Finding Common Ground for Multisectoral Advocacy: Why "Youth Count"
By Jay Gribble, Lauren Morris, Anabella Sanchez, and Marisela De la Cruz
One of the dreams of people working in policy is finding an issue where everyone has a stake in a positive outcome. While several of these types of issues exist, it is difficult to find the right evidence that gets decisionmakers’ and stakeholders’ attention. However, the burgeoning attention on youth is a prime example of one of those multisectoral topics. Those of us working on reproductive health and family planning care about youth for a number of reasons. We care about the health of young people—preventing unintended pregnancies, preventing sexually transmitted infections, including HIV, and preventing the excess deaths that occur among pregnant young women and their infants. We also want to help young people have better access to education and empower them to achieve their full potential. We care about both the positive economic contribution that young people can make when they contribute to the labor force in a meaningful way, and the negative impacts on young people who fail to find their way into meaningful employment. We care about magnitude of these issues on the large young population in so many lower- and middle-income countries.
The topic of youth development is inherently a multisectoral one, and one that sectoral leaders as well as communities and youth themselves need to care about. But finding a way to get these multiple stakeholders on the same page has been challenging because each sector focuses on its own programs, outcomes, and metrics—not to mention government infrastructures and funding streams. What we need is something that can help get these diverse sectors focusing on a set of common information and results. To this complex situation, we introduce “YouthCount,” a new policy model developed by the USAID-supported Health Policy Plus (HP+) project.
The YouthCount model is a new policy model developed by HP+ that estimates the multisectoral benefits of investing in family planning for youth 15 to 19 years of age. The model is customizable and user-friendly, allowing advocates to demonstrate the impacts of family planning use on improved nutrition, maternal and child health, and reproductive health outcomes, as well as socioeconomic indicators. These results can be used to make the case for investing in youth to policymakers both inside and outside the health sector.
The relationships included in the model are based on findings in the scientific literature, as well as analyses of Demographic and Health Surveys. To help explain why youth should “count” in policy decisions, the model includes contextual information to inform different policy scenarios, such as historical trends in marriage age and sexual debut, the age gap between young women and their older partners, as well as other data that provide a fuller picture of the youth population. User-defined scenarios can reflect the impact of different assumptions, such as the percentage of girls that are married or use family planning (as well as the method mix), as well as the proportion that have access to high-quality maternity care in the future.
Applying YouthCount in Guatemala
YouthCount was first applied in Guatemala, where the government is working to reduce teenage pregnancy, increase overall contraceptive prevalence, and reduce childhood malnutrition. Guatemala’ National Plan to Prevent Adolescent Pregnancy 2018–2022 (referred to as PLANEA) has among its goals the reduction of teenage pregnancies from 18 percent of all pregnancies to 13 percent along with a goal of increasing modern conceptive prevalence from 8 percent to 40 percent among sexually active young women ages 15 to 19. Guatemala’s Secretary for Food and Nutrition Security of the Office of the President is implementing the National Grand Crusade for Nutrition, with goals of reducing low birthweight from 14 percent to 10 percent and chronic childhood malnutrition from 46.5 percent to 40 percent by 2024. This political context, along with a goal of increasing overall contraceptive prevalence from 61 percent to 67 percent by 2025, serves as a positive enabling environment for applying YouthCount.
To apply YouthCount in Guatemala, the HP+ team first met with stakeholders in October 2021 to introduce the model and again in October and November 2021 to validate the model’s inputs with agreed-upon data sources. During January 2022, stakeholders agreed upon the model scenarios, with the most ambitious scenario being to increase the modern contraceptive prevalence rate among 15–19-year-olds by threefold by increasing use of implants and injectables, reducing the proportion of married 15–19-year-olds by half, and increasing use of antenatal care by 27 percent.
Key results of the model include that between 2015 (baseline) and 2050 (endline), the adolescent fertility rate would decrease from 112 to 50 pregnancies per 1,000 young women ages 15–19—resulting in a reduction of teenage pregnancies from 113,347 in 2015 to 45,496 in 2050. Similarly, there would be a 60 percent reduction in the numbers of preterm and low birthweight births. The economic loss in terms of GDP resulting from girls dropping out of school due to early marriage and pregnancy would decrease by 36 percent—from US$13.3 million per year (in the constant scenario) to US$8.48 million per year (in the most ambitious scenario). Achieving these goals requires sustained political and financial commitment; currently, Guatemala is focused on investing in the human capital of underserved citizens so that their lives can improve, as well as the overall wellbeing and economic status of the country.
Multisectoral advocacy messages
How different stakeholders use these results to inform advocacy messaging is quite amazing. Stakeholders from the nutrition and reproductive health sectors focused on preventing adolescent pregnancy as part of the 1,000-day window for improving nutrition and development to reduce infant malnutrition, low birthweight, and improve opportunities for adolescent development. A secondary message is that culturally appropriate access to modern contraception and comprehensive sexuality education are important tools to prevent unintended adolescent pregnancies. A second group from the education sector focused on the importance of comprehensive sexuality education as a lifesaver for adolescents. Adolescents with knowledge of reproduction and contraception will better be able to avoid unplanned pregnancies and other deterrents to their integral development. A third group of stakeholders from the youth sector focused on helping youth avoid different types of risk, including the risks faced by the 110 girls who become pregnant each day, and providing opportunities for development as integrated adults with purpose. They followed up with access to family planning being a right and the benefit of enjoying their sexuality without risks.
Natural linkages emerge
What’s interesting to us is how all participants found evidence to support their issues and perspectives, and the links that emerged among participants who saw natural complementarity among their diverse priorities. This natural multisectoral engagement reinforces the opportunities to build bridges among stakeholders when they focus on comprehensive topics like positive youth development. YouthCount is a tool that can help diverse stakeholders and sectors find common ground on how to advocate for greater investments in youth. While the model focuses on improving access to and uptake of modern contraception, the results show that avoiding unintended pregnancies has a range of benefits to girls, children, and the nation. Participants in Guatemala realized that “less is more”: with fewer teen pregnancies, less malnutrition, less mortality among women and their babies, and fewer preterm births, the country can achieve higher levels of economic development for youth, adults, and the country as a whole. Helping youth achieve their potential as they move through the challenges of life has positive benefits for everyone. YouthCount is proving to be a vital tool for generating evidence to assist stakeholders to make the case for needed investments across different sectors so that challenges faced by youth are minimized.