03/07/2013 12:10 pm ET Updated May 07, 2013

Adolescents in Adult Bodies: Adolescent Sexual and Reproductive Health in Emergencies

Lost in transition between childhood and adulthood, adolescence is undoubtedly a daunting phase to be in one's life. The adolescents I meet are strong and inspiring despite living in the midst of humanitarian crises, witnessing humanity's worst cruelties on a daily basis. They vacillate between showing wisdom and perception that is way beyond their age but can just as easily slip into a wide-eyed curiosity about pop culture and romantic love! They determinedly do not want to be called children. They are right. How can they be labeled as children when their lives are bursting with adult-like responsibilities and decisions?
The threats adolescent girls and boys face, sometimes threats to their mere survival, are apparent in every humanitarian context. Along with pivotal protection, education and livelihood programming for this age-group, it is equally critical for sexual and reproductive health concerns of adolescents to be specifically addressed. Some may argue, given the competing priorities in a humanitarian response, adolescent specific interventions may be pushing the agenda too far, too soon. However, the reality of displacement both radically changes and perpetuates cultural norms, gender rules and age restrictions. While documentation through assessments and research (or the lack thereof!) can make a convincing case for acknowledging unmet adolescent needs, my own motivation to meet these gaps comes from stories of adolescents such as Reem, Hibo and Claude.

Reem is a 15 year old displaced Syrian, holding her underweight, two-month-old baby. Her eyes are pools of green brimming over with tears, one teardrop at a time landing upon her sleeping baby. Her husband was killed in cross-fire when Reem was seven months pregnant. She went into premature labor, without her mother, mother-in-law or any female relative at her side. She is now living in a camp with her uncle and some cousins. Reem senses her baby is sick and remembers her mother's advice, "breast-milk is the best food and medicine for your baby." But Reem does not know how to breastfeed. Also, no one told her that she will be bleeding after she gave birth and she has no more clean underwear or sanitary napkins. She thinks it is because of her bleeding that she cannot breastfeed and she fears that she and her baby will die.

On another continent, Hibo is a 13-year-old girl from Somalia, recently settled in a refugee camp with her family. She is the eldest daughter and has five siblings. She tries to help her mother every day with cooking, collecting water, taking care of her younger brothers and sisters. Sometimes, she wants to be alone, where no one is asking her to do anything. At first, she thought she could go to the field where the latrines are. But the field is always surrounded by men, soldiers too, and they say things to her, whistling, making gestures she knows are bad. Hibo has overheard her father tell her mother that he is arranging to get her married to a wealthy landowner. This is a great honor to their family and will also bring them cattle and money. Hibo's mother tells her, as the eldest daughter, it is her responsibility to her family to be married and become a good wife. Her mother said she will first arrange for Hibo's special initiation ceremony, a ceremony that has long been overdue and has not been possible so far because of their continued displacement. Now, this ceremony is essential so she can be presented as a proper bride according to their culture and customs. Hibo does not want to get married. She wants to go to school. She wishes she was not born a girl.

The reality for most adolescent girls like Reem and Hibo is they are most likely to experience the gamut of sexual and reproductive health threats that include: engaging in coerced or consensual sex; being faced with high-risk pregnancies and childbirth; seeking unsafe abortions; and being subject to harmful traditional practices that may be reinforced given the volatility of the environment. Adolescent boys face their own share of threats, including sexual violence; practicing high risk behaviors; and contracting sexually transmitted infections. Additionally, male adolescents are less likely to report violence and come into contact with service providers for health and protection concerns.

Claude is 17 years old and has taken on the role as head of his household. His family is internally displaced and lives in Goma, in the Democratic Republic of Congo. He earns money working as a janitor in a secondary school during the day and selling cigarettes at night. He has very little free time between his jobs and usually comes home very late to get a few hours of sleep before he starts another day. The one thing that brings a smile to his face is the thought of Grace. Grace is a student at the school where he works, and for the last three months, they've spent nearly every afternoon together, just for an hour before Claude has to go sell cigarettes in town. Claude thinks of Grace all the time. She is the only one who really understands him and understands what it means to be internally displaced. Claude wants to spend a night with Grace, to be intimate with her in a way that will bring them only closer. He knows from friends that getting a girl pregnant is not the best choice. He's been told that condoms stop this from happening but does not know where to get one or how to use a condom. Claude decides for their first time it won't be dangerous not to have a condom. After all, there will be many other times.

Adolescents who remain within a nebulous space in emergency health programming and without targeted interventions will routinely remain invisible and alone. The lack in provision of youth-friendly information and services severely debilitates adolescents' ability to make healthy choices and exacerbates their risks of disease, morbidity and in some instances, even mortality. In recognizing these unique needs and risks of adolescents, Save the Children uses a holistic approach of integrating adolescent-inclusive interventions in health, protection and education programming for young people living in emergencies. By creating adolescent-friendly spaces; offering age-appropriate health and gender education; training teachers, health workers and counselors on the provision of youth-friendly services, Save the Children continues to empower adolescents living in some of the worst conditions around the world.

The common thread shared by Reem, Hibo and Claude is their mere pursuit to live in a place that is free of conflict and tragedy, and a chance to truly be young and free.

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This post is part of a series produced by The Huffington Post and the Alliance for International Youth Development (AIYD) entitled "Beyond Emergency: How Conflict Impacts Global Youth." Posts will address issues facing global youth impacted by conflict, underscoring challenges including livelihoods among urban youth refugees and access to basic education in times of conflict, among others. For more information, click here.