The world has more adolescents than ever before - 1.2billion. I am responsible for just two, aged 15 and 18 years. As I look at my son and daughter I see huge potential, and also risk. As we look around the world, especially for girls in low and middle income countries, these risks are magnified.
There are more adolescent pregnancies than ever before: 16million girls under the age of 18 give birth each year, 95% of which are in low and middle income countries. One in three girls in these countries will be pregnant by their 20th birthday, and many are unplanned.
World Population Day on 11 July is a time for us all to focus on adolescent pregnancies and take action. This matters because of the impact on girls, the impact on their babies, and the impact on development and the economy.
Girls aged 10-14 years who become pregnant have a five times greater mortality risk compared to those aged 20-24 years. The risks of obstetric fistula (a hole in the birth canal) are also much higher for these children who have children before they are finished growing. These girls are also at risk of HIV/AIDS, especially in cultures where they have first relationships with older men.
Children having children have the riskiest outcomes with higher rates of stillbirth, preterm birth (born too soon), in-utero growth restriction (born too small), and long-term stunting, as highlighted in the recent Nutrition for Growth Summit. Delaying first pregnancy from 14 to 16 or better still to after 18 or 20 years, would reduce newborn deaths and give a healthier start for babies.
As girls drop out of education, development and economic potential suffers. Recent data from South Africa, which has high rates of adolescent pregnancy, and very high rates of coerced sex and violence against women and girls, show that 75% of school learners leave because they are pregnant, and less than 50% return to complete their education. This is a loss for the girl, her family and the nation.
Although the UK has the highest teen pregnancy rates in Europe, new trend data shows a turnaround - the rates of adolescent pregnancies in the UK are now at their lowest since the 1960s. This progress is related to more strategic focus on reaching adolescents, such as school health programmes and teen friendly services for contraception and reproductive health services.
Yet in the UK and around the world it is still the poorest girls, those who most need to stay in education, who have teenage pregnancies.
The turnaround in the UK shows that change is possible. Global focus and funding for family planning has increased over the last year with the launch of FP2020 by the UK Government and the Bill & Melinda gates Foundation, alongside other partners.
But without specific attention to the gaps for adolescents, these girls who are at greatest risk, and most needing the power to make choices, will be left behind. There are three key gaps to close:
1. Gaps in action, intentionally refocusing service provision to be adolescent friendly and funding these programmes.
2. Gaps in knowledge on how best to reach adolescents, especially if not in school. In Africa this is also linked to how best to prevent HIV in adolescent girls. The INTEGRA study by the London School of Hygiene & Tropical Medicine and the International Planned Parenthood Federation is a good example of integration of HIV and family planning, but adolescents were still at the margins.
3. Gaps in data contributing to invisibility, especially regarding collection of data with the right age groups split out, and a notable lack of data for reproductive health service use amongst unmarried girls and for abortion and for violence.
As well as leadership by country governments all around the world to protect and provide for a healthy adolescence, we need academics and civil society to be more innovative in closing these gaps. The framework for beyond 2015, when the millennium development goals expire, talks of "nobody left behind", but we are leaving 16 million pregnant girls behind each year. Adolescents need specific attention so that we can work towards a day when every pregnancy is wanted, every birth is safe, and the potential of every girl is fulfilled.