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""#iiifVm݌  Ќ  fVm  fVmn0     I.INTRODUCTION#!!G". ""#1fVmn݌   Ќ  fVm  fVm.0     II.ADOLESCENTREPRODUCTIVEHEALTHINTODAYSWORLD#!!G".>""#2fVm.J݌   Ќ  fVm  fVm0     III.PROGRESSSINCETHE1994_ICPD_Ԁ#!!G".-""#3fVm1݌   Ќ  ~!  ~!0  0` ""    A.RightsandPolicy#!!G".HH$` "` "#3~!#݌   Ќ  ~!  ~!0  0` ""    B.ProgrammingforAdolescentReproductiveHealth#!!G".@` "` "#4~!݌   Ќ  fVm  fVm0     IV.CONSTRAINTSANDAPPROACHESTOOVERCOMETHEM#:!:!F".:""#10fVm݌ |  Ќ  fVm  fVm0     V.KEYFUTUREACTIONS#:!:!F". ""#19fVm݌ t Ќ  ~!  ~!| 0  0` ""    A.AdvocacyforAction#:!:!F".``&` "` "#19~!| ݌ p Ќ  ~!  ~!W 0  0` ""    B.FosteringAnEnablingEnvironment#:!:!F".5` "` "#20~!W r ݌ l Ќ  ~!  ~!A 0  0` ""    C.ProgrammesforAdolescents#:!:!F".-` "` "#22~!A \ ݌ h Ќ  ~!  ~!# 0  0` ""    D.StrengtheningKnowledgeforAction#:!:!F".5` "` "#25~!# > ݌ d Ќ  ~!  ~! 0  0` ""    E.ResourceMobilization#:!:!F".(` "` "#27~! ( ݌ ` Ќ  fVm  fVm 0     VI.CONCLUSIONS#:!:!F".H H ""#28fVm ݌ X Ќ  fVm  fVm0     Annex1:Agenda#:!:!F". ""#31fVm݌ L Ќ  fVm  fVmm0     Annex2:Participants,ObserversandSecretariat#:!:!F".:""#41fVmm݌ D  Ќ  fVm  fVmN0     Annex3:DocumentsDistributed#:!:!F".(""#50fVmNj݌ <" Ќ    _i_#Xu3X$#Xu3XXXu3USUK.,8RR#Xu3XXXu3#UK.,US.,RXXu3#XeX1#RXXu3  &R 1P,- REXECUTIVESUMMARY     TheRoundTableonAdolescentSexualandReproductiveHealthmettoreviewprogressmadetowardstheimplementationoftherecommendationsofthe1994InternationalConferenceonPopulationandDevelopment(_ICPD_)inCairo,identifyconstraintsandproposekeyfutureactions.Thesefindingswillbereportedtothemorethan120countriesthatwillattendthe_ICPD_+5InternationalForuminFebruary1999,andtotheUnitedNationsGeneralAssemblySpecialSessiononthereviewandappraisaloftheimplementationofthe_ICPD_ԀProgrammeofActionon30June2July1999. AdolescentReproductiveHealthinTodaysWorld  p      TheRoundTablenotedtheimportanceofcurrentadolescentsexualandreproductivehealthconcerns.Theworldnowhasthelargestgroupofadolescentsinhistory,withsome85percentlivingindevelopingcountries.Changingconditionshavebroughtrisksaswellasopportunities.Whileearlymarriageandsomeharmfultraditionalpracticesarediminishing,measurestopreventunwantedpregnancyandsexuallytransmitteddiseases(STDs)amongadolescentsremaininadequate,andthereisanalarmingriseinHIVinfectionamongyoungpeople.Inadditiontothesereproductivehealthissues,whicharebeginningtobebetterdocumented,thereremainareasofspecialconcernwhichneedmoreresearchandpolicyconsideration.Theseincludesexualabuseandexploitation,includingtrafficking,ofchildrenandyouth. ProgressSincethe1994_ICPD_  \   TheconsensusoftheRoundTablewasthatconsiderableprogresshasbeenachievedonanumberoffronts.Therightstoreproductivehealthofadolescentsaregraduallybeingrealized,andmorecountriesareformulatingpoliciesandinitiatingeffectiveprogramming.Increasedprogrammeevaluationhascreatedaconsensusaroundprinciplesforeffectiveaction.Aholisticandintegratedapproachtothereproductivehealthneedsofyoungpeopleisnowrecognizedasthesurestwaytoprotectandenhancesexualandreproductivehealth.Adolescentparticipationintheprocessisgraduallyincreasingandgenderequalityhasimproved.Emphasisisbeingplacedonfosteringasafeandsupportiveenvironmentinboththehomeandworkenvironments,andtomakeinformation,education,counsellingandhealthservicesmoreaccessibletoadolescents.Crosssectoralcollaborationhasincreasedaswell.Thereismorecooperationacrossdisciplinesandamongdifferentorganizations,withgreaterprivatesectorinvolvement. ConstraintsandApproachestoOvercomeThem  $*t%&   Resistancetoprovidinginformationandservicestoaddressthesexualandreproductivehealthneedsofadolescentshasdeterredyoungpeoplefromseekinghelp.Programmesaretoonarrowly_focused_ԀandoftendonotengageyoungpeopleintheirR  )#R'workorintheirnaturalsettings.Financialconstraintspreventsuccessfulprojectsfrom#Xu3Xe#XXu3 /d*+ beingsustained,expandedorreplicated.Povertyremainsaformidableenemyofhealth.Actionisneededtostrengthentheknowledgeandskillsofpeopleinlocalcommunities  1\,- astheystruggletocreateamoreenablingenvironment.Differencescandiminishifpeopleunitearoundthewellbeingoftheiradolescentchildren.Coalitionscanbecreatedincommunities,andmechanismsestablishedforcooperationamonggovernment,nongovernmentalorganizations,theprivatesector,internationalagenciesandthedonorcommunity.Researchisneededtoexpandknowledgeofeffectiveprogrammesthatcansustainandexpandactiononascalelargeenoughtomeettheneedsofadolescents,includingthosemarginalisedbypovertyandlackofeducation.Betterindicatorsofadolescentdevelopmentwillhelpstimulateandmeasureprogress.Resourcesforinnovativestrategiesandinitiativesshouldbemoreaccessibletoyoungpeopleengagedaspartnerswithadults. KeyFutureActions      TheRoundTableparticipantsplacedspecialemphasisontakingactiontofoster   anenablingenvironmentbytargetingadultsintheircommunities.Theyalsofavouredgreateremphasisonpromotingaholisticandintegratedapproachtoadolescents,withoutlosingsightofthecentralimportanceoftheirsexualandreproductivehealth.Theparticipantsgavespecialattentiontocooperationacrosssectors,especiallywiththeprivatesector,theestablishmentofcoalitions,convertingadversariestoallies,andstrengtheningtheknowledgebaseforbetterpolicy,programmingandadvocacy.ThekeysuggestionsmadebytheRoundTableparticipants,includethefollowing:  *Equipadultstobetterhelpadolescents  *Expandnationalpoliciesandimplementrights  *Increaseandsustainyouthparticipation  *Establishbetterindicatorsofprogress  *Conductmoreevaluationofinitiatives  *Encouragecostsharingandinnovativefinancing#$# Conclusions  D!   TheRoundTableconcludedthatconsiderableprogresshasoccurredsincethe_ICPD_.Peoplearemorecommittedtoseeingthatadolescentsexercisetheirrightstosexualandreproductivehealth.Effectiveactionhasincreasedinmostcountries,andastrongandgrowingconsensushasarisenaroundkeyprinciplesofwhatworks.Increasedrecognitionisbeinggiventothevitalimportanceofthehealthydevelopmentofadolescentsinachievingsexualandreproductivehealthandtotheneedforintegratedapproaches.Thiscannotbedonewithoutadultsfromallsectorscreatinganenvironmentconducivefortheprovisionofinformation,education,skills,counsellingandservicesforadolescents.@aa)aA    RRRR 0+, RRRRR 1h,- RI.INTRODUCTION +  1.  The1994Cairo_ICPD_Ԁprovedtobealandmarkforadolescentreproductivehealth.  Itbroughttogetherpeoplefromvirtuallyallcountriesandculturesoftheworldtoaddresspopulationanddevelopmentissues.Delegatesreachedahighdegreeofconsensusonissuesregardingthesexualandreproductivehealthandwellbeingofyoungpeople.Thedifficultissuesraisedatthe_ICPD_Ԁneverthelessareonlypartlyresolved.Onereasonisthatadolescentsexuality,lyingattheheartofadolescentreproductivehealth,isanareaofgreatsensitivity.Adolescenceoccurswhentheindividualssexualresponseandreproductivehealthsystemsmature,bringingthepotentialforsexualrelations,prematurepregnancyandsexuallytransmitteddiseases(STDs).Todaythishappensassocietiesareundergoingrapidchange.Thetraditionalinfluenceofthefamilyhasdiminishedrelativetootherinfluences,whileyoungpeoplearelivinginconditionswhichdiffermarkedlyfromtheirparentsgeneration.Cairorecognizedthatyoungpeople ...arethemostimportantresourceforthefuture.ConsensuswasreachedontheurgencyofimplementingaProgrammeofAction_  #  1      _Ԁtomeet,amongotherthings,adolescents'needs, x withclearrecommendationsforadolescentreproductivehealth.2.  TheProgrammeofActionisspecific.Inthespecialsectiononadolescentsin l ChapterVII,onReproductiveRightsandReproductiveHealth,theobjectivesare: (a)toaddressadolescentsexualandreproductivehealthissues,includingunwantedpregnancy,unsafeabortionandsexuallytransmitteddiseases,includingHIV/AIDS,throughthepromotionofresponsibleandhealthyreproductiveandsexualbehaviour,includingvoluntaryabstinence,andtheprovisionofappropriateservicesandcounsellingspecificallysuitableforthatagegroup;and(b)tosubstantiallyreducealladolescentpregnancies.(7.44)TheProgrammeofActionalsostatesthat Countries,withthesupportoftheinternationalcommunity,shouldprotectandpromotetherightsofadolescentstoreproductivehealtheducation,informationandcareandgreatlyreducethenumbersofadolescentpregnancies.(7.46)3.  TheProgrammeofActionalsostatesasobjectivesinChapterVItheneed (a)to <" promotetothefullestextentthehealth,wellbeingandpotentialofallchildren,adolescentsandyouthasrepresentingtheworldsfuturehumanresourcesinlinewiththecommitmentsmadeinthisrespectattheWorldSummitforChildrenandinaccordancewiththeConventionontheRightsoftheChild;(b)tomeetthespecialneedsofadolescentsandyouth,especiallyyoungwomen,withdueregardfortheirowncreativecapabilities,forsocial,familyandcommunitysupport,employmentopportunities,participationinthepoliticalprocess,andaccesstoeducation,health,counsellingandhighqualityreproductivehealthservices;and(c)toencouragechildren,adolescentsandyouth,particularlyyoungwomen,tocontinuetheireducationinordertoequipthemforabetterlife,toincreasetheirhumanpotential,tohelppreventearlymarriagesandhighRZu\7eXXdXXd7  RRZu\7eXXdXXd7  Rriskchildbearingandtoreduceassociatedmortalityandmorbidity.(6.7) -`() Zu\7u3XXdXXd7  RZu \ #Xd#  R4.  Inotherwords,theProgrammeofActionrecognizedthatthesexualand  RZu\7u3XXdXXd7  Zu \ #Xd#  Rreproductivehealthofadolescentsdependsnotonlyonwhat they do,butalsoonwhat   adults dotoprovideemotionalsupportforadolescentsandcreateopportunitiesforthem  RZu\7u3XXdXXd7  Rtodeveloptheirfullpotential,aswellasensuringthattheyhaveaccesstohighquality,appropriateandaccessiblecounselling,information,educationandhealthservices.5.  TheRoundTableonAdolescentSexualandReproductiveHealthwasconvened   toexaminethefurtherimplementationoftheProgrammeofActionadoptedatthe_ICPD_.Thisreporthasfourmajorsectionswhichcoverthecurrentstateofadolescentreproductivehealth;progresssincethe1994_ICPD_;constraintsonachievingthe_ICPD_objectivesforadolescentsandhowtheymaybeovercome;andkeyactionsforthefuture.   II.ADOLESCENTREPRODUCTIVEHEALTHINTODAYSWORLD A     6.  TheRoundTablenotedtheseriousnessofadolescentsexualandreproductive  healthconcerns,especiallywithrespecttoemergingtrendsandhiddenissues.Theworldhasthelargestpopulationofadolescentsinhistory.In1995halftheworldspopulationwasunder25,includingmorethanonebillionadolescentsbetweentheagesof10and19.Nearly85precentofthemliveindevelopingcountries.Girlsremaindisadvantaged,thoughthegendergapisnarrowing.7.  Themeanageatmarriageisrising,althoughearlymarriageremainsaproblemin h manycountries.Theonsetofmenarchecomestypicallyearlier,however.Sexualrelationsoftenbegininadolescence,eitherduringorbeforemarriage.Althoughmoreadultsthaneverarenowusingsomeformofmoderncontraception,mostadolescentswhohavesexualrelationsdonotusecontraceptivesorcondomstopreventpregnancyorSTDsandHIV/AIDS.Adolescentpregnanciesandearlychildbirthendangerthehealthandlivesofbothmotherandchild.Inmanycases,adolescentgirlswhobecomepregnantandgivebirthforgoanychanceoffinishingtheireducationoroffindingsuitableemployment.Alargeproportionofadolescentpregnanciesareunwantedanditisestimatedthatasmanyas4.4millionabortionsaresoughtbyadolescentseachyear.8.  OneintwentyadolescentsisestimatedtobesufferingfromaSTD,often <&!" untreated,andmorethan50%ofnewHIVinfectionsoccuramong1524year_olds_,withyoungwomenbeingespeciallyvulnerabletoinfertilityandprematuredeath.Harmfulpracticessuchasfemalegenitalmutilationappeartobedecreasingbutcontinuetoposeahazard.9.  Inadditiontothesereproductivehealthissueswhicharebeginningtobebetter $,t'( documented,thereremainareasofspecialconcern,suchasthesexualabuseofadolescents,whereevidenceisjustbeginningtoemerge.Manyadolescentproblems,particularlyofanemotionalandsexualnature,remainhiddenbecauseyoungpeopleare /h*+ afraidtodiscussthem.Anxietiesaboutsexualfeelingsandsexualorientationareusuallykeptsecret,andignoranceexacerbatesmanyproblems.10.  Adolescentgirlsareespeciallyvulnerabletoreproductivehealthproblemsnotonly  becauseofpregnancybutbecauseoftheirlowersocietalstatus,comparedtoboys.Accordingly,specialattentionmustbegiventopromotetheirsexualandreproductivehealth.However,theRoundTablealsoemphasizedtheimportanceofaddressingtheneedsofadolescentboyswhoseconcernsareoftenoverlooked.11.  Adolescentsexualandreproductivehealthproblemsarecloselyintertwinedwith    otherindividualproblemsandunmetneeds.Forpeopletounderstandtheantecedentsandtakeeffectiveactiontopreventoramelioratethem,attentionmustbegiventothefamilial,social,culturalandeconomicaspectsoftheirenvironment.  III.PROGRESSSINCETHE1994_ICPD_Ԁ N t  12.  TheconsensusoftheRoundTablewasthatconsiderableprogresshasbeen p achievedonanumberoffronts.Therightsofadolescentsaregraduallybeingrealized,especiallyattheinternationallevel.Countriesrequestinghelparenowaskingnotjustwhattodobuthowtodoit.Thefocushasshiftedtoabroaderapproachtoaddressingsexualandreproductivehealthandtheneedtoachieveoveralleconomicandsocialdevelopmentoftheadolescent.Theheterogeneityoftheadolescentpopulationandtheirattendantdifferingneedsisreceivingmoreattention.Thestatusofwomenisimproving,asistheparticipationofyouthindevelopmentefforts.Greaterattentionisbeinggiventotheevaluationofwhatworks.Traditionallynarrowlystructured,orvertical,programmesaregraduallygivingwaytoamoreintegratedapproach.Consensusisbeingreachedonkeyprinciplesforeffectiveaction.Thereismorecooperationacrossdisciplines,amongdifferentorganizationsandbetweenthepublicandprivatesectors.Greaterattentionisbeinggiventotheimportanceofcreatingasafeandsupportiveenvironmentforadolescentsthroughestablishmentoffamilyandcommunitysupportsystems,relevantpoliciesandbetterprogramming.Ultimately,adultsmustcreateanurturingclimateforadolescentsandmakeavailablesoundinformation,education,counsellingandhealthservices.  A.RightsandPolicy T ('x"# 13.  Attheinternationallevel, the_ICPD_Ԁbuiltonthelegalfoundationsofthe1981 ()x$% ConventionontheEliminationofAllFormsofDiscriminationAgainstWomenandthe1989ConventionontheRightsoftheChild.The_ICPD_Ԁgaveastrongvoicetotherightsofadolescentstoreproductivehealthinformationandcare.Italsorecognizedthatyoungpeopleshouldbeinvolvedintheplanning,implementationandevaluationofadolescentreproductivehealthprogrammes.Inpreparationforthe42ndCommissionontheStatusofWomen,theUNDivisionfortheAdvancementofWomen,togetherwithUNICEF, /h*+ _UNFPA_,andtheEconomicCommissionforAfrica,convenedanExpertGroupMeetingonAdolescentGirlsandtheirRightsinOctober1997,whichstronglyadvocatedtheserights.ItsconclusionswerewellreceivedbytheCommissionontheStatusofWomeninMarch1998.Thesepowerfulinternationalendorsementsrepresentmajorstepsinadvancingarightsagendaforadolescents.14.  Atthe national level,asreportedinreviewsofcountryprogrammesaswellasin   nationalandregionalmeetings,manycountrieshaveformulatedpoliciesforadolescenthealth,givingspecificattentiontothesexualandreproductivehealthneedsofadolescents.Attemptsareunderwaytoharmonizelawsandregulationswithincountriestoachieveconsistencyacrosssectorsthatincludehealth,education,socialwelfare,labour,justice,religiousaffairs,andthemassmedia.Sucheffortsinvolvetheremovalofbarrierstoexistinginformationandservicesforadolescentsaswellasgreatereffortstomeettheirneeds.ExamplesfromCostaRica,GhanaandSouthAfricaweredescribedduringtheRoundTable.AninitiativebyWHO,_UNFPA_,UNICEFandAdvocatesforYouthisunderwaytoupdatethe1987WHOpublication, LawsandPoliciesAffectingAdolescentHealthwithRespecttoReproductiveHealth.#Xu3X#15.  XXu3D#Xu3Xs]#isseminatingInformationonRights XXu3Beyondtheestablishmentofguaranteed p rightsforadolescents,theimportanceofdisseminatinginformationtoyoungpeople,professionalsandthegeneralpublicisbeingrecognizedasanessentialcomponentofpopulationprogrammes.Twoexamplesarenoteworthy:the1995_IPPF_Ԁ Charteron l SexualandReproductiveRightsandthe1997CommonwealthSecretariat'sguideforyoungpeopletogovernmentagreements, GlobalCommitmentstoYouthRights.Acountryexampleisthe1996DanishFamilyPlanningAssociationpublication SexualandReproductiveHealthandRightsforYouth.  B.ProgrammingforAdolescentReproductiveHealth#Xu3X]# ` T  16. XXu3  AttentiontoEvaluation Thesuccessinidentifying,elaboratinganddisseminating @! informationaboutadolescentreproductivehealthhasstimulatedactionandthedemandforknowledgeaboutwhatiseffective.Thishasledtomoreprogrammesandprojectevaluationsaimedatincreasingtheknowledgenecessaryforstrategicinterventions.Althoughevaluationremainsinsufficient,therehasbeensomeprogressinthisarea.TwoexampleswerecitedattheRoundTable:theworkoftheFOCUSonYoungAdultsProgram,whichlooksatdifferentmodelsofhealthcare,includingthoseathealthfacilities,schools,outreachprogrammesandtheuseofsocialmarketing;andthe 1995 ,(|#$ WHO/_UNFPA_/UNICEF# d#ԀStudyGrouponProgrammingforAdolescentHealth,which ()x$% reviewedscientificevidenceontheeffectivenessofinterventionsforadolescenthealth,highlightedstrategiestoestablish,implementandsustainprogrammes,anddevelopedaframeworkforcountryprogrammingwithrecommendationsforactionbasedonthesefindings.#Xu3X