Empowerment of Adolescent Girls A Key Process for Achieving the Millennium Development Goals Asdi Asdi Asdi Asdi Asdi Asdi Empowerment of Adolescent Girls A Key Process for Achieving the Millennium Development Goals Asdi Asdi Asdi Asdi Asdi Asdi PAHO Headquarters Library, Washington, DC Cataloging-in-Publication Data © 2010 by the Pan American Health Organization ISBN 978 92 7 53 279 75 Title: EMPOWERMENT OF ADOLESCENT GIRLS: A KEY PROCESS FOR ACHIEVING THE MILLENNIUM DE- VELOPMENT GOALS 1. ADOLESCENT HEALTH 2. ADOLESCENT DEVELOPMENT 3. EMPOWERMENT OF ADOLESCENT GIRLS 4. PERSONAL AUTONOMY 5. GENDER IDENTITY 6. GENDER ROLES 7. EVALUATION NLM WS 462 This publication was produced by the Family and Community Health Area (FCH) of the Pan American Health Orga- nization/World Health Organization (PAHO/WHO). Support for publication was provided by Grant No. 163136 from the Swedish International Development Cooperation Agency (SIDA), Grant No. 230120 from the Spanish Agency for International Development Cooperation (AECID), and Grant No. 251035 from the Norwegian Agency for Development Cooperation (NORAD). The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of SIDA, AECID, or NORAD. This report is available on the website of the Family and Community Health Area and can be accessed through www. paho.org. For any inquiries with respect to this document, please contact [email protected]. Collaborators: First and second editions: Schutt-Aine, Jessie Maddaleno, Matilde Nunes Sorenson, Ewa De la Rosa, Liliana Third edition: Corona, Esther Paredes Drouet, Carla M. Arango, María Clara Acknowledgements: The authors wish to thank Marijke Velzeboer, Alejandro Morlachetti, and Chessa Lutter for their support and participa- tion in developing this document. Empowerment of adolescent girls: a key process for achieving the Millennium Development Goals Pan American Health Organization, 2010 Technical and financial support: Swedish International Development Cooperation Agency (SIDA) Norwegian Agency for Development Cooperation (NORAD) Spanish Agency for International Development Cooperation (AECID) Design and layout: ULTRAdesigns CONTENTS Abbreviations and acronyms . .5 . Foreword . 7. Executive summary . 9. 1 . Introduction . 17. 2 . Seven arguments for the empowerment of adolescent girls . .19 . 3 . Fundamental concepts in gender equity and empowerment . .23 . 3.1 What is gender equity?. 23 3.1.1. Sex and gender. 23 3.1.2 Equality, equity, inequity, and empowerment. .23 3.1.3 Equity in health . .24 3.1.4 Gender inequity in health. 24 3.2 Empowerment and disempowerment. .25 3.2.1 Empowerment as freedom and autonomy . .25 3.2.2 Elements of empowerment with respect to adolescent girls. .25 3.2.3 Levels at which empowerment occurs. .27 3.2.4 Factors favoring the empowerment of adolescent girls. 27 3.2.5 Stages of development of adolescent girls, empowerment, and disempowerment . 31 3.2.6 Gender-based violence and disempowerment. .33 3.3 Barriers to reaching the most vulnerable adolescent girls. 34 3.3.1 Marginality and social exclusion of adolescent girls. 34 3.3.2 Adolescent girls belonging to sexual minorities . .35 3.3.3 Adolescent girls with HIV/AIDS and STIs, and those at high risk of contracting HIV/AIDS . 35 3.3.4. Adolescent girls subject to commercial sexual exploitation. .36 4 . Monitoring and evaluation of processes for empowerment of adolescent girls . .39 . 4.1 Concepts . 39 4.2 Why evaluate programs for empowerment of adolescent girls?. 39 4.3 Variables for measuring empowerment of adolescent girls. .40 4 EMPOWERMENT OF ADOLESCENT GIRLS 5 . Empowerment of adolescent girls as a basic right . .45 . 5.1. Convention on the Rights of the Child (CRC) . 45 5.2. Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). 46 5.3. Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women (Convention of Belém do Pará) . .47 5.4. Ibero-American Convention on the Rights of Youth (CIDJ). 47 6 . Empowerment, gender equity, and achievement of the Millennium Development Goals . 49 6.1. MDG 1: Eradicate extreme poverty and hunger. .49 6.2. MDG 2: Achieve universal primary education. 51 6.3. MDG 3: Promote gender equality and empower women . 53 6.4. MDG 4: Reduce child mortality. .55 6.5. MDG 5: Improve maternal health . .56 6.6. MDG 6: Combat HIV/AIDS, malaria and other diseases. 59 6.7. ODM 7: MDG 7: Ensure environmental sustainability. 61 6.8. MDG 8: Develop a Global Partnership for Development. 65 7 . Recommendations for the empowerment of adolescent girls and examples of good practices . .71 . MDG 1: Eradicate extreme poverty and hunger . .71 MDG 2: Achieve universal primary education. .73 MDG 3: Promote gender equality and empower women. .75 MDG 4: Reduce child mortality . .77 MDG 5: Improve maternal health. 78 MDG 6: Combat HIV/AIDS, malaria and other diseases. .80 MDG 7: Ensure environmental sustainability. .83 MDG 8: Develop a Global Partnership for Development . 84 8 . Conclusions and lessons learned . 87. Works consulted . .89 . Annexes . 97. References . .111 . 5 ABBREVIATIONS AND ACRONYMS AIDS Acquired immunodeficiency syndrome CEDAW Convention on the Elimination of All Forms of Discrimination against Women CIDJ Ibero-American Convention on the Rights of Youth CISALVA Institute for Peace Promotion and Injury/Violence Prevention CRC Convention on the Rights of the Child ECC Eastern Caribbean countries ECLAC Economic Commission for Latin America and the Caribbean FAO United Nations Food and Agriculture Organization GHESKIO Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections HIV Human immunodeficiency virus ICPD International Conference on Population and Development ICT Information and communication technologies IEC Information, education, and communication ILO International Labour Organization IMAN Integrated management of adolescent needs IMCI Integrated management of childhood illness IPPF/WHR International Planned Parenthood Federation/Western Hemisphere Region IWHC International Women’s Health Coalition LAC Latin America and the Caribbean MDG Millennium Development Goal NGO Nongovernmental organization PAHO Pan American Health Organization PC Population Council PIEMA Interagency Program for Empowerment of Adolescent Girls (El Salvador) SRH Sexual and reproductive health STI Sexually transmitted infection UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund UNIFEM United Nations Development Fund for Women WFP United Nations World Food Programme WHO World Health Organization 7 FOREWORD In recent years, increasing attention to the making decisions and carrying out actions to empowerment of adolescent girls in Latin meet girls’ needs.2 America and the Caribbean has led to broader interest in this issue and to cooperative inter- This report presents persuasive arguments and ventions in the international, national, and practical recommendations for putting adoles- local arenas. These initiatives have arisen cent girls at the center of human development mainly from efforts to promote gender equity, policies. It is aligned with the United Nations reflecting countries’ obligations to ensure that Millennium Development Goals (MDGs). The adolescent girls enjoy the full measure of hu- report is also framed within the context of the man rights to which they are entitled. More Regional Strategy for Improving Adolescent and recently, limited but relevant evidence suggests Youth Health (CD48/R5) and the Plan of Action that investments in adolescent girls have the on Adolescent and Youth Health for 2010–2018 potential to help break the intergenerational (CD49/12) developed by the Pan American cycle of poverty.(1) Health Organization/World Health Organiza- tion.(3) Its application will make a key contribu- Nonetheless, adolescent girls1 in the Region as tion to the process of promoting empowerment a group remain disempowered and vulnerable. of adolescent girls and young women and en- (2) This situation has a direct impact on their suring that government health systems work health and well-being, especially their sexual toward this end. This framework calls for inte- and reproductive health. However, adolescent grating and coordinating empowerment efforts girls’ empowerment is seldom considered when with those of other international institutions and government policies are formulated and imple- government sectors, nongovernmental organiza- mented. Relevant data are scattered and are tions, and adolescent girls and young women seldom disaggregated by age and sex, which themselves. It pays special attention to the most obscures the problem and makes it difficult to vulnerable adolescent girls3 and seeks to respond see the complete picture. Lack of data also limits to the disparities in health status between and the possibilities for monitoring the situation of within the countries of the Region. empowerment and taking it into account when 1 PAHO and WHO define “adolescence” as the period from 10 through 19 years, and “youth” as the period from 15 through 24 years. Therefore, the term “adolescent girls” refers to girls 10–19 years of age. This distinction has been made because there is a consensus that interventions, to be effective, cannot treat adolescents and young adults as one homogeneous group. Adolescence can be further divided into preadolescence, early adolescence, middle adolescence,