vices, in particular access to contraceptives and condoms and to testing and treatment for STIs, including HIV/AIDS, are a critical feature of the health service environment for young people.
Over two-thirds of people in developing countries now live in countries in which family planning programs are rated as relatively strong. This represents a substantial improvement in the access to and quality of family planning and reproductive health services over the last 20 years, although not necessarily for young people, particularly if they are unmarried (Ross and Stover, 2000). On average, contraceptive use, including condom use, has risen among young people in developing countries. Nevertheless, large proportions of young women do not use a method of contraception, and levels of unplanned childbearing among young women are significant (see Chapter 4 for further discussion).
For young women in the developing world, maternal mortality and the negative consequences of pregnancy, abortion, and childbearing continue to represent a considerable proportion of their health burden, despite declines in the percentage having births as children. Because adolescents who give birth early tend to be rural, less well educated, and poor, early pregnancy and childbearing can pose significant health risks. There is some evidence that in recent years, the service environment for childbirth has improved somewhat. The proportion of pregnant women who are attended by a professional at their delivery showed some small gains from 1985 to 1996 (WHO, 1997). Adolescents, who seek abortion, often because they fear disclosure and stigma or because they can stay in school, are at greater risk because they are more likely to delay the procedure and use unsafe providers. A little more then 50 percent of women in the developing world live in countries in which abortion is either entirely legal without restriction or available on very broad grounds, including physical and mental health as well as socioeconomic conditions. The overwhelming majority of these women live in two countries: India and China. (In the developed world, 86 percent of women live in countries with liberal laws.) Only a few developing countries have eased their restrictions since 1985. Regardless of legal status, abortion rates are similar in developed and developing countries. The easing of abortion laws has been associated with dramatic declines in levels of maternal death and illness due to abortion (The Alan Guttmacher Institute, 1999).
Other changes in the health environment for young people in developing countries include the aggressive marketing of tobacco to young people, the availability of illicit drugs, and the growing incidence of road traffic-related fatalities, with the increase in vehicular traffic and the growing network of roads. War and violence continue to take a toll as well, mainly on young men.