Greetings,
This digest contains three thoughtful postings, from Finland, Nepal, and one unidentified country. These posts weave together our current topic, medical barriers and accessibility, with our ongoing discussion of how to meet the varied needs of youth, especially girls, through skills training and involving parents and other community members.
Temitope Abayomi Fadiya argues that limited access to basic healthcare makes access to reproductive and sexual health information and services all the harder in sub-Saharan Africa.
Two posts discuss approaches to empowering girls in controlling their sexual autonomy. Prabin Khadka discusses the cultural context of early marriage in Nepal to explain why programs must also target parents. Amy Weissman discusses how her organization, Save the Children, has used field research to develop programming in Malawi aimed at empowering girls to resist unwanted sexual advances.
Best regards,
Ed Scholl, Forum Moderator
On behalf of YouthNet, The INFO Project, and the Implementing Best Practices in Reproductive Health Initiative/World Health Organization
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Forum Digest 9
- Access to Basic Healthcare at Root of Problem
- Target Parents to Help Girls Avoid Early Marriage, Nepal
- Girls Able to Negotiate Sexuality with Skills Training, Community Involvement
1. Access to Basic Healthcare at Root of Problem
If I could be permitted to open the floor of discussion on the topic of medical barriers and accessibility, I would say that this issue is inextricably linked to the contentious issue of accessibility to healthcare. For instance, in an advanced healthcare system like Finland, where quality health care is organised by each municipality for the benefit of its inhabitants, there is equal and adequate access to healthcare; hence, youths in this country are better informed about safe sex and contraceptive issues. Compare this to Nigeria, my home country. In the northern part of the country, about 3,800 people are competing for a hospital bed — or, put another way, there are 3,800 citizens to a doctor. But, in the southern part of the country, the average is much smaller, about 1,000 people to a bed, or to a doctor.
It's quite obvious that a marked disparity exists in access to healthcare, which would adversely affect reproductive health, as well. There is a strong correlation between socio-economic status and access to basic healthcare and information pertaining to contraception. And, the institutional barriers that help foster this must be dealt with in sub-Saharan Africa in order to ensure access to information on reproductive health, female sexuality, and the broad spectrum of contraception.
Regarding another issue, that of traditional African contraceptive methods, which are still being used in the countryside, is there any research available that suggests how to modernize or refine them for greater benefits? This skill exists with the traditional birth attendants in the remote areas, but unfortunately the W.H.O. does not really recognize these efforts, even though they are now being incorporated in some African health systems!
-- Temitope Abayomi Fadiya, MD, Dept. of Public Health and General Practice, University of Kuopio, Finland
2. Target Parents to Help Girls Avoid Early Marriage, Nepal
Nepal is facing a great challenge in controlling early marriage. Emancipating a girl from early marriage has been not an easy task since the parents come mostly from rural areas that are deeply rooted in traditional cultural beliefs. Therefore, in my point of view, just empowering youth will not be enough. Training and awareness campaigns should also address the parents in order to help youth (mainly girls) avoid early marriage.
Thank you so much for conducting such an open discussion forum. Doubtless to say, it has been very informative and beneficial for youth like me.
-- Prabin Khadka, Youth Coordinator(Volunteer work), Family Planning Association of NEPAL
3. Girls Able to Negotiate Sexuality with Skills Training, Community Involvement
In recognition of the direct link between high HIV infection in adolescents, especially girls, and cross-generational sex, Save the Children is working with local partners, including girls themselves, to develop locally-appropriate responses that help to protect and empower girls to make alternative choices.
To help us better respond to the issue of cross-generational sex, Save the Children developed a continuum, based on field experience in several countries in Southern Africa, East Africa and Asia, that helps us understand where a girl is, based on her needs and experiences, and guides appropriate responses. On one end are girls who engage in sexual relationships with older men voluntarily (for emotional reasons). On the other end of the continuum is sex against the girl's will. In the middle is what we refer to as "economically rational sex", which is neither strictly voluntary nor involuntary.
Save the Children posits that different responses are needed for girls at different points of the continuum, ranging from making relationships and practices safer to changing social norms that favor coercion.
Save the Children has operationalized the continuum in Malawi, where we developed a package of activities, designed and tested by girls, to respond to the needs of different girls. These include girls who engage in cross-generational sex of their own volition, those who do so because of poverty or immediate or future real need, and those who were coerced into such relationships. We found that some girls needed someone to intervene when the advances were unwanted. Community aunties, selected by girls, serve that purpose well. The aunties go and talk to the men, sometimes with the girls' parents. After these discussions, girls say that the men do not bother them again. Other adolescent girls engage in cross-generational sex for small gifts or favors. Life skills activities, in addition to the satisfaction of challenging themselves to refuse and, then, rewarding themselves for doing so, worked very well. Other girls asked for and now use small business skills to meet their basic survival needs.
I would also like to mention a Save the Children publication on child marriage: State of the World's Mothers 2004 (PDF, 1.1MB), which in addition to the excellent ICRW publications, may be of interest to members of this group.
-- Amy Weissman, Youth Reproductive Health Advisor, Save the Children
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