Nutrition is basic to health and development. Improving nutrition will provide better infant, child and maternal health, safer pregnancy and childbirth, stronger immunity, and lower risk of chronic 
diseases. Healthy, well-nourished children will learn better and will be more productive (World Health Organization, n.d.-d).

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition addresses three broad groups of conditions:

• undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
• micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
• overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers) (World Health Organization, 2021b).

Known as the double burden of nutrition related concerns, both extremes of overweight/obesity and underweight/starvation often exist within the same population groups, especially in middle- and low-income countries. The two extremes may even be observed within a single household. In many cases, there is also a triple burden of nutrition related issues where overnutrition, undernutrition, and micronutrient deficiencies (also called hidden hunger) all coexist within a single population (World Health Organization, 2017).

Undernutrition makes people more vulnerable to disease and death, and contributes to 45% of deaths in children under age five globally. 

• Wasting = low weight-for-height, often due to a recent severe loss of weight, such as from diarrhea. It increases risk of death, but is treatable.
• Stunting = low height-for-age due to chronic undernutrition. Stunting is often the result of poor economic conditions, frequent illness, poor maternal health, or inappropriate infant and child feeding practices. It prevents children from reaching their physical potential and interferes with learning.
• Underweight = low weight-for-age. A child who is underweight may be stunted, wasted, or both (World Health Organization, 2021b).

Micronutrient deficiencies resulting from inadequate intake of micronutrients (vitamins and minerals) or conditions that result in nutrient malabsorption can also hinder growth and development. Micronutrients enable the body to produce enzymes, hormones, and other substances that are essential for proper growth and development. The most critical micronutrient deficiencies in low-income countries are observed for iodine, vitamin A, and iron. All of these micronutrients are essential for proper growth of children and for healthy pregnancies (World Health Organization, 2021b).

Overnutrition results in overweight and obesity, which are both increasing globally. In the last three decades, worldwide prevalence of obesity has tripled. For most countries in the world, overweight and obesity are now responsible for more deaths than conditions associated with undernutrition. The only exceptions to this general pattern exist in parts of southern Asia and sub-Saharan Africa. 

Overweight and obesity result from an imbalance between energy consumed (too much) and energy expended (too little) (World Health Organization, 2021b). Overweight and obesity are caused by an increase in eating energy dense foods (foods high in fat and sugars), together with a decrease in physical activity. Both increased consumption of energy-dense foods and declines in rates of physical activity are related to development and urbanization. Food processing has also made high-fat and high-sugar foods more accessible, and many forms of work are now more sedentary than they have been in the past (World Health Organization, 2021c).

Nutrition-Related Risk Factors for Noncommunicable Diseases (NCDs)

As the prevalence of infectious diseases continues to decrease, the relative prevalence of NCDs (also called chronic diseases) is increasing. NCDs now kill more people each year than infectious/communicable diseases. 

The most prevalent types of NCDs include:

• Cardiovascular diseases, such as heart attack and stroke
• Cancer
• Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma
• Diabetes

All four types of NCDs have similar risk factors: tobacco use, physical inactivity, alcohol use, and unhealthy diets. All of these risk factors are behaviors that can be changed, so early detection and education are important. Community-wide policies can also help, such as making fruits and vegetables less expensive and more readily available and accessible, and increasing both the number and accessibility of recreational facilities (World Health Organization, 2022d).

Every country in the world is affected by one or more forms of malnutrition. Combating malnutrition in all its forms is one of the greatest global health challenges.

Women, infants, children, and adolescents are at particular risk of malnutrition. Optimizing nutrition early in life—including the 1000 days from conception to a child’s second birthday—ensures the best possible start in life, with long-term benefits (World Health Organization, 2021b).

Undernutrition is estimated to be associated with 2.7 million child deaths annually or 45% of all child deaths. Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. The first 2 years of a child’s life are particularly important, as optimal nutrition during this period lowers morbidity and mortality, reduces the risk of chronic disease, and fosters better development overall (World Health Organization, 2021a).

Poverty amplifies the risk of, and risks from, malnutrition. People who are poor are more likely to be affected by different forms of malnutrition. Also, malnutrition increases health care costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health (World Health Organization, 2021b).

Healthy Diet

(World Health Organization, 2020a)

Key facts

• A healthy diet helps to protect against malnutrition in all its forms, as well as noncommunicable diseases (NCDs), including diabetes, heart disease, stroke and cancer.
• Unhealthy diet and lack of physical activity are leading global risks to health.
• Healthy dietary practices start early in life – breastfeeding fosters healthy growth and improves cognitive development, and may have longer term health benefits such as reducing the risk of becoming overweight or obese and developing NCDs later in life.
• Energy intake (calories) should be in balance with energy expenditure. To avoid unhealthy weight gain, total fat should not exceed 30% of total energy intake. Intake of saturated fats should be less than 10% of total energy intake, and intake of trans fats less than 1% of total energy intake, with a shift in fat consumption away from saturated fats and trans fats to unsaturated fats, and towards the goal of eliminating industrially-produced trans fats.
• Limiting intake of free sugars to less than 10% of total energy intake is part of a healthy diet. A further reduction to less than 5% of total energy intake is suggested for additional health benefits.
• Keeping salt intake to less than 5 g per day (equivalent to sodium intake of less than 2 g per day) helps to prevent hypertension, and reduces the risk of heart disease and stroke in the adult population.

WHO Member States have agreed to reduce the global population’s intake of salt by 30% by 2025; they have also agreed to halt the rise in diabetes and obesity in adults and adolescents as well as in childhood overweight by 2025.

Overview

Consuming a healthy diet throughout the life-course helps to prevent malnutrition in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions. However, increased production of processed foods, rapid urbanization and changing lifestyles have led to a shift in dietary patterns. People are now consuming more foods high in energy, fats, free sugars and salt/sodium, and many people do not eat enough fruits, vegetables and other dietary fiber such as whole grains.

The exact make-up of a diversified, balanced and healthy diet will vary depending on individual characteristics (e.g. age, gender, lifestyle and degree of physical activity), cultural context, locally available foods, and dietary customs. However, the basic principles of what constitutes a healthy diet remain the same.

For adults, a healthy diet includes the following:

• Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat and brown rice).
• At least 400 g (i.e. five portions) of fruits and vegetables per day, excluding potatoes, sweet potatoes, cassava and other starchy roots.
• Less than 10% of total energy intake from free sugars, which is equivalent to 50 g (or about 12 level teaspoons) for a person of healthy body weight consuming about 2000 calories per day. Limiting intake from free sugars to less than 5% of total energy intake provides additional health benefits. Free sugars are all sugars added to foods or drinks by the manufacturer, cook, or consumer, as well as sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.
• Less than 30% of total energy intake from fats. Unsaturated fats (found in fish, avocado and nuts, and in sunflower, soybean, canola and olive oils) are preferable to saturated fats (found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard) and trans fats of all kinds, including both industrially-produced trans fats (found in baked and fried foods, and pre-packaged snacks and foods, such as frozen pizza, pies, cookies, biscuits, wafers, and cooking oils and spreads) and ruminant trans fats (found in meat and dairy foods from ruminant animals, such as cows, sheep, goats and camels). It is suggested that the intake of saturated fats be reduced to less than 10% of total energy intake and trans fats to less than 1% of total energy intake. In particular, industrially-produced trans fats are not part of a healthy diet and should be avoided.
• Less than 5g of salt (equivalent to about one teaspoon) per day.  Salt should be iodized.

For Infants and Young Children

In the first 2 years of a child’s life, optimal nutrition fosters healthy growth and improves cognitive development. It also reduces the risk of becoming overweight or obese and developing NCDs later in life.

Advice on a healthy diet for infants and children is similar to that for adults, but the following elements are also important:

• Infants should be breastfed exclusively during the first 6 months of life.
• Infants should be breastfed continuously until 2 years of age and beyond.
• From 6 months of age, breast milk should be complemented with a variety of adequate, safe, and nutrient-dense foods. Salt and sugars should not be added to complementary foods.

Practical advice for maintaining a healthy diet 

Fruits and Vegetables 

Maintaining a healthy diet can be facilitated by eating fruits and vegetables regularly. Eating at least 400 g, or five portions, of fruit and vegetables per day reduces the risk of NCDs, and helps to ensure an adequate daily intake of dietary fiber.

Fruit and vegetable intake and the associated benefits can be improved by:

• always including vegetables in meals;
• eating fresh fruit and raw vegetables as snacks;
• eating fresh fruit and vegetables that are in season; and
• eating a variety of fruit and vegetables.

Fats

Reducing the amount of total fat intake to less than 30% of total energy intake helps to prevent unhealthy weight gain in the adult population. Also, the risk of developing NCDs is lowered by:

• reducing saturated fats to less than 10% of total energy intake;
• reducing trans fats to less than 1% of total energy intake; and
• replacing both saturated fats and trans fats with unsaturated fats – in particular, with polyunsaturated fats.

Fat intake, especially saturated fat and industrially-produced trans fat intake, can be reduced by:

• steaming or boiling instead of frying when cooking;
• replacing butter, lard and ghee with oils rich in polyunsaturated fats, such as soybean, canola (rapeseed), corn, safflower and sunflower oils;
• eating reduced-fat dairy foods and lean meats, or trimming visible fat from meat; and
• limiting the consumption of baked and fried foods, and pre-packaged snacks and foods (e.g. doughnuts, cakes, pies, cookies, biscuits and wafers) that contain industrially-produced trans fats.

Salt, Sodium and Potassium

Most people consume too much sodium through salt (corresponding to consuming an average of 9–12 g of salt per day) and not enough potassium (less than 3.5 g). High sodium intake and insufficient potassium intake contribute to high blood pressure, which in turn increases the risk of heart disease and stroke.

Reducing salt intake to the recommended level of less than 5 g per day could prevent 1.7 million global deaths each year.

People are often unaware of the amount of salt they consume. In many countries, most salt comes from processed foods (e.g. ready meals; processed meats such as bacon, ham and salami; cheese; and salty snacks) or from foods consumed frequently in large amounts (e.g. bread). Salt is also added to foods during cooking (e.g. bouillon, stock cubes, soy sauce and fish sauce) or at the point of consumption (e.g. table salt).

Salt intake can be reduced by:

• limiting the amount of salt and high-sodium condiments (e.g. soy sauce, fish sauce and bouillon) when cooking and preparing foods;
• not having salt or high-sodium sauces on the table;
• limiting the consumption of salty snacks; and
• choosing products with lower sodium content.

Some food manufacturers are reformulating recipes to reduce the sodium content of their products, and people should be encouraged to check nutrition labels to see how much sodium is in a product before purchasing or consuming it.

Potassium can mitigate the negative effects of elevated sodium consumption on blood pressure. Intake of potassium can be increased by consuming fresh fruit and vegetables.

Sugars

In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake.  A reduction to less than 5% of total energy intake would provide additional health benefits.

Consuming free sugars increases the risk of dental caries (tooth decay). Excess calories from foods and drinks high in free sugars also contribute to unhealthy weight gain, which can lead to overweight and obesity. Recent evidence also shows that free sugars influence blood pressure and serum lipids, and suggests that a reduction in free sugars intake reduces risk factors for cardiovascular diseases.

Sugars intake can be reduced by:

• limiting the consumption of foods and drinks containing high amounts of sugars, such as sugary snacks, candies and sugar-sweetened beverages (i.e. all types of beverages containing free sugars – these include carbonated or non‐carbonated soft drinks, fruit or vegetable juices and drinks, liquid and powder concentrates, flavored water, energy and sports drinks, ready‐to‐drink tea, ready‐to‐drink coffee and flavored milk drinks); and
• eating fresh fruit and raw vegetables as snacks instead of sugary snacks.

How to Promote Healthy Diets

Diet evolves over time, being influenced by many social and economic factors that interact in a complex manner to shape individual dietary patterns. These factors include income, food prices (which will affect the availability and affordability of healthy foods), individual preferences and beliefs, cultural traditions, and geographical and environmental aspects (including climate change). Therefore, promoting a healthy food environment – including food systems that promote a diversified, balanced and healthy diet – requires the involvement of multiple sectors and stakeholders, including government, and the public and private sectors.

Governments have a central role in creating a healthy food environment that enables people to adopt and maintain healthy dietary practices. Effective actions by policy-makers to create a healthy food environment include the following:

Creating coherence in national policies and investment plans – including trade, food and agricultural policies – to promote a healthy diet and protect public health through:

• increasing incentives for producers and retailers to grow, use and sell fresh fruit and vegetables;
• reducing incentives for the food industry to continue or increase production of processed foods containing high levels of saturated fats, trans fats, free sugars and salt/sodium;
• encouraging reformulation of food products to reduce the contents of saturated fats, trans fats, free sugars and salt/sodium, with the goal of eliminating industrially-produced trans fats;
• implementing the WHO recommendations on the marketing of foods and non-alcoholic beverages to children;
• establishing standards to foster healthy dietary practices through ensuring the availability of healthy, nutritious, safe and affordable foods in pre-schools, schools, other public institutions and the workplace;
• exploring regulatory and voluntary instruments (e.g. marketing regulations and nutrition labeling policies), and economic incentives or disincentives (e.g. taxation and subsidies) to promote a healthy diet; and
• encouraging transnational, national and local food services and catering outlets to improve the nutritional quality of their foods – ensuring the availability and affordability of healthy choices – and to review portion sizes and pricing.

Encouraging consumer demand for healthy foods and meals through:

• promoting consumer awareness of a healthy diet;
• developing school policies and programmes that encourage children to adopt and maintain a healthy diet;
• educating children, adolescents and adults about nutrition and healthy dietary practices;
• encouraging culinary skills, including in children through schools;
• supporting point-of-sale information, including through nutrition labeling that ensures accurate, standardized and comprehensible information on nutrient contents in foods (in line with the Codex Alimentarius Commission guidelines), with the addition of front-of-pack labeling to facilitate consumer understanding; and
• providing nutrition and dietary counseling at primary health-care facilities.

Promoting appropriate infant and young child feeding practices can be accomplished through:

• implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions;
• implementing policies and practices to promote protection of working mothers; and
• promoting, protecting and supporting breastfeeding in health services and the community, including through the Baby-friendly Hospital Initiative.
  

Infant and Child Feeding

(World Health Organization, 2021a)

Key facts

• Every infant and child has the right to good nutrition according to the "Convention on the Rights of the Child".
• Undernutrition is associated with 45% of child deaths.
• Globally in 2020, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 38.9 million were overweight or obese.
• About 44% of infants 0–6 months old are exclusively breastfed.
• Few children receive nutritionally adequate and safe complementary foods; in many countries less than a fourth of infants 6–23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age.
• Over 820 000 children's lives could be saved every year among children under 5 years, if all children 0–23 months were optimally breastfed. Breastfeeding improves IQ, school attendance, and is associated with higher income in adult life.
• Improving child development and reducing health costs through breastfeeding results in economic gains for individual families as well as at the national level.
• Undernutrition is estimated to be associated with 2.7 million child deaths annually or 45% of all child deaths. Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. The first 2 years of a child’s life are particularly important, as optimal nutrition during this period lowers morbidity and mortality, reduces the risk of chronic disease, and fosters better development overall.
• Optimal breastfeeding is so critical that it could save the lives of over 820 000 children under the age of 5 years each year.

WHO and UNICEF recommend:

• early initiation of breastfeeding within 1 hour of birth;
• exclusive breastfeeding for the first 6 months of life; and
• introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.

However, many infants and children do not receive optimal feeding. For example, only about 44% of infants aged 0–6 months worldwide were exclusively breastfed over the period of 2015-2020.

Recommendations have been refined to also address the needs for infants born to HIV-infected mothers. Antiretroviral drugs now allow these children to exclusively breastfeed until they are 6 months old and continue breastfeeding until at least 12 months of age with a significantly reduced risk of HIV transmission.

Breastfeeding

Exclusive breastfeeding for 6 months has many benefits for the infant and mother. Chief among these is protection against gastrointestinal infections which is observed not only in developing but also industrialized countries. Early initiation of breastfeeding, within 1 hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhea and other infections can increase in infants who are either partially breastfed or not breastfed at all.

Breast milk is also an important source of energy and nutrients in children aged 6–23 months. It can provide half or more of a child’s energy needs between the ages of 6 and 12 months, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished.

Children and adolescents who were breastfed as babies are less likely to be overweight or obese. Additionally, they perform better on intelligence tests and have higher school attendance. Breastfeeding is associated with higher income in adult life. Improving child development and reducing health costs results in economic gains for individual families as well as at the national level.

Longer durations of breastfeeding also contribute to the health and well-being of mothers: it reduces the risk of ovarian and breast cancer and helps space pregnancies–exclusive breastfeeding of babies under 6 months has a hormonal effect which often induces a lack of menstruation. This is a natural (though not fail-safe) method of birth control known as the Lactation Amenorrhea Method.

Mothers and families need to be supported for their children to be optimally breastfed. Actions that help protect, promote and support breastfeeding include:

• adoption of policies such as the International Labour Organization’s "Maternity Protection Convention 183" and "Recommendation No. 191", which complements "Convention No. 183" by suggesting a longer duration of leave and higher benefits;
• adoption of the "International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions;
• implementation of the "Ten Steps to Successful Breastfeeding" specified in the Baby-Friendly Hospital Initiative, including:
• skin-to-skin contact between mother and baby immediately after birth and initiation of breastfeeding within the first hour of life;
• breastfeeding on demand (that is, as often as the child wants, day and night);
• rooming-in (allowing mothers and infants to remain together 24 hours a day);
• not giving babies additional food or drink, even water, unless medically necessary;
• provision of supportive health services with infant and young child feeding counselling during all contacts with caregivers and young children, such as during antenatal and postnatal care, well-child and sick child visits, and immunization; and
• community support, including mother support groups and community-based health promotion and education activities.
• Breastfeeding practices are highly responsive to supportive interventions, and the prevalence of exclusive and continued breastfeeding can be improved over the course of a few years.

Complementary Feeding

Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed what is provided by breast milk, and complementary foods are necessary to meet those needs. An infant of this age is also developmentally ready for other foods. If complementary foods are not introduced around the age of 6 months, or if they are given inappropriately, an infant’s growth may falter. Guiding principles for appropriate complementary feeding are:

• continue frequent, on-demand breastfeeding until 2 years of age or beyond;
• practice responsive feeding (for example, feed infants directly and assist older children. Feed slowly and patiently, encourage them to eat but do not force them, talk to the child and maintain eye contact);
• practice good hygiene and proper food handling;
• start at 6 months with small amounts of food and increase gradually as the child gets older;
• gradually increase food consistency and variety;
• increase the number of times that the child is fed: 2–3 meals per day for infants 6–8 months of age and 3–4 meals per day for infants 9–23 months of age, with 1–2 additional snacks as required;
• use fortified complementary foods or vitamin-mineral supplements as needed; and
• during illness, increase fluid intake including more breastfeeding, and offer soft, favorite foods.

Feeding in Exceptionally Difficult Circumstances

Families and children in difficult circumstances require special attention and practical support. Wherever possible, mothers and babies should remain together and get the support they need to exercise the most appropriate feeding option available. Breastfeeding remains the preferred mode of infant feeding in almost all difficult situations, for instance:

• low-birth-weight or premature infants;
• mothers living with HIV in settings where mortality due to diarrhea, pneumonia and malnutrition remain prevalent;
• adolescent mothers;
• infants and young children who are malnourished; and
• families suffering the consequences of complex emergencies.
  

Reproductive Health

(World Health Organization, n.d.-f)

Overview

Being a man or a woman has a significant impact on health, as a result of both biological and gender-related differences. The health of women and girls is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors. For example, women and girls face increased vulnerability to HIV/AIDS.

Some of the sociocultural factors that prevent women and girls from benefiting from quality health services and attaining the best possible level of health include:

• unequal power relationships between men and women;
• social norms that decrease education and paid employment opportunities;
• an exclusive focus on women’s reproductive roles; and
• potential or actual experience of physical, sexual and emotional violence.

While poverty is an important barrier to positive health outcomes for both men and women, poverty tends to yield a higher burden on women and girls’ health due to, for example, feeding practices (linked with malnutrition) and use of unsafe cooking fuels (linked with COPD).

While reproductive health is an obvious area of focus and concern for women, men also have important reproductive health needs. The WHO defines reproductive health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so (World Health Organization, n.d.-e).

Family planning allows people to attain their desired number of children, if any, and to determine the spacing of their pregnancies. It is achieved through use of contraceptive methods and the treatment of infertility.

Contraceptive information and services are fundamental to the health and human rights of all individuals.

The prevention of unintended pregnancies helps to lower maternal ill-health and the number of pregnancy-related deaths. Delaying pregnancies in young girls who are at increased risk of health problems from early childbearing, and preventing pregnancies among older women who also face increased risks, are important health benefits of family planning.

By reducing rates of unintended pregnancies, contraception also reduces the need for unsafe abortion and reduces HIV transmission from mothers to newborns. This can also benefit the education of girls and create opportunities for women to participate more fully in society, including paid employment.

According to 2017 estimates, 214 million women of reproductive age in developing regions have an unmet need for contraception. Reasons for this include:

• limited access to contraception
• a limited choice of methods
• a fear or experience of side-effects
• cultural or religious opposition
• poor quality of available services
• gender-based barriers (World Health Organization, n.d.-c).

Ensuring access for all people to their preferred contraceptive methods advances several human rights including the right to life and liberty, freedom of opinion and expression and the right to work and education, as well as bringing significant health and other benefits. Use of contraception prevents pregnancy-related health risks for women, especially for adolescent girls, and when births are separated by less than two years, the infant mortality rate is 45% higher than it is when births are 2-3 years apart and 60% higher than it is when births are four or more years apart. It offers a range of potential non-health benefits that encompass expanded education opportunities and empowerment for women, and sustainable population growth and economic development for countries.

The number of women desiring to use family planning has increased markedly over the past two decades, from 900 million in 2000 to nearly 1.1 billion in 2020.  Consequently, the number of women using a modern contraceptive method increased from 663 million to 851 million and the contraceptive prevalence rate increased from 47.7 to 49.0 per cent. An additional 70 million women are projected to be added by 2030.

The proportion of women of reproductive age who have their need for family planning satisfied by modern contraceptive methods (SDG indicator 3.7.1) has increased gradually in recent decades, rising from 73.6% in 2000 to 76.8% in 2020.

Reasons for this slow increase include:

• limited choice of methods;
• limited access to services, particularly among young, poorer and unmarried people;
• fear or experience of side-effects;
• cultural or religious opposition;
• poor quality of available services;
• users’ and providers’ bias against some methods;
• and gender-based barriers to accessing services.  

As these barriers are addressed in some regions there have been increases in demand satisfied with modern methods of contraception (World Health Organization, 2020d).

Birth Control

The Church has published these statements on birth control:

• “The decision about how many children to have and when to have them is extremely personal and private. It should be left between the couple and the Lord (Handbook 38.6.4);” and
• “Decisions about birth control and the consequences of those decisions rest solely with each married couple” (Gospel Topics).

Abortion

Because human life is sacred, abortion is a serious issue. While it should not be used as a method of birth control, in certain rare situations it may be justified.

The Church has the following positions on abortion (Gospel Topics):

• “Elective abortion for personal or social convenience is contrary to the will and the commandments of God.”
• “. . . some exceptional circumstances may justify an abortion, such as when pregnancy is the result of incest or rape, when the life or health of the mother is judged by competent medical authority to be in serious jeopardy, or when the fetus is known by competent medical authority to have severe defects that will not allow the baby to survive beyond birth.”

Men’s Health

Reproductive health is also an important component of men's overall health and well-being. Too often, males have been overlooked in discussions of reproductive health, especially when reproductive issues such as contraception and infertility have been perceived as female-related. Every day, men, their partners, and healthcare providers can protect their reproductive health by ensuring effective contraception, avoiding sexually transmitted diseases (STDs), and preserving fertility.

Common issues in male reproductive health include:

• Contraception
• Avoiding sexually transmitted diseases
• Infertility/fertility

(NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development, n.d.)

Maternal Mortality  

(World Health Organization, 2023)

Key facts

• Every day in 2020, almost 800 women died from preventable causes related to pregnancy and childbirth.
• A maternal death occurred almost every two minutes in 2020.
• Between 2000 and 2020, the maternal mortality ratio (MMR, number of maternal deaths per 100 000 live births) dropped by about 34% worldwide.
• Almost 95% of all maternal deaths occurred in low and lower middle-income countries in 2020.
• Care by skilled health professionals before, during and after childbirth can save the lives of women and newborns.

Overview

Maternal mortality is unacceptably high. About 287,000 women died during and following pregnancy and childbirth in 2020. Almost 95% of all maternal deaths occurred in low and lower middle-income countries in 2020, and most could have been prevented.

Sub-Saharan Africa and Southern Asia accounted for around 87% (253,000) of the estimated global maternal deaths in 2020. Sub-Saharan Africa alone accounted for around 70% of maternal deaths (202,000), while Southern Asia accounted for around 16% (47,000).

At the same time, between 2000 and 2020, Eastern Europe and Southern Asia achieved the greatest overall reduction in maternal mortality ratio (MMR): a decline of 70% (from an MMR of 38 to 11) and 67% (from an MMR of 408 down to 134), respectively. Despite its very high MMR in 2020, Sub-Saharan Africa also achieved a substantial reduction in MMR of 33% between 2000 and 2020. Four SDG sub-regions roughly halved their MMRs during this period: Eastern Africa, Central Asia, Eastern Asia, and Northern Africa and Western Europe reduced their MMR by around one third. Overall, the maternal mortality ratio (MMR) in least-developed countries declined by just under 50%. In landlocked developing countries, the MMR decreased by 50% (from 729 to 368). In small island developing countries the MMR declined by 19% (from 254 to 206).

Where do maternal deaths occur?

The high number of maternal deaths in some areas of the world reflects inequalities in access to quality health services and highlights the gap between rich and poor. The MMR in low-income countries in 2020 was 430 per 100,000 live births versus 12 per 100,000 live births in high income countries.

Humanitarian, conflict, and post-conflict settings hinder progress in reducing the burden of maternal mortality. In 2020, according to the Fragile States Index, 9 countries were “very high alert” or “high alert” (from highest to lowest: Yemen, Somalia, South Sudan, the Syrian Arab Republic, the Democratic Republic of the Congo, the Central African Republic, Chad, Sudan and Afghanistan); these countries had MMRs ranging from 30 (the Syrian Arab Republic) to 1223 (South Sudan) in 2020. The average MMR for very high and high alert fragile states in 2020 was 551 per 100 000, over double the world average.

Women in low-income countries have a higher lifetime risk of maternal death. A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high income countries, this is 1 in 5300, versus 1 in 49 in low-income countries.

Why do women die?

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. The major complications that account for nearly 75% of all maternal deaths are:

• severe bleeding (mostly bleeding after childbirth);
• infections (usually after childbirth);
• high blood pressure during pregnancy (pre-eclampsia and eclampsia);
• complications from delivery; and
• unsafe abortion.

How can women’s lives be saved?

To avoid maternal deaths, it is vital to prevent unintended pregnancies. All women, including adolescents, need access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care.

Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth. Maternal health and newborn health are closely linked. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the women as well as for the newborn. 

Severe bleeding after birth can kill a healthy woman within hours if she is unattended. Injecting oxytocics immediately after childbirth effectively reduces the risk of bleeding.

Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner.

Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia.

Why do women not get the care they need?

Poor women in remote areas are the least likely to receive adequate health care. This is especially true for SDG regions with relatively low numbers of skilled health care providers, such as Sub-Saharan Africa and Southern Asia.

The latest available data suggest that in most high income and upper middle income countries, approximately 99% of all births benefit from the presence of a trained midwife, doctor or nurse. However, only 68% in low income and 78% in lower-middle-income countries are assisted by such skilled health personnel.

Factors that prevent women from receiving or seeking care during pregnancy and childbirth are:

• health system failures that translate to (i) poor quality of care, including disrespect, mistreatment and abuse, (ii); insufficient numbers of and inadequately trained health workers, (iii); shortages of essential medical supplies; and (iv) the poor accountability of health systems;.
• social determinants, including income, access to education, race and ethnicity, that put some sub-populations at greater risk;
• harmful gender norms and/or inequalities that result in a low prioritization of the rights of women and girls, including their right to safe, quality and affordable sexual and reproductive health services; and
• external factors contributing to instability and health system fragility, such as climate and humanitarian crises.

To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at both health system and societal levels.

Preterm Birth

(World Health Organization, 2022f)

Key facts

• Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation).
• Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015.
• Three-quarters of these deaths could be prevented with current, cost-effective interventions.
• Across countries, the rate of preterm birth ranges from 5% to 18% of babies born.

Overview

Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:

• extremely preterm (less than 28 weeks)
• very preterm (28 to 32 weeks)
• moderate to late preterm (32 to 37 weeks).
• Babies may be born preterm because of spontaneous preterm labor or because there is a medical indication to plan an induction of labor or cesarean birth early.

An estimated 15 million babies are born too early every year. That is more than 1 in 10 babies. Approximately 1 million children die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.

Globally, prematurity is the leading cause of death in children under the age of 5 years. Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care such as warmth, breastfeeding support and basic care for infections and breathing difficulties. In high-income countries, almost all these babies survive. Suboptimal use of technology in middle-income settings is causing an increased burden of disability among preterm babies who survive the neonatal period.

Why does preterm birth happen?

Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to medical reasons such as infections, or other pregnancy complications that require early induction of labor or cesarean birth.

More research is needed to determine the causes and mechanisms of preterm birth. Causes include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence.

Where and when does preterm birth happen?

The majority of preterm births occur in Africa and southern Asia, but preterm birth is truly a global problem. There is a dramatic difference in survival of premature babies depending on where they are born. For example, more than 90% of extremely preterm babies (less than 28 weeks) born in low-income countries die within the first few days of life, yet less than 10% of extremely preterm babies die in high-income settings.

The Solution

Preventing deaths and complications from preterm birth starts with a healthy pregnancy. WHO’s antenatal care guidelines include key interventions to help prevent preterm birth, such as counseling on healthy diet, optimal nutrition, and tobacco and substance use; fetal measurements including use of early ultrasound to help determine gestational age and detect multiple pregnancies; and a minimum of 8 contacts with health professionals throughout pregnancy – starting before 12 weeks – to identify and manage risk factors such as infections.

If a woman experiences preterm labor or is at risk of preterm childbirth, treatments are available to help protect the preterm baby from future neurological impairment as well as difficulties with breathing and infection. These include antenatal steroids and tocolytic treatments to delay labor.

In 2022, WHO also published new recommendations on the care of the preterm infant. These reflect new evidence that simple interventions such as kangaroo mother care immediately after birth, early initiation of breastfeeding, use of continuous positive airway pressure (CPAP) and medicines such as caffeine for breathing problems can substantially reduce mortality in preterm and low birthweight babies.

WHO guidance stresses the need to ensure the mother and family take the pivotal role in their baby’s care. Mothers and newborns should remain together from birth and not be separated unless the baby is critically ill. The recommendations further call for improvements in family support including education and counseling, peer support and home visits by trained health workers.

Newborns - Reducing Mortality

(World Health Organization, 2020c)

Key facts

• Although the global number of newborns deaths declined from 5 million in 1990 to 2.4 million in 2019, children face the greatest risk of death in their first 28 days.
• In 2019, 47% of all under-5 deaths occurred in the newborn period with about one third dying on the day of birth and close to three quarters dying within the first week of life.
• Children who die within the first 28 days of birth suffer from conditions and diseases associated with lack of quality care at birth or skilled care and treatment immediately after birth and in the first days of life.
• Preterm birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects cause most neonatal deaths.
• Women who receive midwife-led continuity of care (MLCC) provided by professional midwives, educated and regulated to international standards, are 16% less likely to lose their baby and 24% less likely to experience preterm birth.

Who is most at risk?

Neonates, or newly-born children. Globally 2.4 million children died in the first month of life in 2019. There are approximately 6 700 newborn deaths every day, amounting to 47% of all child deaths under the age of 5-years, up from 40% in 1990.

The world has made substantial progress in child survival since 1990. Globally, the number of neonatal deaths declined from 5.0 million in 1990 to 2.4 million in 2019. However, the decline in neonatal mortality from 1990 to 2019 has been slower than that of post-neonatal under-5 mortality The share of neonatal deaths among under-five deaths is still relatively low in sub-Saharan Africa (36%), which remains the region with the highest under-five mortality rates. In Europe and Northern America, which has one of the lowest under-five mortality rates among SDG regions, 54% of all under-five deaths occur during the neonatal period. An exception is Southern Asia, where the proportion of neonatal deaths is among the highest (62%) despite a relatively high under-five mortality rate.

Sub-Saharan Africa had the highest neonatal mortality rate in 2019 at 27 deaths per 1,000 live births, followed by Central and Southern Asia with 24 deaths per 1,000 live births. A child born in sub-Saharan Africa or in Southern Asia is 10 times more likely to die in the first month than a child born in a high-income country.

Top 10 countries with the highest number (thousands) of newborn deaths, 2019

Causes

The majority of all neonatal deaths (75%) occur during the first week of life, and about 1 million newborns die within the first 24 hours. Preterm birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects cause most neonatal deaths in 2017. From the end of the neonatal period and through the first 5 years of life, the main causes of death are pneumonia, diarrhea, birth defects and malaria. Malnutrition is the underlying contributing factor, making children more vulnerable to severe diseases.

Priority Strategies

The vast majority of newborn deaths take place in low and middle-income countries. It is possible to improve survival and health of newborns and end preventable stillbirths by reaching high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick newborns. In settings with well-functioning midwife programmes the provision of midwife-led continuity of care  (MLCC) can reduce preterm births by up to 24%. MLCC is a model of care in which a midwife or a team of midwives provide care to the same woman throughout her pregnancy, childbirth and the postnatal period, calling upon medical support if necessary. With the increase in facility births (almost 80% globally), there is a great opportunity for providing essential newborn care and identifying and managing high risk newborns.  However, few women and newborns stay in the facility for the recommended 24 hours after birth, which is the most critical time when complications can present. In addition, too many newborns die at home because of early discharge from the hospital, barriers to access and delays in seeking care. The four recommended postnatal care contacts delivered at health facilities or through home visits play a key role to reach these newborns and their families.

Accelerated progress for neonatal survival and promotion of health and wellbeing requires strengthening quality of care as well as ensuring availability of quality health services for the small and sick newborn.

Essential Newborn Care

All babies should receive the following:

• thermal protection (e.g. promoting skin-to-skin contact between mother and infant);
• hygienic umbilical cord and skin care;
• early and exclusive breastfeeding;
• assessment for signs of serious health problems or need of additional care (e.g. those that are low-birth-weight, sick or have an HIV-infected mother
• preventive treatment (e.g. immunization BCG and Hepatitis B, vitamin k and ocular prophylaxis)

Families should be advised to:

• seek prompt medical care if necessary (danger signs include feeding problems, or if the newborn has reduced activity, difficult breathing, a fever, fits or convulsions, jaundice in first 24 hours after birth, yellow palms and soles at any age, or if the baby feels cold);
• register the birth;
• bring the baby for timely vaccination according to national schedules.
• Some newborns require additional attention and care during hospitalization and at home to minimize their health risks.

Low-birth-weight and preterm babies:

• If a low-birth weight newborn is identified at home, the family should be helped in locating a hospital or facility to care for the baby.
• increased attention to keeping the newborn warm, including skin-to-skin care, unless there are medically justifiable reasons for delayed contact with the mother;
• assistance with initiation of breastfeeding, such as helping the mother express breast milk for feeding the baby from a cup or other means if necessary;
• extra attention to hygiene, especially hand washing;
• extra attention to danger signs and the need for care; and
• additional support for breastfeeding and monitoring growth.

Sick Newborns

Danger signs should be identified as soon as possible in health facilities or at home and the baby referred to the appropriate service for further diagnosis and care;
If a sick newborn is identified at home, the family should be helped in locating a hospital or facility to care for the baby.

Newborns of HIV-Infected Mothers

• preventive antiretroviral treatment (ART) for mothers and newborns to prevent opportunistic infections;
• HIV testing and care for exposed infants; and
• counseling and support to mothers for infant feeding. Community health workers should be aware of the specialized issues around infant feeding. Many HIV-infected newborns are born prematurely and are more susceptible to infections.

Levels and Trends in Child Under 5 Mortality

(World Health Organization, 2022a)

Key facts

• In 2020 an estimated 5 million children under the age of 5 years died, mostly from preventable and treatable causes. Approximately half of those deaths, 2.4 million, occurred among newborns (in the first 28 days of life).
• While the global under-5 mortality rate (U5MR) fell to 37 deaths per 1000 live births in 2020, children in sub-Saharan continued to have the highest rates of mortality in the world at 74 deaths per 1000 live births- 14 times higher than the risk for children in Europe and North America.
• The leading causes of death in children under 5 years are preterm birth complications, birth asphyxia/trauma, pneumonia, diarrhea and malaria, all of which can be prevented or treated with access to affordable interventions in health and sanitation.
• SARS-CoV-2 infections among children and adolescents typically cause less severe illness and fewer deaths as compared to adults. Moreover, the youngest children are least vulnerable, with less than 0.1% of global deaths (1902) occurring in children under 5 years of age.

Overview

Substantial global progress has been made in reducing childhood mortality since 1990. The total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to 5 million in 2020. Since 1990, the global under-5 mortality rate has dropped by 60%, from 93 deaths per 1000 live births in 1990 to 37 in 2020. This is equivalent to 1 in 11 children dying before reaching age 5 in 1990, compared to 1 in 27 in 2020.

While the global under-5 mortality rate (U5MR) fell to 37 (35–­­40) deaths per 1000 live births in 2020, children in sub-Saharan Africa continued to have the highest rates of mortality in the world at 74 (68–­­86) deaths per 1000 live births- 14 times higher than the risk for children in Europe and North America.

Sub-Saharan Africa and southern Asia, account for more than 80% of the 5 million under-5 deaths in 2020, while they only account for 53% of the global live births. Half of all under-5 deaths in 2020 occurred in just 5 countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia. Nigeria and India alone account for almost a third of all deaths.

At the country level, under-5 mortality rates in 2020 ranged from 2 deaths per 1000 live births to 115 deaths per 1000 live births, and the risk of dying before turning 5 for a child born in the highest-mortality country was about 65 times higher than in the lowest-mortality country.

Top 10 countries with the highest numbers of deaths (thousands) for children under 5 years, 2020

Globally, infectious diseases, including pneumonia, diarrhea and malaria, along with preterm birth complications, birth asphyxia and trauma and congenital anomalies remain the leading causes of death for children under 5 years.  Access to basic lifesaving interventions such as skilled delivery at birth, postnatal care, breastfeeding and adequate nutrition, vaccinations and treatment for common childhood diseases can save many young lives.

Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illnesses such as diarrhea, pneumonia and malaria. Nutrition-related factors contribute to about 45% of deaths in children under 5 years of age.

Mortality Among Children Aged 5-14 Years 

(World Health Organization, 2019)

Key facts

• An estimated 0.9 million children aged 5 to 14 years died in 2018, about 2,500 deaths in this age group a day. Mortality rates for older children aged 5 to 9 years are higher than for young adolescents aged 10 to 14 years.
• From 1990 to 2018, the mortality rate in children aged 5 to 14 years declined by 53 per cent, and the number of deaths dropped by 46 per cent from 1.7 (to 0.9 million per year.
• On current trends, 9.8 million children aged 5–14 years will die between 2019 and 2030. Almost 80% of these projected deaths will occur in sub-Saharan Africa (5.8 million) and Southern Asia (2 million)
• Injuries (including road traffic injuries, drowning, burns, and falls) are leading causes of death and lifelong disability among older children and young adolescents. Infectious diseases have declined since 2000 for this age group.

Overview

The probability of dying among children aged 5 to 14 years was 7.1 deaths per 1000 children aged 5 in 2018, roughly 18% of the under-5 mortality rate in the same year. Globally deaths among children aged 5-9 years accounted for 61% of all deaths of children aged 5 to 14 years. However, survival chances for older children and young adolescents vary greatly across the world. In sub-Saharan Africa, the probability of dying among children aged 5–14 years in 2018 was 17.9 deaths per 1,000 children aged 5 years, followed by Oceania (excluding Australia and New Zealand) with 7.8 deaths and Central and Southern Asia with 5.8. More than half (55%) of deaths among children aged 5–14 years occurred in sub-Saharan Africa, followed by Southern Asia with about 24%. The average risk of dying between the fifth and fifteenth birthday was 14 times higher in sub-Saharan Africa than in Northern America and Europe.

At the country level, mortality ranged from 0.4 to 37.3 deaths per 1,000 children aged 5 years. The higher mortality countries are concentrated in sub-Saharan Africa with the 14 countries having a mortality rate for children aged 5–14 years above 20 deaths per 1,000 children aged 5 years in 2018 all in this region. Countries with the highest number of deaths for this age group include India, Nigeria, DR Congo, Pakistan and China.

What are the leading causes of death?

Injuries (including road traffic injuries, drowning, burns, and falls) rank among the top causes of death and lifelong disability among children aged 5-14 years. The patterns of death in older children and young adolescents reflect the underlying risk profiles of the age groups, with a shift away from infectious diseases of childhood and towards accidents and injuries, notably drowning and road traffic injuries for older children and young adolescents. 

What can be done to improve older child and young adolescent survival?

The rise of injury deaths, particularly, road traffic injuries and drowning, demonstrate that the risk exposure is different for those over the age of 5 years. As a result, the nature of interventions needed to prevent poor health outcomes have shifted away from health sector actions to prevent and treat the infectious diseases of early childhood towards other sectors needed to take action to prevent mortality from road traffic injuries, violence and mental health problems. Actions across a range of government sectors including education, transportation and road infrastructure, water and sanitation and law enforcement are needed to prevent premature mortality in older children and young adolescents. National governments will need to critically assess their countries’ older child and young adolescent health needs, determine the most appropriate evidence-based intervention to address them and then prioritize these within their national health programming. WHO can help by providing guidance on effective interventions, prioritization, programme planning, monitoring and evaluation and research areas to strengthen the response.

Older adolescent (15 to 19 years) and young adult (20 to 24 years) mortality

(World Health Organization, 2022b)

Key facts

• Approximately 1.3 million adolescents and young adults (aged 15 to 24 years) died in 2020, resulting in a probability of dying in this age group of 11 deaths per 1000 adolescents in 2020.
• Globally deaths among adolescents aged 15 to 19 years accounted for 43% of all deaths in those aged 5 to 24 years.
• Approximately 569 000 older adolescents (15 to 19 years) and 762 000 young adults (20 to 24 years) died in 2020. Females have lower mortality rates than males in these age groups.
• Injuries (including road traffic injuries and drowning), violence, self-harm, infectious diseases such as respiratory infections and maternal conditions (complications for pregnancy) are leading causes of death among adolescents and young adults.

Overview

Across all regions, the risk of dying at age 15–24 is lower than for children under 5 years old. The probability of dying among adolescents and youth aged 10–24 years was 14 deaths per 1000 children aged 10 in 2020. Globally, deaths among adolescents aged 10 to 19 years accounted for 43% of all deaths in those aged 5 to 24 years.

Females have lower mortality rates for the ages 15 to 24 years than males. For example, the ratio of male to female mortality rates rises from 1.1 in those aged 5 to 9 years compared to 1.5 for those aged 20 to 24 years, showing a female advantage in mortality increasing with age. The underlying reason for this change is that the cause of death structure shifts from infectious diseases in young children to accidents and injuries primarily among older male adolescents and young adults.

However, survival chances for adolescents and young adults also vary greatly across the world. In sub-Saharan Africa, the probability of dying among those aged 15–24 years in 2019 was 23 deaths per 1,000 adolescents aged 15 years. Most deaths among those aged 15–24 years occurred in sub-Saharan Africa, and Oceania (excluding Australia and New Zealand). The third highest regional rate for older adolescents (15 to 19 years) and young adults (20 to 24 years) is in Latin America and the Caribbean.

At the country level, mortality for those aged 15–24 years ranged from 2 to 41 per 1000 adolescents aged 15. The higher mortality countries are concentrated in sub-Saharan Africa. Countries with the highest number of deaths for this age group include the Democratic Republic of the Congo, Chad, Sierra Leone and Somalia.

Causes of Death

The patterns of death in those aged 15 to 24 years reflect the underlying risk profiles of the age groups, with a shift away from infectious diseases of childhood and towards accidents and injuries, self-harm and interpersonal violence. Sex differences in mortality rates become apparent in adolescence. Rates are higher for males from the conditions mentioned above along with collective violence and legal intervention (war/conflict). Maternal conditions become an increasingly important cause of death for young women in lower-income countries.

Response

The rise of injury deaths, particularly, road traffic injuries and drowning, demonstrate that the risk exposure is different for those over the age of 15 years. As a result, the nature of interventions needed to prevent poor health outcomes have shifted away from health sector actions to prevent and treat the infectious diseases of early childhood towards other sectors needed to take action to prevent mortality from road traffic injuries, violence and mental health problems.

Actions across a range of government sectors including education, transportation and road infrastructure, water and sanitation and law enforcement are needed to prevent premature mortality in older children, adolescents and young adults. National governments will need to critically assess their countries’ adolescent and young adult health needs, determine the most appropriate evidence-based intervention to address them and then prioritize these within their national health programming. WHO can help by providing guidance on effective interventions, prioritization, programme planning, monitoring and evaluation and research areas to strengthen the response.

Adolescent and Young Adult Health

(World Health Organization, 2022c)

Key facts

• Over 1.5 million adolescents and young adults aged 10–24 years died in 2020, nearly 5000 every day.
• Young adolescents aged 10–14 years have the lowest risk of death of all age groups.
• Injuries (including road traffic injuries and drowning), violence, self-harm and maternal conditions are the leading causes of death among adolescents and young adults
• Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.
• Early onset of substance use is associated with higher risks of developing dependence and other problems during adult life, and people of younger ages are disproportionately affected by substance use compared with people of older ages.
• Globally, there were 41 births per 1000 to girls aged 15–19 years in 2020.
  

Overview

Survival chances for adolescents and young adults vary greatly across the world. In 2020, the probability of dying among those aged 10–24 years was highest in sub-Saharan Africa, Oceania (excluding Australia and New Zealand), northern Africa and southern Asia (1). The average global probability of a 10-year-old dying before age 24 was 6 times higher in sub-Saharan Africa than in North America and Europe.

Main Health Issues

Injuries

Unintentional injuries are the leading cause of death and disability among adolescents. In 2019, nearly 100,000 adolescents (10–19 years) died as a result of road traffic accidents. Many of those who died were vulnerable road users, including pedestrians, cyclists or users of motorized two-wheelers. In many countries, road safety laws need to be made more comprehensive, and enforcement of such laws needs to be strengthened. Furthermore, young drivers need advice on driving safely, while laws that prohibit driving under the influence of alcohol and drugs need to be strictly enforced among all age groups. Blood alcohol levels should be set lower for young drivers than for adults. Graduated licenses for novice drivers with zero-tolerance for drink-driving are recommended.

Drowning

Drowning is also among the top causes of death among adolescents; more than 40,000 adolescents, over three quarters of them boys, are estimated to have drowned in 2019. Teaching children and adolescents to swim is an essential intervention to prevent these deaths.

Violence

Interpersonal violence is among the leading causes of death in adolescents and young people globally. Its prominence varies substantially by world region. It causes nearly a third of all adolescent male deaths in low- and middle-income countries in the WHO Region of the Americas. According to the global school-based student health survey 42% of adolescent boys and 37% of adolescent girls were exposed to bullying. Sexual violence also affects a significant proportion of youth: 1 in 8 young people report sexual abuse.

Violence during adolescence also increases the risks of injury, HIV and other sexually transmitted infections, mental health problems, poor school performance and dropout, early pregnancy, reproductive health problems, and communicable and noncommunicable diseases.

Effective prevention and response strategies include promoting parenting and early childhood development; addressing school-based bullying prevention, programmes that develop life and social skills, and community approaches to reduce access to alcohol and firearms. Effective and empathetic care for adolescent survivors of violence, including ongoing support, can help with the physical and psychological consequences.

Mental Health

Depression is one of the leading causes of illness and disability among adolescents, and suicide is the second leading cause of death in people aged 15–19 years. Mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years. Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.

Many factors have an impact on the well-being and mental health of adolescents. Violence, poverty, stigma, exclusion, and living in humanitarian and fragile settings can increase the risk of developing mental health problems. The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Building socioemotional skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programs to help strengthen the ties between adolescents and their families and improve the quality of home environments are also important. If problems arise, they should be detected and timely managed by competent and caring health workers.

Alcohol and Drug Use

Drinking alcohol among adolescents is a major concern in many countries. It can reduce self-control and increase risky behaviors, such as unsafe sex or dangerous driving. It is an underlying cause of injuries (including those due to road traffic accidents), violence and premature deaths. It can also lead to health problems in later life and affects life expectancy. Worldwide, more than a quarter of all people aged 15–19 years are current drinkers, amounting to 155 million adolescents. Prevalence of heavy episodic drinking among adolescents aged 15­–19 years was 13.6% in 2016, with males most at risk.

Cannabis is the most widely used psychoactive drug among young people with about 4.7% of people aged 15–16 years using it at least once in 2018. Alcohol and drug use in children and adolescents is associated with neurocognitive alterations which can lead to behavioral, emotional, social and academic problems in later life.

Prevention of alcohol and drug use are important areas of public health actions and may include population-based strategies and interventions, activities in school, community, family and on the individual level. Setting a minimum age for buying and consuming alcohol and eliminating marketing and advertising to minors are among the key strategies for reducing drinking among adolescents.

Tobacco Use

The vast majority of people using tobacco today began doing so when they were adolescents. Prohibiting the sale of tobacco products to minors (under 18 years) and increasing the price of tobacco products through higher taxes, banning tobacco advertising and ensuring smoke-free environments are crucial. Globally, at least 1 in 10 adolescents aged 13–15 years uses tobacco, although there are areas where this figure is much higher.

HIV/AIDS

An estimated 1.7 million adolescents (age 10–19 years) were living with HIV in 2019 with around 90% in the WHO African Region. While there have been substantial declines in new infections amongst adolescents from a peak in 1994, adolescents still account for about 10% of new adult HIV infections, with three-quarters amongst adolescent girls. Additionally, while new infections may have fallen in many of the most severely affected countries, recent testing coverage remains low suggesting that many adolescents and young people living with HIV may not know their status.

Adolescents living with HIV have worse access to antiretroviral treatment, adherence to treatment, retention in care and viral suppression. A key factor contributing to these is limited provision of adolescent-friendly services including psychosocial interventions and support.

Adolescents and young people need to know how to protect themselves from HIV infection and must also have the means to do so. This includes being able to obtain access to HIV prevention interventions including voluntary medical male circumcision, condoms and pre-exposure prophylaxis, better access to HIV testing and counseling, and stronger links to HIV treatment services for those who test HIV positive.

Other Infectious Diseases

Thanks to improved childhood vaccination, adolescent deaths and disability from measles have fallen markedly. For example, adolescent mortality from measles fell by 90% in the African Region between 2000 and 2012.

Diarrhea and lower respiratory tract infections (pneumonia) are estimated to be among the top 10 causes of death for adolescents 10–14 years. These two diseases, along with meningitis, are all among the top 5 causes of adolescent death in African low- and middle-income countries.

Infectious diseases like with human papilloma virus that normally occurs after onset of sexual activity can lead to both short-term disease (genital warts) during adolescence but more importantly also leads to cervical and other cancers several decades later. Early adolescence (9–14 years) is the optimal time for vaccination against HPV infection and it is estimated that if 90% of girls globally get the HPV vaccine more than 40 million lives could be saved over the next century. However, it is estimated that in 2019 only 15% of girls globally received the vaccine.

Early Pregnancy and Childbirth

Approximately 12 million girls aged 15–19 years and at least 777,000 girls under 15 years give birth each year in developing regions. Complications from pregnancy and childbirth are among the leading causes of death for girls aged 15–19 years globally.

The UN Population Division puts the global adolescent birth rate in 2020 at 41 births per 1000 girls this age, and country rates range from 1 to over 200 births per 1000 girls. This indicates a marked decrease since 1990. This decrease is reflected in a similar decline in maternal mortality rates among girls aged 15–19 years.

One of the specific targets of the health Sustainable Development Goal (SDG 3) is that by 2030, the world should ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

Adolescents need and have a right to comprehensive sexuality education, a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. Better access to contraceptive information and services can reduce the number of girls becoming pregnant and giving birth at too young an age. Laws that are enforced that specify a minimum age of marriage at 18 can help.

Girls who do become pregnant need access to quality antenatal care. Where permitted by law, adolescents who opt to terminate their pregnancies should have access to safe abortion.

Nutrition and Micronutrient Deficiencies

Iron deficiency anemia was the second leading cause of years lost by adolescents to death and disability in 2019. Iron and folic acid supplements are a solution that also helps to promote health before adolescents become parents. Regular deworming in areas where intestinal helminths such as hookworm are common is recommended to prevent micronutrient (including iron) deficiencies.

Developing healthy eating habits in adolescence are foundations for good health in adulthood. Reducing the marketing of foods high in saturated fats, trans fatty acids, free sugars, or salt and providing access to healthy foods are important for all, but especially for children and adolescents.

Undernutrition and Obesity

Many boys and girls in developing countries enter adolescence undernourished, making them more vulnerable to disease and early death. At the other end of the spectrum, the number of adolescents who are overweight or obese is increasing in low-, middle- and high-income countries.

Globally, in 2016, over 1 in 6 adolescents aged 10–19 years was overweight. Prevalence varied across WHO regions, from lower than 10% in the WHO South-East Asia Region to over 30% in the WHO Region of the Americas.

Physical Activity

Physical activity provides fundamental health benefits for adolescents, including improved cardiorespiratory and muscular fitness, bone health, maintenance of a healthy body weight, and psychosocial benefits. WHO recommends that adolescents accumulate at least 60 minutes of moderate to vigorous intensity physical activity on average per day across the week, which may include play, games, sports, but also activity for transportation (such as cycling and walking), or physical education.

Globally, only 1 in 5 adolescents are estimated to meet these guidelines. Prevalence of inactivity is high across all WHO regions, and higher in female adolescents as compared to male adolescents.

To increase activity levels, countries, societies and communities need to create safe and enabling environments and opportunities for physical activity for all adolescents.

Rights of Adolescents

The rights of children (people under 18 years of age) to survive, grow and develop are enshrined in international legal documents. In 2013, the Committee on the Rights of the Child (CRC), which oversees the child rights convention, published guidelines on the right of children and adolescents to the enjoyment of the highest attainable standard of health, and a General Comment on realizing the rights of children during adolescence was published in 2016. It highlights states’ obligations to recognize the special health and development needs and rights of adolescents and young people.

The Convention on the Elimination of Discrimination Against Women (CEDAW) also sets out the rights of women and girls to health and adequate health care.

Ageing and Health

Every person – in every country in the world – should have the opportunity to live a long and healthy life. Yet, the environments in which we live can favor health or be harmful to it. Environments are highly influential on our behavior and our exposure to health risks (for example, air pollution or violence), our access to services (for example, health and social care) and the opportunities that aging brings.  

The number and proportion of people aged 60 years and older in the population is increasing. In 2019, the number of people aged 60 years and older was 1 billion. This number will increase to 1.4 billion by 2030 and 2.1 billion by 2050. This increase is occurring at an unprecedented pace and will accelerate in coming decades, particularly in developing countries.

This historically significant change in the global population requires adaptations to the way societies are structured across all sectors. For example, health and social care, transportation, housing and urban planning. Working to make the world more age-friendly is an essential and urgent part of our changing demographics. (World Health Organization, n.d.-b)

Aging presents both challenges and opportunities. It will increase demand for primary health care and long-term care, require a larger and better trained workforce, intensify the need for physical and social environments to be made more age-friendly, and call for everyone in every sector to combat ageism. Yet, these investments can enable the many contributions of older people – whether it be within their family, to their local community (e.g., as volunteers or within the formal or informal workforce) or to society more broadly. (World Health Organization, n.d.-b) (Tab 2)

In practical terms, age-friendly environments are free from physical and social barriers and supported by policies, systems, services, products and technologies that:

• promote health and build and maintain physical and mental capacity across the life course; and
• enable people, even when experiencing capacity loss, to continue to do the things they value.
  

Age-friendly practices help build older people's abilities to:

• meet their basic needs;
• learn, grow and make decisions;
• be mobile;
• build and maintain relationships; and
• contribute to society and their own goals.

In doing so, age-friendly practices:

• recognize the wide range of capacities and resources among older people;
• anticipate and respond flexibly to aging-related needs and preferences;
• respect older people's decisions and lifestyle choices;
• reduce inequities;
• protect those who are most vulnerable; and
• promote older people's inclusion in and contribute to all areas of community life.

(World Health Organization, n.d.-a)

Societies that adapt to this changing demographic and invest in healthy aging can enable individuals to live both longer and healthier lives and for societies to reap the dividends (World Health Organization, n.d.-b)(Tab 2).

Ageing and Health

(World Health Organization, 2022e)

Key facts

• All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.
• In 2050, 80% of older people will be living in low- and middle-income countries.
• The pace of population aging is much faster than in the past.
• In 2020, the number of people aged 60 years and older outnumbered children younger than 5 years.
• Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%.

Overview

People worldwide are living longer. Today most people can expect to live into their sixties and beyond. Every country in the world is experiencing growth in both the size and the proportion of older persons in the population.

By 2030, 1 in 6 people in the world will be aged 60 years or over. At this time the share of the population aged 60 years and over will increase from 1 billion in 2020 to 1.4 billion. By 2050, the world’s population of people aged 60 years and older will double (2.1 billion). The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million.

While this shift in distribution of a country's population towards older ages – known as population aging – started in high-income countries (for example in Japan 30% of the population is already over 60 years old), it is now low- and middle-income countries that are experiencing the greatest change. By 2050, two-thirds of the world’s population over 60 years of age will live in low- and middle-income countries.

Aging Explained

At the biological level, aging results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease and ultimately death. These changes are neither linear nor consistent, and they are only loosely associated with a person’s age in years. The diversity seen in older age is not random. Beyond biological changes, aging is often associated with other life transitions such as retirement, relocation to more appropriate housing and the death of friends and partners.

Common Health Conditions Associated with Ageing

Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia. As people age, they are more likely to experience several conditions at the same time.

Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.

Factors Influencing Healthy Aging

A longer life brings with it opportunities, not only for older people and their families, but also for societies as a whole. Additional years provide the chance to pursue new activities such as further education, a new career or a long-neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on one factor: health.

Evidence suggests that the proportion of life in good health has remained broadly constant, implying that the additional years are in poor health. If people can experience these extra years of life in good health and if they live in a supportive environment, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are more negative.

Although some of the variations in older people’s health are genetic, most of the variation is due to people’s physical and social environments – including their homes, neighborhoods, and communities, as well as their personal characteristics – such as their sex, ethnicity, or socioeconomic status. The environments that people live in as children – or even as developing fetuses – combined with their personal characteristics, have long-term effects on how they age.

Physical and social environments can affect health directly or through barriers or incentives that affect opportunities, decisions and health behavior. Maintaining healthy behaviors throughout life, particularly eating a balanced diet, engaging in regular physical activity and refraining from tobacco use, all contribute to reducing the risk of non-communicable diseases, improving physical and mental capacity and delaying care dependency.

Supportive physical and social environments also enable people to do what is important to them, despite losses in capacity. The availability of safe and accessible public buildings and transport, and places that are easy to walk around, are examples of supportive environments. In developing a public-health response to aging, it is important not just to consider individual and environmental approaches that ameliorate the losses associated with older age, but also those that may reinforce recovery, adaptation and psychosocial growth.

Challenges in Responding to Population Ageing

There is no typical older person. Some 80-year-olds have physical and mental capacities similar to many 30-year-olds. Other people experience significant declines in capacities at much younger ages. A comprehensive public health response must address this wide range of older people’s experiences and needs.

The diversity seen in older age is not random. A large part arises from people’s physical and social environments and the impact of these environments on their opportunities and health behavior. The relationship we have with our environments is skewed by personal characteristics such as the family we were born into, our sex and our ethnicity, leading to inequalities in health.

Older people are often assumed to be frail or dependent and a burden to society. Public health professionals, and society as a whole, need to address these and other ageist attitudes, which can lead to discrimination, affect the way policies are developed and the opportunities older people have to experience healthy aging.

Globalization, technological developments (e.g., in transport and communication), urbanization, migration and changing gender norms are influencing the lives of older people in direct and indirect ways. A public health response must take stock of these current and projected trends and frame policies accordingly.

References

NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d.). Men’s Reproductive Health. NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/factsheets/menshealth

World Health Organization. (n.d.-a). Age-Friendly in Practice. Age-Friendly World. https://extranet.who.int/agefriendlyworld/age-friendly-practices/

World Health Organization. (n.d.-b). Ageing. World Health Organization. https://www.who.int/health-topics/ageing#tab=tab_1

World Health Organization. (n.d.-c). Contraception. World Health Organization. https://www.who.int/health-topics/contraception#tab=tab_1

World Health Organization. (n.d.-d). Nutrition. World Health Organization. https://www.who.int/health-topics/nutrition

World Health Organization. (n.d.-e). Reproductive health. World Health Organization. https://www.who.int/westernpacific/health-topics/reproductive-health

World Health Organization. (n.d.-f). Women’s health. World Health Organization. https://www.who.int/health-topics/women-s-health

World Health Organization. (2017). The double burden of malnutrition: Policy brief. https://www.who.int/publications/i/item/WHO-NMH-NHD-17.3

World Health Organization. (2019, September 23). Mortality among children aged 5-14 years. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mortality-among-children-aged-5-14-years

World Health Organization. (2020a, April 29). Healthy diet. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/healthy-diet

World Health Organization. (2020b, September 8). Children: Improving survival and well-being. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality

World Health Organization. (2020c, September 19). Newborns: Improving survival and well-being. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality

World Health Organization. (2020d, November 9). Family planning/contraception methods. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception

World Health Organization. (2021a, June 9). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

World Health Organization. (2021b, June 9). Malnutrition. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/malnutrition

World Health Organization. (2021c, June 9). Obesity and overweight. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

World Health Organization. (2022a, January 28). Child mortality (under 5 years). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-under-5-mortality-in-2020

World Health Organization. (2022b, January 28). Older adolescent (15 to 19 years) and young adult (20 to 24 years) mortality. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-older-adolescent-(15-to-19-years)-and-young-adult-(20-to-24-years)-mortality

World Health Organization. (2022c, August 10). Adolescent and young adult health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions

World Health Organization. (2022d, September 16). Noncommunicable diseases. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

World Health Organization. (2022e, October 1). Aging and health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

World Health Organization. (2022f, November 14). Preterm birth. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/preterm-birth

World Health Organization. (2023, February 22). Maternal mortality. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality