Adolescence is an important time in life but for millions of girls in the poor countries, the onset of puberty begins a time of acute vulnerability
Anyone who has gone through the rigors of adolescence knows what an acutely important time it is in life. The experiences, relationships and decisions you make during your teenage years often fundamentally shape the course of your future history.
Yet for millions of girls across the world this is not only one of the most crucial, but one of the most dangerous times of their lives.
For millions in developing and middle-income countries, the onset of puberty begins a time of acute vulnerability. It is the time when they are most likely to drop out of school, to be married too young, experience dangerously early pregnancy, HIV, sexual exploitation, coercion and violence.
Approximately one-third of all girls in developing countries across the world are married before the age of 18. A 2012 United Nations Population Fund report concluded that girls who enter into marriage face serious health risks. Aside from being more exposed to violence and HIV infection, complications in pregnancy and childbirth are now the leading causes of death for girls aged 15-19 in low- and middle-income countries across the world.
Instead of being able to access the services they need to be able to make crucial decisions about their own sexual health and protect themselves, according the UNFPA report, girls are less likely than older women to be able to access sexual and reproductive health care including modern contraception and skilled assistance during pregnancy and childbirth.
The UN agency put this down to a lack of economic power, limited education and knowledge of sexual and reproductive health services and, crucially, many lack the ability to make independent decisions about their health.
"It's a simple fact that millions of girls across the world don't have control over their own bodies, their sexual lives and their reproduction," says Marianne Møllmann, senior policy adviser at Amnesty International.
Mollmann points to recent research carried out for the My Body, My Rights campaign, which exposes the catastrophic consequences of women and girls lacking access to effective health services.
"The problem is you don't need any more pieces of research to work out that it's a good idea to give girls control over their own bodies and that a girl's life chances will improve if they are valued and invested in. While this makes sense on paper, the challenge has been how to make this a reality on the ground."
The idea that investments in the reproductive health, education and employment of young girls could provide some of the most cost-effective and quick-win development gains and bring major long-term social and economic benefits has been gaining traction.
"A decade ago when you talked about improving girls' access to reproductive and sexual health services, this meant finding ways to persuade men and boys to let them use contraceptives," says Sara Seims, a visiting fellow at the London School of Economics and a senior advisor to the Packard Foundation in San Francisco.
"Now there is a recognition that this won't necessarily change anything unless you put value in the girls themselves, find ways to empower them and invest in their future."
In 2011 the World Bank attempted to put a monetary value on this idea of investing in girls.
The Bank explored the knock-on effect to national economies of reversing the trends in three widely prevalent aspects of adolescent girls' lives" – school dropouts, teenage pregnancy and joblessness. It calculated that Kenya could add $3.4bn to its gross income every year if all 1.6 million adolescent girls in Kenya completed secondary school and the 220,000 adolescent mothers were employed instead of falling pregnant early.
Yet while the evidence mounts, the connections aren't being made on the ground, says Kevin Watkins from the Brookings Institution.
"A girl's ability to stay in school is absolutely fundamental to improving her life chances, to give her the potential of economic independence, to avoid early marriage and decrease the chances of teenage pregnancy," he says. "Yet development work is often still done in silos. Reproductive health is seen as exclusively a health sector problem and vice versa with the issue of boosting numbers of girls in secondary schools being considered solely an education issue. Without taking a holistic view the reality of how to really improve girl's life chances isn't clear."
Without serious political investment in changing entrenched attitudes towards the value of adolescent young girls, nothing can really change.
"The problem with girls is that it isn't as simple as putting financial investment in education or health systems," says Watkins. "What we're dealing with is countries around the world with very stark gender disparity solidified in entrenched cultural attitudes at all levels of society, which still value girls only as wombs or dowries."
While some countries like Bangladesh have seen serious attempts at challenging those values, in many countries where adolescent girls are most at risk, enough is not being done.
"While we have seen a lot of high-level talk of the need to invest in young girls, you simply haven't seen political campaigns at either national or international level that seriously try to address this," says Watkins. "Until this happens as a political investment I'm afraid that these girls will continue to walk alone."
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