Meeting Reproductive Health Service Needs
Since the ICPD in 1994, there has been an upsurge in efforts to provide appropriate sexual and reproductive health services to young people. These new initiatives have been developed in response to the evidence that young people often feel unwelcome at traditional family planning or reproductive health clinics, combined with an increased awareness of the special needs and rights of youth in the area of sexual and reproductive health.
Among the many barriers to services for young people are: legal and policy constraints related to age and marital status; fear of being seen, due to a lack of privacy and confidentiality; fear that they will be treated badly; inconvenient hours and locations of facilities; and high costs. In addition, many young people have a poor understanding of their own needs, know little about available services, or are deterred by shame or embarrassment.(19)
To overcome these obstacles, a variety of programme models are being used to provide “youth-friendly services” based on evidence documenting what young people want (see Box 21). These models vary from region to region.
WHAT MAKES HEALTH SERVICES YOUTH-FRIENDLY
- Specially trained staff.
- Respect for young people.
- Privacy and confidentiality honoured.
- Adequate time for client-provider interaction.
- Peer counsellors available.
- Separate space or special times set aside.
- Convenient hours and location.
- Adequate space and sufficient privacy.
- Comfortable surroundings.
- Youth involved in design, service outreach and delivery,
and continuing feedback.
- Drop-in clients welcomed or appointments arranged rapidly.
- No overcrowding and short waiting times.
- Affordable fees.
- Publicity and recruitment that inform and reassure youth.
- Boys and young men welcomed and served.
- Wide range of services available.
- Necessary referrals available.
Other possible characteristics:
- Educational material available on site to take.
- Group discussions available.
- Delay of pelvic examination and blood tests possible.
- Alternative ways to access information, counselling
Most countries already have a network of health facilities that can be adapted to meet adolescents’ needs, especially treatment needs that are best met in adequately equipped and staffed clinics. In addition, other promising approaches have been tested since the ICPD. These include peer outreach and social marketing of condoms at non-traditional outlets (such as kiosks, bus stations, discos and petrol stations), mobile clinics, and programmes in schools and workplaces.
For the most part, such activities in developing countries have been organized only on a small scale. Larger-scale efforts in developed countries have shown that young people will use services that meet their needs—if there is community support that allows their establishment and use. New assessment tools have been developed to determine what adjustments could make clinics more youth-friendly, along with curricula to train staff on adolescents’ special needs, with an emphasis on effective communication and youth-friendly counselling.
Community support for youth-friendly services is critical to their successful use. Advocacy and efforts to involve communities are therefore essential, especially in more conservative societies.
One of the most basic needs is for better evaluation of programme achievements. There are few good evaluations of projects providing youth-friendly services, and most of those were done with very short implementation periods. Good programmes take time—particularly because they depend on trained and sensitive providers who must adjust to the needs of a new generation.
REMOVING LEGAL OBSTACLES Venezuela’s 2002 National Youth Law guarantees young people the right to health care, information and education about sexual and reproductive health, responsible and voluntary parenthood without risk, and access to health services for sexually transmitted infections.(20) Also in 2002, Costa Rica and Panama amended their laws to reinforce adolescent mothers’ rights to care, information and guidance.(21)
South Africa’s 1996 post-apartheid constitution affirms universal rights to reproductive choice and reproductive health care. Under South African law, anyone 14 years or older has a right to receive contraception.(22)
In 2002, Argentina created a National Programme of Sexual Health and Responsible Procreation to promote adolescents’ sexual health and prevention of unwanted pregnancies and STIs including HIV/AIDS, by ensuring access to information and services.(23) India in 2000 approved a population policy containing provisions on sexuality education and services for adolescents.(24)
To address the obstacles young people face trying to reconcile schooling and parenthood, Chile in 2000 and Portugal in 2001 passed legislation that ensures young parents’ rights to education and guarantees greater flexibility within educational institutions to respond to the dual demands of studying and parenting.(25)