| Information
and Care for Adolescents Young women and men face many health
risks, yet they receive inadequate information, guidance and services to help them
negotiate the difficult passage to adulthood.
Adolescents need support to build self-esteem, to develop life skills, including
managing intimate relationships, and to practise gender equality. Parents have the first
responsibility: they need to be involved in the design of programmes for adolescents, and
they should also be encouraged to talk to their children about sexuality and reproductive
health. Many studies have shown that better information encourages sexual responsibility
among adolescents, including abstinence.51
In most cultures, gender norms produce a sexual double standard for girls and boys.52 Girls often lack information or
opportunities given to boys, though they are most at risk.53
Early childbearing narrows the life opportunities of girls. In many countries, girls who
become pregnant are not allowed to continue to attend school. In others, the education of
boys is simply valued higher than that of girls: girls are two thirds of the more than 130
million children not attending school. In Kenya alone, an estimated 10,000 girls a year
leave school because of pregnancy.54
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Using Peer Education to Reduce
Adolescent Pregnancy
Pregnancy has become the principal cause of death among females between ages 15 and 19
in the Dominican Republic. Nearly one in four in this age group is either pregnant or has
already given birth. There are few reproductive health services for young people in the
marginal communities surrounding major cities, where 64 per cent of the population is
concentrated.
Two non-governmental organizations — the Dominican Association for Family
Well-being (Profamilia) and the Dominican Institute for Integrated Development (IDDI)
— have been working since 1997 to expand young people’s access to sexual
education and reproductive health services in 36 neighbourhoods of Santo Domingo and in
three smaller cities.
Using peer education and counselling, the UNFPA-supported project aims to reduce
adolescent pregnancy and STD and AIDS infection rates by making young people more aware of
the health risks of unprotected sex. Teens are encouraged to postpone their first sexual
encounter or to maintain a faithful relationship with one partner.
Some 360 adolescents have been trained as voluntary peer counsellors on sexual and
reproductive health matters. Each counsels between 15 to 30 youths and distributes
educational material and, with parental consent, contraceptive methods (condoms,
spermicides, and pills after their first prescription by a physician); they refer special
cases to health services and follow up these referrals. The counsellors also conduct town
meetings and theatrical presentations for their communities.
In two years, the project has counselled nearly 9,000 young people, 30 per cent of whom
are not in school. Growing demand has given rise to open educational activities in
schools, churches and community gathering places. Strong bonds of support have developed
between counsellors and their clients, as became evident in the aftermath of the
devastating Hurricane Georges.
The project has also trained 90 Ministry of Health physicians, nurses and psychologists
in integrated adolescent health care, and produced a manual on sexual and reproductive
health, a video and other educational materials. |
In many countries, the topic of adolescent sexuality and reproductive
health is still politically sensitive, and reproductive health information and services
simply do not reach most adolescents. However, some 55 countries have taken policy and
programme measures to address the health needs of adolescents including reproductive
health. Some, such as Jamaica, are putting adolescents at the centre of their reproductive
health strategies. Burkina Faso was one of the first West African countries to launch a
reproductive health programme aimed at the needs of youth. The centrepiece of the
programme has been the establishment of youth centres in urban areas offering reproductive
health services and peer-based education.
Studies show that family life education should begin early, in some countries even
before adolescence, to help young people through the years when they are reaching puberty,
learning about their sexuality and beginning to be interested in sexual matters.55 Messages for sexually active youth
should be different than for those who have not initiated sexual activity,56 and should be as specific as possible.
For example, in one study, Albanian youth said they want practical information such as how
to avoid condom breakage and emergency contraception.57
Since unprotected sexual relations place adolescent girls at risk for unwanted
pregnancy and both girls and boys at risk for STDs, including HIV/AIDS, they need not only
preventive services, but also youth-friendly health services including diagnosis,
treatment, information and counselling. Clinic staff need special training to treat young
clients in a supportive and non-judgmental way.58
Young adults also need information on family planning and on STDs including HIV/AIDS.
Worldwide experience 59 has shown
that programmes for adolescents should:
- Recognize and address the fact that the programme needs of young people differ according
to their sexual experience and other key characteristics.
- Start with what young people want and with what they are doing already to obtain
reproductive health information and services.
- Include building skills (both generic and specific to reproductive health) as a core
intervention.
- Engage adults in creating a safer and more supportive environment in which young people
can develop and learn to manage their lives, including their sexual and reproductive
health.
- Use a greater variety of settings and providers — both private and public, clinical
and non-clinical — to provide sexual and reproductive health information and
services.
- Make the most of what exists. Building upon and linking existing programmes and services
in new and flexible ways so that they reach many more young people.
NGOs have been particularly active in testing new approaches to reaching adolescents,
such as peer education, skills-building, counselling, and other services. Actions to
foster understanding and support among adults in the family and in the community are now
also recognized as a key investment. In Colombia, the NGO Profamilia, among many other
reproductive health and women’s empowerment activities, supports sexual and
reproductive health education in youth centres in 20 of the country’s cities.
In Kenya, the hit song "I Need to Know", performed by young Nairobi
musicians, has helped adolescents ask that reproductive health be added to school health
services. Through a youth-to-youth programme in the Marshall Islands, trained peer
educators and counsellors provide health education to youth, their families and the
community on issues such as teenage pregnancy, STDs and HIV/AIDS, substance abuse and
nutrition. The programme also meets the contraceptive needs of adolescents.
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