This paper reviews the evidence on sexual and reproductive health and rights (SRHR) of adolescent girls in low-income and middle-income countries (LMIC) in light of the policy and programme commitments made at the International Conference on Population and Development (ICPD), analyses progress since 1994, and maps challenges in and opportunities for protecting their health and human rights. Findings indicate that many countries have yet to make significant progress in delaying marriage and childbearing, reducing unintended childbearing, narrowing gender disparities that put girls at risk of poor SRH outcomes, expanding health awareness or enabling access to SRH services. While governments have reaffirmed many commitments, policy development and programme implementation fall far short of realising these commitments. Future success requires increased political will and engagement of young people in the formulation and implementation of policies and programmes, along with increased investments to deliver at scale comprehensive sexuality education, health services that are approachable and not judgemental, safe spaces programmes, especially for vulnerable girls, and programmes that engage families and communities. Stronger policy-making and programming also require expanding the evidence on adolescent health and rights in LMICs for both younger and older adolescents, boys and girls, and relating to a range of key health matters affecting adolescents.

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The findings call for further examination of the health consequences of early marriage. What are even less clear are the pathways through which the associations between early marriage and adverse outcomes take place. There is a need for research that traces these links. At the same time, findings argue strongly for programmatic measures that delay marriage and recognize the special vulnerabilities of married adolescent girls.

For married young women, sex is not always consensual or wanted. Further research is required to determine the effects of unwanted sex on sexual and reproductive health outcomes and to help programs develop the best strategies for dealing with coerced sex within marriage.

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In India, evidence is sparse regarding the demand for contraception to delay first pregnancy among married young people. Using data drawn from a study conducted in six Indian states among 9,572 women aged 15-24 who were married for five or fewer years, we explore the scope of this demand, the extent to which it has been satisfied, and, using logistic regression analyses, the factors correlated with contraceptive use to delay first pregnancy among those reporting demand. Findings confirm considerable demand for contraception to postpone first pregnancy (51 percent). Of those with demand, only 10 percent had practiced contraception. Contraception was more likely to have been practiced by educated women, those aware of family planning methods before they were married, those exposed to quality sexuality education, and those who participated in marriage-related decision making. Women who reported feeling pressure to prove their fertility were less likely to have practiced contraception.