• Very young adolescents (10-14 years), especially girls, are at risk of sexual exploitation and abuse because of their dependence, lack of power, and their lack of participation in decision-making processes. • Pregnant adolescent girls, particularly those under 16, are at increased risk of obstructed labour, a life-threatening obstetric emergency that can develop when the immature pelvis is too small to allow the passage of a baby through the birth canal. Emergency obstetric care services are often unavailable in crisis settings, increasing the risk of morbidity and mortality among adolescent mothers and their babies. • Marginalised adolescents, including
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appropriate support from those who should be helping them. The uncertain situations they find themselves in before, during and after an emergency, and the ways that they have to cope with their circumstances while going through puberty and even motherhood during these stressful times, can affect them for the rest of their lives. Adolescents have the right to reproductive health under both international and national laws in many countries, including the International Covenant on Economic, Social and Cultural Rights and the Universal Declaration of Human Rights.17 The Minimum Initial Service Package, or MISP, is a Sphere standard that outlines the necessary equipment and the actions that trained staff should undertake during the early days of a crisis, but does not provide specific adolescent criteria. The Adolescent Sexual and Reproductive Health Toolkit produced by UNFPA and Save the Children includes specific criteria for adolescents and sexual violence; adolescents and maternal and newborn health; adolescents and STI/HIV prevention and treatment; and adolescents and family planning.18 Family planning and access to anti-retroviral drugs (ARVs) for pregnant women and girls were introduced as a minimum standard for humanitarian response in 2011.19 The United Nations Population Fund (UNFPA) points to three sub-groups of adolescents that are particularly at risk in disasters and emergencies. Two out of the three categories are girls:20
those who are HIV-positive, those with disabilities, non-heterosexual adolescents, indigenous groups and migrants, may face difficulties accessing services because of stigma, prejudice, culture, language and physical or mental limitations. They are also at risk of increased poverty and sexual exploitation and abuse because of their lack of power and participation.
nutrition centre in burkina Faso.
In a disaster, the disruption of families and of health services may leave adolescents without access to the information and services they need about sexual and reproductive health. For girls and young women, this is precisely the time when their situation and their age and sex puts them most at risk of unwanted pregnancy, unsafe abortion, sexually transmitted infections (STIs) and HIV. Adolescence for many young people is a time of experimentation, sexual and otherwise. They may be lucky enough to have understanding and supportive parents and good sexual and reproductive health services, including advice and contraception if they need it. But often this is not the case and they struggle with their own emerging sexuality and the constraints of the societies in which they live. But it doesn’t have to be this way. A strong public health system is a good shock absorber and reduces the negative health impacts of disasters on adolescent girls. And if the right support and services are in place, and if girls are listened to about what they need and want, as we will see later in this report, then sometimes a disaster can become an opportunity to turn their lives around. 37