On April 27, Knowledge SUCCESS hosted a webinar, “COVID-19 and Adolescent and Youth Sexual and Reproductive Health (AYSRH): Stories of Resilience and Lessons Learned from Program Adaptations.” Five speakers from around the world presented data and their experiences on the impact of COVID-19 on AYSRH outcomes, services, and programs.
Moderator: Dr. Zayithwa Fabiano,
Founder, Health Access Initiative Malawi
Senior Research Associate,
Dr. Astha Ramaiya,
Johns Hopkins Bloomberg School of Public Health
Lara van Kouterik,
Head of Learning and Partnership Development,
Girls Not Brides
Dr. Nicola Gray,
Vice President for Europe,
International Association of Adolescent Health (IAAH)
Adolescent Sexual and Reproductive Health and Rights Consultant,
Earlier this year, Knowledge SUCCESS launched the interactive experience Connecting the Dots. It explores the impact of COVID-19 on family planning in Africa and Asia. Connecting the Dots was not focused on youth, so Ms. Packer presented a new subanalysis to pull out the impact of COVID-19 on young women’s contraceptive use. This analysis used Performance Monitoring for Action data from December 2019 to January 2021. They sought to answer two questions about the pandemic’s impact on young women:
The data show very little change in contraceptive use in women younger than 25 as well as overall. The later COVID-19 survey showed contraceptive use in Burkina Faso and Kenya was actually slightly higher than pre-pandemic levels (see graph below).
The later COVID-19 survey showed a slight increase in women switching to a less effective contraceptive method or no method at. Generally, fewer or similar percentages of younger women compared to older women switched (see graph below).
The same survey also showed that more women cited COVID-19-related reasons for contraceptive non-use. In Lagos, more younger women cited COVID-19 as a reason for non-use, but this was not the case in other settings (see graph below).
“In this analysis, it appears that COVID-19’s impacts on contraceptive use during the first year of the pandemic may not have been as severe as originally feared.”
The objective of Dr. Ramaiya’s research was to map and synthesize the literature on the impact of the COVID-19 pandemic on adolescents’ health and social outcomes in low- and middle-income countries (LMICs). These outcomes were grouped as health, social relationship, education, and disparities (see chart below).
Dr. Ramaiya and her colleagues completed a rapid literature review of 90 articles to create an analysis based on a broad, sound body of evidence.
Ms. Van Kouterik began her presentation by exploring the definition of child marriage and how many girls around the world were married before age 18.
What is child marriage?
Ms. Van Kouterik shared that COVID-19 could impact progress toward eliminating child marriage. UNICEF projects that an additional 10 million girls could enter into child marriage by 2030 due to school closures, increased rates of adolescent pregnancy, disruption in SRH care, economic shocks, and the death of parents.
Child marriage data is collected by looking at women aged 20–24 and identifying at what age they were married. This means that it is too soon to tell what kind of impact COVID-19 has had on child marriage. In order to mitigate that impact, Girls not Brides recommends ensuring access to health care and education and offset the economic shocks of the pandemic.
West and Central Africa
To learn more about the impact of COVID-19 on child marriage, head to the Girls Not Brides learning hub. Briefs are available in English, French, Spanish, Arabic, Bangla, and Portuguese.
Dr. Gray began her presentation with a short introduction to International Association for Adolescent Health (IAAH), a non-government organization working to improve adolescent health across the globe. In response to the COVID-19 pandemic, IAAH released a statement on protecting adolescent health during this public health emergency. Dr. Gray highlighted the projections that millions of additional child marriages and unintended pregnancies may occur as a result of the pandemic (as Ms. Packer and Ms. van Kouterik discussed earlier in the session). IAAH included recommendations on how to sustain and expand efforts to reach adolescents. Dr. Gray detailed examples from three different kinds of interventions: legislative, telehealth, and service delivery.
In Malaysia, the government passed laws to protect adolescents by increasing the age for statutory rape from 12 to 16 years old. It also prohibited and penalized child marriage. Due to pandemic school closures and economic hardships, many adolescents were at risk of sexual violence or child marriage. This kind of legislation is a “pillar to protect ASRH.”
In the United Kingdom, a digital health service, Brook, launched its “digital front door” service to reach adolescents seeking SRH care through telehealth. There are a variety of challenges regarding digital health, including:
The safeguarding of adolescents seeking care is essential to the operation of any intervention, especially digital health. In order to ensure the safety of its patients, Brook encourages those at risk to disclose it through the app. It trains staff on how to identify patients who may be at risk (those using alcohol or drugs before sex, engaging in sex with an older partner, feeling generally low or depressed).
Due to COVID-19’s disruption of health service delivery in Nigeria, a network of health workers decided to adapt their services to reach adolescent girls. Adolescents 360 (A360) saw its weekly service decrease from 2,000+ pre-pandemic to 250+ in April 2020. To make sure its counselors were providing the necessary care to its patients, A360 conducted virtual trainings to provide counselors with up-to-date COVID-19 information. It also instituted a process to integrate COVID-19 into its current work. This allowed the counselors to meet face to face with their patients in their communities. There they provided SRH and COVID-19 information while implementing safety measures to mitigate the spread of COVID-19. The counselors were able to then refer patients to A360 hubs for necessary follow-ups by phone or text.
Mr. Ali detailed lessons from a WHO report on ASRH care in the context of COVID-19. It detailed case studies on the work of 36 organizations from 16 countries. It was apparent that it was up to local and international organizations to keep the focus on AYSRH care, as many governments turned their sole attention to the economic burden of the pandemic.
How did organizations adapt their responses to the SRH needs of adolescents during the COVID-19 pandemic? The WHO posted an open call to submit case studies. The case studies represented a focus on SRH services, such as:
The studies mostly targeted adolescent girls and vulnerable adolescent populations such as those living with HIV, LGBTQ+ adolescents, and those living in remote areas.
Can you elaborate on suicidal ideation in adolescents?
Dr. Ramaiya: Rates of suicidal ideation and attempts ranged from 10% to 36%. Suicidal ideation was outlined in one study in China. It took two groups of adolescents: one who were “left behind” children and categorized as marginalized and then another group were not “left behind” and categorized as non-marginalized. Suicidal ideation was found to be 36% among these adolescents. For non-marginalized adolescents, factors associated with suicidal ideation included low parental education and higher anxiety and depression symptoms. For marginalized adolescents, the risk factors included being female, lower parental education, a perceived worse family economic status, and anxiety and depression symptoms.
Can you offer potential reasoning why the PMA data indicating a minimal drop in contraceptive use among young women reconciles with the literature indicating increased rates of adolescent pregnancy and child, early, and forced marriage or union (CEFMU), as offered by the other presenters? Do these PMA findings align with other national/global data collection findings?
Ms. Packer: The denominator for the PMA indicator was women at risk of unintended pregnancy. This is defined as non-pregnant, non-infertile, married, or partnered women who did not want to have a child in the next year. Fewer adolescents aged 15–19 would fit this definition. We had similar findings to a recent FP2030 report. This data showed higher than expected contraceptive use in four countries and a slight decrease in two countries but overall not much change. Guttmacher data from March 2020 to December 2020 showed very little decline in adolescent contraceptive use. For Uganda, it actually increased from pre-pandemic levels. Available data are still limited, but consistently indicate that the disruptions have had less impact on SRH than initially expected. But it still may be too soon to see these impacts reflected in the data, so we have to wait a bit longer and review other data sources to understand the impact.
What are two recommendations for immediate action to mitigate crises, and also two recommendations that policymakers and program implementers should take note of, especially with regard to emergency preparedness and response?