There are more young people alive today than ever before-over a billion between the ages of 15 and 24-and with more of them sexually active, countries are increasingly grappling with the controversial issue of sexual and reproductive health education. According to the just-released report by the United Nations Population Fund (UNFPA), nearly half of all countries have taken new measures to address the reproductive health needs of adolescents, as they were urged to do at the 1994 International Conference on Population and Development (ICPD) in Cairo.
At the conference, the world's governments agreed that young people have the same right to reproductive health as their elders. With HIV/AIDS spreading faster than anticipated, governments went even further at the 1999 fifth-year review of the ICPD, calling for reproductive health education for all schoolchildren, and access to information and services for 90 per cent of 15- to 24-year-olds by the year 2005, to reach 95 per cent by 2010. These services include access to female and male condoms, voluntary testing, counselling and follow-up.
"Today's young people are frequently at risk of unwanted pregnancy, HIV/AIDS and other sexually transmitted diseases, sexual exploitation, and alienation from parents and communities," The State of World Population 1999 report states. And "ignoring the issue incurs a high cost in ill-health, wasted opportunities and social disruption." According to the report, more than 14 million adolescent girls give birth each year and a large proportion of these pregnancies are unwanted.
The World Health Organization (WHO) estimates that adolescent girls seek as many as 4.4 million abortions each year. Providing reproductive health information and services would reduce the number of teenage pregnancies, abortions and resulting health complications, and give girls and boys a better chance to succeed. In many countries, girls who become pregnant are not allowed to continue school. In Kenya alone, an estimated 10,000 girls leave school each year because of pregnancy, the report says.
Research refutes the widely held view that sex education promotes promiscuity. On the contrary, "studies show that better information encourages responsible sexual behaviour among adolescents, including abstinence," the report states.
In most cultures around the world, there is a sexual double standard. Girls are expected to refrain from sex and not talk about it, while boys are encouraged to experiment. Many young people of both sexes are ill-informed about sexual matters. With cases of sexually transmitted diseases (STDs) on the rise, and sexual violence widespread, this situation is dangerous and needs to be addressed.
Studies show that family life education should begin early to help young people through the years when they are beginning to be interested in sex, the report says. Worldwide experience has shown that programmes should be different for youth who are sexually active and those who are not, and should be as specific as possible. For example, in one study in Albania, young people said they wanted practical information such as how to avoid condom breakage and obtain emergency contraception.
Around the world, non-governmental organisations (NGOs) have been particularly active in testing new approaches to reaching adolescents. Actions to foster understanding and support among adults in the family and community are now also recognised as a key investment.
One of the cases cited is the Dominican Republic, where pregnancy and birth complications are a leading cause of death among teenage girls. According to the report, nearly one in four girls aged 15 to 19 is either pregnant or has already given birth in this Caribbean nation, and there are few health services to meet their needs.
Since 1997, two NGOs-the Dominican Association for Family Well-being (Profamilia) and the Dominican Institute for Integrated Development-have been working to expand sexual education and reproductive health services to adolescents. Working in 36 neighbourhoods surrounding the capital, and three smaller cities, the groups use peer education and counselling to make young people more aware of the health risks of unprotected sex.
The project, supported by UNFPA, encourages teens to postpone their first sexual encounter or to maintain a faithful relationship with one partner. Since 1997, training has been provided to over 350 teenagers who volunteer their time to talk to other teens about sex and STDs. They even provide contraceptives to teens who have parental consent. Since the work started, demand has increased for services and expanded into schools, churches and community centres. Nearly 9,000 young people have received information and services, and 90 doctors, nurses and psychologists from the Ministry of Health have received training in integrated adolescent health care.
However, in many countries, the topic of adolescent sexuality remains stigmatised and reproductive health services do not reach young people. It has often proved difficult, the report says, "to reconcile the important role of parents with the capacity of young people to make their own decisions as they grow towards adulthood, or to define the role of society in mediating what is primarily a family matter." Even married young people are often poorly served.
Despite constraints, the number of countries addressing the issue is increasing. Some, such as Jamaica, are putting adolescents at the centre of their reproductive health strategies. Others-such as Burkina Faso, one of the first West African countries to launch a reproductive health programme for young people-have opened youth centres in urban areas that offer health services and peer-based education. 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. The song has inspired a Nigerian television series of the same title.
With the rate of HIV infection increasing rapidly among young people, especially in sub-Saharan Africa, providing information and services can be a matter of life and death. Globally new infections number 11 a minute, and over half of those infected are young people below the age of 24. In Uganda and Thailand, the incidence of new infections, particularly in young people, has declined by about a third in response to intensive information and protection campaigns.
According to Edith Mukisa, founder and director of the Naguru Teenage Information and Health Centre in Kampala, Uganda, demand for condoms is strong. Just as important, she says, is counselling, especially for girls. "We have to give them the skills to negotiate using the condom." Skills, information and services are needed to help young people make responsible decisions about sexual relations and reproduction. Given that more than one person in six is now between the ages of 15 and 24, and 40 per cent of the population in 62 countries is below age 15, the issue is more pressing than ever.
Review: 6 Billion
