UNFPAState of World Population 2003
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HOME: STATE OF WORLD POPULATION 2003: Meeting Reproductive Health Service Needs
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Meeting Reproductive Health Service Needs

Early Pregnancy
Unmet Need for Family Planning
'Youth-friendly' Health Services
Programme Achievements

Programme Achievements

Family planning associations in various countries pioneered youth-friendly services. International Planned Parenthood Federation (IPPF) has been a leader in promoting adolescent sexual and reproductive health. In Latin America, youth centres were established, combining reproductive health information, counselling and services with recreational, vocational and other opportunities. Youth centres face some key challenges including financial sustainability and breadth of coverage.(26) Later efforts in Africa showed the same results.(27)

Many NGO efforts appear more promising although no rigorous evaluations have been conducted. Action Health International outside Lagos, Nigeria, appears to attract significant numbers of young men and women, offering reproductive health education and services, life planning skills, special entertainment activities and a quarterly magazine.(28) In Haiti, the NGO FOSREF (Fondation de la santé reproductive et l’éducation familiale) offers a wide range of services, family life education programmes, clubs and contests. Attendance is high and there is a large number of contraceptive acceptors.(29)

In Ecuador, a national network of health and family planning clinics run by El Centro Médico de Orientación y Planificación Familiar has expanded its services to better meet adolescents’ needs. For example, clinic hours of operation and fees charged to adolescents have been revised. Young people participated in each stage of the effort.(30)

Jamaica’s Family Planning Association is working to improve rural youth’s access to sexual and reproductive health information and services, tailoring its efforts to meet needs identified by parents, local youth programmes and adolescents themselves. Its youth programmes focus on education and counselling, while also providing contraception and diagnosis and treatment of STIs, along with gynaecological care. A Youth Resource Centre offers education programmes, individual and group counselling, and social and cultural activities.(31)

In Zambia, district health managers, with support from an international NGO, are seeking to improve reproductive health services for urban adolescents and youth in clinics in the capital, Lusaka. Before launching the project, an evaluation exercise was conducted to identify adolescents’ needs and increase community awareness. Parents, service providers, community health committees and adolescents all participated.(32)

Most family planning associations in Latin America and increasing numbers in Africa and elsewhere provide youth-friendly services in clinics and through outreach by peer educators. In Burkina Faso, for example, Youth for Youth supports peer educators and contraception distributors, counselling, various reproductive health services and some recreational activities. Service statistics show that 82 per cent of those who visit the project actually seek clinical services or counselling and that 77 per cent are young women (most attendees at other youth centres tend to be males).(33)

Cost and sustainability are key challenges in providing separate services for youth. Colombia’s family planning association, Profamilia, long a pioneer in providing sexual and reproductive health care to youth, integrated services for young people within 13 adult clinics in mid-sized cities and small towns throughout the country. They used existing space, materials and personnel, rather than investing in new infrastructure and staff. All staff received specialized training. Advocacy was undertaken among community and governmental agencies. Adolescent visits to participating clinics increased 37 per cent during the first six months, and adolescent pregnancy tests increased by 64 per cent.(34)

Government health units at various levels have begun planning to expand youth-friendly services in public health facilities.

A UNFPA-supported project in the Russian Federation provided comprehensive assistance to youth centres in six cities and encouraged positive public attitudes about adolescent access to reproductive health information. Young people helped to design these centres, ensuring that they would be well attended. Attractive factors included staff with effective communication skills, individual and group counselling, reduced waiting times, free contraception and links with other social service providers. Advocacy work with teachers and parents has been a key facilitating factor.(35)

In Jamaica, a project called “Youth.now” seeks to implement national policies and guidelines, to improve reproductive health knowledge and skills, to change attitudes and norms, and to increase access to quality services. It offers training in nursing and midwifery schools, and has established school-linked and freestanding clinics through both the private and public sectors.(36)

22 ADDRESSING THE NEEDS OF YOUNG MARRIED WOMEN

Many adolescent women are married. Early marriage is typically accompanied by strong cultural pressure to begin childbearing as soon as possible. Facing such social norms as well as barriers to reaching young women, programme planners face a challenge in trying to delay too-early first or second births.

One programme, in Bangladesh, has been successful in promoting good reproductive health among this target group. Pathfinder International has worked with NGOs for more than a decade to reach younger couples before they begin childbearing. In this programme, all newly married couples are registered and visited by a field worker, establishing a relationship with the couple and their in-laws while providing information and, when appropriate, services and referrals. As a result, contraceptive use among newlywed adolescents in the targeted areas increased from 19 per cent in 1993 to 39 per cent in 1997.See Source

PRIVATE HEALTH PROVIDERS Some programmes have taken advantage of young people’s preference, when they can afford it, to use private health care, which offers greater confidentiality and privacy.(37) Examples include a voucher programme in Kenya and Zimbabwe,(38) and the use of private midwives to deliver youth-friendly services in Zambia.(39) This approach may be more viable than previously thought given recent findings that young women are just as willing to pay price increases for services as older women, if services are confidential and patients are treated with respect and dignity.(40)

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