Background
Factors that affect adolescent sexual and reproductive
Biological changes
Influence of family and friends
The communities in which young people live
Access to economic and academic opportunities
The new paradigm
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Biological changes: No approach can change biology, but we can help young people better cope with the biological changes typical of adolescence by providing age-appropriate and developmentally-appropriate sexuality education. Adolescents will gain information about safe behaviors and the skills needed to safely navigate the biological factors that may put them at risk [22, 23]. Research confirms that delivery of high-quality SRH information has a positive impact on young people’s attitudes and practice, including SRH-seeking behavior [24]. Sexual and reproductive health curricula that address gender and power are more likely to lead to reductions in sexually transmitted infections and decreases in unintended pregnancies among adolescents and youth [25].
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Influence of family and friends: Programs to strengthen family connections, increase association with positive peer groups, and provide safe spaces for young people to meet with peers all afford adolescents the opportunity to form meaningful relationships and contribute to positive SRH outcomes [13, 14]. For example, a randomized control trial examining the impact of an intervention to improve parent–adolescent communication about SRH found the intervention to be effective in improving young people’s knowledge about condoms and their self-efficacy to use them [26].
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Communities in which young people live: We can engage community members to transform norms and improve the physical surroundings in which young people live. Doing so helps create environments where adolescents feel safe and valued and that are supportive of their SRH [8]. For example, a program to delay first birth and improve birth spacing among married adolescents in India engaged community members in discussions about the health benefits of such practices. The program resulted in a significant increase in contraceptive use among married adolescents [27, 28].
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Access to economic and academic opportunities: Positive economic status and access to cash, credit, and savings can have a strong effect on SRH outcomes [25]. When combined with other social support and life skills, building adolescents’ financial capital can lead to reduced sexual risk-taking behavior, increased health knowledge, and increased service-seeking behavior [16, 25]. Additionally, higher rates of participation in education are associated with lower HIV prevalence among adolescents, fewer adolescent pregnancies, and delayed sexual initiation [17, 26, 27]. For example, beneficiaries of a program in Malawi that provides adolescents and their families cash transfers conditional on school attendance were more likely to stay in school, less likely to become pregnant, and more likely to avoid risky sexual and reproductive health behaviors [29].