UNFPA AND ADOLESCENTS
Introduction
Whenever adolescent reproductive health is discussed, a series of critical
issues emerges. Should adolescents be allowed to have access to reproductive health
information and services? Will formal education about reproductive health and sexuality
lead to promiscuity? What forms of education are needed, and who should provide it? Should
newly married couples be encouraged to postpone the first pregnancy?
While respecting social and cultural diversity, the position of the United
Nations Population Fund (UNFPA) on reproductive health is unequivocal. Reproductive health
is a right for everyone, including young people. When young people have access to private
and confidential services, they are better able to protect themselves against sexually
transmitted diseases (STDs), avoid unwanted pregnancy, care for their reproductive health
and take advantage of educational and other opportunities that will affect their lifelong
well-being. Some people fear that access to information and services will lead to greater
sexual activity among youth, but numerous studies have found that this simply is not the
case. Young people need comprehensive information and access to services. They have the
right to privacy, confidentiality and respect.
When considering the programme requirements of adolescents, it is
important to recognize and address the diversity of needs. Young married couples, sexually
and nonsexually active teenagers, young mothers, abused adolescents, girls who have
suffered female genital mutilation (FGM), as well as children in especially difficult
circumstances like refugees, street children, commercial sex workers, handicapped, poor
and uneducated adolescents and adolescents with an STD or HIV/AIDS all have very different
needs. These diverse needs must be approached and addressed in very different ways. A
comprehensive and socio-culturally appropriate approach to information and education
activities and services should be provided. Knowledge as well as contraceptives and
youth-friendly health services are needed to encourage healthy and responsible behaviour.
It is important to understand adolescent sexual and reproductive health in
the context of the individual's overall life situation. Sexual and reproductive health is
part of physical and emotional well-being. A holistic approach is essential if adolescent
sexual and reproductive health needs are to be addressed successfully.
Adolescents are faced with a number of critical issues unique to their age
group, such as changes in the body brought on by puberty, and the implications of teen
pregnancy. In light of the importance of these matters, UNFPA approaches adolescent
reproductive health in a number of ways within the parameters of its three programme
areas: reproductive health; population and development strategies; and advocacy.
On the local and global scales, the Fund integrates young people's
opinions into its activities from design to implementation and evaluation. Over the past
three decades, UNFPA has funded the development and inclusion of population education in
school curricula and programmes to reach out-ofschool youth in over 100 countries. The
Fund promotes the formulation and adoption of laws and policies to support adolescent
reproductive health worldwide. Clearly, there is much that UNFPA--together with young
people, their families, parents, teachers, religious leaders, communities,
governments, the media, as well as grassroots and other organizations--can do to expand
young people's life options, so that they can develop their full potential and contribute
effectively to their communities.
Why Focus on Adolescents?
As we move into the next millennium, some 17.5 per cent of the estimated
world population of 6.09 billion in the year 2000 will be aged 15 through 24. Today,
births to teenage women account for a little over 10 per cent of all births worldwide.
While the global birth rate for women under age 20 is declining, the number of adolescents
worldwide is increasing, so that the total number of births to young women is growing.
Moreover, fertility rates are declining more rapidly among women of other age groups,
which means that births to adolescents account for an increasing proportion of overall
births in many countries.
Actions taken during adolescence can affect a person's life opportunities,
behavioural patterns and health. For physical, sociocultural, economic and psychological
reasons, young people are typically poorly informed about how to protect themselves
sexually and are thus particularly susceptible to unwanted pregnancies and sexually
transmitted diseases, including HIV/AIDS.
Did You Know:
- More than half of the world's population is under age 25.
- The number of people aged 10-19 was 1.1 billion in 1995.
- The United Nations estimates this number to increase to 1.25 billion in
the year 2010 and to 1.3 billion by 2020--a 22 per cent increase from 1995.
- 17 per cent of married women aged 15-19 use contraception in less
developed countries.
- 15 million adolescent women give birth each year, mainly in developing
countries.
- Infant mortality rate to adolescent mothers is 1.5 times higher than to
mothers aged 20-29.
- Up to 4.4 million abortions to adolescent women in developing countries
take place each year.
- 1 in 20 adolescents contracts an STD each year.
- Half of all cases of HIV infection are in people under age 25.
- 20 per cent of adolescents are illiterate in less developed countries.
Sources: UN, "The Sex and Age Distribution of the World
Population" 1994; Population Reference Bureau/Centre for Population Options,
"The World's Youth 1994: A Special Focus on Reproductive Health ". |
In some societies, premarital pregnancy and childbearing is
culturally accepted--and even condoned--as a way for a young woman to prove her fertility.
In other places, a large proportion of teenage pregnancies is unwanted, as evidenced by
the fact that the abortion ratio for teenagers is high. It has been estimated that between
1 and 4.4 million adolescent women have abortions in developing countries each year.
Young single women frequently seek abortions in unsafe conditions. This is
partly because they are more reluctant than adults to admit to their pregnancy at an early
stage. Even where abortion is legal, unmarried adolescents often avoid seeking help from
the official health care system since they do not want anyone to know they are pregnant.
There is widespread misinformation among adolescents about self-induced abortions; these
can be fatal.
Teenage mothers face a higher-than-average risk of maternal death than
mothers in their twenties, and their children have higher levels of morbidity and
mortality. Early marriage and childbearing also impede young women's educational and
employment activities. This, in turn, impacts negatively overall on a country's
development as a whole.
High levels of adolescent pregnancy, childbearing and unsafe abortions
reflect--and result in--a lack of educational and economic opportunities. Young women and
girls, particularly those who are poor, face considerable pressure to engage in sexual
activity and are especially vulnerable to sexual abuse, violence and prostitution.
"Early childbearing increases the likelihood
that an adolescent mother and her children end up on the streets: an estimated 100 million
children around the world live and work on city streets, sometimes as prostitutes. Studies
have found that approximately 800,000 girls under age 20 work as prostitutes in Thailand,
500,000 in Brazil, and 400,000 in India. " --Population Reference Bureau,
1994.
Laying the Groundwork
for the Future
Adolescence is a time of gradual yet dramatic transition: socially,
physically and psychologically. It is a "preparation period", during which the
child develops into an adult. This definition is new in many societies, where the
transition from child to adult was traditionally rapid, often marked by a special event
with a symbolic or educational aspect.
In the past, adolescents were largely neglected in both health and family
planning programmes. This is partly explained by the fact that in many societies
adolescents are not considered sexual beings until marriage. Another factor in this
systemic neglect is the unfounded fear that providing information and services would
encourage premarital sexual activity. As a result, unmarried adolescents have been denied
access to services by law or policy. And yet, young people's reproductive health needs
require urgent consideration, as indicated by recent global trends.
In many countries, young people are spending more time pursuing an
education, marrying later and reaching the onset of puberty at an earlier age. According
to a 1995 study by the International Planned Parenthood Federation (IPPF), the majority of
young people become sexually active in their teens. These trends coincide with increasing
urbanization, poverty, exposure to conflicting ideas about sexual values and behaviour,
and breakdown of traditional channels of information about sexuality and reproduction. As
a result, adolescents are increasingly engaged in premarital sexual activity, often
without the intent to reproduce, without the knowledge or means to do so safely and
sometimes without the young person's free consent.
"In developed and in developing countries,
adolescents initiated sexual activity at about the same age. However, pregnancy rates are
5 to 20 times higher in developing countries, because sexual and contraceptive education
and services are usually absent. "
--Evert Ketting, "Planned Parenthood Challenges. Empowering Youth. " IPPF, 1995.
In addition to the new realities of the modern world,
harmful traditional practices, as well as societal values and structures often directly
worsen the adolescent's sexual and reproductive health, and restrict access to empowering
opportunities. As a result, young people are exposed to serious risks that threaten to
compromise their health, and future social and economic situation.
The health risks include too-early and unwanted pregnancy and childbirth,
unsafe abortion, female genital mutilation (FGM.), and transmission of STDs, including
HIV/AIDS. These risks can lead to disease, infertility and death. Social risks include
rejection and lower education which generally lead to decreased life opportunities and
greater likelihood of poverty.
From a national perspective, these risks are costly. There are
expenditures directly associated with both child-bearing and disease, and indirect costs
incurred when the full potential of the individual is not realized. Moreover, early
child-bearing generally leads to higher lifetime fertility for the individual woman and to
a reduction in the time-span between generations.
International
Support for the Rights of Young People
The rights of children (to the age of 18) are outlined in the United
Nations Convention on the Rights of the Child and were reaffirmed at the World Conference
on Human Rights in 1993. The 1994 International Conference on Population and Development
(ICPD) Programme of Action speaks specifically of the right of adolescents to reproductive
health education, information and care. In addition, the ICPD Programme of Action and the
1995 Fourth World Conference on Women (FWCW) Platform for Action deal specifically with
the special needs and the rights of the girl child.
The ICPD agreed in Cairo in 1994 to "substantially reduce all
adolescent pregnancies". This was further strengthened at the 1995 Fourth World
Conference on Women in Beijing, which took the position that "In all actions
concerning children, the best interests of the child shall be a primary
consideration." Furthermore, the World Programme of Action for Youth for the Year
2000 and beyond, adopted by the General Assembly in 1995, singled out UNFPA for mention in
continuing to meet the health needs, including reproductive health, of adolescents.
International support for adolescent reproductive health and adolescent
rights has been reinforced by a number of initiatives supported by the United Nations. In
1989, the World Health Organization (WHO), UNFPA, and the United Nations Children's Fund
(UNICEF) published a joint strategy for action for adolescent reproductive health and have
since supported a number of related regional and country programmes.
Although many governments support these rights, enforceable laws are
not always in place to ensure that they are guaranteed. As a result, the status of
adolescent sexual and reproductive health in many countries needs to be improved.
ICPD Programme of Action. Paragraph 7.44:
"The objectives are:
(a) To address adolescent sexual and reproductive health issues, including
unwanted pregnancy, unsafe abortion and sexually transmitted diseases, including HIV/AIDS,
through the promotion of responsible and healthy reproductive and sexual behaviour,
including voluntary abstinence, and the provision of appropriate services and counselling
specifically suitable for that age group;
(b) To substantially reduce all adolescent pregnancies. "
ICPD Programme of Action. Paragraph 7.41:
"... In particular, information and services should be made available
to adolescents to help them understand their sexuality and protect them from unwanted
pregnancies, sexually transmitted diseases and subsequent risk of infertility. This should
be combined with the education of young men to respect women's self-determination and to
share responsibility with women in matters of sexuality and reproduction.... "
International Consensus On Children's Rights U.N. Convention on the Rights of
the Child, Article 27: "States should recognize the right of every child to a
standard of living adequate for the child's physical, mental, spiritual, moral and social
development... "
World Conference on Human Rights, Vienna Declaration and Programme of Action, Part
III, Chapter II, Paragraph D: "Exploitation and abuse of children should be
actively combatted, including byaddressing their root causes...." and "... The
World Conference urges States to repeal existing laws and regulations and remove customs
and practices which discriminate against and cause harm to the girl child".
ICPD, Paragraph 7.46: "Countries, with the support of the international
community, should protect and promote the rights of adolescents to reproductive health
education, information and care and greatly reduce the number of adolescent
pregnancies".
FWCW Platform for Action, Paragraph 97: "The human rights of women include
their right to have control over and decide freely and responsibly on matters related to
their sexuality, including sexual and reproductive health, free of coercion,
discrimination and violence. " |
Critical
Aspects of Adolescent Reproductive Health
Although certain risks are associated with all sexual activity, this is
particularly so for adolescents. Young people need education and economic opportunities.
They also need information and services to protect their reproductive health and help them
avoid abortion.
Teen Pregnancy
To the young mother, pregnancy can be a health risk. A young woman is
usually not ready for childbirth until she is at least 18 years old. Yet approximately 15
million young women ages 15 to 19 give birth every year, accounting for more than 10 per
cent of all babies born worldwide. Pregnancy is much more dangerous for teens--four times
riskier than for 25 to 29 year olds. For girls ages 10 to 14, maternal mortality rates may
be five times higher than for women in their early twenties, and their children are also
more likely to fall sick or die in infancy.
Maternal MortalityPregnant adolescents are at
higher risk than 20 to 34-year-olds of encountering the four main causes of maternal
mortality: haemorrhage; hypertensive diseases of pregnancy; infection; and abortion. These
risks can be substantially decreased by measures such as access to essential obstetric
care and by preventing unsafe abortion. |
Biological and socio-economic factors, including physical
immaturity, poverty, lack of education and lack of access to appropriate medical care,
increase an adolescent's risk of pregnancy-related complications. Adequate pre-natal care
and nutrition are of particular importance for young mothers.
Very often, young pregnant women face severe social problems. Many girls
find themselves mothers on their own without responsible fathers for their child. Women
who become mothers during their teens generally end up with less education and fewer job
opportunities. This, in turn, exposes them to greater risk of poverty. In a minority of
cases, this may also work the other way around: getting pregnant and being supported by a
man can be a survival mechanism for a poor, uneducated woman.
The infant of a teen mother faces greater risks than a child born to a
mother in her twenties. The child is more likely to be hurt during delivery or to have low
birth weight In addition, when pregnancy has adversely impacted the mother's life
opportunities, the child is more likely to suffer from poor nutrition, as well as late
physical and cognitive development. These setbacks can lead to the child having learning
problems when compared to peers.
Female Genital Mutilation
(FGM)
The practice of female genital mutilation has a life long effect on the
sexual and reproductive health of girls (see box). The related health risks include
haemorrhage, shock, infection, chronic pelvic inflammatory disease, psychological
problems, sexual dysfunction, infertility, obstructed labour and death. By removing the
organs that give a woman sexual pleasure, FGM often limits a woman's sexuality to one
area: reproduction. The practice is a deeply-rooted tradition in many societies and must
be challenged in a multi-disciplinary approach that changes public opinion.
The Health Risks of FGM FGM is a violation of the basic human right to bodily
integrity and it involves serious health risks. The body of the girl is mutilated in an
irreversible manner at an age where the girl herself is not able to make an independent
decision as to whether she wants to go through this procedure. These are the main reasons
why FGM should be actively abolished. Besides the serious health risks connected to the
procedure itself, FGM increases vulnerability to STDs and HIV. Transmission can occur
during the mutilation if the same instrument is used on several girls. Afterwards, the
wounds and the increased likelihood of tearing of the skin during sexual intercourse
constitute major risks for STDs and HIV transmission.
FGM is practised in as many as 28 African countries and
known or suspected to be practised in a number of developed countries by immigrants from
Africa. WHO has estimated that between 85 and 1 15 million women living in the world today
have been subjected to FGM and that 2 million girls under go the procedure each year. |
Combatting
FGM Nationally and Globally
Thanks to a recent UNFPA pilot project in eastern
Uganda, the Reproductive, Educative and Community Health Programme (REACH), the number of
girls and women undergoing "cutting" in the targeted district declined by 36 per
cent between 1994 and 1996. REACH actively educates policy makers, health professionals,
parents and adolescents on the need to abolish the practice. The programme stresses that a
community's cultural values are different from its practices, and that the
latter can change without compromising the former. It promotes ceremonies marking
adolescents' passage to adulthood which preserve the feasting and dancing that often
accompany female genital mutilation, but replace the circumcision procedure with symbolic
gift-giving.
On the global level, UNFPA joined with UNICEF and WHO to
adopt a joint plan to bring about a major decline in female genital mutilation in 10 years
and to completely eliminate the practice within three generations. The three agencies will
emphasize a multi-disciplinary approach and teamwork at the local and global levels. They
will bring together governments, political and religious institutions, international
organizations and funding agencies in their effort to eliminate the harmful traditional
practice. Emphasizing changing public opinion, the three agencies will target audiences
including the general public, medical professionals, decision makers, governments,
political, religious and village leaders, traditional healers and birth attendants.
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Sexually
Transmitted Diseases and HIV/AIDS
Sexually transmitted diseases, including HIV/AIDS, pose serious
threats for all sexually active people, but they constitute a particular risk to
adolescents due to physical, psychological and social factors.
Often, young adults do not understand how to protect themselves against
sexually transmitted diseases. Because most societies frown on premarital sex, young
people may be embarrassed to seek help and may be turned away if they do.
Stopping the
Spread of AIDS
UNFPA currently supports HIV/AIDS prevention activities for youth and
adolescents in 95 countries.
Increasing attention is being given to specifically addressing the
reproductive health needs of young people. In the majority of the countries reporting
support for HIV/AIDS prevention, UNFPA projects target adolescents either through
population education activities in schools or through community based information and
education activities. During 1996, several countries initiated projects involving
reproductive health counselling directed to adolescents on unwanted pregnancies and the
prevention of STDs, including HIV (Dominican Republic, Mali, Namibia, Nicaragua, Panama,
South Africa and Uganda). An important means of reaching out to adolescents is through
prevention programmes targeting scouts (Burundi, Botswana, Kenya, Mongolia, Madagascar and
Senegal), youth groups (Morocco and Egypt) and holiday camps (Romania and Syria).
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Evidence suggests that adolescent women constitute the sex and age group
most susceptible to STDs including HIV infection. Young women are physiologically more
vulnerable to STDs and also more vulnerable to coercion.
Social reasons for increased risk of STDs including HIV and unwanted
pregnancy exist on different levels. Some relate directly to the situations in which
adolescents are put at risk such as unequal relationships because of the low status of
women, young people and the poor. Examples of this are manifold and include sexual abuse,
incest and situations where the woman is not able to determine when and how to have sexual
intercourse. Sexually transmitted diseases are also transmitted because of to the failure
or inability to negotiate contraceptive use, promiscuous behaviour by partners,
relationships involving money for sexual favours ("Sugar Daddies" or "Sugar
Mommies") and full-time prostitution.
From 75 to 85 out of every 100 HIV infections are transmitted through
unprotected sexual intercourse, but the virus also spreads through mother-child
transmission, blood transfusion and drug use. The latter constitutes a particular danger
for young people. Tobacco, alcohol and other drugs are readily available to most young
people. In the modern world, these substances constitute a real danger to adolescent
health in both the short and long term. Their use has been linked to high rates of STD and
HIV transmission.
Dispelling
Myths in the Philippines
The Second Young Adult Fertility and Sexuality Study, implemented by
the University of the Philippines Population Institute with financial assistance from
UNFPA, was a nationwide study involving some 11,000 youths.
The study found that young Filipinos generally are aware of HIV/AIDS,
and that most understand how HIV is transmitted and how it can be avoided. But many do not
know that an infected person can remain asymptomatic for years, and there are still some
who believe--mistakenly--that AIDS can be cured.
The survey revealed that although about 10 per cent of the young men
interviewed had engaged in casual or commercial sex, only a small proportion used condoms.
These findings illustrate the need for education to address mistaken
attitudes and help these young people realize their greatest potential.
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Contraceptive Use
Although the use of condoms is known to guard against the transmission of
STDs, young people's psychological development often leads to risky sexual behaviour.
Having unprotected sex might also be a result of adolescents being less capable of
thinking through the consequences than adults. Young people have less developed
"future orientations". The embarrassment of obtaining condoms may be more
important than the fear of pregnancy or a future disease. Moreover, the adolescent is
likely to believe in what is called the "personal myth," i.e., that "bad
things will not happen to me".
Another developmental aspect that may influence the use of contraception
involves the fact that adolescents are usually still influenced by the values of their
parents and other adults. When a young person knows that these adults disapprove of
adolescent sexual activity, then he or she may be less likely to obtain contraception
beforehand since that would be admitting to the intention to do something perceived as
wrong.
Another indirect social cause is the failure of societies to recognize and
address all these problems in a way that will meet the needs and respect the rights of
adolescents. Unmarried adolescents have often been denied access to sexual and
reproductive health services including access to contraceptives. In many places, the
expectation of young married couples to prove fertility has prevented them from practising
family planning.
Programming
for Adolescent Reproductive Health
Healthy adolescent development can be undermined by factors in the social
environment. These include poverty and unemployment, gender and ethnic discrimination, and
the impact of social changes on familial and cultural support systems. While programming
for adolescent health cannot directly focus on the inequities present in many countries,
these conditions represent real constraints to improving the health and welfare of youth.
The attitudes and behaviours that health programmes seek to influence often arise from
other socioeconomic influences. For this reason, adolescent reproductive health
programming must be integrated with all aspects of social development.
Young men and young women both require comprehensive education and
services; the different needs of each group must be a factor in programme design and
implementation. Gender differences and developmental stages must be addressed in
programming.
Male Involvement--Male NeedsRecently,
male involvement and responsibility have been increasingly incorporated into sexual and
reproductive health policies and programmes.
In adolescent programming, it should be natural to stress the equal and individual
responsibility for safe and healthy sexual behaviour; the need for the man to respect the
reproductive choices of the woman; and the shared responsibility in case of pregnancy and
childbirth.
However, men are sometimes raised with very different ideas and expectations. In this
regard, special attention also has to be paid to male adolescent needs and attitudes. |
Young girls hospitalized for abortion complications will
have a particular need for information about contraceptive use and the dangers of unsafe
abortion. Pregnant adolescents have special nutritional needs and are in special need of
maternity and postnatal care. Adolescents wishing to delay first sexual intercourse might
be in special need of improved self-esteem and negotiating and communication skills. When
dealing with street children there is a particular need to view their health risks in
light of their circumstances.
Adolescent Refugees
The case of adolescents in refugee situations illustrates the
importance of taking into consideration the special conditions of the life situation of
the target group. Adolescent refugees who have lost their natural role models, i.e., peers
and relatives, may be more likely to look to service providers as role models; service
providers should be aware of their potential influence. The same loss may lead to an
increase in risky behaviour since there is less risk in being condemned. A larger
prevalence of sexual violence may also result in this situation.
Source: UNHCR: The Interagency Field Manual for Reproductive Health
in Refugee Situations, 1995 |
Involving Young People
In light of the complexity of issues facing adolescent reproductive health
programming, it is crucial that young people be involved in all aspects of programming.
They should be the subjects and not the objects of programmes. They must be involved in
baseline studies of adolescent need, as well as in the planning, implementation and
evaluation stages of a programme.
Family Planning at
Health Clinics
In Jamaica and Antigua, where family planning is offered
to all individuals at health clinics, a UNFPA evaluation team found that setting aside
special days or space for family planning services discouraged adolescents to make use of
the services, because this system exposed what services adolescents came to the clinic to
obtain.
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I nvolving adolescents in programme planning enables programme
personnel and management to understand the adolescent way of thinking, behaving and
responding in the particular cultural setting.
Training
Youth to Train Youth and Stay in School
Since 1994, UNFPA has supported the Botswana YWCA's Education Centre
for Adolescent Women (ECAW), which helps teen mothers finish school, and its Peer Approach
to Counselling by Teens (PACT) programme.
ECAW is a one-year study programme designed to help young mothers
continue their education. It provides an integrated programme of education, counselling,
and day care to prepare young women for the certification necessary to enter secondary or
vocational schools.
PACT is a preventive programme that helps teens counsel each other. In
each participating school, ten students and one teacher attend a one-week workshop as well
as weekly meetings to help them address teenage troubles. Counsellors are trained in a
variety of topics, ranging from human sexuality to problem-solving. They urge their peers
to stay in school, delay having sex, and, if they are already sexually active, to get and
use contraceptives to prevent unplanned pregnancy and STDs. A recent evaluation showed
that PACT is ready to be introduced to schools nationwide.
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Involving Young
People: Essay Competition
To give greater voice to youth, and to assist the Fund in its work with
young people, UNFPA organized an essay contest last year under the theme "Promoting
Responsible Reproductive Health Behaviour: The Youth Perspective". The response was
overwhelming. Thousands of young people from 112 countries sent in entries that were
serious and direct. Worldwide, youth are requesting unrestricted access to education,
information and services of reproductive health.
The essays made clear that young people want information on reproductive
health and sexuality education, preferably from their parents. They want this information
early and in a form appropriate to their psychological and physical development.
Young people want to have at their disposal --and this does not mean they
will automatically use those services--family planning information and supplies to avoid
early and unwanted pregnancy, and abortion, and to protect themselves from sexually
transmitted diseases, including HIV/AIDS.
Another key theme that emerges from these entries is an abhorrence of sex
discrimination. The writers accurately point out that sex discrimination begins at the
moment of birth in many cultures, where the family rejoices over the birth of a boy, but
not if the baby is a girl. They also want everyone, particularly girls, to have access to
basic education. They firmly condemn all forms of sexual abuse and exploitation,
particularly that of young women.
The essay contest was held as part of the momentum for the World Youth
Forum, held in Vienna in November 1996. More than 300 representatives of young people' s
nongovernmental organizations (NGOs) attended the Forum. Its focus was on how
nongovernmental organizations can best work with the United Nations to implement the World
Programme of Action for Youth. In conjunction with UNFPA, many youth and youth-related
NGOs also helped organize the essay contest. Other large organizations such as national
chapters of the World Young Women's Christian Association, the World Association of Girl
Guides and Girl Scouts and the World Organization of the Scout Movement participated.
Medical students and young Rotarians also helped organize the contest. In addition, there
were numerous entries from religious groups, arranged through the Geneva-based World
Council of Churches.
Many countries organized nationwide contests. There were 3,000 entries
from South Africa alone. The contest in El Salvador became a community event, with
participation of not only the young people, but also their parents and teachers.
Involving Young
People: Africa Youth Forum
More than 500 delegates from throughout subSaharan Africa attended the
historic African Forum on Adolescent Reproductive Health, convened in Ethiopia in January
1997 by the Fund's Africa Division. The Forum brought together a diverse group of people,
indicating the importance with which adolescent reproductive health is regarded in the
region. Those attending included youth activists and health promoters, top government
officials, experienced front-line health care providers, religious leaders, researchers
and academicians, legal experts, traditional artists, donors and journalists. Forty-one
African countries were represented, as well as 12 North American, Caribbean, European and
Asian nations.
Young people comprised one third of the delegates. They brought their own
ideas and perspectives about the issues and enlivened each day with their dynamism and
commitment. The exchange of ideas continued beyond the working groups and workshops into
the evening hours and again in the early morning, before the plenaries began. People of
all ages shared their thinking and discovered common ground on which to form and
strengthen coalitions.
Youth Speak Out UNFPA's
First International Essay Contest
"On the one hand, society places a protective veil over the realm
of sex, preventing young people from getting the knowledge they need; on the other, young
people's senses are excited ... how can teenage pregnancy be prevented under such
conditions? I believe that the fundamental solution is to provide sex education to young
people."
--Zhou Quan, 18, China
"The media must play a role in this raising of awareness ... They
must try to learn young people's opinions, particularly with regard to subjects relating
to population and development, in order that in the future, every person is able to enjoy
all his rights and freedoms ... without discrimination.."
--Moshera Saad El-Deen Mahmoud Zidan, 19, Egypt
"People must be educated not to disapprove when a woman carries
out activities which only men can allegedly perform ... and also not to disapprove of men
who help out at home or in some other activities which until now have only been done by
women."
--Carolina Leonor Ruiz Herrera, 18, Guatemala
"History demonstrates that the imposition of
extremely strict taboos on sexual relations yields no effective results. On the contrary,
various benighted interpretations of the sex act emerge which have a pernicious effect on
young people."
--Elmira Gilmudinova, 17, Kazakhstan
"Man, like a bird, needs the combined force of his two wings--one
male and one female--to fly, otherwise his flight will be skewed. As long as I'm prevented
from realizing my fullest potential, you won't be able to realize yours because you'll be
working alone for two. Encourage me to study and acquire knowledge so that all my sisters
and I won't be unemployed as a result of ignorance and
illiteracy."
--Mwimpe Kamanga Julie-Jamal, 19, Zaire
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Discussion produced a rich variety of conclusions and recommendations for
strengthening health policies and services to better meet the critical needs of
adolescents. Recommendations included making reproductive health services"adolescent-
friendly" to encourage the patronage of young people; providing services to
disadvantaged adolescents such as those who are imprisoned, disabled or orphaned; and
formulating comprehensive national policies to meet the reproductive health needs of all
teenagers.
"Youth-friendly"
Health Services
Sexual and reproductive health services should include preventive services
such as the provision of contraceptives, counselling and testing services for pregnancy
and STDs. They should also provide intervention and treatment in case of disease, delivery
services and pre- and post-natal care.
Opportunity should be provided for feed-back from young clients.
Adolescents, like all individuals, should be empowered to make fully informed
contraceptive choices. This implies an understanding of contraceptive options: how they
work, how to use them and their side-effects. Moreover, the counsellor should address the
fears the adolescent may have regarding contraceptive use, on negotiating contraceptive
use with the partner and regarding the counselling itself. For example, if postponement of
the pelvic examination would increase the likelihood of continued use of both
contraception and the counselling service, then this should be considered.
By Women for
Women: Comprehensive Services for Palestinian Refugees
Poverty and an environment inattentive to women's needs are part of
life in the Gaza Strip. Female teenagers in Gaza are an especially neglected group.
Because tradition holds that these girls are best protected by strict family codes, issues
such as incest and rape usually go unmentioned in an attempt to safeguard family honour.
In addition, health programmes for women generally focus on maternal health. But now,
teenage girls have a place to turn in Gaza.
In 1995, UNFPA supported the establishment of a women's centre at the
Al-Bureij refugee camp. It now provides reproductive health services, pre- and postnatal
care, family planning, legal assistance and, most recently, exercise programmes so that
women can increase their physical fitness. All services are located under one roof, and
are provided for women, by women, and based on a comprehensive approach to the well-being
of women. Staff members conduct home visits to introduce the Centre and its services and
for follow-up. Free transportation is provided for women living in remote areas. The men
from the Al-Bureij have been supportive of the programme and have even attended some of
the Centre's activities.
The Centre holds weekly seminars, where the women who attend choose
topics. These have included the importance of breast-feeding, anaemia, violence in the
family, social conservatism, menopause, sexual education (for both women and men),
post-partum depression, labour rights, women and divorce, inheritance, and dowries.
"We are able to discuss issues that usually we cannot," says camp resident Zaleh
Odeh.
Because of its comprehensive approach, individualized care and direct
focus on education and counselling, the Women's Health Centre at Al-Bureij has become a
beacon of hope for women throughout the West Bank and Gaza Strip. It will soon be
replicated in another area with staff trained at Bureij.
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Youth-friendly Health
Services"
Two words cover the requirements for success in terms of adolescent use
of services: "accessibility" and "acceptability". In practical terms,
this means: - Privacy and anonymity should be assured.
- Time and place: Services should be within an accessible distance,
have convenient hours and waiting time should be limited.
- Personnel: Empathic and nonjudgemental personnel should be able to
communicate with adolescents, be sensitive to their fears and their relationships in the
community. Strangers might be preferable to parents' acquaintances.
- Quality: A wide range of services should be available in one place;
safety is a must, and this includes sterile and proper equipment and well-trained
personnel. Sufficient time should be available for each client, and comprehensive
information given in everyday language and with informational material.
- Cost: Services should be affordable for adolescents.
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Studies show that in some places, the majority of adolescents think that
using contraceptives can lead to infertility. In addition, many young people use
contraceptives incorrectly. For instance, some take birth control pills only after
intercourse. It is important that contraceptive counselling be explicit.
Clinical services for adolescents must be equipped to handle the
complications of unsafe abortion. In areas where adolescents account for the majority of
abortions, an appropriate response might be to establish a clinic for adolescents that
would provide a comprehensive range of services (including emergency contraception) and
STD prevention and treatment services, including providing advice on alcohol and drug use.
Health care providers in clinics serving adolescents should be able to
screen and refer high risk pregnancies. It is not enough to only care for the mother
during pregnancy; postnatal services must also be provided. The success of adolescent
reproductive health services should be measured by several factors, including decreased
pregnancy and birth rates. Other measures of success are increased use of the facilities
over the years, as well as increased knowledge about health and safe sex practices.
Clients should be satisfied with the counselling they receive.
Giving
Chilean Youth a Forum to Discuss Their Sexuality
The non-governmental organization Education for Improving the Quality
of Life has created a forum where young people can discuss their feelings and sexuality,
and receive the information they need to understand their fertility and make informed
choices about sexuality and child-bearing.
The programme (known by its Spanish acronym, JOCAS), organizes group
discussions of 20 people or fewer. The dialogues cover a range of previously taboo topics
(including the use of condoms and prevention of sexually transmitted diseases).
Participants are encouraged to share information, explore prevailing attitudes, discuss
their values, and express their doubts, anxieties and questions about sexuality.
Facilitators are trained to encourage participation and to respect silences during the two
hour dialogues. Questions are noted and answered the following day by nurses,
psychologists and clerics.
In Chile, which has one of the highest rates of illegal abortion in
Latin America, this project offers a welcome forum for youth to gain the tools they need
to understand their fertility and the challenges of responsible parenthood.
The UNFPA-supported programme started in several regions in 1995. It
was expanded in 1996 and is now spreading to all parts of the country.
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Adolescents often more readily open up to peers than to adults about
issues of sexual and reproductive health. This makes young people the obvious choice for a
number of roles including:
- Facilitators in participatory education and group discussions;
- Safe sex promoters;
- Condom distributors
- Peer counsellors and educators; and
- researchers.
Advocacy. Law and Policy
It is essential to increase awareness--at all levels of society--of the
importance of the issues involved in adolescent reproductive health. Building such an
enabling environment is one of the Fund's greatest challenges. Efforts in this regard take
the form of political advocacy to develop and enforce laws and policies in support of
adolescent sexual and reproductive well-being. Advocacy efforts also include strengthening
government ministries and local organizations, fostering strategic alliances and
increasing public awareness.
High rates of childbirth, abortions and transmission of STDs and HIV among
adolescents cause problems for society and are costly to a nation. Thus, it is in the
interest of governments to address the problems of adolescent sexual and reproductive
health. Moreover, if the countries have ratified the United Nations Convention on the
Elimination of All Forms of Discrimination Against Women and the United Nations Convention
on the Rights of the Child they are obligated to modify their laws and programmes
accordingly. Countries which adopted the ICPD Programme of Action and the FWCW Platform
for Action are expected (although not bound) to bring their own programmes in line with
these agreements.
States are increasingly recognizing the needs of young people including
adolescents and are developing "youth policies" as part of national population
and development policy. Adolescent sexual and reproductive health should be a made part of
any such youth policy.
Policies in support of adolescent sexual and reproductive health should
include equal rights for women and equal life opportunities; minimum legal age for
marriage, access to health care including adequate nutrition, reproductive health services
and contraceptive services; and sexual and reproductive health education as part of a
wider framework of universal education for all.
In addition to societal structures which can make it difficult for a
programme to reach adolescents, the Fund has found that "gatekeepers" such as
parents, community leaders, religious leaders, health personnel and educators may oppose
adolescent reproductive health programmes for various reasons. For example, despite
numerous findings to the contrary, there is widespread belief that providing information
and contraceptives will increase sexual activity among adolescents. Religious and
traditional leaders might be afraid to lose the status they hold in society when
traditional beliefs, values and customs are challenged. Parents might feel that programmes
invade the privacy of the family, where they hold responsibility and are in charge. These
obstacles can be successfully addressed by building a climate of awareness and trust.
Advocacy in the Arab States
In spite of great diversity in terms of social indicators, Arab
countries face several common challenges with respect to the well-being of young people.
Harmful traditional practices, including female genital mutilation, are prevalent and the
overall status of girls and women is low.
Still, governments throughout the region share a commitment to
population and development issues and to implementing the goals and objectives of the ICPD
Programme of Action. A national conference on reproductive health was held in Baghdad,
Iraq, where the Minister of Health reaffirmed the Government's support for family
planning. In Sudan, a workshop was organized to develop a five-year plan for reproductive
health activities.
The Fund works closely with governmental and nongovernmental agencies
in order to strengthen the adaptation and implementation of guidelines for reproductive
health, and to set programme priorities. It provides training and logistical support, all
with the aim of strengthening national capacity.
UNFPA emphasizes incorporating adolescent reproductive health
components into national policies, in spite of socio-cultural barriers and conservative
trends prevailing in some countries. There is an increased awareness among policy makers
and community leaders of the importance of this issue, and UNFPA has helped to improve
coordination of the initiatives undertaken by governments and NGOs in this area.
With support from UNFPA and other donors, a number of countries of the
region launched new programmes on sexual and reproductive health for youth. To further
sustain this new trend and as part of its advocacy efforts aiming to promote the
reproductive health of youth in the region, UNFPA organized a regional meeting that
gathered more than 60 government, youth and NGO representatives. UNFPA enlisted additional
allies in this field, and a joint agreement was signed with the Islamic Educational,
Scientific and Cultural Organization (ISESCO) in 1996.
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Knowledge
and Responsibility: Population Education
Population education devotes considerable attention to family life,
sexuality and human ecology. Educators have long realized that traditional methods of
instruction do not sufficiently prepare young people to meet realistic and important
challenges.
Population education stresses participatory teaching techniques that
encourage students to think about the implications of their own behaviour. Children become
sensitized; they learn to care what happens to other people and the environment as a
result of irresponsible behaviour.
Contrary to popular belief, population education does not increase
promiscuity.
Population education emphasizes family life and sexuality education, which
encourages responsible and ethical behaviour, including higher levels of abstinence, later
start of sexual activity, higher use of contraceptives and fewer sexual partners.
In-school
Population Education for Russian Teens
UNFPA is supporting a project in the Russian Federation to address the
critical lack of family life education in the school system. With one of the world's
highest abortion rates and rapidly spreading STDs, there is urgent need to develop
awareness of sexual health issues.
UNFPA supports both the Ministry of Education and the Russian Family
Planning Association in their efforts to increase awareness of key officials and
strengthen the Ministry of Education. It also focuses on measuring and improving knowledge
and attitude about reproductive health among teachers, parents and students, through
meetings, surveys and the development of academic materials.
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The Fund has worked with ministries of education in over 100 countries to
introduce education regarding population, including reproductive health and gender issues.
Spreading
the Word: Population Education in the Americas
UNFPA supports including population education in formal and non-formal
educational sectors.
The Fund helped achieve the inclusion of population education into
curricula as part of educational reforms in countries including Bolivia, Peru and
Honduras. In Colombia and Venezuela, UNFPA supported the development of innovative
outreach and school associated approaches; in some cases governments have taken over these
models and built upon them. In Ecuador, population education activities are being
operationalized with the involvement of local populations in school activities in order to
reach youngsters as well as their parents.
UNFPA also supports non-traditional forms of education, largely through
its assistance to innovative local projects and the work of NGOs. UNFPA created an
inter-institutional group to coordinate activities in the Dominican Republic and optimize
resource utilization. In Saint Lucia and El Salvador, UNFPA-supported activities involving
parents, teachers, the community and the mass media to promote responsible sexual
behaviour.
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Experience shows that it is possible to introduce some of the most
important concepts in the area of reproductive and sexual health to adolescents without
arousing controversy. These include respect for others (especially persons of the other
sex); self-esteem; the possibility of planning families and understanding that children
are ideally born as the result of a conscious decision by loving and responsible parents;
the importance of postponing the first pregnancy; and the ability to withstand peer
pressure.
UNFPA, through its innovative work in population education, has played an
important role in promoting girls' education and improving the quality of basic education.
Programme efforts have emphasized review and revision of curricula to include concepts of
gender equality and equity, women's empowerment, enhancement of girl's self-esteem, gender
roles, and status and rights of women.
A key ingredient in the success of these projects is the involvement and
support of parents and the community. Population education is most effective when
supported by parents who frankly discuss sex with their children, but such discussions are
difficult and most families do not undertake them. Health systems, and health educators in
particular, can play an important role in ensuring that support.
Learning What
Works: Methods and Manners
UNFPA emphasizes several aspects to enhance population education.
Qualitative evaluation is important to assess whether the learning objectives have been
met. If they have not, the evaluation/monitoring process enables educators to improve
their performance before mistakes are perpetuated or repeated on a large scale. Focusing
on a breadth of information may be counterproductive; when content is spread so thinly it
can become diluted and children learn little, if anything at all.
In the 1970s, projects tried to teach broad demographic concepts to young
children with poor results. Older children were somehow expected to be predisposed to
practice family planning later because they learned something about population growth in
school. This approach has not been effective.
Enhancing Education
UNFPA is strengthening the quality of education activities by:
1. Improving qualitative evaluation and research;
2. Focusing the content of population education on key issues (many of
which should be selected with personal relevance in mind);
3. Emphasizing attitude formation rather than memorization of facts and
figures; and
4. Introducing population education at an early age.
Lessons learned in developing family life education enhance the quality
of basic education.
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Educational content must be clear and relevant to the individual learner.
Otherwise, it may be easily forgotten. Learners must be able to see the implications of
population issues for themselves and their future families. Then, they will be able to
take actions that reflect their interests and concerns.
Age Matters
The age at which information and services are provided has been
proven very significant. While information should at all times be adjusted to the
developmental level of the learner, it is at the same time important that it be provided
ahead of the developmental stage of the young people, preferably from pre-adolescence.
This provides young people with knowledge about the changes they will experience before
the changes occur.
If abstinence or postponement of the initiation of sexual activity are
among the prograrnme goals, programmes should reach adolescents before sexual activity is
likely to start. While it is important that many of the above-mentioned subjects are
addressed continuously throughout adolescence, it is equally important that sexuality
education is handled in a sensitive way to encourage adolescents to discuss their
concerns. |
While facts and figures are important, attitudes and values
determine children's outlook on life and their future behaviour. Since attitude formation
is so important, and since it begins at an early age, it is important to introduce
population education at the primary level. This has been done with success in a number of
countries, and in some instances parents also participate in pre-school population
education activities.
The Impact of
Population Education
Many external factors contribute to changes of behaviour. It is therefore
difficult to attribute causality to any one intervention or factor. The impact of
population education on behavioural change is long-term, making it even more difficult to
track, because longitudinal studies are expensive and, by definition, take a long time to
complete. The impact of population education over the long-term has not been studied.
Several recent developments indicate that population education in schools
is having an impact on behaviour. In China, pilot school projects reported that following
exposure to population education, students who had agreed to postpone marriage were
sticking to their agreement.
Rural health officials in Bangladesh started to
notice a sudden and steady influx of young couples coming to health centres to ask for
family planning. The timing of this event coincided with the graduation from school of the
first cohort of young people who had been exposed to several years of population education
in the classroom.
Sex Education Promotes
Responsible BehaviourNineteen studies all disprove the myth
that sex education "teaches youth to have sex" and promotes premature sexual
behaviour, according to WHO's Global Programme on AIDS. The studies confirmed that:
Youth who were already sexually active adopted safer practices after
receiving sex education;
Programmes advocating both postponement of sexual intercourse as well
as condom use when sex occurs were more effective than those that only promoted
abstinence;
Sexuality education is most effective if begun before the onset of
sexual activity;
Access to counselling and contraceptive services did not encourage
earlier or increased sexual activity.
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The
Importance of a Comprehensive Approach
The impact of population education may suffer when there is a conflict
between what students learn in school and what they learn from other sources. The
information about health, sexuality, and the responsibilities of parenthood that young
people acquire from their peers or "in the street", and sometimes even from
their families, may conflict with what they get from their teachers in school. This can
negate whatever gains in learning might be made through population education efforts.
A comprehensive approach to population education can guard against such
counterinfluences. Such an approach ensures that students are reached through a variety of
channels with messages that reinforce what they learn in school. It also implies the
importance of involving the larger community, including parents, school administrators,
the church, the mass media, and other concerned groups, in the development and promotion
of population education programmes.
Senegal: Education
beyond the Classroom
An NGO called GEEP--Groupe pour l' étude sur l'enseignement de
la population--is working under the guidance of Senegal's Ministry of Education to
increase awareness about population, environment and development. With UNFPA support, GEEP
is targeting 50 secondary schools. The programme sensitizes parents and children on family
life issues through a variety of non-traditional teaching methods. The group has
Environment and Family Life Clubs, and a related summer camp. Exchanges between rural and
urban youths are being considered.
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One-on-one counselling
Private counselling should give young people the opportunity to ask
personal questions on all subjects related to maturing, puberty, sex, reproduction and
relationships. Counselling should be confidential, private, accessible and acceptable. The
counsellors should be nonjudgemental and have good communication skills.
The advantages of peer counsellors needs to be underscored. They usually
understand adolescent life in a manner that cannot be taught to other counsellors. Peer
counsellors are only peers for a relatively limited period of time and, therefore new
counsellors have to be trained continuously. Such counsellors should have experience as
peer educators before being selected and trained for peer counselling. While many
adolescents tend to prefer counselling from peers, it should be noted that some may prefer
to work with adults.
Improving the
Quality of Basic Education
Education, particularly the education of girls, has a profound
influence on reproductive health. Population education contributes to improving the
quality of basic education in several ways. It introduces contents with direct relevance
to the learners. It emphasizes participatory education, which facilitates learning.
Population education influences gender attitudes, responsible behaviour
and the development of self-esteem. When introduced in the early years of basic education,
before harmful practices and patterns are established, its chances of success are
strengthened.
UNFPA co-sponsored the 1990 World Conference on Education for All in
Jomtien, Thailand, and supplied population education material for the conference
documents. These documents have become the principal education reference materials for
countries around the world as they work to reach the goal of education for all.
Selecting issues to be dealt with in the classroom is an ongoing
process. The contents have to be directly related to the project objectives. In the
interest of improving the quality of projects, the Fund developed a set of indicators for
measuring the impact of population education.
Delivering high quality education, services and counselling to young
people is a specialized skill. Counsellors and others require specific training, both in
programme and content and communication skills.
Educating
Young Mothers: Jamaica Women's Centre
In 1978 the Women's Centre in Jamaica, then a single centre in
Kingston, initiated low-profile activities to support pregnant young women and to help
them to finish their education after delivery. Programme success has gradually led to
broad community support, expansion in reach and scope and, in 1985, to actual change of
national policy to specifically allow for young mothers to return to school.
Today, the programme, which has been supported by UNFPA since 1986,
consists of seven main centres and 11 outreach stations. The programme now offers academic
instruction, counselling, skills training, parenting course-work, training in family
planning and family life, nursery school services, and outreach counselling, training and
education. Because of its continuous expansion, the programme is considered an innovative
approach in adolescent reproductive health programming. For example, the programme's
success has demonstrated the importance of combining education, information and services
in pregnancy prevention: only 1.4 per cent of girls reached by the programme had a second
pregnancy before graduation or starting work. The project now serves as model for other
programmes.
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Strategic Alliances
Because of the diversity among young people, creative and strategic
alliances are needed to convey information and services. Multiple settings and innovative
approaches are necessary.
Private sector involvement is a relatively new area in the realm of
adolescent reproductive rights. Yet in many ways it is the wave of the future. UNFPA has
already supported several successful and innovative approaches to working with the private
sector in developing information services. In one such partnership with the private
sector, popular recording artists in Ghana and Nigeria were enlisted to incorporate
population education messages into their music. The project was successful on all sides:
the music sold and the message got out
Mass Media
Mass media is a potent force in shaping adolescent expectations and ideas
of behaviour. It already reaches most places in the world, communicating messages to
adolescents on sexuality, relationships and love. Because of its influence, the media can
be an important ally or a potent foe in communicating facts and shaping values concerning
adolescent sexuality and reproductive health.
Often, images portrayed in the mass media are unrealistic. The primary
focus is usually on the romance of initiating a relationship while important aspects such
as declining an unwanted sexual proposition or negotiating contraceptive use are most
often neglected. Moreover, these images often enforce stereotyped gender roles.
Mass media can use--and create--popular culture to articulate messages in
young people's own terms. That makes it an especially important tool for reaching
adolescents. Television, radio and magazines can be used for informational programming and
for documentaries, and also to incorporate realistic images and important messages into
existing popular programmes or by making special soaps, radio serials or romantic stories.
Love Is on
the Air: Radio Soaps in Tanzania Teach While They Entertain
It is difficult to quantify the impact of an immensely popular
drama stimulating conversations throughout the country on a broad range of critical
population- and development-related topics. But 19 per cent of married women who don't
listen to a certain radio show in Tanzania use family planning, while 64 per cent of the
show's married female fans do.
Technically referred to as an "entertainment-education radio soap
opera on family planning and HIV/AIDS prevention", the show goes by a more catchy
name in Swahili,"Twende Na Wakati", or "Let's Go with the Times". And
it seems that Tanzanians are not only listening to the soap, but emulating its values,
according to a study done by the University of New Mexico, which found that awareness was
being raised throughout the country due to the show's realistic and personal approach to
sensitive issues.
The immensely popular show, currently sponsored by UNFPA and Population
Communications International, will become self-sustaining in the coming months due to the
interest of commercial sponsors. The show's producers plan to help set up a similar
project in Namibia. And still more developing countries are interested in creating
responsible radio soaps of their own
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Inter-Agency Collaboration
The Fund works with other development agencies in order to better address
the diverse needs of adolescents. UNFPA has successfully collaborated with WHO and UNICEF
to develop policy statements on adolescent reproductive health. On the global level, UNFPA
has supported WHO's Adolescent Health and Development programme. Collaboration also occurs
at the country level.
For instance, in Fiji, UNFPA, UNDP and UNICEF jointly sponsored two
activities: a rock music competition, where 23 secondary schools performed rock music and
dance with HIV/AIDS prevention themes and a month long AIDS Awareness Campaign on the
national level. In addition, UNFPA is specifically responsible for monitoring the
implementation of the UNAIDS work plan for Fiji and Tuvalu.
Combining
Forces: "PEARL" Programme Uganda
The UNFPA-supported Programme for Enhancing Adolescent Reproductive
Life (PEARL) in Uganda has been developed through a participatory process involving all
social partners. Government departments, NGOs, community groups, the donor community,
young people, district authorities and other social partners come together to enhance
young people's reproductive health. The approach is broad; it includes advocacy and
awareness building along with information and service provision. The project seeks to
build a supportive environment and empower adolescents.
All societal levels influencing adolescent reproductive health are
involved in implementation. Political and community support is promoted. Parents, children
and teens are encouraged to improve and increase inter-personal communication. Education,
skills training and recreational opportunities are increased; reproductive health services
are provided and personnel trained. Positive cultural practices are being investigated and
negative issues like sexual abuse addressed. Coordination and information flow among all
these levels are integrated into the project.
Messages are disseminated through the mass media, seminars, workshops,
community meetings, village-level discussions, peer educators, talks at schools and
churches, competitions, existing health services and recreational facilities.
First implemented in four of the country's 39 districts, PEARL, is
being expanded to 20 districts, reaching more than half the country's population.
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Non-Governmental
Organizations (NGO)
UNFPA aims to tailor programmes to be carried out in close collaboration
with national and local NGOs that have an internal understanding of the community and are
already accepted locally. Obvious choices for effective NGO partnerships are organizations
which focus on young people, women, human rights, parents and teachers, and national
family planning agencies. On the global level, the Fund benefits from input provided by
its NGO Advisory Committee.
The activities of local NGOs are sometimes restricted due to limited
capacities. In these eases, the Fund helps expand those capacities or facilitates
correspondence with other organizations. Sometimes, NGO efforts are hampered by
governmental reluctance to provide funds for organizations working in what may be
considered a controversial field. When this happens, UNFPA and other agencies encourage
governments to overcome their reluctance through advocacy and awareness building.
NGO Involvement in Egypt
A UNFPA-supported programme in Egypt seeks to combine youth involvement
and institutional capacity building of local NGOs. The programme supports local NGOs
develop the capacity to carry out reproductive health education programmes by formulating
and implementing reproductive health training programmes for youth leaders. These youth
leaders are trained to educate other young adults about reproductive health, as well as
gender and empowerment issues. The project involves both youth and youth-serving NGOs.
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Gatekeepers
Developing alliances with social gatekeepers is an ongoing process. Part
of this process involves providing information and education to the gatekeepers
themselves, who are usually adults. Such messages should address the problems and changes
of adolescence in this age of conflicting influences. Correct and specific information
should be provided on the health risks young people face. It is important to definitively
dispel the prevailing myth that providing reproductive and sexual health information to
adolescents promotes sexual activities.
Programme designers need to respect and work with these influential
adults. Their concerns--and the reasons for them--should be understood and evaluated. In
order to fully succeed, programmes require community acceptance. In some places programmes
start out on a very small scale to gain acceptance before expanding.
In working with gatekeepers, programme designers should consider the
degree to which consensus can be built around the overall goals of adolescent health and
development, rather than focus too rigidly on the means, which tend to be more
controversial. If service provision cannot be accepted on the large scale, it may be
better, over the long term, to start a small-scale information and services programme. If
information and services cannot be combined at all, resources may be better spent on
advocacy and awareness building.
Programme adaptation should not compromise the intended programme beyond
an acceptable degree. When such initial adaptation is incorporated into programme design,
the longer-term goals should not be forgotten. Efforts to change the inhibiting structure
should be carried out in parallel with the adapted programme.
Where Do We Go From Here?
There are tremendous challenges ahead in the area of adolescent
well-being. But lessons can be drawn from past efforts, which will enhance our future
work. UNFPA' s work with adolescents highlighted certain components.
Baseline studies are an important starting point. They identify target
groups and assess needs. Adolescents must be involved in designing, implementing and
evaluating programmes. There should be creativity and mix in programme design. Whenever
possible, NGOs should be involved in programme implementation. Education, information and
communication strategies should be comprehensive and always combined with services.
Clinical services, including contraceptives, should be accessible and acceptable.
Programmes must be designed with sociocultural sensitivity and keeping
gatekeepers in mind. To maximize impact, programmes should collaborate with related
efforts (horizontal networking). Vertical networking between policy makers, service
providers and clients is needed to create a supportive environment and create awareness.
Finally, because the well-being of adolescents affects the international community
equally, the results of programme evaluation should be shared. Successful programming
promotes sustainability, necessary for real and lasting improvement in the well-being of
young people.
Charting a Course
Young people have choices to make. It is not enough to wish the situation
facing our young people were less complex. Adults have the obligation--on the
institutional and personal levels--to equip youth with the tools they require to protect
and maximize their future opportunities.
Adolescent reproductive health is inextricably linked with factors
relating to poverty and environmental degradation. Concrete and concerted action is today
an ethical and practical requirement. Based on the premise that each individual is of
prime importance, we must chart a course designed to maximize opportunities and utilize
potential. This is the formula for the future.
Copyright©1997 United Nations Population Fund
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