Provide Services That Suit Young People's Situations and Concerns

Young people need, want and have a right to sexual and reproductive health services. Ignoring their sexuality will not make their problems go away. It only makes them worse. It only leaves them vulnerable to unsafe abortion, unwanted pregnancy and sexually transmitted disease. That's no way to protect a future of promise. In fact, young people themselves want to protect their own health and future.

Young people from 150 countries identified the kind of support they need to take care of themselves when they wrote the following list at the World Youth Forum of the United Nations System in 1998 in Braga, Portugal: "Youth-friendly health services, counselling and especially reproductive health services that are comprehensive, accessible and participatory, to ensure the holistic well-being of all young people."

If these recommendations are acted upon, the world will see lower rates of pregnancy, decreasing birth rates, and increased knowledge about health and safe sex practices.

Today, however, the ability of young people to act on their own behalf is hindered by many forces. There are the major obstacles to development, including poverty, unemployment, gender discrimination, ethnic discrimination, and the impact of social change on the family and cultural support systems. In addition, some adults are opposed to important services. And, even where services exist, teenagers may hesitate to use them.

Sometimes young people are not welcome. As a young woman of 19 in India says, "I am not married. How can I go to a family planning clinic?"

Other times it just feels that way. A young woman in the UK worries that staff at the clinic will be "condescending or patronizing" and wonders if they could "just treat me with some dignity and respect".

The reasons that keep young people away are as individual as they are. But there are some ways to make services more accessible. Convenient locations and hours, welcoming staff and reason-able prices–young people everywhere say this would help.

Adolescents’ Right to Reproductive Health Services

Acknowledging parental rights to provide appropriate guidance in sexual and reproduc-tive matters, the ICPD Programme of Action (paragraph 7.45) goes on to state: "...Countries must ensure that the programmes and attitudes of health-care service providers do not restrict the access of adolescents to appropriate services and the information they need, including on sexually transmitted diseases and sexual abuse. In doing so, these services must safe-guard the rights of adolescents to privacy, confidentiality, respect, and informed consent, respecting cultural values and religious beliefs. Countries should, where appropriate, remove legal, regulatory, and social barriers to repro-ductive health information and care for adolescents."

At the World Youth Forum, young people detailed what they thought health policies and programmes should address. They specified sexual and reproductive health, HIV/AIDS, infectious diseases, substance abuse, nutrition and hygiene, harmful traditional practices such as female genital mutilation, sexual abuse, sexual exploitation, mental health and occupational and environmental health. Such a list of concerns counters any idea that teenagers live in simple times.

In such a complex world, young people need services that treat them in the context of their life situation. Young people know what they want from health care providers:

In general, preventive services will provide contraceptives, counselling and testing. Sexually active adolescents need special family-planning information, counselling and services including intervention in case of disease. Young people need to know how contraceptives work, how to use them and how to negotiate their use with a partner. Those who become pregnant need prenatal care, postnatal care and support from the family and community.

Girls in Urban Slums
Become Health Guides for Their Peers

Conditions are difficult in Jabalpur city in Madhya Pradesh, India, but a programme that empowers girls to reach other girls with information on reproductive health and services is making a difference. Supported by UNFPA, the goals are to provide better medical care, improve maternal care and increase use of family planning and reproductive health services among young women living in the city’s slums. A study found that adolescent girls knew little about their bodies and that young people suffered from a lack of health services and the dangers of sexual exploitation, unwanted pregnancy and unsafe abortion.

Today, young community health workers assist in counselling, education and awareness-raising among in-school and out-of-school adolescents. They also provide referrals to the expanding and increasingly youth-friendly network of services, distribute contraceptives and talk with teachers and parents.

Katherine, 19, from Ghana, suggests a comprehensive approach: "Health and counselling services should be made accessible to young people in schools, churches and health centres and these should be equipped with well-trained personnel who have the right information to help young people to have deeper and better understanding of their sexuality."

At one time a young woman or young man may need preventive care, information, diagnosis, counselling or treatment. A range of services might be provided through a telephone hotline, peer counselling programmes, a health centre at a school, or a youth focal-point at a larger health facility. When young people try to take care of themselves, it is important that providers do not miss the opportunity to help with all of their health care concerns.

Young People Taking Charge of Their Health

Young people are the organizers, educators and counsellors for a programme designed to help their peers take charge of their reproductive health. Run mainly by young people themselves, "Youth to Youth in Health" is credited with reducing the number of births to adolescent mothers from 21 per cent of all births in the Marshall Islands to 14 per cent over recent years. In 1996, the group became an NGO supported by the Government’s Ministry of Health and UNFPA.

Health education is a main focus of the programme, which has trained more than 340 peer educators and counsellors to convey information on contraceptives, sexuality and staying healthy. By the end of 1996, 50,000 "contacts" had been made with young people, families and communities– providing health education through person-to-person counselling, small group discussion and large outreach meetings. The topics they talk about range from how to avoid sexually transmitted diseases and HIV/AIDS to substance abuse to good nutrition. The young educators use music, dance, drama and video to combine local cultural elements with their health messages.

Services were expanded recently to include a youth health clinic with a UNFPA-sponsored registered nurse on staff, who is assisted by volunteer educators and peer counsellors. The clinic, set up in Majuro at the main centre of "Youth to Youth in Health", offers services for family planning and reproductive and sexual health.

A List of Essential Services

"Reproductive health care in the context of primary health care should, inter alia, include: family planning counselling, information, education, communication and services; education and services for prenatal care, safe delivery and post-natal care, especially breast-feeding and infant and women’s health care; prevention and appropriate treatment of infertility; prevention of abortion and the management of consequences of abortion; treatment of reproductive tract infections; sexually transmitted diseases and other reproductive health conditions; and information, education and counselling, as appropriate, on human sexuality, reproductive health, and responsible parenthood." (ICPD Programme of Action, paragraph 7.6)