondary or higher education. However, those with no education are three times more likely to marry or enter into union before age 18 as those with a secondary or higher education.”

Adah is very fortunate to have completed primary school. Because of her country’s improving commitment to early and lifelong learning for every adolescent regardless of their circumstances, soon there will be as many young girls as boys in both primary and secondary school in her community, so everyone will be able to read, write and count.

Better education allows more members of the community to utilize creative problem-solving skills and to responsibly exercise freedoms. As more girls join boys at the secondary level, their opportunities expand. Adah and other girls like her are provided with the chance to gain new skills and knowledge. As developments in education increase, the government will need to ensure that there are more opportunities for vocational education and training, and create work-directed learning to benefit girls and contribute to a growing economy. These investments clearly pay off, since girls who don't attend secondary school are three times as likely to become child brides and experience adolescent pregnancy, which compromises their health and safety, and limits their potential and opportunities.

“Growing female literacy correlates with healthier families and stronger economic growth.”

Many governments in Sub-Saharan Africa have started campaigns to teach and prepare young people for their sexual lives. By providing adequate, gender-sensitive and comprehensive sexuality education, they are empowering youth to make responsible and autonomous decisions about their sexual and reproductive health and rights. In addition to secondary school, this will help Adah and girls like her to achieve their full potential.

Investing in Young People: Equal Access to Education

Nearly two-thirds of countries (128 out of 193) reported in 2012 that they had achieved gender parity in primary schools. Boys continue to benefit from greater access, however.

Fighting for Secondary Education

Over the past five years, 82% of countries addressed the issue of ensuring equal access of girls to education at all levels; 81% addressed keeping more girls and adolescents in secondary school.

Investing in Young People: Ensuring Equal Access to SRHR

In Africa, 52% of countries have sought to ensure that adolescents and youth have access to sexual and reproductive health information and services that respect privacy, confidentiality and informed consent. This compares to 96% in the Americas, 90% in Europe and 80% in Asia.

What Your Government Can Do

States should recognize that comprehensive sexuality education, consistent with the evolving capacities of young people both in and out of school, is essential to enable them to protect themselves from unwanted pregnancy, HIV and sexually transmitted infections; to promote values of tolerance, mutual respect and non-violence in relationships; and to plan their lives. States should design and implement comprehensive sexuality education programmes that provide accurate information, taking into account scientific data and evidence about human sexuality, including growth and development, anatomy and physiology; reproduction, pregnancy and childbirth; contraception; HIV and sexually transmitted infections; family life and interpersonal relationships; culture and sexuality; human rights protection, fulfilment and empowerment; non-discrimination, equality and gender roles; sexual behaviour; sexual abuse, gender-based violence and harmful practices; as well as youth-friendly programmes to explore values, attitudes and norms concerning sexual and social relationships; promote the acquisition of skills and encourage young people to assume responsibility for their own behaviour and to respect the rights of others; are gender-sensitive and life-skills-based; and provide young people with the knowledge, skills and efficacy to make informed decisions about their sexuality.

States should preserve the dignity and rights of women and girls by eradicating all harmful practices, including child, early and forced marriage, through integrated multisectoral strategies, including the universal adoption and enforcement of laws that criminalize marriage before the age of 18, and through widespread campaigns to create awareness around the harmful health and life consequences of early marriage, supporting national targets and incentives to eliminate this practice within a generation.

To Enjoy a Childhood

Right now Adah is free to be a young girl. This means she can focus more on developing herself, her dreams and her aspirations. Adah has long been accused of having a wild imagination by the elders in her community. Depending on how it’s told to her, she knows this is both a compliment and a criticism. At Adah's new school, she is learning geography and discovering faraway places like Australia, Italy, Japan, Mexico and the United States. These places fill her dreams. One day, she would like to visit the islands of Jamaica and Puerto Rico. Why? Because she loves reggae music and Bob Marley! (Adah and her sisters also love dancing to reggaeton star Sean Paul, but Bob Marley is their favorite.) Adah is very creative and often sketches herself and her sisters in the places that she learns about. She draws them based on how she envisions them in her mind.

“Safeguarding the rights of young people and investing in their quality education, decent employment opportunities, effective livelihood skills, and access to sexual and reproductive health and comprehensive sexuality education strengthen young people’s individual resilience and create the conditions under which they can achieve their full potential.”

Throughout Adah’s adolescence, however, she and her siblings, parents and extended family experience the incredible difficulties of staggering inequalities. Despite new opportunities, the family continues to live below the poverty level. They don’t have equal access to opportunities or services that would allow them to fully enjoy their own individual capability, dignity and freedom in order to thrive. These economic inequalities have become both the cause and consequence of other social inequalities involving gender, race, disabilities, age, and other dimensions of identity and circumstance. With education, Adah’s future life stands a chance of improvement; otherwise, Adah likely will experience, just as her older siblings, mother and the generations before her, longstanding vulnerability to stigma and discrimination.

“Early, child and forced marriage and female genital mutilation/cutting remain prevalent harmful practices despite advances in legislation in many countries.”

Investing in Young People

Acknowledging the more than 1.8 billion young people in the world today, the focus on adolescents and youth in the global development agenda is based on four crucial conditions:

The decline in fertility that followed their births means that they must become self-supporting and thrive, for there will be no larger, younger cohort to support them as they themselves age, and they can be expected to live to an advanced age, given increasing life expectancy.
They will also need to support the existing and growing population of elderly persons.
The majority of this cohort is growing up in poor countries, where education and health systems are low quality, reproductive choice and health are not guaranteed, good jobs are scarce and migration is constrained.
They have expectations—higher than the generations before them—for self-direction, freedom and opportunity. The information age has taught them their human rights and given them a broader vision of what their lives could be.

Access to Quality Education

Access to good quality education is especially limited for those living in poverty. Schools serving poor children characteristically have teachers who are overburdened, unsupervised and underpaid; crowded classrooms; and a lack of adequate learning materials, therefore producing poorer outcomes, even in wealthy countries.

What Your Government Can Do

States should implement their commitments to promote and protect the rights of girls by enacting and implementing targeted and coordinated policies and programmes that concretely address: (a) ensuring gender parity in access to school; (b) providing comprehensive sexuality education; (c) reducing adolescent pregnancy; (d) enabling the reintegration of pregnant girls and young mothers into education at all levels, with a view to empowering the girl child and young women to achieve their fullest potential; and (e) eliminating of harmful traditional practices such as child, early and forced marriage and female genital mutilation/cutting.

States should develop, strengthen and implement effective, integrated, coordinated and coherent national strategies to eradicate poverty and break the cycles of exclusion and inequality as a condition for achieving development, also targeting persons belonging to marginalized or disadvantaged groups, in both urban and rural areas, guaranteeing for all people the chance to live a life free from poverty and to enjoy protection and exercise of their human rights.

States should accord the highest priority to poverty eradication by ensuring that all persons have equal opportunities to share in the fruits of economic and social development, to find productive employment, and to live in peace and dignity, free from discrimination. injustice, fear, want or disease.

States should guarantee for boys, girls, adolescents and young people the opportunities, mentoring and skills to build healthy social relationships, harmonious coexistence and a life free from violence through multisectoral strategies and education that engage peer groups and families, and promote tolerance and appreciation of diversity, gender equality, self-respect, conflict resolution and peace.

States should commit to and support early and lifelong learning, including pre-primary education, to ensure that every child, regardless of circumstance, completes primary education and is able to read, write and count, to undertake creative problem-solving and to responsibly exercise his or her freedoms. States should also ensure access to secondary education for all and expand postsecondary opportunities; enable the acquisition of new skills and knowledge at all ages; and enhance vocational education and training, and work-directed learning linked to the new and emerging economies.

Safety and Security: Investing in Young People

“In certain regions, women’s agency may be further compromised by early or forced marriage, unintended pregnancy and early childbearing (particularly without adequate support from the health system), lack of education, lower wages than men and gender-based violence.”

There are challenges that sometimes interfere with Adah’s education. There is a lot of stress at home felt by all family members. One of her married older sisters, Khadijah, is once again pregnant and frequently comes home in the middle of the night to stay with the family. She comes to escape the violent outbursts of her middle-aged husband, to whom she always returns. “I have to,” is what she says, and what Adah’s father and mother say. When she comes in the middle of the night, she brings her two children. The extra crowding causes tensions to rise, and there are fewer resources to go around. Because Adah’s attendance at school isn’t mandatory, and given so many pressures, there is no guarantee she will continue for the full duration of her secondary education.

“Women and children bear a disproportionate burden as a consequence of poverty.”

The Prevalence of Gender-Based Violence

An estimated one in three women worldwide report that they have experienced physical and/or sexual abuse, mostly at the hands of an intimate partner, making this form of violence against women and girls one of the most prevalent forms of human rights violations worldwide.

Eliminating Gender-Based Violence

The elimination of all forms of violence, including sexual violence, rape, domestic violence and femicide, among others, is consistently mentioned by civil society organizations across all regions as the number one top priority issue for public policy for the next 5-10 years (Africa: 20%; the Americas: 22%; Europe: 26%).

What Your Government Can Do

States should adopt and implement legislation, policies and measures that prevent, punish and eradicate gender-based violence within and outside the family, as well as in conflict and post-conflict situations. Laws that exonerate perpetrators of violence against women and girls, including provisions that allow them to evade punishment if they marry the victim, or are the partners or husbands of the victim, should be revised. Sexual violence should also be eliminated from post conflict amnesty provisions within the framework of strengthened legislation and enforcement to end impunity.

States should further ensure that all victims/survivors of gender-based violence have immediate access to critical services, including 24-hour hotlines; psychosocial and mental health support; treatment of injuries; post-rape care, including emergency contraception, post-exposure prophylaxis for HIV prevention and access to safe abortion services in all cases of violence, rape and incest; police protection, safe housing and shelter; documentation of cases, forensic services and legal aid; and referrals and longer-term support.

Health and Well-Being: Ensuring Reproductive Rights

Learning and working hard within the school system is a big job that Adah is excited about and committed to continuing. There are hurdles, however, that are often beyond her control. In addition to her studies, Adah needs to stay healthy. Young people frequently struggle with bouts of extreme diarrhoea. This leaves them prone to dehydration and other related ailments that when left untreated can become deadly. The older generations experience their own health concerns—many battling constant, chronic illnesses like pneumonia. Malaria is an ongoing threat, with inconsistent access to prevention and treatment.

“The objectives in primary health care and the health-care sector are to increase the accessibility, availability, acceptability and affordability of health-care services and facilities to all people; to increase healthy lifespans and improve the quality of life of all people; and to reduce disparities in life expectancy between and within countries.”

All of these medical conditions are treatable with stable health care systems in place. When health facilities and other basic services aren’t easy to reach and don’t maintain consistent quality, Adah’s family and families like hers suffer greatly, losing opportunities to learn, work and enjoy a greater sense of well-being.

Adah’s mother, Fatima, is personally invested in Adah’s future being bright and fully realized. Motherhood hasn’t been easy on Fatima, and she’s very lucky to still be alive. Two of Adah’s siblings died during childbirth, probably because they were not born in a hospital. It wasn’t easy for Fatima and Adah’s father, Joseph, to get to a medical facility because of the lack of reliable access. When they did make it to the hospital, the care wasn’t safe. Fatima’s most recent pregnancy left her with a fistula, which caused great suffering until UNFPA provided her with fistula repair surgery. Overall, maternal and infant mortality still cause much anguish to Adah’s community.

“Adolescent birth rates declined from 1990 to 2010 across countries in all income groups and regions. Worldwide, more than 15 million girls aged 15-19 still give birth each year.”

And this is why secretly Fatima is very happy that Adah’s school has started offering programmes that teach students about sexuality. Comprehensive sexuality education focuses on teaching adolescents about their sexual health and reproductive rights. Joseph isn’t happy about this, however. “Why would a young girl need to have sexuality education? What are people going to think?” he asks. Joseph struggles with what is customary and traditional within his community, and with what he wants for his daughter and the women in his family. Indeed the topic of sex is taboo in their community. Civil society and community organizations have carefully navigated these sensitive issues with educational programming. This is how Fatima came to an empowering place where she is determined to do whatever she can to ensure Adah does not have to endure much of the agony that she barely survived. It is simple: Fatima wants Adah to live a longer, happier and healthier life.

This may be the case as their community is transitioning and further accepting that life can improve for everyone when all people are empowered—from the educated girl, to the mother who makes choices for her own body and fertility, to the grandmother who can grow old with all the services she needs to age comfortably. Right now, learning within a secondary school has set the foundation for a promising future for Adah.

“Early parenthood can increase the risk of poverty.”

Sexual Health and Reproductive Rights

Nine of 10 births to girls below age 18 occur within early marriage. Girls who become pregnant before age 15 in low- and middle-income countries have a risk of maternal death and obstetric fistula that is double the rate for older women (including older adolescents), in particular in sub-Saharan Africa and South Asia. There are significant health risks to the infants and children of adolescent mothers: Stillbirths and newborn deaths are 50% higher among infants of adolescent mothers than among infants of mothers between the ages of 20 and 29.

A Shortage of Skilled Health Personnel

Differences in access among urban and rural women are strikingly inequitable, with rural women much less likely than urban women to have a skilled attendant during delivery. There is a profound health worker shortage in the 58 countries in which 91% of maternal deaths occur. Overall, sub-Saharan African as a region has made little progress in extending skilled birth attendance; skilled personnel assist with fewer than half of all births.

The Value of Skilled Health Personnel

The proportion of deliveries attended by skilled health personnel rose in developing countries from 56% in 1990 to 67% in 2011. Despite the positive trends, access to good maternal health care remains highly inequitable across regions, and within countries, between poor and wealthier women.

Poverty

Despite a significant reduction in the number of people living in poverty, an estimated 1.2 billion people continue to live in extreme poverty.

Inequality and Access to Basic Resources

Increasing economic inequality is disruptive and highly detrimental to sustainable development. Inequality impedes trust and social cohesion, threatens public health, and marginalizes the poor and the middle class from political influence.

What Your Government Can Do

States should eliminate preventable maternal mortality and morbidity as urgently as possible by strengthening health systems and thereby ensuring universal access to quality prenatal care, skilled attendance at birth, emergency obstetric care and postnatal care for all women, including those living in rural and remote areas.

States should review all such policies and remove legal, regulatory and social barriers to reproductive health information and care for adolescents.

States should fund and develop, in partnership with young people and health-care providers, policies, laws and programmes that recognize, promote and protect young peoples’ sexual and reproductive health and rights and lifelong health. All programmes serving adolescents and youth, whether in or out of school, should provide referral to reliable, quality sexual and reproductive health counselling and services.

Substantial Investment is needed in the capabilities of children, adolescents and youth, while ensuring that every child and young person, regardless to quality pre-primary, primary and secondary education and comprehensive sexuality education holistically defined and consistent with their evolving capacities, and has a rapid, safe and productive transition from school to working life and adulthood.

States should accord the highest priority to poverty eradication by ensuring that all persons have equal opportunities to share in the fruits of economic and social development, to find productive employment, and to live in peace and dignity, free from discrimination, injustice, fear, want or disease.

In establishing universal health coverage schemes, States should ensure mechanisms for: (a) the fair and affordable participation of all potential beneficiaries in their country; (b) the inclusion of essential sexual and reproductive health services within universal health coverage packages and the realization of comprehensive sexual and reproductive health care, especially for young people and the poor; and (c) the assurance of fairness and equality through the participation of civil society, independent commissions and advocacy groups in the oversight of allowable procedures, providers and reimbursements.

States should give the highest priority to strengthening the structure, organization and management of health systems, including the development and maintenance of necessary infrastructure, such as roads, electricity, clean water, facilities, equipment and commodities, to ensure fair and equal access by all persons to comprehensive, integrated and quality primary care that includes sexual and reproductive health care and proximity to referral centres of excellence for higher levels of care, with a commitment to providing universal access to quality healthcare to all rural, remote and poor populations, indigenous peoples, and all those living without adequate health care today.

States should develop, strengthen and implement effective, integrated, coordinated and coherent national strategies to eradicate poverty and break the cycles of exclusion and inequality as a condition for achieving development, also targeting persons belonging to marginalized or disadvantaged groups, in both urban and rural areas, guaranteeing for all people the chance to live a life free from poverty and to enjoy protection and exercise of their human rights.

States should accord the highest priority to poverty eradication by ensuring that all persons have equal opportunities to share in the fruits of economic and social development, to find productive employment, and to live in peace and dignity, free from discrimination, injustice, fear, want or disease.

Education & Health

The Adolescent Girl : Transforming The Future — ADAH

ICDP Review Report The 5 Pillars