Giving Priority to Adolescents
Action to address the critical challenges facing adolescents and young people is an urgent priority if social and economic development efforts are to succeed in alleviating poverty, curbing the AIDS pandemic, and empowering women and men to create a more equitable world. Investing in programmes to meet adolescents’ reproductive health needs, in particular, is essential.
As this report has emphasized, programmes have to recognize the diversity of needs, skills and social inclusion among adolescents in different cultures, varied circumstances (in-school, out-of-school, rural, urban, rich, poor, displaced) and different ages, sexes and marital status.(1) Programme efforts must be grounded in improved dialogue with communities and community support.
Experience since the ICPD in addressing adolescent sexual and reproductive health concerns has shown the urgency of having supportive policies in place. Programmes dealing with these sensitive issues cannot survive in a hostile climate. Yet few countries have policies that explicitly address the information and service needs of young people. While it is desirable to have governments establish appropriate policies before programmes are started, formal policy change may coincide with or even follow programme implementation.
Advocacy efforts are critical to gaining institutional and public support for policy changes at many levels, including national laws, policies and regulations affecting standards of practice, and community customs and traditions.
Restrictive policies can harm adolescents’ sexual and reproductive health by preventing them from acquiring lifesaving information and accessing services. Laws in some countries prohibit the provision of contraceptives to minors under age 16 or to unmarried women. Even where the law permits such services, some clinics do not. In other cases, fear of condemnation by the community, or parts of the community, may dissuade young people from seeking services. Parental or spousal consent requirements also restrict young people’s access to reproductive health education and services.
The absence of specific laws or policies—for instance, discouraging early marriage, or protecting girls against sexual abuse and violence—can also compromise sexual and reproductive health. Policies and laws that encourage or mandate needed programmes can have a positive impact.
A basic challenge in advocacy, especially in very traditional societies, is breaking the taboo of discussing sexual issues publicly, including acknowledging that many young people are sexually active before marriage. This would bring about a healthier society better able to meet new challenges with increased communication and respect between generations. This is essential for generating understanding within the community of the need for policy changes, particularly in response to the HIV/AIDS pandemic. Communications of diverse kinds are needed, from mass media to folk performances to discussion groups.
POLITICAL LEADERSHIP IS KEY Political commitment—at the highest levels, matched with resources and sustained over time—is crucial for the success of programmes addressing the often-sensitive issues related to adolescent sexuality. Many governments have taken years to accept that their countries have an AIDS crisis, and to recognize that the number of AIDS cases could explode within a decade unless much more is done to stem the spread of the epidemic, including caring for citizens already living with HIV/AIDS.(2)
The countries most successful in reducing HIV/AIDS are those whose leaders took the epidemic seriously more than a decade ago, including Brazil, Jamaica, Senegal, Thailand and Uganda. Other governments have more recently recognized the seriousness of the crisis and have begun to achieve results. In India, the prime minister has urged parliament to consider HIV/AIDS as the most severe public health problem facing the country.(3)
In contrast, some policies devised to combat AIDS may stigmatize young people and infringe on their human rights, such as requiring young women to wear special clothing or markings to indicate that they are virgins. Such approaches only marginalize those in greatest need of information and outreach, while not providing urgently needed skills and protection.
There is little research measuring the impact of programmes to change laws and policy, to alter cultural norms, or to foster a supportive environment with respect to adolescent sexual and reproductive health. Such monitoring efforts are relatively new, and assessment is difficult. Most evidence of successful outcomes in this area comes from case studies and reports. Further efforts are needed to improve the documentation and evaluation of programmes.
EXAMPLES OF POLICY PROGRESS Bolivia and the Dominican Republic approved national youth policies incorporating adolescent sexual and reproductive health in 1998. Both efforts depended on strong leadership from influential politicians—in Bolivia, a former first lady and a vice-minister; in the Dominican Republic, the vice president—along with organized youth involvement, support from international agencies, and successful coordination among several sectors of government.(4)
UNFPA and the U.S. Agency for International Development helped the Government of Ghana to develop an Adolescent Reproductive Health Policy reflecting ICPD goals.(5)
In Viet Nam, the Ministry of Health has developed national reproductive health standards and guidelines that include a specific section on adolescents.(6) UNFPA is working with the Government of Jordan to develop a comprehensive youth strategy emphasizing girls’ life skills and reproductive health, with advocacy efforts focused on the Ministry of Education, other ministries, NGOs and school administrators.(7)
The Kenya Youth Initiatives Project trained local leaders to become advocates for adolescent reproductive health with their national counterparts, helping to raise the priority given the issue in national policies.(8)