The COVID-19 pandemic has aggravated pre-existing challenges associated with adolescents’ sexual and reproductive health and rights (SRHR). Evolving evidence suggest that it could adversely impact the progress made towards improving sexual and reproductive health outcomes among young people. The pandemic has stalled achievements in reducing adolescent pregnancy and child marriage by reinforcing contextual and structural determinants of these reproductive health outcomes, especially among girls. The pandemic has increased disruptions to schooling, decreased access to sexual and reproductive health services and compounded pre-existing socio-economic vulnerabilities. The consequences of neglecting adolescent sexual and reproductive health services over the past 2 years, to focus on COVID-19, continue to emerge. This commentary argues for targeted and responsive approaches to adolescent SRHR that tackle preventable consequences resulting from inequities faced by adolescents globally, particularly girls.
Adolescents’ sexual and reproductive health and rights (SRHR) are continuously undermined; health services and access are lacking, and little attention is paid to equipping adolescents with the autonomy, empowerment and education to make decisions regarding their SRHR . In this commentary, we discuss how the global COVID-19 pandemic has exacerbated existing issues and hindered progress towards adolescent SRHR outcomes (i.e., child marriage, access to safe abortions/contraception, access to education, maternal health, sexual violence). Unfortunately, adolescent girls bear the brunt of this social injustice, leading to increased negative health and socioeconomic outcomes.
Adolescent pregnancy and sexual and reproductive health and rights
Before the outbreak of the COVID-19 pandemic, adolescent pregnancy was already a major public health concern globally, with developing countries disproportionately affected [2,3,4,5]. Adolescent pregnancy within or outside the contexts of (child) marriage poses a significant health and developmental challenge [5, 6]. Unplanned pregnancy among adolescent girls occurring outside the context of marriage, reduces likelihood of completing education and may also lead to forced marriage. According to UNICEF, millions of girls worldwide are married before their 18th birthday . When girls are married off early, they are robbed of their childhood, denied education, and deprived of the prospects of fully developing their potential [2, 6]. Additionally, adolescent pregnancy has been associated with health and socioeconomic consequences .
Adolescent girls are less likely to be psychologically and physiologically ready for pregnancy, childbirth and childcare [6,7,8]. Health-related evidence shows that complications resulting from pregnancy and childbirth are the leading cause of death for girls aged 15–19 years, globally [9, 10]. Also, it is estimated that 3.9 of the 5.6 million abortions that occur among adolescent girls aged 15–19 years annually, are unsafe, thereby contributing to maternal mortality, morbidity and lifelong reproductive health problems . Moreover, babies born to adolescent mothers have higher risks of low birth weight, preterm delivery and severe neonatal conditions [12,13,14].
Socio-economically, adolescent pregnancy is more likely to result in child or forced marriage. It can lead to adolescent girls dropping out of school, thereby impacting their future education and job opportunities [2, 6, 15]. In addition, adolescent pregnancy occurring outside the context of marriage may have social consequences such as stigma, rejection and/or violence by partner, parents or peers [7, 8, 16]. Consequently, the impact of adolescent pregnancy––within or outside marriages––is not restricted to adolescent girls and their families, but extends to both societal and generational spheres.
Projections before the outbreak of the COVID-19 pandemic indicate that 100 million girls will become child brides over the next decade . This projection is a far cry from the global goal of ending child marriage by 2030 [6, 17]. Concerningly, this projection has been compounded by the COVID-19 pandemic. It is estimated that over the next decade, ten million girls will be at risk of becoming child brides because of the impact of the COVID-19 pandemic . Consequently, the pandemic threatens the progress that has been made over the last decade in averting 25 million child marriages by reducing prevalence from 1 in 4 to 1 in 5 girls .
COVID-19 pandemic and adolescent pregnancy
Disruptions associated with the COVID-19 pandemic reinforced pre-pandemic vulnerabilities to adolescent pregnancy and child marriage. A recent review of evidence on adolescent pregnancy in sub-Saharan Africa showed that the pandemic aggravated pre-existing determinants of adolescent pregnancy . One common determinant of adolescent pregnancy is access to education [2,3,4, 19]. Evidence across the world indicates that school closures [6, 20], socio-economic distress [19, 21], disruptions to sexual and reproductive health (SRH) services  and increased sexual violence [7, 21] may have contributed to adolescent pregnancy and child marriages during the COVID-19 era. Lockdown was a major strategy and policy response to the COVID-19 outbreak. In the early days of the outbreak, and when no vaccine was available, total and protracted lockdowns resulted in the closure of schools worldwide. While some countries, depending on their socio-economic and infrastructural development, transitioned to online learning, there was total shutdown of schooling in most of the less developed countries. Staying out of school increased the vulnerabilities of adolescent girls in debuting sex or increasing sexual activity. Notably, this increase was occurring within the context of disrupted access to contraceptives and other SRH services.
A Kenyan-based study ––which compared COVID-19 and pre-COVID-19 cohorts—showed that more adolescents dropped out of school (9.7% vs. 3.0%), debuted sex (47.4% vs. 25.5%) and reported a pregnancy incident (10.9% vs. 5.2%). In addition, a systematic review of studies that examined the impact of the COVID-19 pandemic on adolescents’ SRH in low- and middle-income countries, linked school closure to increased rates of early marriages . Similarly, COVID-19 related disruptions to schooling, and the economic hardship brought about by the pandemic, have been linked to early marriage among Indonesian adolescents aged 14–17 years . Moreover, closure of schools, due to the COVID-19 pandemic could impact school-delivered reproductive and sexual health interventions . Beyond pregnancy and early marriage, the COVID-19 pandemic also compounded chronic stress associated with teen parenting . Even before the pandemic, adolescent parents were more likely to report feeling overwhelmed with the demand of childcare and parenting, partly due to economic instability and inadequate access to health care .
Furthermore, COVID-19-related disruptions to adolescent sexual and reproductive health services—which were less effective or even non-existent, especially in low- and middle-income countries (LMICs) [7, 26, 27]—may have also contributed to increased adolescent pregnancy. The pandemic compounded knowledge gaps, misconceptions and access to condoms and other contraceptives among young people [28,29,30,31]. Evidence suggests that sexual activity among adolescents and young adults co-existed with disruptions to SRH services during COVID-19 [28, 31]. In fact, fewer adolescents reported condom (47.8% vs. 52.2%) and hormonal contraceptive (4.1% vs. 7.0%) use after the pandemic compared to before .
Of note, priority shift to fighting the COVID-19 pandemic may have also contributed to poorer access to adolescent SRH information and services, thereby elevating risks for poor sexual and reproductive health outcomes [6, 28, 31]. In addition, the fear of contracting SARS-CoV-2 at hospitals may have also contributed to reduced seeking of and access to contraceptives. This is supported by evidence from the Ebola Virus Disease epidemic in some West African countries which showed the use of condoms and other contraceptives plummeted by a range of 90–95% . This sharp drop in contraceptive access resulted in increased number of unplanned pregnancies among women and adolescent girls.
Moreover, the likelihood of sexual violence in increasing adolescent pregnancy during the COVID-19 lockdowns, cannot be ignored. Before the pandemic, evidence suggested that sexual violence contributes significantly to adolescent pregnancy . Sexual violence against girls and women is commonly reported with pre-COVID-19 estimates of more than one third of girls experiencing coerced sexual debut in some countries . COVID-19 restrictive lockdowns resulted in closure of schools, workplaces and settings where ‘fun-seekers’ may get sexual gratification. Spending more time in lockdown also implies that adolescent girls may experience greater exposure to perpetrators of sexual violence, which may include family members and other known people [4, 32, 33]. Compared to pre-COVID cohorts, a greater proportion of adolescent girls in Kenya during the pandemic (3.2% vs. 1.4%) reported experiencing sexual violence. Disruptions to condom and contraceptives services during COVID-19 amplified consequences of sexual violence by not only increasing the risk of pregnancy, but also of sexually transmissible blood-borne viruses (e.g., HIV) and/or infections (e.g., chlamydia).
Promoting adolescent sexual and reproductive health and rights
The COVID-19 pandemic is not the first, neither will it be the last pandemic or public health emergency that the world will experience. The Monkeypox has recently been declared as a public health emergency of international concern . Ample evidence has shown that adolescent pregnancy increases in times of public health emergencies as evidenced by the Ebola Virus Disease epidemic and the near-endemic COVID-19 state. Thus, beyond narratives, a key concern should be on how to leverage the experiences drawn from these public health emergencies to promote, reinforce and enable adolescent SRHR. A recent SRH profile of 132 countries highlighted the need for massive investment in sexual and reproductive health care, especially in LMICs .
Against this backdrop, it is important to establish a strong system for adolescent and young adult sexual and reproductive health services. These services need to be agile and robust to remain responsive even in the face of a public health emergency. While it is basic human instinct to stratify healthcare needs and prioritize efforts during a public health emergency, such prioritization must not neglect other health problems which might be tips of larger icebergs. Consequences of neglecting SRH services to focus on COVID-19 in the past two years continue to emerge, and the resulting lessons learned must go beyond documenting what happened. Instead, these lessons must spur action to fast-track global responses to addressing the SRH needs of adolescents.
The WHO states that “the right to health…includes freedoms and entitlements…freedoms to control one’s health and body and to be free from interference…and entitlements … the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health” . With this pandemic and previous epidemics, negative adolescent SRHR outcomes are not surprising. Yet, we continue to be caught unprepared and unresponsive during emergencies, falling short to meet this basic human rights standard to health. We are failing to provide our adolescents, particularly girls, with the proper SRH services, policies, opportunities, and autonomy to access care, make decisions and live healthy and productive lives to their full potential. There needs to be expanded access to SRH services and education––beyond just information––by ensuring individual, interpersonal and structural level barriers are addressed to reach this at-risk population. This is especially true in LMICs, where the COVID-19 pandemic escalated the problem of poor access to SRH services.
Availability of data and materials
Centre for Reproductive Rights. Adolescent sexual and reproductive health and rights. Centre for Reproductive Rights. https://reproductiverights.org/our-issues/adolescent-sexual-and-reproductive-health-and-rights/. Accessed 09 Sep 2022.
UNESCO. Early and Unintended pregnancy & the education sector: evidence review and recommendations. Paris: UNESCO; 2017. https://healtheducationresources.unesco.org/library/documents/early-and-unintended-pregnancy-and-education-sector-evidence-review-and. Accessed 31 Aug 2022.
UNICEF. Ending child marriage: progress and prospects. New York: UNICEF, 2014. https://gdc.unicef.org/resource/ending-child-marriage-progress-and-prospects. Accessed 18 Aug 2022.
UNDP. Assessing the socio-economic impacts of Ebola Virus Disease in Guinea, Liberia and Sierra Leone—The Road to Recovery. UNDP; 2016. https://www.undp.org/africa/publications/assessing-socio-economic-impact-ebola-west-africa. Accessed 14 Aug 2022.
Pan American Health Organization, United Nations Population Fund, and United Nations Children’s Fund. Accelerating progress toward the reduction of adolescent pregnancy in Latin America and the Caribbean. Report of a technical consultation. PAHO/UNFPA/UNICEF; 2017. https://iris.paho.org/bitstream/handle/10665.2/34493/9789275119761-eng.pdf?sequence=1&isAllowed=y. Accessed 14 Aug 2022.
United Nations Children’s Fund. COVID-19: A threat to progress against child marriage. UNICEF, New York, 2021. https://data.unicef.org/resources/covid-19-a-threat-to-progress-against-child-marriage/
WHO. Adolescents pregnancy. Geneva: WHO; 2020. https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy. Accessed 10 Aug 2022.
Govender D, Naidoo S, Taylor M. “I have to provide for another life emotionally, physically and financially”: understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa. BMC Pregnancy Childbirth. 2020;20(1):620. https://doi.org/10.1186/s12884-020-03319-7.
Neal S, Matthews Z, Frost M, Fogstad H, Camacho AV, Laski L. Childbearing in adolescents aged 12–15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand. 2012;91(9):1114–8. https://doi.org/10.1111/j.1600-0412.2012.01467.x.
WHO. Adolescent and young adult health. WHO Newsroom 10 August 2022. https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions. Accessed 16 Aug 2022.
Darroch J, Woog V, Bankole A, Ashford LS. Adding it up: Costs and benefits of meeting the contraceptive needs of adolescents. New York: Guttmacher Institute; 2016. https://www.guttmacher.org/sites/default/files/report_pdf/adding-it-up-adolescents-report.pdf. Accessed 29 Aug 2022.
Marvin-Dowle K, Kilner K, Burley VJ, Soltani H. Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort. BMJ Open. 2018;8(3): e016258. https://doi.org/10.1136/bmjopen-2017-016258.
Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A, Goldenberg RL, Goudar SS, Saleem S, Esamai F, Chomba E, Bauserman M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Koso-Thomas M, Nolen TL, McClure EM, Hibberd PL. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries. Reprod Health. 2020;17(Suppl 3):187. https://doi.org/10.1186/s12978-020-01029-z.
WHO. Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: WHO; 2016.
World Health Organization, UNAIDS. Global standards for quality health-care services for adolescents: a guide to implement a standards-driven approach to improve the quality of health care services for adolescents. Geneva: WHO; 2015. https://apps.who.int/iris/handle/10665/183935
Raj A, Boehmer U. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries. Violence Against Women. 2013;19(4):536–51. https://doi.org/10.1177/1077801213487747.
Plesons M, Travers E, Malhotra A, Finnie A, Maksud N, Chalasani S, Chandra-Mouli V. Updated research gaps on ending child marriage and supporting married girls for 2020–2030. Reprod Health. 2021;18(1):152. https://doi.org/10.1186/s12978-021-01176-x.
Kons K, Biney AAE, Sznajder K. Factors associated with adolescent pregnancy in sub-Saharan Africa during the COVID-19 pandemic: a review of socioeconomic influences and essential interventions. Int J Sex Health. 2022;34(3):386–96. https://doi.org/10.1080/19317611.2022.2084199.
Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, Walker N, editors. Reproductive, maternal, newborn, and child health: disease control priorities, vol. 2. 3rd ed. Washington: The International Bank for Reconstruction and Development/The World Bank; 2016.
Raheim MDH. COVID-19 and the surge of child marriages: a phenomenon in Nusa Tenggara Barat, Indonesia. Child Abuse Negl. 2021;118: 105168. https://doi.org/10.1016/j.chiabu.2021.105168.
Zulaika G, Bulbarelli M, Nyothach E, et al. Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya. BMJ Glob Health. 2022;7: e007666. https://doi.org/10.1136/bmjgh-2021-007666.
Meherali S, Adewale B, Ali S, Kennedy M, Salami BO, Richter S, Okeke-Ihejirika PE, Ali P, da Silva KL, Adjorlolo S, Aziato L, Kwankye SO, Lassi Z. Impact of the COVID-19 pandemic on adolescents’ sexual and reproductive health in low- and middle-income countries. Int J Environ Res Public Health. 2021;18(24):13221. https://doi.org/10.3390/ijerph182413221.
Ministry of Social Welfare, Gender and Children’s Affairs, UN Women Sierra Leone, OXFAM Sierra Leone and Statistics Sierra Leone. Report of the multisector impact assessment of gender dimensions of the Ebola Virus Disease (EVD) in Sierra Leone. 2014. Ministry of Social Welfare, Gender and Children’s Affairs, UN Women Sierra Leone, OXFAM Sierra Leone and Statistics Sierra Leone. https://awdf.org/wp-content/uploads/FINAL-REPORT-OF-THE-Multi-Sectoral-GENDER-Impact-Assessment_Launchedon_24th-Feb-2015_Family_kingdom_Resort.pdf. Accessed 23 Aug 2022.
Smiley Y, Sadeghi N, Jolda C, Chokshi B. Parenting in a pandemic: needs of teen parents during COVID-19. Clin Pediatr. 2021;60(14):559–63.
Leftwich HK, Alves MV. Adolescent pregnancy. Pediatr Clin North Am. 2017;64:381–8. https://doi.org/10.1016/j.pcl.2016.11.007.
Guttmacher Institute. Guttmacher Institute Releases Sexual and Reproductive Health Profiles for More Than 130 Countries. New York: Guttmacher Institute, 2021. https://www.guttmacher.org/news-release/2021/guttmacher-institute-releases-sexual-and-reproductive-health-profiles-more-130. Accessed 31 Aug 2022
Herrán K, Palacios I. Evaluating and improving upon Ecuador’s adolescent pregnancy prevention policies in an era of increased urgency. Ann Glob Health. 2020;86(1):110. https://doi.org/10.5334/aogh.3030.
Okeke SR. “Compared to COVID, HIV Is nothing”: exploring how onshore East Asian and Sub-Saharan African international students in Sydney navigate COVID-19 versus BBVs/STIs risk spectrum. Int J Environ Res Public Health. 2022;19(10):6264. https://doi.org/10.3390/ijerph19106264.
Polis CB, Biddlecom A, Singh S, Ushie BA, Rosman L, Saad A. Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review. Sex Reprod Health Matters. 2022;30:1. https://doi.org/10.1080/26410397.2022.2098557.
Aly J, Haeger KO, Christy AY, Johnson AM. Contraception access during the COVID-19 pandemic. Contracept Reprod Med. 2020;8(5):17. https://doi.org/10.1186/s40834-020-00114-9.
Lewis R, Blake C, Shimonovich M, Coia N, Duffy J, Kerr Y, Wilson J, Graham CA, Mitchell KR. Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey. BMJ Sex Reprod Health. 2021;47:269–76.
Barbara G, Albertini V, Tagi VM, Maggioni L, Gorio MC, Cattaneo C, Parazzini F, Ricci E, Buggio L, Kustermann A. Characteristics of sexual violence against adolescent girls: a 10 years’ retrospective study of 731 sexually abused adolescents. Int J Womens Health. 2022;14:311–21. https://doi.org/10.2147/IJWH.S343935.
da Costa EL, Faundes A, Nunes R. The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study. Jornal de pediatria. 2022;98(3):310–5. https://doi.org/10.1016/j.jped.2021.07.001.
WHO. WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. WHO News Release. 23 July 2022. https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern. Accessed 31 Aug 2022.
WHO. Human rights and health. WHO. Geneva; 2017. https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health. Accessed 09 Sep 2022
No funding was received for this work.
Ethics approval and consent to participate
Consent for publication
Sanni Yaya is Editor-in-chief of Reproductive Health.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Okeke, S.R., Idriss-Wheeler, D. & Yaya, S. Adolescent pregnancy in the time of COVID-19: what are the implications for sexual and reproductive health and rights globally?. Reprod Health 19, 207 (2022). https://doi.org/10.1186/s12978-022-01505-8