Early and unintended pregnancies put at risk the health, lives, and well-being of young women and girls. Around the world, complications during pregnancy and childbirth are the leading cause of death and the third-highest cause of disability-adjusted life years lost for 15–19-year-old girls. Pregnant adolescents also face a higher risk of severe conditions such as eclampsia than women aged 20 to 24 years.¹ Beyond health, the lack of reproductive health choices and poor quality in their delivery reduce the opportunities for these same young women and girls for continuing education, delayed marriage, and eventually non-traditional roles in the economy and society.

Obstetricians, gynaecologists, and those in related health care professions, including nurses, midwives, and even pharmacists, can prevent this needless risk of morbidities and loss of life, as well as loss of opportunities, for many young women and girls. By having open and honest discussions about safe sex, contraception, and infection prevention, health care practitioners can protect the health and lives of young people by ensuring they are aware of their safe reproductive health care options and choices.

FIGO position on the issue

A health care counselling session with a young person is incomplete if it does not mention sexual health, including safe, consensual, pleasurable sex, contraception, and infection prevention. Yet despite this, so many young women and girls do not have access to the education or information they need to make safe and informed decisions about their sexual and reproductive health, including on abortions.

Legal restrictions, stigma, community norms and beliefs, and a lack of awareness and information about the availability of safe abortion options are just some of the reasons why young people with an unwanted pregnancy may resort to unsafe abortion. Of the estimated 5.6 million abortions that occur each year among adolescents aged 15–19 years, 3.9 million are unsafe. As a result, young girls account for nearly a third of all unsafe abortion-related deaths each year.² Early and comprehensive sexual education, access to accurate information about safe sexual practices, effective contraception, and infection control can prevent these deaths.

That is why FIGO is calling on all member societies to recommend to their members and allied health practitioners that health care providers working in public-sector institutions or private practice commit to discussing sexual and reproductive health – including contraception, infection prevention and safe sex – in their conversations with young people, girls, and boys. By doing so, we can together improve young people’s physical and mental health, save lives, and help them to pursue the educational and economic futures of their choice.

FIGO recommendations

FIGO’s Committee on Contraception and Family Planning, together with the Committee on Human Rights, Refugees and Violence Against Women and the Committee on Safe Abortion, has developed a set of priorities to improve vulnerable groups’ access to family planning and contraception information and services. These groups include adolescents and young adults, who now number more than half of the world population. Remarkably, this large cohort of young people often has great difficulty in accessing reliable and unbiased information and services in most health settings.^3,4  

FIGO member societies should strongly recommend the following actions to their members, to engage the range of health care providers that serve young women and girls wherever they live.

A toolkit on sharing more information about these actions is available on the FIGO website.

Ensure access to sexual and reproductive health services (SRHS) and information

• Access to accurate information and affordable, safe products enables young people to access services they need to protect their health, lives, and futures.
• National universal health care (UHC) programmes should make contraception available to all young people who need it, employing resources in both the public and private sectors. Where local laws permit, comprehensive reproductive health services should also include access to safe abortion and post-abortion care.
• Funding contraceptive services for young women and girls at risk of unwanted or unintended pregnancies is an essential service, integral to UHC.

Engage consistently in health care counselling

• Health care counseling with a young person is incomplete if it does not mention sexual health, including safe, consensual, pleasurable sex, contraception, and infection prevention.
• When informed, young people are better able to make sexual and reproductive choices that are best for them. Post-abortion and postpartum care offers an additional opportunity for reducing potential future risk of unplanned pregnancies.
• Addressing issues of rape, incest, and other forms of gender-based violence are critical elements of care for young people.

Address complications during pregnancy and childbirth with quality of care

• Sharing information with policy makers about the options for addressing complications during pregnancy and childbirth – the leading cause of death globally for 15–19-year-olds.
• Ensuring that open and honest discussions about contraception are held by the full range of practitioners serving youth, so that young people can protect their health and save lives.
• Collaborating with other providers in the public and private sectors to ensure coherence and follow-up of specialized care, including addressing the consequences of traditional harmful practices such as FGM.

Explore opportunities to contribute to special areas of SRHS

• Lack of respectful care and information that ignores their rights and interests can prevent young people from seeking sexual and reproductive health care. This may include support for gender identity and sexual orientation.
• Providers must commit to having open dialogues on sexual health – including contraception and infection prevention – to expand access and save lives.
• Special attention should be given to young people in humanitarian settings, immigrants, homeless people, and vulnerable people with other conditions.

FIGO commitments

Following this statement, FIGO is raising awareness of the need for access to accurate information and affordable, safe, and acceptable products, to ensure young people access to the services they need to protect their health, lives, and futures.

FIGO commits to:

• bring the voices and interests of young women and girls to the development and review of practice guidelines
• cooperate with national OBGYN societies, the International Confederation of Midwives (ICM), UN agencies such as WHO, UNICEF, and PMNCH, as well as civil society organizations such as IPPF, Rotary International and others, in support of the health and wellbeing of young women and girls
• share appropriate evidence and best practices in support of the SRHS needs of young women and girls in each country with a member society. This should include the role of telemedicine, task shifting, and the use of social media to support the health and wellbeing of young women and girls
• provide technical support to national societies interested in reviewing policies and guidelines, as well as opportunities for consultation on emerging issues through webinars and use of social media
• ensure that medical ethics, respect, confidentiality, and equity are part of all discussions on information and services for youth.

References

1. WHO. Adolescent and young adult health. 2021.
2. WHO. Preventing unsafe abortion. 2020.
3. Guttmacher. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents. 2016
4. UNFPA and Guttmacher Institute. Contraception for adolescents and youth: Being responsive to their sexual and reproductive health needs and rights. November 2019.