Adolescents Have Become Visible

Approximately 1.2 billion people on the planet today are adolescents, a population group evenly distributed by sex that currently represents 18% of the world's population. The vast majority of this age group (88%) live in low and middle income countries. Although every human being aged under 18 years is a child according to the Convention on the Rights of the Child, the rights of adolescents are systematically violated in many parts of the world, with many of them living in extremely vulnerable situations and being forced at an early age to assume adult roles and behaviours. Such coercion deprives them of a key stage in their development and often determines the course of their lives.

Adolescence has often been considered to be a period of life associated with good health. That perception, together with the weak political voice of adolescents compared to other groups, has in the past led to the marginalisation of this age group in development and global health agendas. Although mortality among adolescents could be considered low compared to that of other age groups, every year 1.5 million adolescents die from preventable or avoidable causes, such as traffic accidents, human immunodeficiency virus, suicide, respiratory infections and interpersonal violence. These statistics highlight the specific needs of this age group. Moreover, most of the factors that determine the health of adolescents fall outside the competence of the health sector,  making the problem even more complex and requiring still greater coordination between sectors. Such coordination, which has been very uncommon in the past, is now crucial if we are to make progress.

Without minimising the factors that affect teenage boys to a greater degree (violence, traffic accidents, child labor), we can say that the governments of low and middle income countries and the other actors involved have been slow to recognise the impact of issues affecting adolescent girls (child marriage and early pregnancy) on the failure to achieve Millennium Development Goals (MDGs) .
This lack of recognition is particularly evident in the case of MDG5 (improve maternal health), the goal now furthest from achieving its targets of all the MDG's. It is estimated that adolescent girls account for 70 000 maternal deaths annually worldwide, with pregnancy- and childbirth-related disease and injury being the second leading cause of death of girls aged between 15 and 19 years. At the same time, the statistics indicate that adolescent girls—particularly those who are unmarried—are the group with the least access to contraception.
The social consequences of teenage pregnancy are also serious because it limits the possibility of the mother continuing her education. This situation has negative repercussions on the income and personal autonomy of teenage mothers and ultimately a knock-on effect on the health and education of their children. Finally, this early sexual activity places adolescent girls at greater risk of contracting sexually transmitted diseases and HIV.
Furthermore, since early marriage and teenage pregnancy are strong determinants of underdevelopment, any analysis of the trends observed in recent years yields discouraging conclusions: advances have been scarce and progress slow in all regions of the world. More than 60 countries have levels of child or forced marriage of 20% or higher, and the statistics have not varied over the last ten years. Levels of teenage pregnancy have also remained unchanged since the 1990s.
Adolescent girls are also affected by health inequities, that is, unfair and avoidable differences in access to health care. The situation of adolescents varies considerably owing to gender as well as socioeconomic, ethnic and geographic differences. For example: the adolescent fertility rate (number of births per 1000 women aged 15 to 19 years) ranges from 1 to 299 depending on the country. Where little variation is seen, however, is in the overall trends: teenage mothers come primarily from rural areas, are predominantly uneducated or have lower levels of education and belong to the poorest quintiles, as compared to girls in urban areas with secondary or higher education belonging to the richest quintiles.

What Can We Expect in This New Stage?

Now, for the first time, adolescents have managed to achieve visibility and their own space in the new Agenda for Sustainable Development adopted in September this year. The letter "A" has started to creep into acronyms and some of the most important strategies. Adolescents have been recognised as a distinct group with their own particular risks, rights and needs. At last, we have a target relating to the elimination of child, forced and early marriage. This new framework provides a better base from which to lobby for an increase in the allocation of resources to this problem and for the creation of policies and programmes that focus on human rights, pro-equality and greater coordination between the different sectors. While there is only one Sustainable Development Goal (SDG) specifically related to health (SDG3), most of the other goals are closely linked to physical wellbeing (SDG1, the reduction of poverty and the implementation of social protection systems; SDG2, food security and improved nutrition; SDG4, education; SDG5, access to sexual and reproductive health and reproductive rights and ending sexual violence, child marriage, and female genital mutilation; SDG8, economic growth; and SDG10, reducing inequalities).

In any case, addressing the needs of one-fifth of the population of developing countries—a group that represents 35% of the global burden of disease—is an indispensable prerequisite for genuine sustainable development. If this new trend were confirmed, it would be the best way to redeem a historical failure by making amends to today's teenagers, those who were born precisely at the time when the MDGs were adopted in 2000, and to upcoming generations.