Greetings,
This digest marks the end of week three of the forum. Thanks to those who raised questions and offered provocative comments related to access to contraception, both at the service delivery and societal levels. Below Jim Shelton offers provocative closing thoughts about contraception and youth, focusing on issues related to condoms.
Next, we will send out an introduction to week 4, focusing on issues related to the "ABC" approach to interventions for youth. We look forward to continued comments on any of the issues raised through the first three weeks, as well as the "ABC" theme for our last week.
The four postings in this digest (from France, Nigeria, Trinidad and Tobago, and the U.S.) emphasize the importance of sex education, including values-based approaches, and affordable services. One posting provides links to two recent studies that summarize successful youth programs. In addition to those links, a synthesis of successful intervention strategies developed by the FOCUS on Young Adults project is available in YouthNet's Youth Issues Paper 1 (scroll to No. 1, available in English, French, and Spanish).
Below are Dr. Shelton's closing thoughts followed by the digest of postings.
Sincerely,
Ed Scholl, for the Forum coordinators
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I've appreciated the opportunity to serve as guest panelist and to see the insightful postings. In my final message, I want to put an important issue on the table. I think we have a difficult quandary about recommending condoms as something of a preferred method of contraception for youth.
On the one hand it is true that condoms have the added benefit of providing some protection from STIs. But here are some reservations:
- It is not necessarily true that any particular youth is at higher risk of STIs simply because they are young. They may be in very stable faithful relationships.
- Condoms are only effective in preventing pregnancy if they are use correctly and consistently. Unfortunately that is not the case probably for most people and is probably even less likely for many youth.
- The protection from STIs also depends to a large extent on correct and consistent use. Again this is a real constraint. Inconsistent use may provide little protection.
So I think for youth, as well as older people, contraceptive method choice depends a lot on the individual. Factors such as the need for effectiveness, the actual risk of STIs, and the realistic potential to use a method correctly are all very important. We don't do youth any favors with unrealistic expectations.
Happy to hear other thoughts.
Sincerely,
Jim Shelton
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Forum Digest 12
- Sex Education Vital
- Values-Based Approach, Males Need Role Models
- Affordable Services, Education, Empowerment Needed
- Youth Programs That Work
1. Sex Education Vital
Effective sex education provides correct information, starts early, and recognizes the value of the community. In countries where sexuality spreads quickly, a large number of teenagers find that their parents do not want to bother, or do not have the necessary competence, to explain sexuality to them. Today, a great number of young people who make the decision to become sexually active do it in a way that is inadequate and badly informed.
Young people have the right to get appropriate information in order to make decisions, depending on their ability to act in a responsible way in general. Sex education neither encourages young people and teenagers to have earlier first sexual relations nor does it encourage them to increase their sexual activity. If young people receive sex education before their first time having sex, they can delay their first sexual experience or adopt more sensible sexual behaviors. Sex education on STIs and AIDS can lead to a reduction in the number of sexual partners and an increase in the rate of the use of contraceptives, fewer pregnancies, less transmission of the STIs and AIDS.
The goal of sex education is not only to avoid the problems caused by ignorance about sexuality, but, rather, the more serious consequences which cause the most concern for parents, for the community, as well as for leaders. This is because a child born to HIV+ parents is directly infected by AIDS, and that also brings a higher rate of maternal mortality and morbidity.
Unwanted pregnancies in adolescents increase each day in developing countries. Because of a lack of sexual experience and necessary information on sexuality, many young people are ignorant about the use of contraceptives. This causes the births of many children whose fathers are unknown. This leads to the number 5910, defined as:
- 5 = 5 minutes
- 9 = 9 months of pregnancy
- 1 = 1 child
- 0 = no father (father unknown)
Children born to the youngest mothers do not have much chance of survival. They often have complications at birth and die in the first three months after their births.
-- Jean Pierre Clavers Kouetolo, France
2. Values-Based Approach, Males Need Role Models
Permit me to add my comments on last week's discussion, which I think was very animated and beautiful. I do agree with the notion that adults must change their attitudes in order that projects targeting youth are successful.
However, attempts by agencies, both national and international, to empower youth to be assertive in expressing their sexuality, may further exacerbate their risks. It is my view that there is a need for balance in our approaches to addressing the needs of youth, in order to minimize conflicts with adults, which can help ensure their support.
Below, I share my experiences as Director of the Population Programme Unit of the Ministry of Health, Trinidad and Tobago, and as a facilitator of youth-focused sexuality workshops. My work is in a context of a multi-religious and plural society.
Not all young people desire being sexually active. However, the multiple influences of mixed messages from a variety of sources do create cognitive dissonance for them. Some youth are made to believe that failure to be sexually active is abnormal. My interventions have focused on a values-based approach that allows for exploration of values through role play and other interactive activities. This allows those who are sexually active to consider protective behaviors and those who are not sexually active to feel comfortable with abstinence as their preferred choice.
Finally, in our society — where gender inequality is not as pronounced a problem as it is in other societies — special emphasis should be placed on males. Young men need role models who understand the importance of relationships and value monogamy. In this regard, we work with men as well as women to sensitize them about socialization of their sons. The overwhelming response has been that they had never considered the impact of socialization on their sons relative to their behaviors in relationships.
-- Oscar Noel Ocho, Director, Population Programme Unit, Ministry of Health, Trinidad and Tobago
3. Affordable Services, Education, Empowerment Needed
I wish all of us a blissful month of April and a successful discussion this week that could lead to a breakthrough. This is a common thing to apportion blame to one and another's failure; it's very easy to pass the buck. I would rather have us find a solution to this nightmare.
Here in Nigeria, especially during the military era, it was rumored that drugs and other medical equipment, meant for the use of the general public, often ended up with private chemists, clinics, and hospitals, where they were sold at exorbitant prices. Under such circumstances, there is a barrier for youth in obtaining reproductive health services. During the period in question, the common language in the hospital was "OS," meaning "out of service." This led to an upsurge of fake drugs in the Nigerian market, as the ordinary man could no longer afford essential drugs.
The situation today is a little better because NAFDAC is nailing fake drugs in the board. However, the price of drugs is still astronomical for the common man, whose earning is nothing to write home about. Until a frantic effort is made by government and corporate bodies to supply these reproductive health services free, or at a very subsidized price, it will remain unattainable by the youth.
In my own opinion, the issue of poverty in Nigeria is of grave consequence, and it must be urgently addressed. If youth are empowered economically, the solution is nearby.
Education as through awareness campaigns and economic empowerment can make a lot of difference, even if there is no medical solution to the problem of HIV/AIDS. People will no longer surrender to temptations of money, food, shelter, and other forms of wealth. Our performing artists could do a lot through a community theatre production which will drive home these points in a practical manner. Thanks for this opportunity given me to express myself.
-- Adavi Abraham, Action Support for Upset Group, Lokoja, Kogi State, Nigeria
4. Youth Programs That Work
Several participants have asked for examples of successful programs working with youth. The following document reviews several programs: Science and Success in Developing Countries: Holistic Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Also helpful is, Franchised Youth Clinics Motivate Behavior Change in Madagascar (PDF, 168K).
-- Judith Collins, U.S.
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