Improving access to adolescent sexual and reproductive health and rights

Adolescence (ages 10-–19) can be an uneasy time for girls and boys because of sudden changes to the body, the starting of a period, new social norms and expectations, the possibility of child, early and forced marriage (CEFM) and early pregnancy. During this time, adolescent girls and boys need access to health care and education that addresses their specific needs and challenges. Through our Strengthening Health Outcomes for Women and Children (SHOW) project, we’re training health care workers to provide gender responsive and adolescent-friendly health services and empowering youth to be leaders of their own sexual health to help them make informed decisions about their future.

Explore this six-part multimedia series by scrolling through the content below to learn more about how this gender transformative* Gender transformative projects have an explicit rights-based intention to transform unequal gender power relations which are often at the heart of many disadvantages faced by women and girls; the focus goes beyond improving the condition of women and girls to improve their social position. Gender transformative projects address the root causes of gender inequality and promote the value of women and girls health project is helping entire communities champion women and adolescent girls’ health while moving the needle on gender equality.

Learn, demand, Lead

Plan International and its partners are improving health for vulnerable women, adolescent girls and children in five countries by tackling gender inequality, a root cause of maternal and child deaths.

Boys in classroom Boys in classroom
3 girls 3 girls
Two girls sitting in doorway Two girls sitting in doorway

Adolescents girls and boys have specific sexual and reproductive health needs, and require tailored health services.

Chris Armstrong

Director of Health
Plan International Canada

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There is now a peer group of adolescent girl champions. This is bringing people into the future.

tayo Fatinikun

LHI,SHOW Partner, Nigeria

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The SHOW adolescent groups made a big difference. girls are now making their own decisions AND raising their voices.

Dr. Najia Amin Salsabil

MNCH Specialist
Plan International Bangladesh

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Contraceptives chart midterm findings
contraceptives chart endline findings
contraceptives chart endline findings

Adolescent Health

The onset of adolescence can be fraught; with sudden changes to the body, the onset of menstruation, new social norms and expectations for girls and boys, and even the possibility of child, early and forced marriage and early pregnancy.

“Normally, a young person stops going to the health centre after their immunization is complete. They often don’t go again for years. Unfortunately, an early pregnancy may be the reason for a next visit,” explains Chris Armstrong at Plan International Canada.

The Barriers

There may be problems with the health facility itself such as opening hours may conflict with school. The facility may be nearby but offer no privacy, or too far away to reach easily. It may be too costly. There may be no separate toilet for girls. The health worker may not have adequate materials.* Based on SHOW adolescent surveys in Ghana and Senegal.

In many places, that gap translates to little access to information and services about sexual and reproductive health, including about contraception and pregnancy.

Children attend contraceptives talk

“Talking about menstruation is difficult for girls. They need to know it’s not a drama to menstruate. But they don’t talk about it, which can lead to more issues for their health, including sexually transmitted infections and pregnancy,” says Ndeye Mingué Ndiaté Ndiaye Gackou, who coordinates gender issues in Senegal’s Ministry of Health.

For example, a mid-project survey of adolescents in Ghana found that just half of adolescents could name birth control pills as a modern contraceptive, and 6 in 10 boys listed condoms as a contraceptive option. In Senegal, just a third of girls listed oral contraceptives, and two-thirds listed condoms.


“Adolescent girls aren't to go outside alone. That is why they don’t have access to SRHR and MNCH information. They are deprived of these health facilities,” says Borna Alham Chowdhury, with Plan International Bangladesh.

Children attend contraceptives talk

In our culture, if an adolescent girl goes to the health centre, there will be gossip: ‘Who is that girl? What’s she doing there? Who are her parents?’

mansour diouf

ministry of women, family, gender
and child protection, senegal

The attitudes of the health workers themselves may also be a barrier. They may make unmarried pregnant girls feel ashamed for being pregnant and seeking health care.

As soon as the doctor knows you’re not married he can have prejudices against you and change his behavior and not receive you in the same fashion as a married woman.

unmarried adolescent girl
Sokoto State, Nigeria

Married adolescent girls are also at risk of marital rape, unwanted pregnancies, unsafe abortions, sexually transmitted infections and complications during childbirth.

Child, early and forced marriage further jeopardize adolescent health. In Bangladesh*, Source: World Bank Group, Basic Profile of Child Marriage in Bangladesh , for example, more than half of all girls are married before the legal age of 18.

Similar patterns exist in most of the SHOW areas. These girls face multiple risks to their health, and an abrupt stop to their education and future work opportunities.

“In typical communities where we work in Ghana, you’d find no girls in senior school,” explains Hafsatu Sety Sumani of NORSAAC, a local SHOW partner. “Many of the girls drop out because of pregnancy.” The lower a girl’s level of education, the more likely she is to be poor in the future.

Globally birth complications* WHO Fact Sheet Adolescents - health risks and solutions are the leading cause of death for girls aged 15-19.

Adolescent-friendly health services for girls and boys should be accessible, affordable or free, and have convenient hours.

staff should be trained professionals who are non-judgmental, maintain confidentiality, and respect.

The health facilities should be equipped with the appropriate drugs, supplies and equipment; be appealing and 'friendly' with, for example, adolescent and breastfeeding corners, privacy screens and safe, separate toilets.

sexual and reproductive health and rights infographic

SHOW improves services

The SHOW project improves adolescent sexual and reproductive health, by providing ‘gender responsive and adolescent friendly’ services.

“These services should be confidential, accessible, non-judgemental, convenient, affordable or free, and be staffed by people who know what adolescents need,” says Chris Armstrong. “Staff should also have the right equipment, drugs and supplies.”

To address the different gaps in health services, we assessed health facilities in each of the districts and documented the ways they should be improved.


We worked with more than 2800 health service providers to strengthen their knowledge and skills on maternal, newborn and child health, adolescent sexual and reproductive health and rights as well as gender-responsive and adolescent-friendly health service delivery. About 70% of the health workers we trained are women.

“We worked with health providers to be more empathetic and sensitive to the needs of adolescent girls and boys, whatever their age and background” says Chris Armstrong.


I actually thought there was nothing wrong with denying adolescent girls contraceptives. I thought I was helping them to be good girls. Now I know better.

health care provider
In addition, the SHOW project:
  • Improved 206 health centres, refurbishing many with adolescent-friendly spaces, clean birthing rooms with new beds, new sex-segregated toilets, safe water supply, and incinerators to burn waste properly.
  • Provided essential equipment and supplies for MNCH/SRH services to 413 health facilities
  • Built capacity of government officials within the Ministries of Health and Women’s Affairs and other agencies for gender responsive and adolescent friendly service provision, equipping them to help develop gender responsive plans and budgets.
  • Trained Community Health Committee members on gender responsive and adolescent friendly services and encouraged adolescent girls and boys to join the committees so they were empowered to advocate for their needs. This was particularly successful in Bangladesh and Nigeria.
  • Included supportive supervisory visits so that health workers could receive direct technical support and more training to improve the quality of their work
  • Improved the referral system, from community to better-equipped and staffed health facilities so that women and adolescent girls with high-risk pregnancies could be referred on time, and drivers were available to safely and respectfully take them.

For pregnant adolescent girls, appropriate and efficient referrals are critical – especially for those who aren’t married or may be hiding their pregnancies. By strengthening referrals, we are directly reducing maternal and newborn deathS.

Chris Armstrong

Director of Health
Plan international canada
Heath cards

SHOW Improved health centres to provide:

· adolescent-friendly spaces

· clean birthing rooms

· new sex-segregated toilets

· safe water supply


Before, girls were mocked and their privacy was not respected. If they were pregnant the whole town would know about it. Now they tell us they are being treated so much better. They are so much happier.

Theodora Quaye

SHOW Project Manager
Plan International Ghana
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Girls height being measured Girls height being measured
Nurse Nurse
Girl at outdoor meeting Girl at outdoor meeting

After receiving training on gender responsive and adolescent-friendly health services, I provide counselling to people who come to my clinic. I tell people not to discriminate between boys and girls, and maintain client privacy.

Bangladeshi health worker

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Adolescents are generally shy to say why they've come to see me. When they say they have a bellyache, I know it’s usually about a sexually transmitted infection. Then, I do counselling.
With the project, we have identified a space where teenagers can have more privacy for information.

mme badji

Midwife, rural senegal

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It's very important to teach the girls about the challenges with child marriage. They are becoming more confident to share what they learn.


Peer Group Facilitator, Bangladesh

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As with all SHOW programming, we worked with partners to improve health services, and with communities to build demand for them.

“We wanted young people to know more about their sexual and reproductive health and rights,” says Theodora Quaye. “Adolescents can take action when they have information.”

SHOW created a variety of ways to engage adolescents – through youth clubs, radio shows, community discussions and dramas.

In Haiti there are the “Champions of Change” – mixed youth groups where adolescent boys and girls can learn about sexual and reproductive health and rights together.

“Young boys in general think they are superior,” says Dr. Elie Juin, the SHOW Coordinator in Haiti. “They believe they should have first choice to go to school, or to play outside while girls stay home and do the housework. This program allowed them to see things differently.”

Dr. Juin says he’s personally seen change. He says young people talk about new ways of seeing and doing things including boys helping at home or girls talking freely to their parents about their needs.

group of women

In Senegal, SHOW built on the existing “Club Education à la Vie Familiale” (Education for Family Life) or EVF, which are youth peer groups encouraged by the Ministry of Education. These are spaces for youth to talk about adolescent issues, including about pregnancy, HIV, early marriage and gender-based violence.

One major motivation is to keep girls in school, says Aminata Traore Seck, an SRHR specialist within the Ministry of Education. In Senegal, about a third of girls are married before age 18, and about 18% of adolescents living in rural areas become pregnant.* Source: Senegal Demographic and Health Survey 2018

Topics of sexuality and pregnancy are normally taboo. It’s up to us to help adolescents discuss openly and to ask questions. This is the way to reduce the disparities between boys and girls, reduce adolescent pregnancies and keep girls in school.

Aminata traore Seck

ministry of education, Senegal
Young boy reading under a tree

The first step to create the Clubs is to train teachers who can facilitate groups based on a curriculum that includes pregnancy, contraception, and personal and menstrual hygiene. Clubs are mixed and girls are encouraged to be club President. They meet and plan for larger activities with other students, such as sessions on pregnancy.

Senegal also trained midwives and nurses to be resource persons for the clubs. Adolescents can visit them at the health facility, and they can also participate in group activities, to give information and start conversations.

“These SHOW-sponsored clubs make a big difference,” says Aminata Traore Seck. “Parents changed their minds and started to accept the clubs. They realised these were helping to keep their girls in school. They saw there were real solutions.”


One student, Oumou, has been a gender equality leader in her community in Senegal. She talks with her family, her EVF club and community members about contraception, pregnancy and safe delivery.

“I believe if we raise family awareness and share information, the situation will change. Because men will find out that we have relevant ideas,” Oumou says. “Boys help in house chores, but not often, she says. “This situation may change one day, because sometimes my younger brother helps me sweep the house. This did not happen before.”

The EVF clubs continue in Senegal.

These clubs are an essential platform to ensure girls have confidence in themselves, that they know they can do as much as, or even more than boys. This changed the dynamic in the community. This was excellent work by Plan.

Aminata Traore Seck

ministry of education, Senegal


An adolescent survey conducted by SHOW partners in Senegal shows that the percentage of surveyed adolescent girls who thought it was important to delay pregnancy in order to complete their studies almost doubled, from 28% to 59%. More boys said they thought the health centre was keeping more accessible hours. More girls felt health workers would respect their confidentiality.

In Ghana, a similar survey showed that girls who mentioned modern contraception as a way to avoid pregnancy increased from 48% to 98%.

Our research showed real progress for adolescents. These girls may have been married with children by age 15. The fact these peer groups could work to defy the norms, is such important learning. We must continue on this path!

tanjina mirza

chief programs officer
Plan international canada
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Father and son riding mule Father and son riding mule

And there's more!

Child rights

In Sokoto State in Nigeria, SHOW partners worked together with UNICEF to draft and advocate for a new Child Protection Law. Partners discussed the law with the Sultan of Sokoto, the most senior religious leader, and he subsequently established committees of traditional, religious and legal thinkers to review it and ensure it conformed to the religion and culture of the people of Sokoto State. It’s now with the Sokoto House of Assembly and should soon be passed.

Members of the State Child Protection Network have also been trained on gender equality, child safe-guarding and protection. In addition, a new centre for victims of sexual assault opened in Sokoto with support from UN Women, offering medical and psychosocial support to those who need it.

Without the SHOW work on the Child Protection Law, we wouldn’t have these additional safeguards for the community.

Aisha Dantsoho

Permanent Secretary for Women
and Children in Sokoto State

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