Lack of knowledge and information

• Young people lack basic knowledge of reproductive anatomy and physiology, how pregnancies or STIs occur, how to prevent them and where to obtain protection.
• Parents may feel ill-prepared, uncomfortable or embarrassed to talk about sex with their children.
• Well-meaning parents and other adults, eager to protect their children, may believe that education about sexuality and reproductive health will encourage young people to become sexually active.

Lack of access to services and programs

• Youth may have little or no money to pay for services, lack transportation or do not know how to use services.
• Health workers may hold judgmental attitudes toward adolescent sexual activity.
• Health workers may not have up-to-date scientific information on contraceptive safety for adolescents.
• Health clinics may not be open at hours that are convenient for young people.
• Clinics often are designed for married women rather than single women, men or adolescents.
• Requirements for medical tests and pelvic exams may discourage young people from seeking contraception.^*
• National health policies may present legal barriers to youth seeking reproductive health information or services.

* In most cases, medical tests are not necessary for contraceptive use. A pelvic exam is necessary for diaphragm fitting and intrauterine device (IUD) insertion. However, pelvic exams, laboratory tests and breast exams are not essential for the use of pills, injectables, implants, most barrier methods or natural family planning. Blood pressure checks are advisable before pill use.

Psychological or social barriers

• Adolescents may be afraid to admit they are having sex.
• They may hold unrealistic views of individual pregnancy and STI risks ­ the "it cannot happen to me" syndrome.
• They worry that contraception will damage their health and future fertility.
• They are vulnerable to sexual violence, coercion and abuse.
• Girls may be reluctant to discuss reproductive health issues, fearing knowledge will be interpreted as promiscuity.
• Boys may be reluctant to ask questions about sexuality, fearing that lack of knowledge will mean loss of status among their peers.
• Motherhood may be a means for girls to gain status and respect in their families and communities.
• Sexual activity is often seen as a way for boys to gain status among their peers.
• Sex is a survival tool for young people who live on the street or who are poor.
• They fear they will be shunned or stigmatized if they admit homosexual or bisexual behavior or desires.
• Young people may be afraid or embarrassed to seek help for rape or incest.
• Mass media tend to emphasize fun but not responsibility or consequences of sexual behavior.

Questions for Providers and Program Managers about Barriers to Reproductive Health Care

? What obstacles do young people in your community face in trying to obtain health information or services? ? How can you educate and inform young people in your community about reproductive health? ? How can you educate and inform adults in your community about young people's reproductive health needs? ? What internal policies in your clinic or program discourage young people from seeking reproductive services? How can these policies be modified or removed? ? What national policies discourage provision of information and services to young people? ? How do gender norms ­ societal views on what is appropriate behavior for women and men ­ affect young women's access to health services? How do they affect young men? ? What can your clinic do to help minimize or eliminate barriers to adolescent health education and services?

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