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Youth and adolescents in Mainland Tanzania Facts & ďŹ gures, Challenges and Recommendations Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

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Introduction The aim of this document is to provide a brief picture on the status of sexual and reproductive health of young men and women living in Mainland Tanzania. This document also aims to highlight the challenges faced by young people and to provide recommendations as to how these challenges can be addressed by development partners, gate keepers and key stakeholders.

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Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

1. Adolescents and Youth This document uses the following definitions: • Adolescents – age 10 to 19 years • Youth – age 15 to 24 years • Young people – age 10 to 24 years • The Government of Tanzania defines youth as people aged 15 – 35 years.

According to results of the 2012 census, there are 43,625,434 people living in Tanzania Mainland: while census details are yet to be released, projections show that 31% of the population are between the ages of 10 – 25 and 78% are below the age of 35 years.

Figure 1 Projected population of Mainland Tanzania (NBS, 2006 Projections for 2012 and 2025)

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

Age dependency ratio is the ratio of people in a population who are younger than 15 and older than 64, when compared to the working age population aged (15 – 64). Tanzania has an age dependency ratio of 92 and ranks high when compared to it neighbours in the East Africa Block, with Ethiopia 72, Kenya 82 and Rwanda 83.

Characteristics of adolescents and youth: • Education: Mainland Tanzania is well on its way to achieving the MDG 2 target of universal primary education with a 95.4% Net Enrolment Rate (NER) in primary education : enrolment rates for secondary school are not as encouraging, showing a sharp rise from 12% in 2002 to 60% in 2006 and then a fall to 35% in 2011 . Great efforts have been made towards ensuring universal primary education for all but questions have been raised on the quality of education as recent National school leaving certificate exams for both secondary and primary school show significant drops in the pass rate.

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• Employment: The unemployment rate amongst young people aged 15 – 24 years is 13.4%5.

Unemployment is also higher amongst young women (14.3%) than amongst young men of the same age, (12.3%)5. The Agriculture and Fishery sectors are the largest employer of young people and about 74.3% of young people aged 15-24 are employed in the agriculture and fishery sectors .

• Sexuality Education and Life Skills: Sexuality education begins in schools as early as age 7 (standard 1) and continues for the rest of the school cycle. Sexuality Education in most schools covers important aspects of HIV/ AIDS and safe sex in the context of STIs, but tends to leave out issues related to sexuality, sexual behaviour and human rights related to these issues7. Only 22% and 28% of schools cover Sexuality and reproductive health issues as part of life skills education and family planning is not addressed specifically7.

2 Sexual and Reproductive Health of Adolescents and Youth Sexual Activity and Behaviour of Youth and Adolescents There has been a positive trend in sexual and reproductive health behaviour of young women over the past decade. On Average, young women begin sexual activity at the age of 18 while young men begin at the age of 20. About 52% of young women aged 18 – 24 have had sex before age 18: this is compared to 60% in 2007/08. The number of young men aged 18-24 who had sex before the age of 18 has stayed the same between 2007/2008 and 2011/20129. About 9.4% of young women and 12% of young men aged 15-24 had their first sexual intercourse before the age of 158.

• Young men aged 15 – 24 are almost four times as likely as young women of the same age to have 2 or more sexual partners.

Youth living in rural areas are more likely to have had multiple sexual partners than youth of the same age in urban areas8.

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Figure 2: Percentage of young people aged 15 - 24 who had sex by age 18 (HMIS 2007/08 and 2011/12)

Unmet Need for Family Planning Women, (married or in a union) who are capable of reproducing, yet do not want any more children or want to wait two or more years before having another child, but are not using contraception are said to have an unmet need for family planning. The unmet need for Family Planning amongst young women is 22%8.

• 17% of young women are currently using a modern method of family planning.

Use of modern methods of contraception among women aged 15 – 24 is twice as high among unmarried (42%) than among married women (21%) 8.

• Levels of child marriage are quite high, the adolescent fertility rate for Tanzania is 116 per 1000 adolescent girls8. 18% of girls Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

aged 15 – 19 are already married and 37% of girls aged 20 – 24 were married or in a union by age 188. However there has been a decline in the number of women aged 20 -24, married on or before the age of 18 (from 41% in 2004/051). Child marriage is most common in the regions of Shinyanga (59%), Mara (55%) and lowest in Dar es Salaam (19%) and Iringa (8%) 8.

• Young women marry significantly earlier than young men of the same age. In 2010, 45% of women aged 15 – 24 were married compared to 14% of men of the same age8.

Maternal Health of Young women

than their urban counterparts and there is a strong inverse relationship between education and early childbearing8.

• Antenatal Care (ANC), coverage for young women is high with 95% of young women receiving at least 1 ANC visit from a skilled provider8.

• In 2010 it was estimated that, 56% of young, pregnant women delivered in a health facility and 56% received delivery assistance from a skilled health provider (doctor, clinical officer, nurse, midwife or maternal and child health aide)8. Young women living in urban areas are almost two times as likely as their counterparts in rural areas to deliver in a health facility.

There has been an increase in the number of women among all age groups, who deliver in a health facility since the 2004/05: from 47% in 20048 to 50.2% in 20108 • There is no great variation in the number of women, younger or older who received antenatal care from a skilled health provider over the past 5 years. However, women under the age of 20 are more likely to deliver in a health facility and to receive skilled assistance during delivery8. While no data exist in Tanzania as to why this occurs, research shows that younger women and women who are pregnant for the first time are more likely to seek delivery care due to advice from older female relatives or fear of birthing experience2.

Positive trends can also be observed in indicators for Maternal Health of young women between 2004/05-2010. About 23% of young girls aged 15 – 19 have begun child bearing, 17% have had a live birth and 6% are pregnant with their first child8. This has decreased slightly from 26% in 2004/0511. Young girls in rural areas are more likely to start child bearing

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

• Only 35% of young women living in mainland Tanzania received (PNC) within the first 2 days of delivery8.

• Overall in Tanzania, about 67% of women aged 15-49 years have heard about the condition Fistula and less than 1% of women of that age reported to have ever had a fistula8.

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3 HIV/AIDS among adolescents and Youth Overall in Tanzania, 2% of young women and men aged 15 – 24 are HIV positive and there has been no significant change since 2007/089. There has been a slight decrease in HIV prevalence amongst young people with the largest decrease being in the age group 20 – 24.

In 2007/08 the HIV prevalence among women and men aged 20 – 24 was 6.3% and 4.3%9 compared to 4.4% and 3.2% in 2011/1210: however the HIV prevalence is still higher for young women than young men.

According to the 2010 TDHS, Comprehensive knowledge on HIV is defined as correctly identifying the two major ways of preventing sexual transmission of HIV and rejecting the most common local misconceptions about HIV transmission8.

• The number of young women aged 15 24 who have comprehensive knowledge of HIV has remained unchanged at 40% between 2007/08 and 2011/1210, however there has been an increase for young men of the same age, from 42%9 to 47%10.

There have been significant increases in the number of young women and men aged 15 – 24 who know a source of condom between 2007/08 and 2011/12: from 60%9 to 66%10 for young women and from 78%9 to 86%10 for young men. Knowledge of a condom source increases with household wealth and education8.

• The rate of condom use among never married young people aged 15 – 24, increased between 2007/08 and 2011/12: from 49%9 to about 59%10 for both women and men.

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• Wide age gaps between sexual partners can lead to an imbalanced relationship, where the younger partner most of the time female, has less decision making power and is less able to negotiate condom use during sex. In 2007/8, it was estimated that among young women aged 15 – 19, 7.6% had been in a sexual relationship with a man 10 or more years older than themselves 9.

• Overall in Tanzania, 49% of young women and 32% of young men tested for HIV and received their results in the past 1 year 10:

Figure 3: Percentage of condom use amongst young people aged 15 - 24 between 2004 and 2010

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

4 Gender Based Violence • The 2010 TDHS was ground breaking in that it was the first time in which statistics were presented on the levels of gender based violence all over Tanzania, there is no comparable data prior to this.

• 31% of young women have ever experienced physical violence since the age of 158: levels of GBV towards young women vary according to regions, with over 50% of young women in Dodoma, Mara and Morogoro regions reporting to have ever experienced violence since the age of 158.

16% of young women have ever experienced sexual violence and similar to physical violence, this varies according to regions with the highest being 28% in Kigoma and the lowest being 3% in Kilimanjaro8.

• There has been a slight drop (from 42.1% in 2004/05 to 38.8% in 2010), in the number of all men aged 15 – 49 who believe that a husband is justified in beating his wife for reasons ranging from refusing to have sex with him to neglecting the children. About 55% of women aged 15 – 49 believe that a man is justified in beating his wife for the same reasons8, this has dropped slightly from the reported 60% in 2004/0510.

Figure 4: Percentage of all men aged 15 – 49 who believe that a husband is justified in beating his wife, comparison between 2004/05 and 2010 (DHS 2004 and 2010)

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

Female Genital Mutilation Female genital mutilation/cutting comprises of all procedures involving the partial or total removal of the external female genitalia or any other injury to the female genital organs for non-medical purposes.

• The highest proportions of women who are circumcised are found in the Northern and Central zones. Female Genital Mutilation/ Cutting (FGM/C) is most common in Dodoma and Manyara regions where more than 60% of all women have been mutilated8. The prevalence of FGM/C has increased significantly in 10 regions between 2004/0510 and 20108: the most notable cases being Singida, from 43.2% to 51%; Arusha, from 55% to 59% and Mara, from 38% to 40% 8.

• Young girls are increasingly being subjected to FGM/C at an earlier age: in 2010, it was estimated that 31.7% of women were cut before the age of 1 year, 10.6% between the age of 6 – 10 years and 26.9% after the age of 13 years 8.

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5 Policy and Legal environment for adolescents and youth National • The 2007, National Youth Development Policy (NYDP) calls on government to provide adequate mechanisms for the participation of youth in key decision making structures at the national and international levels, including the formation of a National Youth Council 1.

• The National Population Policy, 2006 highlights young people in Tanzania as a special group to be taken into consideration in order for national issues of population growth and employment to be addressed.

The policy aims to facilitate youth access to valuable resources for self-reliance and to promote the rights of youth in general3.

• The National Policy on HIV/AIDS, 2001 recognises youth as a most vulnerable population in the context of HIV in Tanzania and promotes the inclusion of Reproductive and Sexual Health Education in early stages of schooling curricula. The policy also recognises the rights of youth who are out of school to information and services on HIV/AIDS, Sexual and Reproductive Health4.

• The Law of the Child Act, 2009 defines a person below the age of 18 years as a child. It also promotes the protection and maintenance of the welfare and rights of the child. The law stipulates the responsibilities of a parent towards the child and also makes provision for a child needing care and protection outside of their homes5 • The Law of Marriage Act, 1971 stipulates the minimum age of marriage to be 18 years of age for males and 15 years of age for females or 14 years for both males and females with permission from the court.

The law also states that no persons should be forced to enter into a marriage without their consent6.

• The Sexual Offences Special Provisions Act of 1998 makes special provisions for addressing sexual and other offences against women and children. The act was developed to amend sections in other laws including the Penal Code, 1981; the Criminal Procedure Act, 1985; the Evidence Act, 1967; the Children and Young Persons Ordinance and the Minimum Sentence Act, 1972.

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Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

Regional

International

• In 2006, Heads of Member States of the African Union adopted the African Youth Charter, in which government committed to create supportive policies and programmes for youth. The Charter was ratified with one reservation which prevents young girls who fall pregnant or get married during their school years from returning to school7.

• The United Republic of Tanzania has ratified several international conventions and agreements including the International Conference on Population and Development (ICPD), Convention on the Elimination of all forms of Discrimination against Women (CEDAW), Convention on the rights of the Child (CRC) amongst others.

6 Government Ministries in support of the adolescents and Youth Ministry of Information, Youth, Sports and Culture: This is the main ministry responsible for implementing all programmes concerning youth development.

• This ministry utilises the NYDP, 2007 as the main document for development of programmes and is currently in the process of reviewing the NYDP. • In the 2011/2012 financial year, the Ministry was allocated a total of USD 939, 480 to implement development programmes for youth: Its 2 key programmes include the Youth Development Fund which focuses on creating employment and economic empowerment opportunities for young people and the Youth Volunteer programme which works in collaboration with local nongovernmental organisations and Local government organisations to place youth volunteers in working camps.

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

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Ministry of Health and Social Welfare: This is the main Ministry responsible for the formulation, implementation, monitoring and evaluation of health policies. The Ministry is currently implementing the Adolescence and Reproductive Health services programme under the Reproductive and Child Health Unit. This programme focuses on increasing access to HIV and sexual and reproductive Information and services for youth and adolescents, however family planning is not addressed in this programme.

Ministry of Finance and Economic Affairs: This is the main Ministry responsible for the implementation of the National Strategy for Growth and Reduction of Poverty II (NSGRP II). Also known as MKUKUTA II, the Strategy focuses on accelerating economic growth, reducing poverty and improving the lives and welfare of the people of Mainland Tanzania8.

• The Strategy emphasizes that provision of productive and decent employment for women and youth is the principal route to ending poverty and the gains in provision of employment for women and young people will also affect other issues such as high fertility rate.

• It emphasizes the need for equitable access to quality education for all young people, and also the need for literacy programmes for all adults.

• The Strategy also emphasizes the need for improving the health, nutrition and

Ministry of Labour and Employment: Formally known as the ministry of labour, employment and youth development, this is the main ministry with the mandate of formulation, monitoring and evaluation of labour, labour market, social security and employment policies. This Ministry does not have a specific department for youth activities however it does have a department of employment promotion through which it implements activities reaching all groups of people.

Ministry of Community Development, Women and Children: This Ministry is responsible for ensuring the implementation of all national and international legislation and agreements signed by Tanzania in relation to the rights and welfare of the child. In collaboration with international partners, the Ministry has also developed the Women’s information Center, the Women’s Documentation Center and the Women’s Information Window, to improve access to information on rights and services applicable to women.

Other important strategy documents and programmes at the National Level include the Tanzania 5 Year Development Plan, 2011/2012 – 2015/2016 and the Big Results Now delivery Programme. These identify a set of priority areas for strategic planning and development however Youth development is not among the identified key areas in either document.

wellbeing for all children, women and vulnerable groups.

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Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

7 Investing in youth, why?

• The 2012 Census shows that the Tanzanian population is increasing rapidly at a growth rate of 2.7% per annum. This combined with the high Total Fertility Rate (TFR) of 5.4 will result in an even larger youth population which is affected by a myriad of challenges including: high dependency rates (compounded by high youth unemployment), high school drop-out rates, poor reproductive health choices, high prevalence of HIV/AIDs, poor maternal and child health services and high maternal mortality rates over time.

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

• However, this large proportion of young people can also create an opportunity to reap a substantial “demographic bonus” for Tanzania’s economic development, resilience, sustainability, and productivity.

This bonus, created by a temporary decrease in the relative presence of dependent populations as compared to the young and economically active populations, can create the space needed to increase social and household investments in human capital which, in turn, can have a positive influence on growth and development.

• The most important commitment a country can make for its future economic, social, and political progress, as well as stability,

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Figure 5 Population Pyramid for Tanzania, 2010 and 2050

is to invest in the growth and development needs of young people and if investment place priority on the poorest youth in the hardest-to-reach places, progress will be achieved more quickly and cost effectively.

Evidence and research from all around the world also show that equipping young people with knowledge and skills on sexuality, does not hasten the initiation or increase sexual activity, but encourages

them to make responsible choices about their sexual lives. • Such investments are also essential if we are to achieve the world’s aspirations, as expressed in the Millennium Development Goals and post-2015 development frameworks, in international agreements on human rights, and in our common quest for peace and security.

8 What is UNFPA doing

UNFPA in Mainland Tanzania works with government partners on the following mandate

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areas: Population Dynamics, Reproductive Health, HIV Prevention and Gender.

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

Policy and Planning: Technical and financial support for: • The development of the Youth Situation Analysis in Zanzibar and the review of the Zanzibar Youth Policy • Assessment of the Ministry of Youth, Information, Sports and Culture and other ministries with a mandate for young people, to utilize the Africa Youth Charter in programme planning and implementation efforts.

• Supported the Ministry of Health and Social Welfare to conduct an assessment of the status of Adolescent Sexual and Reproductive Health services and to develop a strategy for the improvement of ASRH services.

Capacity Building and Advocacy • Capacity development of young people to enable effective participation in the MKUKUTA II development processes and in the ratification process for the Africa Youth Charter.

• Awareness raising and demand creation on sexual and reproductive health and HIV services for women, youth and key populations including sex workers.

• Established the UNFPA Youth Advisory panel and Youth Network as mechanisms for open dialogue and exchange between youth and partners to encourage wider participation of young people in its programme development activities.

• Supports young people to participate in key Regional and International conferences

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

• Provided technical and financial assistance to the completion of the ICPD beyond 2014 country review and also contributed the MDG beyond 2015 country report on issues affecting young people.

Programme: Some highlights and supported interventions include: • Supports innovative methods of condom distribution and provision of family planning services through visible international and national local events • Supported the up scaling of alternative rites of passage at the Masanga center for girls at risk of undergoing FGM/C, including supporting a psychosocial counselor to be based at the center during the cutting season. Also supported a meeting with traditional leaders which led to a commitment from leaders to support the enrolment of more girls in the alternative rites of passage • Technical and financial inputs for increased availability of age and sex disaggregated data on population and health through support to the completion of the 2012 Census and publication of the 2010 Demographic and Health Survey (DHS), the Youth DHS booklet, the Youth HIV and Malaria Indicator Survey Booklet • Supported the use of innovative mobile technology to enhance access to fistula treatment services for women especially young women living in rural areas of Tanzania

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9 What more can be done?

• Utilise emerging opportunities to engage in review of laws and policies which promote discriminatory practices against young people especially young women and girls including the Constitution Review.

• The development of partnership and capacity development of Ministries working towards Youth Development in order to better address the needs of young people through improved implementation and coordination of programmes.

• Meaningful youth participation in national platforms for policy development, planning and implementation. This ensures that the views and opinions of young people are represented and the policies and strategies developed resonate with youth.

Capacity Building and Advocacy

Policy and Planning Technical and financial support to: • The development of a National Strategic Plan to ensure prioritisation of issues relating to young people in national platform and for increased investment and support for youth.

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• Enhance knowledge base and participation skills of young people to advocate for their rights to information and services on Sexual and Reproductive Health and Family Planning

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

• Promote dialogue between adults and youth on sensitive issues of adolescent sexuality such as sexuality education, sexual violence and abuse, gender roles and traditional practices.

• Support media visibility on key issues affecting young people especially issues of high fertility rates, high drop-out rates of pregnant girls, child marriage and Female Genital Mutilation.

Endnotes 1.

National Youth Development Policy, Ministry of Information, Youth, Sports and Culture, 2007

2.

National Bureau of Statistics Preliminary results, 2012

3.

World Bank Development Indicators, 2011

4.

United Nations Development Programme, Country Report on the Millennium Development Goals, 2011

Programme • Invest in life skills education and reproductive health and rights of youth with a special focus on hard to reach and vulnerable groups such as adolescent girls, youth in rural areas, out of school youth etc.

• Integrate comprehensive family planning in HIV prevention education and scaling up of efforts to increase access to youth friendly services for young people and key populations • Actively engage young people in the design, implementation, monitoring and evaluation of adolescent sexual and reproductive health policies, services and programmes,

5.

MKUKUTA Poverty and Human Development Report, 2011

6.

Integrated Labour Force Survey

7.

UNESCO, A Report on Sexuality Education, Review and Assessment, 2012

8.

Tanzania Demographic Health Survey, 2010

9.

Tanzania HIV and Malaria Indicator Survey, 2007/08

10.

Tanzania HIV and Malaria Indicator Survey, 2011/12

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Tanzania Demographic Health Survey, 2004/05

12.

Van Eijk, A et al (2006), ‘Use of antenatal services and delivery care among women in rural western Kenya: a community based survey’, Reproductive Health, 3(2), pp. 1-9

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National Population Policy, 2006

14.

National Policy on HIV/AIDS, 2001

15.

The Law of the Child Act, 2009

16.

The Law of Marriage Act, 1971

17.

Africa Youth Charter, 2006

18.

National Strategy for Growth and Poverty Reduction II, 2010

Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations

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Plot 11 Ocean Road, Sea View P.O. Box 9182 Dar es Salaam Tanzania.

Email: tanzania.info@unfpa.org Web site: http://tanzania.unfpa.org www.unfpa.org Delivering a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.

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Youth and adolescents in Mainland Tanzania Facts& figures, Challenges and Recommendations