Financial hardship, legal restrictions and gaps in health services are preventing adolescents across Asia and the Pacific from accessing essential sexual and reproductive health care, according to a United Nations Population Fund (UNFPA) report.
Titled 650 Million Reasons: Achieving Universal Health Coverage for Adolescent Sexual and Reproductive Health in Asia and the Pacific, the report examines policies, laws and health data across 30 low- and middle-income countries. Developed with the Burnet Institute, it finds that services remain fragmented and underfunded despite widespread policy commitments, leaving many adolescents without essential information, protection and care.
Asia and the Pacific is home to nearly 650 million adolescents aged 10–19, almost half the world's total. The report says meeting their health needs is essential to achieving universal health coverage, which ensures everyone can access quality health services without financial hardship.
According to the findings, up to 65% of adolescent girls in countries with available data report financial difficulties accessing health care. An average gap of 3 years separates the legal age of consent to sex from the legal age of consent to health care, while only 9 of the 30 countries provide clear guidance on accessing contraception without parental consent.
In most countries covered by the report, fewer than half of sexually active adolescent girls who need family planning services are able to use contraception.
The report also identifies judgmental treatment, discrimination and concerns about privacy as barriers to care. Even when services are free, transportation costs, informal fees and uncertainty about entitlements can prevent adolescents from seeking help.
“For an adolescent who cannot afford care or is turned away because of their age or marital status, a policy commitment offers little protection,” said Pio Smith, UNFPA Regional Director for Asia and the Pacific.
“Governments must turn those commitments into services young people can access, afford and trust. Investing in their health protects their choices, their education and their futures,” he added.
The report finds that most countries recognize adolescents in national health policies and have standards for services tailored to their needs. However, contradictory laws, insufficient financing and uneven implementation undermine these commitments.
It outlines 7 priorities for reform, including making adolescent sexual and reproductive health central to national health coverage plans, securing sustainable financing and improving the quality and reach of services.
Other priorities include reviewing discriminatory restrictions, clarifying consent rules, strengthening health information and community support, and involving adolescents in decisions about their care.
UNFPA has urged governments, development partners and civil society to translate the recommendations into funded action, with particular attention to adolescents who are out of school, displaced, living in poverty or otherwise excluded from services.
The report says universal health coverage will remain an unfinished promise until adolescents can access the care they need.