2015年-世界发展银行全球_Beginning_a_Family_and_Adopting_a_Healthy_Lifestyle___Situation_Analysis_for_Zambia_4页_1mb

Policy Brief Summary: Zambia

Core Content

This policy brief focuses on the key transitions that adolescents in Zambia face—beginning a family and adopting a healthy lifestyle—and how these decisions impact both individuals and the country's potential to benefit from a demographic dividend. It highlights the long-term consequences of these choices on health, human development, and economic growth.

Main Transitions and Their Impacts

1. Beginning a Family

• Early marriage is common, with 17% of adolescent girls (15–19 years) married, and this percentage has remained unchanged since 2007.
• The median age at first marriage was 18.4 years in 2013–14, showing a slight improvement over the years.
• Early marriage is more prevalent in rural areas (22%) than in urban areas (10%).
• Adolescent fertility is among the highest in Eastern and Southern Africa, with 29% of girls 15–19 being pregnant or already mothers.
• Fertility rates are higher in rural areas (36%) than in urban areas (20%), and there is significant variation by province, ranging from 16% in Copperbelt to 41% in Northwestern.
• Adolescent fertility has declined in urban areas, but remained stable in rural areas over the 1996–2014 period.
• The ideal number of children among adolescent girls has seen little recent change, fluctuating between 3.7 and 3.8 since 2007.

2. Adopting a Healthy Lifestyle

• Modern contraceptive use among married adolescent girls is 36%, lower than that of older married women.
• Unmet need for contraception among married adolescents has increased from 22% in 1996 to 25% in 2013–14.
• Undernutrition is a concern among adolescents, with 16.4% having a below-normal BMI.
• Overweight and obesity are rising, with 8.6% of adolescent girls classified as overweight or obese.
• HIV prevalence is 5% among adolescent girls, compared to 15% among all women.
• Adolescent girls are more likely to engage in risky sexual behaviors, such as not negotiating safer sex or not being tested for HIV.
• HIV prevalence is higher in urban areas than in rural areas, with more than twice as many urban youth being HIV positive.

Health and Development Trends

• Maternal mortality has declined in Zambia, from 630 per 100,000 live births in 1995 to 280 in 2013, a 56% reduction.
• The decline in maternal mortality is attributed to factors such as lower fertility rates, increased skilled deliveries, improved education, and poverty reduction.
• Skilled deliveries increased from 47% in 1996 to 64% in 2013–14, with 70% of adolescent girls giving birth with skilled attendance.
• However, antenatal care (ANC) visits have declined, with only 50% of women receiving four or more visits before delivery.
• Tetanus toxoid vaccination during pregnancy is only 19%, indicating a gap in health interventions.

Policy Framework

Zambia has implemented and is reviewing several policies to address the health and development of adolescents:

• National Population Policy aims to reduce adolescent fertility and maternal, infant, and child mortality.
• National Youth Policy seeks to improve economic and educational opportunities and health services for youth.
• Health sector policies include the National Health Policy, National Health Strategic Plan (2011–2015), and Adolescent Health Strategic Framework (2011–2015).
• Additional policies under review include:
  • National Child Health Policy
  • National HIV/AIDS, STI, and TB Policy
  • National Reproductive Health Policy
  • National Food and Nutrition Policy
  • National Mental Health Policy
• A National Social Protection Policy was launched in 2014 to improve conditions for the most vulnerable groups.
• The National Strategy on Ending Child Marriage includes legislation defining the minimum legal age of marriage as 18 years.

Key Findings and Conclusions

• Substantial gaps exist in adolescent decision-making regarding family and health.
• Early marriage and high adolescent fertility continue to be major issues.
• Contraceptive use is low, especially among unmarried adolescent girls.
• Undernutrition and rising obesity among adolescents affect both personal and child health.
• Risky sexual behaviors increase the likelihood of HIV infection and other health complications.
• Skilled delivery and ANC visits have improved, but coverage remains unequal between urban and rural areas.
• To harness the demographic dividend, it is essential to address sexual and reproductive health, nutrition, and risky behaviors among adolescents.

Recommendations

• Strengthen policies and programs to delay marriage and reduce adolescent fertility.
• Increase access to and use of modern contraception, especially among unmarried adolescents.
• Improve nutrition and health education for adolescents to reduce undernourishment and obesity.
• Promote safe sexual practices and HIV testing among adolescents.
• Address health inequities between urban and rural areas through targeted interventions.
• Enhance antenatal care and skilled delivery services to ensure better maternal and child health outcomes.