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Opinion

There is dire need for Canada to spend its $650-million for reproductive health and rights in a strategic, integrated manner

By Greg Duly      

Given the limited time frame to use the $650-million, it will be critical to rely on evidence-based programs, cultivate partners with experience in fragile contexts, and seek-out successful existing projects that can be strengthened and brought to scale.

A young girl in Freetown, Sierra Leone. Unequal power relations between adults and adolescents, and between men and women, often place girls at greater risk of early and/or unwanted pregnancy; HIV and other sexually transmitted infections; and sexual violence—particularly during times of conflict, disaster, displacement and crisis. Photograph courtesy of the United Nations by Martine Perret
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The question of how Marie-Claude Bibeau, minister of International Development and La Francophonie, decides to allocate the $650-million in funding that Prime Minister Trudeau announced on International Women’s Day has become more critical than ever, given last week’s decision by the U.S. government to deny future funding to the UN Population Fund (UNFPA).

In its response statement, UNFPA referred to the successes of programs funded through past U.S. contributions, including reductions in maternal deaths in some of the world’s most volatile places, and in 2016 alone, the prevention of 947,000 unintended pregnancies.

While the risk of maternal death is very real for women across fragile contexts, one group that is most at risk is adolescent girls. There are more than 13 million adolescent girls, aged 15-19, who give birth annually. A whopping 95 per cent of these births occur in developing countries. At the same time, pregnancy and birth-related complications are the second-leading cause of death amongst girls in this age bracket.

The need for adolescent sexual and reproductive health services is unquestionably great—and focusing services specifically on adolescents also offers an incredible opportunity for sustainable change.

Adolescence represents a critical time when young people are learning to make independent decisions and forming their own attitudes and beliefs. Sexual and reproductive health and rights programs take advantage of this development milestone to improve not only their immediate health and well-being, but also their future health as adults, and that of the next generation, if and when these adults have planned pregnancies.

As Minister Bibeau looks to identify how best to address gaps in the sexual and reproductive health of women and girls—essentially, how best to invest this chunk of federal funding—it is crucial for her to consider the unique needs of adolescent girls, and the opportunity presented to create sustainable change towards gender equality and girls’ empowerment.

Nowhere is this more relevant than in fragile settings.

For example: at age 14, Safiya was kidnapped from her home and taken as a child bride by insurgents in volatile north-east Nigeria. Her son, Hussein, was born out of that forced marriage. Over the course of Nigeria’s seven-year insurgency, adolescent girls like Safiya have survived terrible violence, to the point where more than 2.7 million children are in need of protection—including against sexual violence, forced marriage, and unwanted pregnancies.

Times of crisis also create specific vulnerabilities for adolescent girls that are different from the experiences of adult women.

At the height of the devastating Ebola crisis in Sierra Leone in 2015, schools were closed across the country, leaving girls like 16 year-old Juliet at home, often alone. One such day, Juliet was brutally raped by her neighbor. Without prior access to reliable modern contraceptives or comprehensive reproductive health information and services, Juliet became pregnant and gave birth to her daughter, Marie.

For Juliet, control over her body and the choice over her pregnancy was not hers. She did not have the options many young women in Canada have. In its endeavor to increase gender equality and the empowerment of women and girls through this $650-million in funding, the Canadian government can build on its efforts to help right this wrong.

Juliet’s case in Sierra Leone, and Safiya’s in Nigeria, are not unique. Social norms that discriminate against women and young people place adolescent girls at a particular disadvantage, facing double discrimination based on their gender and their age. Unequal power relations between adults and adolescents, and between men and women, often place girls at greater risk of early and/or unwanted pregnancy; HIV and other sexually transmitted infections; and sexual violence—particularly during times of conflict, disaster, displacement and crisis.

Humanitarian crises disrupt families, social structures like school, and limit access to health care or traditional networks that keep children safe. The risk of early or forced marriage, selling or trading sex for survival needs, and vulnerability to rape are all augmented during crises, and increase the risk of sexually transmitted infection and incidents of unwanted pregnancy.

So how can this need best be addressed?

Given the limited time frame to use the $650-million, it will be critical to rely on evidence-based programs, cultivate partners with experience in fragile contexts, and seek-out successful existing projects that can be strengthened and brought to scale.

Evidence and experience from the sector demonstrates the importance of gender-transformative and integrated approaches—embedding sexual and reproductive health information and services into education and broader health programs—as well as skills training or apprenticeship initiatives, including those tailored to humanitarian contexts. By using existing entry points where aid agencies are already accessing the hardest to reach adolescents—out of school, in remote areas, affected by conflict or famine, or forced from their homes—we can ensure this group does not get left behind.

In countries where openly addressing sexual and reproductive health is taboo, existing entry points like education can also help ensure essential information and services are shared with adolescents within a culturally accessible safe space. Over time, this helps empower more adolescent girls and shifts the power dynamics that discriminate against them, preventing them from exercising control of their own bodies and choices on when and whether to have children.

With the right investment, Canada can help empower adolescent girls to make this choice for themselves.

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