KNOWLEDGE SUMMARY:
WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH
20 20 37
Hosted by the World Health Organization
The world’s 1.2 billion adolescents (aged 10–19 years) have a fundamental right to engage
meaningfully in all matters that affect their lives (Box 1) (1, 2) . This includes the right to engage in decision-making as equal and valuable partners, while being supported in their roles as adolescent leaders and advocates (3). When adolescents participate in decision-making, the resulting policies and programmes are more likely to respond to their diverse needs (4) . Such engagement requires the empowerment of adolescents, by increasing their capacities, skills, autonomy and decision- making power, and by advancing their rights (5–7).
Box 1. Definition of meaningful adolescent engagement (1)
Meaningful adolescent engagement is defined as an inclusive, intentional and mutually respectful partnership between adolescents and adults, whereby power is shared, respective contributions are valued, and young people’s ideas, perspectives, skills and strengths are integrated into the design and delivery of programmes, strategies, policies and funding mechanisms that affect their lives, communities and countries, and the wider world.
ADOLESCENT EMPOWERMENT AND
ENGAGEMENT FOR HEALTH AND WELL-BEING:
strengthening capacities, opportunities and rights
Photo: Flickr Creative Commons License/UN Women/Ryan Brown
What do we know about engaging adolescents to improve health and well-being?
In recent years there has been an important shift away from viewing adolescents solely as passive beneficiaries of services, and towards considering them as powerful agents of change.
The collective agency of adolescents is one of the most underused resources for achieving global health and development goals.
Their agency is epitomized by their current global activism concerning climate change (8).
It is widely recognized that meaningful engagement of adolescents helps to improve health policies and services for adolescents, which in turn improve health and broader societal outcomes (1, 9–11). Much can be learnt from the efforts to meaningfully engage adolescents in the HIV response (5, 12–14). Greater engagement by adolescents in their health and well-being is positively
associated with improvements in quality of care (15), overall programme effectiveness and equity (5, 9, 16, 17). Respecting adolescents’ views and providing adolescent-responsive care and services ensures that more adolescents seek services and remain engaged in accessing them (Box 2) (9). Increasing access to digital technologies is transforming adolescent engagement in education and learning, and also has wider societal implications (18).
Meaningful engagement enhances adolescents’ social capital and connections with their peers. It enables the development of leadership skills and the competencies and confidence needed in adulthood (Box 3) (6). This positive influence on adolescent’s social and emotional development can empower adolescents to claim their rights and realize their full potential (9, 10, 21, 22).
Figure 1 shows the pathways leading from the engagement of adolescents to the realization of their health and well-being.
Figure 1. Pathways from adolescent engagement to health and well-being Box 2. Engaging adolescents to
improve HIV service delivery
Zvandiri is a multicomponent service delivery programme for children and adolescents living with HIV in Zimbabwe.
It integrates peer-led community interventions and psychosocial support with clinic-based government health services (19). The programme was developed through the active
engagement, training and leadership of adolescents living with HIV (Community Adolescent Treatment Supporters (CATS)) to ensure that adolescent- identified needs, values and perceptions informed planning and implementation.
The focus on shared experiences, role modelling and supportive friendship through CATS visits and support groups has improved adolescents’ lives. It has also strengthened knowledge about HIV among adolescents and their caregivers, helping to improve treatment adherence and increase adolescent self-esteem.
From one support group in 2004, Zvandiri has been adopted by the Ministry of Health and Child Care and scaled up across all 10 provinces of Zimbabwe, reaching 51 of its 63 districts (20).
Adolescents have evolving capacities,
resources, agency and skills
Meaningful adolescent engagement
Improved adolescent-adult relationships Increased self-efficacy
and empowerment
Improved identity and sense of purpose Increased social capital
and peer connections Improved competencies
and confidence
Increased decision-making
in health and well-being
Improved health and
well-being outcomes
Supportive laws, policies and structures;
responsive adults/decision-makers Institutionalization
of engagement Equitable policies;
quality health care
Why do we need to draw attention to adolescent engagement for health and well-being?
The right of adolescents to take part in and influence processes and decisions that affect their lives was enshrined in the 1989 United Nations Convention on the Rights of the Child and related General Comments on the right to be heard and on the rights of adolescents (6, 28, 29). Upholding this right supports adolescents’ attainment of voice and agency to engage meaningfully in decision-making,
regardless of their socially determined circumstances.
Despite binding international obligations, there is global institutional underinvestment in the development of robust adolescent engagement strategies (9, 30). As shown by recent climate change activism, adolescents have the energy and optimism needed to influence governance and demand accountability. However, despite some progress (28, 30) few governments or organizations have made the necessary commitments, in terms of budgets, legal and policy frameworks, and programmes, to support adolescents’ right to engage. For example, although 84% of national health policy documents from 109 countries included some reference to adolescents, only 15% of these specified support for adolescent engagement as a specific goal, indicator or target (31).
To support further investment in adolescent engagement, more
research is needed to systematically examine the effects of adolescent engagement on health and well-being (6, 15) and to conceptualize measures and methodologies appropriate for adolescents of different ages and genders (11, 32, 33). However, adolescent engagement should not be evaluated only in terms of impact indicators. The quality of the engagement should also be measured, as well as other factors, such as the context of the engagement, social change and gender dynamics (11, 34). Such efforts would take into account the continuum of adolescent engagement (Figure 2) and include the engagement of adolescents in the research process itself (32, 35).
Box 3. Adolescent Participation Forums
Argentina’s Adolescent Participation Forums enable adolescents to engage in developing public policy proposals to address their critical health challenges (23). In 2018, 13 Forums were held in four provinces of Argentina, at which 2800
adolescents discussed and developed recommendations for tackling
adolescent pregnancy, suicide and mental health challenges. The Forums also served as accountability mechanisms: adolescents interacted with the authorities and demanded answers to their concerns. The Forums were complemented by Adolescent Health Advisory Services (AHAS), established in secondary schools, health centres and hospitals to promote adolescent engagement and leadership (24). In 2018, the number of AHAS increased from 68 to 1148, with participation by 64 000 adolescents. The Ministry of Health convened a National Advisory Board on Adolescents to ensure systematic engagement of adolescent representatives in national policy.
Showing what can be achieved by increasing adolescent participation and adolescent-led accountability mechanisms, two provinces have now extended national policy by developing specific protocols to assist pregnant adolescents, particularly those under age 15, who currently suffer the greatest rights violations (25–27). The enhanced partnership between adolescents and service providers generated integrated policies and interventions on adolescent health education and adolescent-friendly health services and the expansion of AHAS in secondary schools. The process of adolescent participation and their exchanges with local authorities was documented in the publication Voices that Matter (23).
Figure 2. Continuum of adolescent engagement
Inform Adolescents
may be informed but do not impact
decisions.
Adults are in full control.
Increasing impact on decisions Consult
Adolescents may be consulted, but
it is often ad hoc, and they do not impact decisions.
Typically adults’
agenda takes precedence.
Influence Adolescents systematically are consulted and their inputs
are taken seriously.
Information sharing is
two-way.
Partnership Adolescents
are in joint control with adults. Tasks
are jointly negotiated delegated.and
Empowerment Adolescents
have full control and
this is recognized
formally.
Typically but not always adolescent initiated and
directed.
Challenges to meaningful adolescent engagement
To enable a positive pathway from adolescence to adulthood, adolescents must be able to express their views to service providers and decision-makers, as well as practice their evolving capacities and decision-making skills within their families, communities and beyond (4, 5). However, adolescents in some settings have far fewer opportunities than others to engage meaningfully in the conceptualization, design, delivery and evaluation of programmes that affect them (36).
Power dynamics must be realigned to ensure more egalitarian relations among adolescents, and between them and decision-makers, to enable meaningful engagement (10). Systems and structures must be put in place to institutionalize adolescent engagement, including a supportive legal and policy environment.
This includes addressing legal and regulatory barriers, such as those relating to privacy, confidentiality and evolving capacities to give informed consent. It also requires the removal of bureaucratic structures that prevent adolescent engagement (31). Currently,
decisions in the home, school and community are often taken by adults, without giving due consideration to adolescents’ views (10). While adults can be allies in amplifying adolescents’ perspectives, they can only encourage or enable genuine engagement if they have the understanding and skills necessary to carry out participatory practices (5).
Adolescent engagement ranges from tokenistic
participation to initiatives that are wholly adolescent-led (Figure 2) (11, 37). Limited efforts to include
adolescents in decision-making reinforce their distrust, apathy and despondency (6). Consideration must also be given to uneven dynamics within adolescent
movements, especially those which disadvantage girls.
Adolescents who see benefits resulting from their influence on decisions are likely to become more committed, engaged and motivated (34).
Many adolescents lack the capacity, resources, agency and skills to influence decisions affecting their health and well-being, or are unaware of their right to do so, which reduces their demands for services and
engagement (7, 10, 28). This is particularly the case for adolescents experiencing poverty, disabilities or chronic illnesses, and those marginalized because of their sexual orientation, HIV status, gender identity, ethnicity, class or other sociocultural factors, as well as those living in humanitarian and fragile settings (21). Unequal social and gender norms also result in adolescent girls experiencing structural, cultural, economic and political constraints that impede their autonomy and agency (39, 40). This poses significant barriers to their meaningful engagement in both private and public life.
The heterogeneity of adolescents (for example in age, level of maturity) and the role of caregivers must also be considered when determining their ability to independently engage for better policy decisions and programmes, especially for those aged 10–14 years (9).
Photo: Flickr Creative Commons License/U.S. Embassy Phnom Penh
What actions are needed?
Adolescents, especially those living in challenging circumstances, need support in developing the knowledge, skills and capacities necessary to play an active role in society. This requires a conducive environment, with institutions across sectors that are responsive to the ideas and priorities of adolescents.
Digital platforms are important for facilitating engagement. As policy-makers, champions and members of PMNCH constituencies, we must draw on existing efforts (9) to galvanize global commitment to mainstreaming adolescent engagement through advocacy, learning and sharing best practices. We must work together to undertake the following actions in an integrated way.
Social norms, skills and capabilities for engagement (5, 9, 22, 28, 39–43)
We must address the social context for adolescent engagement and support adolescents in building the knowledge, skills and self-confidence required to engage meaningfully in decision-making for their health and rights.
• Challenge discriminatory norms. Unequal power relations between adolescents and adults need to be addressed at the individual, relational, resource and structural levels. This includes training adults to listen, and making activities gender-sensitive and participatory, for example by training health service providers, including community health workers, in adolescent friendly service global standards. It requires tackling discriminatory social and gender norms that lead to the subordination and
disempowerment of adolescent girls and other vulnerable adolescents, while promoting norms which foster positive outcomes.
• Build adolescent knowledge, skills and agency to engage in dialogue and action for their health and rights. Strengthening adolescent competencies and leadership skills enables adolescents to engage more effectively in decision-making. Younger adolescents should be allowed to learn at their own pace.
Funding should be made available for training, especially for those living in poverty. Knowledge and awareness must be built among adolescents, families and communities about adolescents’ rights, as well as their policy and legal entitlements (and limitations) under national laws and regulations.
Illustrative examples from the HIV response, sexual and reproductive health and rights, education and positive youth development programmes, among others, include:
- access to information (e.g. about what to expect from schools and health services) and peer counselling about rights and opportunities;
- social and life skills training, including communication and leadership skills;
- comprehensive sexuality education to improve knowledge, skills, attitudes and values relating to adolescent health, well-being and dignity;
- safe and friendly social platforms (e.g. school, sports and arts clubs, peer networks and digital hubs);
- community-based support groups to facilitate learning, goal setting, confidence building and socializing;
- formal platforms (e.g. roundtable discussions, symposiums and panels); and
- family and community mobilization and dialogue.
Photo: Flickr Creative Commons License/UN Women/Khristina Godfrey
Policies, programming and service delivery (5, 6, 9, 13, 43, 44)
It is the obligation of the state, through adult duty-bearers, to create the conditions for the meaningful engagement of adolescents, in collaboration with other stakeholders.
• Ensure that national policy frameworks recognize the importance of meaningful engagement in public and private life and establish mechanisms to guarantee it. This requires addressing, across all sectors, structures that constrain adolescents, for example by reforming laws, policies and institutions that disadvantage them, particularly adolescent girls.
This includes ensuring access for adolescent girls to primary and secondary education and policies that protect them from early marriage. Funders should invest in earnest and provide core long-term support to adolescent-led and adolescent-driven initiatives.
• Avoid ad hoc and occasional engagement.
Systematic opportunities for adolescent engagement must be created across sectors. A minimum
standard for structures and processes should ensure equitable representation of the most marginalized adolescents in relevant areas of public policy, financing and programme implementation. This includes building mechanisms into programmes and services to facilitate adolescent engagement in identifying, prioritizing and finding solutions to problems. In the health sector this includes
reinforcing current global standards on the delivery of adolescent-friendly services, especially Standard 8 on adolescent engagement.
Accountability (6, 9, 10, 34, 39)
We must reach and support the engagement of the most marginalized adolescents to ensure that the causes of discrimination against them and their lack of engagement are fully addressed.
• Create forums of accountability for meaningful adolescent engagement, with a focus on adolescent girls and other vulnerable groups, as leaders and key stakeholders at the national and sub-national levels (e.g. independent youth commissioners; youth councils). Adolescent advocates have the motivation to challenge corruption and harmful traditional practices, and to advocate for good governance and accountability. Resources must be available for independent oversight of government actions.
• Ensure national and sub-national processes and mechanisms for remedy and redress. When
adolescents are prevented from enjoying their rights, such as the right to participate in decisions about their health and well-being, they should have access to mechanisms offering effective remedies and redress. This could be through subnational complaint mechanisms, children’s/adolescents’ ombudspersons, courts and/or national human rights institutions, as well as regional and international judicial and human rights bodies.
Photo: Flickr Creative Commons License/Unicef Ethiopia
Research and measurement (9, 11, 14, 33-35, 41, 43) Building on existing efforts, stakeholders must act together to systematically evaluate adolescent engagement, using clear indicators and improved methodologies. More research and documentation are needed, as well as the adoption of innovative practices for engaging adolescents in research and in monitoring and evaluation (M&E).
• Identify the objectives of adolescent engagement and institutionalize the M&E of adolescent engagement with specific indicators to inform country and donor investments. We need to understand which approaches to engagement with adolescent subpopulations in different contexts work, and which do not. Programmes need to be rigorously designed, and outcomes need to go beyond
measuring individual attitudes to changes in community-level norms, behaviours over time and implementation strategies.
• Establish a set of minimum requirements for meaningful engagement in M&E and adolescent- related studies. This involves a wide range of
activities, from qualitative work to quasi-experimental or randomized trials, and from research prioritization to impact on policy and programmes. It also includes involving adolescents in the M&E of programmes, organizations, agencies and systems designed to serve them. Experiences, good practices and models of successful adolescent-led interventions and research should be shared.
References
1. Global consensus statement: meaningful adolescent and youth engagement [press release]. Geneva: Partnership for Maternal, Newborn & Child Health; 2018 (https://www.who.int/pmnch/
mye-statement.pdf).
2. World population prospects 2019 [online database]. New York: United Nations Population Division; 2019 (https://population.un.org/wpp/).
3. Engel DMC, Paul M, Chalasani S, Gonsalves L, Ross DA, Chandra- Mouli V, et al. A package of sexual and reproductive health and rights interventions – what does it mean for adolescents? J Adolesc Health.
2019;65(6S):S41–S50.
4. My body, my life, my world. Rights and choices for all adolescents and youth: a UNFPA global strategy. New York: UNFPA; 2019 (https://www.unfpa.org/youthstrategy).
5. Ending the AIDS epidemic for adolescents, with adolescents. A guide to meaningfully engage adolescents in the AIDS response. Geneva:
UNAIDS; 2016 (https://www.unaids.org/en/resources/
documents/2016/ending-AIDS-epidemic-adolescents).
6. Adolescent and youth engagement strategic framework. New York:
UNICEF; 2017 (http://www.unicefinemergencies.com/downloads/
eresource/docs/Adolescents/63792683.pdf).
7. Malhotra A, Schuler SR, Boender C. Measuring women’s empowerment as a variable in international development. Washington, DC: World Bank; 2003 (http://siteresources.worldbank.org/INTEMPOWERMENT/
Resources/486312-1095970750368/529763-1095970803335/
malhotra.pdf).
8. Singh M, Oliver M, Siddique H, Zhou N. Global climate strike: Greta Thunberg and school students lead climate crisis protest – as it happened. The Guardian. 9 September 2019 (https://www.
theguardian.com/environment/live/2019/sep/20/climate-strike-global- change-protest-sydney-melbourne-london-new-york-nyc-school- student-protest-greta-thunberg-rally-live-news-latest-updates).
9. Global accelerated action for the health of adolescents (AA-HA!):
guidance to support country implementation. Geneva: World Health Organization; 2017 (https://www.who.int/maternal_child_adolescent/
topics/adolescence/framework-accelerated-action/en/).
10. Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al.
Our future: a Lancet commission on adolescent health and well-being.
Lancet. 2016;387(10036):2423–78.
11. Villa-Torres L, Svanemyr J. Ensuring youth’s right to participation and promotion of youth leadership in the development of sexual and reproductive health policies and programs. J Adolesc Health.
2015;56(1 Suppl):S51–7.
12. Vicari M, Oliveras C, Gleeson H, Hatane L, Teen Advisory Group, PATA Youth Advisory Panel, et al. Meaningful engagement of adolescents and young people in national and local HIV programming. New York:
UNICEF; 2019 (https://www.childrenandaids.org/sites/default/
files/2018-07/09MeaningfulEngagement-CSWG.pdf).
13. UNAIDS, UNICEF. Catalysing the HIV response for adolescents. New York: UNICEF; 2018 (https://www.unicef.org/esa/media/126/file/
ALL-IN-in-Eastern-and-Southern-Africa-2018.pdf).
14. Oliveras C, Cluver L, Bernays S, Armstrong A. Nothing about us without RIGHTS – meaningful engagement of children and youth: from research prioritization to clinical trials, implementation science and policy. J Acquir Immune Defic Syndr. 2018;78 Suppl 1:S27–S31.
15. Sebastian RA, Ramos MM, Stumbo S, McGrath J, Fairbrother G.
Measuring youth health engagement: development of the youth engagement with health services survey. J Adolesc Health.
2014;55(3):334–40.
16. Asker S, Gero A. The role of child and youth participation in development effectiveness: a literature review. Surry Hills: University of Technology and Child Fund Australia; 2012.
17. Lal A, Bulc B, Bewa MJ, Cassim MY, Choonara S, Efendioglu E, et al.
Changing the narrative: responsibility for youth engagement is a two-way street. Lancet Child Adolesc Health. 2019;3(10):673–518.
18. Growing up in a digital world: benefits and risks. Lancet Child Adolesc Health. 2018;2(2):79.
19. Willis N, Napei T, Armstrong A, Jackson H, Apollo T, Mushavi A, et al.
Zvandiri – bringing a differentiated service delivery programme to scale for children, adolescents and young people in Zimbabwe. J Acquir Immune Defic Syndr. 2018;78 Suppl 2:S115–S23.
20. Policy brief. Differentiated service delivery for adolescents living with HIV in Zimbabwe. The Zvandiri cluster randomized trial. Geneva:
International AIDS Society; 2019 (http://www.differentiatedservicedelivery.
org/Portals/0/adam/Content/m2HhmsMUEEis01eU-igdnA/URL/
Zvandiri%20Trial%20Policy%20Brief%207%20August%202019.pdf).
Photo: Flickr Creative Commons License/UN Women/Urjasi Rudra
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Acknowledgements
Scientific writer: Rachael Hinton, RHEdit. Editor: Joanne McManus. Technical contributions (in alphabetical order): Wole Ameyan, World Health Organization; Avni Amin, World Health Organization; Vicky Camacho, UNFPA; Nazneen Damji, UN Women; Karen Devries, London School of Hygiene and Tropical Medicine; Joshua Dilawar, Institute for Social and Youth Development (Pakistan);
Danielle Engel, UNFPA; Regina Guthold, World Health Organization; Alan Jarandilla Nuñez, International Youth Alliance for Family Planning; Tamar Kabakian-Khasholian, American University of Beirut; Chisina Kapungu, WomenStrong International; Joanna Lai, UNICEF; Joweri Namulondo, Uganda Youth and Adolescents Health Forum; Sarah Onyango, International Planned Parenthood Federation; Suzanne Petroni, Gender Equality Solutions, LLC; Meghna Ranganathan; London School of Hygiene and Tropical Medicine; Emily Sullivan, FP2020; Linda Weisert, Children’s Investment Fund Foundation; William Yeung, Reach Out (Australia).
Coordinated by: Anshu Mohan and Meheret (Mimi) Melles-Brewer (PMNCH). Design: Annovi Design.
21. Mendonca V, Van Zyl M, Martinez K. Toolkit for adolescent and youth engagement. New York: UNICEF; 2018 (https://www.alnap.
org/help-library/toolkit-for-adolescent-and-youth-engagement).
22. Catalano RF, Skinner ML, Alvarado G, Kapungu C, Reavley N, Patton GC, et al. Positive youth development programmes in low- and middle-income countries: a conceptual framework and systematic review of efficacy. J Adolesc Health. 2019;65(1):15–31.
23. Voices that matter. Reflections and proposals of adolescents about their health. New York: UNICEF; 2019 (https://drive.google.com/
drive/u/0/folders/1ErbleF1HpJxmt67T5ezwj5nHlm5ptMIb).
24. UNICEF, Ministry of Education, Ministry of Health, Office of the President of Argentina. Adolescent Health Advisory Services (AHAS) in Secondary Schools. (https://drive.google.com/drive/
folders/1Oq2RIguynjhy8DSAT6XL8-WyrkMZWWTX).
25. UNICEF, Government of Jujuy. Protocolo para la atención del embarazo en adolescentes menores de 15 años (Protocol for the care of pregnant adolescents under age 15). Jujuy: General Directorate of Maternity and Childhood of the Ministry of Health; 2018 (https://www.unicef.
org/argentina/informes/protocolo-para-la-atenci%C3%B3n-del- embarazo-en-adolescentes-menores-de-15-a%C3%B1os).
26. UNICEF, Misiones Province Ministry of Health. Guía de atención integral de niñas y adolescentes embarazadas menores de 15 años en la Provincia de Misiones (Guide for the comprehensive care of pregnant adolescent girls under age 15 in the Misiones Province).
Misiones: Ministry of Public Health; 2019 (https://www.unicef.org/
argentina/media/6646/file/Atenci%C3%B3n%20Ni%C3%B1as%20 y%20Adolescentes%20embarazadas%20-%20Misiones.pdf).
27. Ministry of Health and Social Development of the Nation. Atención de niñas y adolescentes menores de 15 años embarazadas (Care of girls and pregnant adolescents under the age of 15 years). Buenos Aires: UNICEF; 2019 (https://www.unicef.org/argentina/atencion- ninias-adolescentes-menores-15-embarazadas).
28. Engaging young people for health and sustainable development.
Strategic opportunities for the World Health Organization and partners. Geneva: World Health Organization; 2018 (https://www.
who.int/life-course/publications/engaging-young-people-for-health- and-sustainable-development/en/).
29. Committee on the Rights of the Child. New York: United Nations Human Rights Office of the High Commissioner; 2019 (https://www.
ohchr.org/EN/HRBodies/CRC/Pages/CRCIndex.aspx).
30. Bulc B, Al-Wahdani B, Bustreo F, Choonara S, Demaio A, Jácome DI, et al. Urgency for transformation: youth engagement in global health. Lancet Glob Health. 2019;7(7):e839–e40.
31. Health for the world’s adolescents. A second chance in the second decade. Geneva: World Health Organization; 2014 (https://www.
who.int/maternal_child_adolescent/documents/second-decade/en/).
32. McManus M. The promise and potential of adolescent engagement in health. J Adolesc Health. 2014;55:214.
33. The global action for measurement of adolescent health (GAMA).
Geneva: World Health Organization; 2019 (https://www.who.int/
data/maternal-newborn-child-adolescent/gama).
34. Marston C, Hinton R, Kean S, Baral S, Ahuja A, Costello A, et al.
Community participation for transformative action on women’s, children’s and adolescents’ health. Bull World Health Organ.
2016;94(5):376–82.
35. Percy-Smith B. ‘You think you know? ... You have no idea’: youth participation in health policy development. Health Educ Res.
2007;22(6):879–94.
36. Plan International, UNICEF, World Health Organization, PMNCH, Child Health Initiative, UNFPA, et al. Adolescent health. The missing population in universal health coverage. London: Plan International; 2019 (https://plan-uk.org/file/plan-adolescent- health-reportpdf/download?token=VVsY-cTp).
37. Wong NT, Zimmerman MA, Parker EA. A typology of youth participation and empowerment for child and adolescent health promotion. Am J Community Psychol. 2010;46(1-2):100–14.
38. De Kort G, UNICEF, Middle East and North Africa (MENA) UN:NGO Adolescent and Youth Regional Group. Systematic participation of adolescents and youth in programming (MENA).
Nothing about us without us! Amman: UNICEF Middle East and North Africa Regional Office; 2017 (https://www.menayouthhub.
org/sites/menayouthhub.org/files/webform/contribute_a_
resource_to_nlg/448/eye2_systematic-participation-of- adolescents-and-youth-in-programming-%28mena.-nothing- about-us-without-us_esay2017.pdf).
39. Amin A, Chandra-Mouli V. Empowering adolescent girls:
developing egalitarian gender norms and relations to end violence. Reprod Health. 2014;11(1):75.
40. Pulerwitz J, Blum R, Cislaghi B, Costenbader E, Harper C, Heise L, et al. Proposing a conceptual framework to address social norms that influence adolescent sexual and reproductive health.
J Adolesc Health. 2019;64(4S):S7–S9.
41. Rankin K, Jarvis-Thiébault J, Pfeifer N, Engelbert M, Perng J, Yoon S, et al. Adolescent sexual and reproductive health: an evidence gap map. London: International Initiative for Impact Evaluation (3ie); 2016 (https://www.3ieimpact.org/evidence- hub/publications/evidence-gap-maps/adolescent-sexual-and- reproductive-health-evidence-gap).
42. Why comprehensive sexuality education is important. Paris:
UNESCO; 2018 (https://en.unesco.org/news/why- comprehensive-sexuality-education-important).
43. Catino J, Battistini E, Babchek A. Young people advancing sexual and reproductive health: towards a new normal.
Washington, DC: The Summit Foundation; 2019 (https://www.
summitfdn.org/wp-content/uploads/2019/05/Yield_full-report_
June-2019_final.pdf).
44. World Health Organization, UNAIDS. Global standards for quality health-care services for adolescents. Geneva: World Health Organization; 2015 (https://www.who.int/maternal_child_
adolescent/documents/global-standards-adolescent-care/en/).
PMNCH Knowledge Summaries synthesize recent evidence into a clear, concise and user-friendly format to support advocacy, policy and practice on issues related to sexual, reproductive, maternal, newborn, child and adolescent health and well-being. Each Knowledge Summary is targeted at policy-makers, champions and PMNCH constituencies. PMNCH works actively with partners from different organizations and constituencies, not only to develop the series, but also to ensure that the summaries reach key stakeholders.
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