Greetings,
The seven postings in this digest come from the Dominican Republic, Ghana, Malawi, and South Africa.
Several posts provide a thoughtful discussion of access issues faced by youth. Effie Kamwendo of Malawi charts how cultural beliefs, poor information access, and gender norms constrain condom use and contraception. Vladimir Encarnación Jáquez of the Dominican Republic argues that services do not encourage youth access. Effie Kamwendo, in a second posting, asks for specific examples, both community-level and school-level, regarding the effectiveness of Behavior Change Interventions in reducing HIV/AIDS among youth in developing countries.
Aku Xornam Adzraku discusses various factors contributing to HIV infection and pregnancy among youth in Ghana. Olga "Olgies" Mashia of Pretoria explores the challenges faced by parents in communicating with children. In a second post, she discusses the success of life skills education, as part of the school curriculum, and encourages a peer education approach.
Responding to a post about access to basic health care in sub-Saharan Africa, Babalola Faseru notes that W.H.O. has training programs in Nigeria for traditional birth attendants and community health workers.
In response to Dr. Shelton's introductory comments, I would like to invite additional participants to ask questions or share experiences of their own concerning medical barriers or other access barriers to contraception for youth and how you or your organization may have dealt with them. There may also be questions concerning the medical eligibility criteria for contraception among youth that were presented by Dr. Shelton.
I would also like to invite participants to review YouthLens No. 12 entitled "Expanding Contraceptive Options and Access for Youth." If your primary language is Spanish or French, you will also see a link to the appropriate translation. Of particular interest to this week's discussion is the sidebar on p. 3 that provides resources on contraceptive options for youth. One of those resources provides a useful, easy-to-access source of information on side effects and other aspects of various contraceptive methods (developed by Pathfinder), available online (scroll down to "Adolescent Cue Cards").
Below, Dr. Shelton offers several comments on the latest postings.
Kind regards,
Ed Scholl
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I think Effie Kamwendo of CARE, Malawi makes many excellent and poignant points about the variety of misconceptions many people have about contraceptive methods. It reinforces the need to address such misconceptions and deal explicitly and forthrightly about common side effects.
Vladimir Jaquez of the Dominican Republic also points out the importance of making services appealing to youth, or "youth friendly." An annotated guide to web-based tools and resources to assist programs in providing youth-friendly services is available on the YouthNet web site. This site includes tools on advocacy and planning, assessment and implementation of services, provider training curriculum and job aids, and evaluation. Various organizations developed the tools, including EngenderHealth, the Catalyst Consortium, Family Health International, PATH, Pathfinder, and the World Health Organization.
Sincerely,
Jim Shelton
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Forum Digest 10
- Attitudes, Beliefs, Gender Equality Limit Contraceptive Use
- Services Not Designed for Youth
- Effectiveness of BCI Methods
- Factors Encouraging HIV Infection and Teen Pregnancy, Ghana
- Parents Face Challenges Communicating with Youth
- Promote Life Skills Training with Peer Education
- Training Available for Traditional Birth Attendants
1. Attitudes, Beliefs, Gender Equality Limit Contraceptive Use
I just want to share some of the experiences I have had in the community that I have worked with. Indeed, there are a lot of access barriers to RH services for youth.
The first factor is that of misconceptions. A lot of youth believe that using modern contraceptive methods (e.g. Depo Provera) will cause them to be infertile because they believe that the manufacturers of those products added some harmful chemicals in the contraceptives so that people would never bear children. This misconception denies them access to the contraceptives. They also believe that a condom contains HIV (put there by manufacturers), so that a lot of people would die, that the aim is that of reducing the population — since they hear on the radio that the population is increasing every day. So, they opt for unprotected sex.
Many also believe that the loop (the intrauterine device or IUD) is returned in the uterus, and becomes implanted with time, and, hence, it will make them infertile in the future. They also think that loop is not effective as a contraceptive, and, if used, the woman becomes pregnant, and the baby is born while holding the loop in the hand, which they say is harmful for the baby.
Some personal values and beliefs also act as access barriers to RH services for youth. Some people believe that it is wrong to use contraceptives. And, other religions also forbid their members to use contraceptives. Some youth feel that if they go for contraceptives and people — especially the elderly — discover that, then they will present a bad picture to the community. People will think that that particular person is sexually active or is promiscuous, and nobody would want to present that picture.
A lot of people dwell on the side effects of contraceptives, rather than on positive things. For example, one young mother was on Depo Provera, and she had continuous menses over some months. When she went to the hospital, she was told that it is normal for the first 3 months. But, she kept on worrying. When she told her friends in the village, everybody was afraid to go for Depo. And, yet, there were other women in the same village who were getting well with the same Depo Provera.
When someone became ill — while on any contraceptive — the problem was always attributed to the contraceptive, even if it was mere malaria. And, yet, a lot of people suffering from the same ailment but were not on any contraceptive.
Lack of information given to clients also posed a great problem in this area, especially on the side effects of contraceptives and what to do if those side effects occur.
Lack of decision-making in women also acts as a barrier. It was observed that a woman could not go for any contraceptive without approval of her husband. Other women went for the contraceptives behind their husbands' backs. When the husbands discovered this, the women faced the consequences. Sometimes, even divorce would occur. So, women wanting to secure their marriages chose not to access contraceptives.
-- Effie Kamwendo, CARE, Malawi
2. Services Not Designed for Youth
I think that one of the most important barriers is that services are definitely not designed for youth. For me, as a young person, when I need to go for a medical service, I can't find a place where I can feel comfortable or even fine, as most of our medical centers are developed for all kind of people — adults, children, and young people. The structures and the services provided do not meet all the needs of any of these different populations.
-- Vladimir Encarnación Jáquez, Dominican Republic
3. Effectiveness of BCI Methods
I have implemented and evaluated youth programs for quiet along time. I have observed that, despite various interventions done to combat the HIV/AIDS infection, the youth still indulge in unprotected sexual intercourse and early marriages.
I just wanted to know if the BCI (Behavior Change Intervention) strategies have worked in reducing incidences of HIV/AIDS among adolescents and the youth in some of the developing countries. Specific examples of the interventions and the outputs/outcomes, both at the community level and the school level, may help me.
-- Effie Kamwendo, CARE Malawi
4. Factors Encouraging HIV Infection and Teen Pregnancy, Ghana
Teenage pregnancy is really an issue that should be addressed in this time of HIV. In Ghana, services for young people in the rural communities, especially, are quite difficult. Several factors contribute to why lots of young people are getting infected with HIV and getting pregnant:
- Lack of access to education on the use of modern contraceptives. Apart from condoms, young people have always known contraceptives to be for adults. So, it is quite difficult for young people to change focus and use other modern contraceptives. Some young people in urban centres are used to these methods now, though it is not common.
- Even though young people know about these methods, it has not been translated to continuous use of them.
- Attitudes of service providers are definitely a factor, and it is very necessary for service providers to be updated on the new way of doing things especially in relation to young people.
-- Aku Xornam Adzraku, PPAG volunteer, Ghana
5. Parents Face Challenges Communicating with Youth
I totally agree with Michelle Burton, Belize: when she says parents needs to be educated on parenting skills. Yeah, it is true, from my experience as a young parent of two children, 14 and 10 year old. I find it difficult to relate to my kids. However, exposure to a lot of information makes it easier to know how to deal with certain situations when it comes to parenting.
I think taking parents through a Systematic Training on Effective Parenting could be a good thing. Parents would have to learn to communicate with their children and teach them the basics, and this would occur well before the outside world would play its role.
I have attended a lot of workshops where young people were targeted, and the workshops called for parents to start talking to them and stop speculating that when young people go outside, they are going to have sex. They also want us parents (adults) to trust them. My concern is that surely most of the parents do not know what to say, or when and how to say it.
Some parents are still old fashioned; they impose things on young people, and young people revolt. Times have changed, though. Whether we like it or not, young people will continue to be a step or three ahead of us, due to the exposure they have through a lot of mass media and technology. They are so advanced, it is like they have an inborn way of managing electronic gadgets and stuff. Therefore, they have a capacity to learn, and their behaviour could change. It is never late to keep on trying.
Youth are an asset in our communities, and we should treasure them. But, we also have a responsibility to make them what they want to be by empowering and supporting them.
-- Olga " Olgies" Mashia, Assistant Director, Youth & Adolescent Health, National Department of Health, Pretoria, South Africa
6. Promote Life Skills Training with Peer Education
Thank you for the informative discussions posted so far. I agree with Lynn Collins that we need to reinforce and mentor young people's skills to negotiate for sex. Negotiating for sex is the best way to control what you want and how you want it. However, communication between parents and children and partner to partner is minimal or non-existent most of the time, thus making it difficult for people, especially young people, to agree on certain issues in relationships. Negotiating condom use is not easy: Even some adults fail to negotiate, which is why you find that married couples infect each other. This is because the unfaithful one cannot be made to use a condom.
The best way is to educate our children, specifically to talk about safe sex and condom use early in the relationship, and not in the heat of the moment. It is also important for them to know each other well as partners, to talk and agree before going deeper in the relationship, so that they can dump any partner who cannot accept the terms laid in the relationship. However, a lot of young people are forced to have sex by their partners. In this case, I believe young people have to be taught to respect their fellow partners and their feelings.
In our schools, children take Life Orientation as a subject and are taught life skills, including communication, assertiveness, self respect, peer pressure, friendships, etc. This takes place from grade 4 (around 10 years of age). It enables children to have values and to know what is right and to believe in themselves. It is important to empower children while they are young to ensure that are moulded with the right attitude.
Also, if young people could be empowered to educate each other about life skills, it would be great because young people get more information from their peers and spend a lot time hanging around together. Again, a lot of information sharing and giving should take place where young people meet in groups, as opposed to preaching to the converted during awareness campaigns. Superstar role models could be used to spread positive life styles messages to young people.
Thank you for the contributions that were shared in the forum. They are quite empowering.
-- Olga " Olgies" Mashia, Assistant Director, Youth & Adolescent Health, National Department of Health, Pretoria, South Africa
7. Training Available for Traditional Birth Attendants
I quickly want to correct a comment in one of the postings of digest No. 9 that W.H.O is not recognizing the traditional birth attendants. I must say that W.H.O recognises traditional birth attendants and community health workers, and many training opportunities exist in the Local Government Health services for these people so that they can standardize their practices, know their limits, and refer patients appropriately in order to reduce maternal mortality. I am sure of such arrangements in Somolu Local Government where I had my Local Government Health Service Rotation as a registrar in public health. This program is, of course, funded by W.H.O, in conjunction with the Ministry of Health.
Nevertheless, I agree that there is more to be done, considering the fact that access to basic health care is grossly inadequate. What we need in sub-Saharan Africa is prioritization of health needs in the context of primary health care. Reproductive and sexual health is definitely a basic and essential health service and a component of primary health care.
-- Babalola Faseru, Department of Community Medicine, University College Hospital, Nigeria
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