sex education for 21st century

7/27/2019 sex education for 21st century

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he nternational planne parenthooFeeration (ppF) is a lobal servierovier an a leain avoate of seal

an rerotive health an rihts forall. We are a worlwie movement of national oranizations workin with an forommnities an inivials.

ppF works towars a worl where women, men an oneole everwhere have ontrol over their own boies, antherefore their estinies. worl where the are free to hoose

arenthoo or not; free to eie how man hilren the willhave an when; free to rse health seal lives withot fearof nwante renanies an seall transmitte infetions,inlin V. worl where ener or sealit are no lonera sore of ineqalit or stima. We will not retreat from oineverthin we an to safear these imortant hoies anrihts for rrent an ftre enerations.

knowleementsIPPF would like to thank all who helped create Stand and Deliver: Sex, healthand young people in the 21st century. Our sincere thanks goes to the Ministry oForeign Aairs o the Netherlands, to YouAct (the European Youth Network onSexual and Reproductive Rights), to the Youth Coalition or Sexual and ReproductiveRights and to the World YWCA or their contributions and or reviewing dratso the publication. Thank you to Dennis Ferhatovic, Sada Nasim and MilindaRajapaksha, IPPF youth volunteers; to IPPF Regional Ofces; and to the CentralOfce Resource Mobilization Team or their assistance and support. The Advocacyand Communications team at Central Ofce wrote and produced Stand and Deliver,with important contributions rom the Youth and HIV teams. This publication was

made possible through the generous support o the SALIN+ Fund, an initiative othe Netherlands. Thank you all.



Foreword: Andrea Núñez Argote, youth volunteer, YWCA 4Foreword: Bert Koenders, Minister or Development Cooperationo the Kingdom o the Netherlands 5Foreword: Dr Gill Greer, Director-General o IPPF 6

IntroductIon 8Young/vulnerable 10

Why now? 13

Youngpeople’ssexualandreproductIvehealth 16Case study: Mauritania – An inconvenient marriage 19Case study: Bolivia – Supporting young people to bring home the bread 20

cultIvatIngmIndsandbodIes:thebuIldIngofacItIzen 22Creating youth-riendly services 24Case study: Tanzania – Abortion, the choice that never was 27Faith, religion and sexuality 28

Youngpeople’shumanrIghts 30

Love, lie and HIV: Young people living with HIV 31Case study: Uganda – Promoting empowerment, respect and civil responsibility 32Case study: Europe – Youth Advocates in Action 33Case study: Southeast Asia – Building a youth advocacy movement 34

recommendatIons 36conclusIon 38Reerences 40

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Foreword

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Today, most young people still do not have access to inormation, proper guidanceand supportive services, neither rom the health sector nor our teacher and parents,who are oten uncomortable talking to us about sex and sexuality.

In my own country, México, the Ministry o Health provides general inormationin the school curricula or students to understand their sexuality and reproductivehealth. General inormation is not enough – we need comprehensive inormationwith ample time to discuss difcult issues in an open manner. When teachers skipthese topics, we don’t get the inormation we need. Instead we are let to talkabout these issues with our riends, who know the same or less than us, and all toooten we are ashamed to ask or the inormation in ear o being criticized.

In many cases, young women and girls are not treated equally to young menand boys. We know that amily values and gender roles are inherited rom ouroreathers and oremothers and that cultural environments also inuence gender

dynamics. I understand that I have the ability and that I am empowered enough tobreak this cycle. It is my responsibility to remember this when I become a mother.Everything depends on the will o communities to accept this kind o change andmost o the time young people are more open to change.

This publication makes reerence to non-governmental organizations (NGOs) such asAsonat, where young people can access SRHR inormation and services. We needmore organizations like Asonat, which understand the social determinants o youngpeople’s lives. Asonat reminded me o my association back home – the YWCA oNaucalpan – where I work as a volunteer. We have a programme on HIV and AIDSprevention, and we also address SRHR. We provide sae places or young peopleto access the inormation they need through activities such as dance classes, karate

and drawing.

I believe that this publication provides a rich source o inormation on SRHR oryoung people. We need to know what our rights are, we need to understand ourown background, we need to learn rom all this to create a better uture or all, andwe need to do this today.

Stand and Deliver: Se, health an on eole in the 21st entr4



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Young people have the right to be ully inormed about sexuality and to haveaccess to contraceptives and other services. These rights are enshrined in variousinternationally agreed human rights conventions and treaties, but – unortunately

– they are still not universally respected. This explains why the Netherlands’ policieson oreign aairs and development are centred on human rights. And whythe Dutch government remains committed to the Programme o Action o theInternational Conerence on Population and Development. Our support to IPPF andother organizations which implement this important agenda is testimony to thiscommitment.

Young people deserve special attention in development settings, where theyoten lack access to services that adults in many countries take or granted. This

makes young people vulnerable. Millions do not know how to protect themselvesagainst unwanted pregnancy or sexually transmitted inections such as HIV, or areill equipped to do so. Young women and girls lack decision-making power andmany are subjected to gender-based violence every day. In many places, lesbian,gay, bisexual and transgender young people live in ear o discrimination andstigmatization. Numerous countries do not regard sexual health or rights as alegitimate part o the public duty o care or acknowledge that young people aresexual beings. The taboo on youth sexuality is one o the key orces driving the AIDSepidemic and high rates o teenage pregnancy and maternal mortality.

I believe that as a matter o urgency, we must make progress on achieving theMillennium Development Goals – notably MDG 3 (promoting gender equality and

empowering women) MDG 5 (improving maternal health) and MDG 6 (combatingHIV/AIDS, malaria and other diseases). The whole world needs to accept that manyyoung people, married and unmarried, are sexually active. Governments, donors,communities, leaders and individuals, all have a role to play in creating a sae andenabling environment where young people get the support and care they need orgood sexual and reproductive health and rights, and where they have a real say inmatters concerning their bodies and their health.

Together, let us fnally recognize young people as catalysts or change. Let us enablethem to develop their ull potential – or their own sake and or the sake o theiruture.

Foreword

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Stand and Deliver: Se, health an on eole in the 21st entr 5



Foreword

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As Stand and Deliver demonstrates, however, poverty and inequity make girls and

young women vulnerable, threatening not only their individual well-being andhuman rights, but the realization o development goals.

Stand and Deliver highlights acts we have known or decades, but have beenneglected until now: girls and young women bear a disproportionate burden osexual and reproductive ill health and mortality, including maternal mortality, unsaeabortion and HIV. Why do they suer needlessly? The answer is simple: they havelittle power over their own lives. While realizing the solutions are not easy, weknow what needs to be done. We must ocus special attention on the needs ogirls and young women. Greater investment in primary and secondary educationor girls, comprehensive sexuality education or boys and girls, both in and out oschool, which can break down gender stereotypes, and provision o youth-riendly

services that ignore taboos and stigma around intimacy and sex will empower girlsand young women. Young women, like young men, must be given the reedom toassume leadership and responsibility or building a better world.

Stand and Deliver: Sex, health and young people in the 21st century presents uswith some choices and recommendations that can transorm today as well astomorrow. I trust and hope, with young women and young men as our partners,that we will make choices that contribute to gender equality, social justice and atruly better world or all.






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Every week there is a new virus, or a fnancial collapse, acatastrophic hurricane or a drastic increase in ood shortages,and the ramifcations that ollow rumble on through daysand months, sometimes years, brushing by some people and

hitting others square on. Climate change and rapid populationgrowth – a potent, oreboding pair – are already deliveringblows that are sudden and staggering; they are also causingcumulative, damaging environmental change that makespeople’s everyday lives increasingly difcult. Rich and poor,young and old eel the impact o global crises, in developedand developing countries. The dierence lies in the resourcesthat are available to adapt and rebuild, and, most especially,o the capacity o individuals to conront change. Wherepeople are empowered to take the reins and make decisionsto ensure their own security and well-being, as well as that otheir amilies, communities are resilient and peace is secure.

As globalization accelerates the speed at which risks tohealth and home spread around the globe, building a worldo empowered global citizens is an urgent and revolutionarychallenge. It is one we cannot aord to delay.

The world is home to the largest generation o youngpeople in history – more than 1.75 billion people between10 and 24 years o age.1 They are a vastly diverse group oindividuals whose lie circumstances, including opportunitiesand obstacles to improve their lives, vary signifcantly romone country to the next, and even rom one area to anotherwithin a single country. The majority o young people livein developing countries2 and 42 per cent live in poverty.3

Capabilities among them range widely: some young peopleare income-poor and thus ace barriers in many areas o their

daily lives; others are poor in health, particularly sexual andreproductive health; and some are excluded rom political,social and labour market participation. Young people in thepoorest areas oten lack access to essential resources such

as clean water, good sanitation and ood, a situation thatis perpetuated by illiteracy and limited access to education.Many young people have yet to exercise their basic right tochoose a lie that they value.

Despite all o this, young people everywhere are aninexhaustible source o ideas, energy and optimism. Allthrough history, young people have broken away romnegative behavioural patterns and changed intergenerationalcycles o discrimination and poverty. They have the potentialto build a world that is inclusive and compassionate, orpeople and or the planet, and the good news is they want to

be involved!

In this report we take a good look at the lives o youngpeople, their needs or comprehensive sexual andreproductive health services, their unmet needs and theirdesires, in a global context that is presenting us with dauntingchallenges that will shape the uture. Supported by evidenceat the country level, we argue that the only way to builda more just world is to invest in and involve young people,to support them to be decisive, adaptable, inormed andassertive citizens, and to engage with them as partners indevelopment. This generation o young people is a git and anopportunity that will not come around a second time.

Now, mo han v, poblms mgingin oh pas of h wold dicly affco sociis, o conomis and o livs.




whirlwin on the soial sene, Milina, 24, rstjoine the Famil plannin ssoiation of Srianka as a eer eator in 2004. e reeivetrainin, an then went ot to meet oneole in 16 istrits to reveal all abot sealan rerotive health an rihts. Milina washooke: he saw the nee for information anservies an mae it a ersonal mission to raiseawareness of on eole’s isses. Sine then,Milina searheae the eveloment of thenational oth oli, he has beome the onvenorof a national ivil soiet form, an he fonec, Sri anka’s rst oth onferene on Van dS, an the ational yoth coalition onSeal an erotive ihts.

“I always ask young people to believe intheir rights because health is not a benet,but a fundamental right. I work to developthe capacity of young people like me to doeffective advocacy, to work with media andensure a rights-based approach.”



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Young people represent a signifcant proportion o the overallpopulation in low income countries, and they also representa disproportionate burden o global poverty. The ChronicPoverty Research Centre has identifed three critical societaleatures that keep poor people poor: limited citizenship, socialdiscrimination and poor work opportunities.4 Most youngpeople in developing countries struggle with one, two or allthree o these barriers, which also contribute to the relentlesscycle o intergenerational poverty, to instability at thehousehold level and state ragility.

¼Nearly 93 million young people are unemployed5

¼Young people (between 10 and 24 years) accountor two-thirds o premature deaths6

¼One-third o the total disease burden in adultscan be attributed to behaviours or events romadolescence, including smoking, exposure toviolence, mental illness and unsae sex7

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As most societies defne adolescence and youth in termso both age and lie circumstances, there is no universalagreement on what is a ‘young person’. The nationallegal age or political participation and the availability odata on dierent age groups can also determine howsocieties defne youth. The World Health Organizationdefnes young people as those rom 10 to 24 years oage, including adolescents (10–19 years) and youth (15–24years). IPPF uses the terms young people, youth andadolescents interchangeably to reer to people who are

between 10 and 24 years. Defning all people under 18years o age as a child is oten not useul because it ignoresthe circumstances o youth who are aced with pressuresand responsibilities that are usually reserved or adults.

Policies and programmes or young people should ocusnot so much on age, but on the specifc developmentalneeds and rights o individuals as they transition romchildhood to adulthood.

Whil h cn gnaion of yongpopl a an opponiy, a psn hyfac incdibl bais o impoving hilivs and conibing o sociy.




“Tackle the inequitable distribution of power, money, andresources – the structural drivers of the conditions of dailylife – globally, nationally and locally.”ne of three ke reommenations mae b the Worl ealth ranizationcommission on the Soial determinants of ealth8

FI 1: INterNet ue uN ee, e 15–24

Source: International Telecommunication Union (2008) Use of information and communication technology by the world’s children and youth Geneva: ITU

Disparities in access to essential basic services, such assanitation, clean water, health, education and access to the judiciary system, are undamental inequities that can producelielong inequalities and deep-seated eelings o injustice.These inequities extend to things like access to inormation:while access to communication technologies, including theinternet, may seem like a luxury, in reality it means that while

most young people in developed countries, and the wealthieryoung people in poor countries, can obtain the inormationthey seek, others cannot (see Figure 1). The violation oyoung people’s rights to inormation, to health care services,to contraception and counselling, to education, to politicaland social participation, and to health is a denial o theirpersonhood and o their citizenship.

Young people suer social discrimination on multiple accounts,frst because they are poor and again because they areyoung. Marginalized young people, including men who have

sex with men, sex workers, transgendered people, youngpeople in rural areas or in urban slums, and others are urtherstigmatized. Girls’ and young womens’ choices are especiallylimited.

In some countries, persistent inequity has resulted in sociallyand politically volatile populations; rustrated youth are

vulnerable to the appeals o undamentalist, religious orpolitical groups.9 The lack o opportunities to improve theirlives leaves young people with nowhere to go and no one toturn to: they become caught in the poverty trap, and escape,or many, can seem like an impossible dream. I we are goingto give these young people any chance at all to create a lie otheir choosing, we must invest in social programmes to reachout to marginalized youth, including through civil societyorganizations, to help build their sel-esteem and give themopportunities or education and training.

Australia

Bermuda

EU27

Iceland

Japan

New Zealand

Norway

United States

DEVELOPED

COUNTRIES

DEVELOPING

COUNTRIES

Azerbaijan

Brazil

China

Costa Rica

Malaysia

Mauritius

Mexico

Morocco

Paraguay

Thailand

0% 10% 60%50%30% 80%20% 70%40% 90% 100%




Countries should aim to meet the needs and aspirations ofyouth... thereby ensuring their integration and participationin all spheres of society, including participation in thepolitical process and preparation for leadership roles.cpd proramme of tion, ararah 6.13

When both young women and young men are ully inormedand engaged, with the reedom to pursue higher levelso education and access to youth-riendly health services,they become concerned and contributing citizens in thecommunity. As such, they are oten able to escape povertyand help others to do the same.

A youth health research organization based at MelbourneUniversity reports that young people’s experience o

“engagement, belonging and connectedness are protectiveactors in the prevention o long-term mental and physicalhealth and social problems.”10 Protective actors and processesmay be located within the young person (e.g. learnedattitudes or belies), in the amily (e.g. caring adults) or inschools and the community. As the number o protectiveactors and processes surrounding a young person increases,the more resilient he or she becomes. While these fndings arebased on evidence in developed countries, the same is true inthe developing world.

Investing in sexuality education, social programmes or youth,youth-riendly sexual and reproductive health services, andpromoting gender equality are vital to help young peopledevelop the ability to cope with and respond to an ever-changing world. Governments should also seek to providesocial protection to help young people avoid alling intopoverty, or to help them escape it, and to help them plan

and lead a productive, healthy lie. In the long-term, resilientcitizens translate into resilient communities and resilient states.

Social protection means protecting the vulnerableagainst risks that threaten their livelihood or income, andenhancing the social status o marginalized groups.11

Social protection may include transers o money or goods,welare services and social policies.

Government is unable or unwillingto meet population’s needs

Efficient delivery of essential public services

Lack of employment opportunities Citizens can act to improvetheir lives

Repressed political competition Robust political processes andcivil participation

Inability to deal withdisasters and shocks

The ability of individuals to copewith change and plan for crises

Vulnerability to violentinternal conflict

Capacity to manage and resolveconflict without violence

Source: OECD (2008) Concepts and dilemmas of state building in fragile situations. Paris: OECD.

FI 2: te rIIt – reIIeNe NtINuu




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Many developing countries have experienced demographictransition in the past several decades. That is, “as death ratesdecline, ollowed later by a decline in birth rates, populationsgrow rapidly [and then] eventually plateau at a relativelystable level.”12 (see Figure 3: The demographic transition) Thisis already occurring in countries like Bangladesh, Egypt andPeru. In these countries the risk o civil conict is declining andthere is tremendous opportunity to stimulate uture economicgrowth by supporting an upcoming workorce.13

In these contexts, young people have the potential to developinto a large, productive workorce, an inormed and capablecitizenry who will transorm their countries into secure,healthy and peaceul nations.14 This ‘demographic bonus’ is aone-time opportunity, it is a “period o as many as 50 yearsduring which an initially high ratio o the working age to thedependent population gradually declines.”15

In other countries, however, population growth is still high,driven largely by unwanted ertility, a high proportion opeople o reproductive age and high desired amily size (seeFigure 4: Causes o population growth). Aghanistan, theDemocratic Republic o Congo, Haiti and Uganda are allcountries with high population growth. In many countrieso Arica and the Middle East, up to hal o the population isyounger than 15 years.16 Very young populations like thesetend to undermine countries’ development and security.17

FI 3: te erI trNItIN

Source: Population Action International (2007) The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World. Washington, DC: PAI.

Birth rate

Death rate

Populationgrowth

BIRTH AND

DEATH RATES

(PER 1000 PEOPLE)

50

40

30

20

10

0

Time




The most immediate consequences o a youth bulge (even,or a limited period, in countries where population growthhas stabilized) is that government tax income, gained rom aminority adult labour orce, is insufcient to provide the publicservices that all people need. This is exacerbated in countrieswith severe HIV epidemics, where AIDS has devastated ageneration o working-age adults. In many poor countries,

there aren’t enough jobs to meet demand. Governmentsacing this problem should incorporate incentives into labour,trade and skills training policies to increase employmentopportunities or young people. More extreme outcomes othe demographic youth bulge (and associated poverty andlack o opportunities) include dangerous anti-social behaviourssuch as terrorism and suicide.

The current generation want to have ewer children thantheir parents18, 19: given the inormation, services and suppliesthey need, they will achieve these desires, and they willcontribute to population growth stabilization. But at themoment, the number o people o reproductive age whowant contraception is increasing aster than the availability oservices and supplies.20

Tomorrow approaches rapidly, and while much good work isunderway, with each year that passes opportunities to reacheven more young people are lost. The opportunity to ‘catchthem while they’re young – a truly golden rule when it comesto cultivating mindulness, healthy behaviours and socialvalues – is time-bound, and time is running out.

FI 4: jr ue rjete utIN rWt: eeIN uNtrIe, 1995–2010

Source: Bongaarts, J (1994) Population policy options in a developing world. Science, vol. 263, pp 771–776.

12

10

8

6

4

2

0

1900 1950 2000 2050 2100

POPULATIONGROWTH

(BILLIONS)

Causes of population

growth

Unwantedfertility

High familysize desired

Populationmomentum




lthoh she ha omlete a niversit ereean ha a keen interest in eveloment, it wasn’tntil Saaf, 22, bean volnteerin with the Familplannin ssoiation of pakistan (Fpp) that shelearnt the real meanin of avoa, of motivationan artiiation. ow Saaf attens an seaksat oth smmits an international onferenes,an she has written srits for a loal serial thatfeatres eole livin with V an dS.

“very single moment of my journey withFPAP was fruitful and fullling. It was apractical training of self expression andempowerment. I believe in thinking positive,I believe in nding solutions. I believe we,the youth, can bring a change.”



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Young people’s limited access to education, employment,money and inormation (about sex, gender roles andrelationships, or example), and the lack o opportunitiesthey have to make decisions about their own lives andaccess sexual and reproductive health services, makes themvulnerable to poor sexual and reproductive health.

Only 17 per cent o sexually active young people usecontraceptives, or example, and young people between15 and 24 years account or 50 per cent o all new HIVinections.21 Complications related to pregnancy and childbirthare the number one killer o adolescent girls in developingcountries.22 Signifcantly, it must be noted that the current

generation o young people is just beginning its sexual andreproductive period. Demand or amily planning is expectedto increase by about 50 to 75 per cent rom 2005 to 2020 incountries that rely on donor assistance to implement theirprogrammes*.23

Although some progress has been made to reduce the

number o adolescent pregnancies24 – an indicator orMillennium Development Goal 5, to improve maternal health

– i there is to be any chance o sustaining these achievementseorts must be scaled up substantially to meet the needs oan increasing number o women and men o reproductive age.

T FACTS I FIS

Sexually active young people who usecontraceptives

17%25

Young people who are newly inectedwith a sexually transmitted inection(excluding HIV) each day

500,00026

Unsae abortions that are perormedon adolescents (women aged 15-19)in developing countries annually

2.5 million27

Proportion o new HIV inections thatoccur among young people aged15–24 years

50%28

Proportion o young women whosesexual initiation is orced (based onstudies in a broad range o countries)

19–48%29

* The lower number is the expected increase in demand based on projected ertility declines (UN median variant). The higher is required to eliminate unmet need

or amily planning in these countries. O these projected increases, 33 per cent are due to population growth; the rest to expected increases in demand.




“Sexual health is the integration of the somatic, emotional,intellectual and social aspects of sexual being, in waysthat are positively enriching and that enhance personality,communication and love.”Worl ealth ranization30

Because they have a lower status than males in practicallyall societies, girls and young women have less power todetermine their own lives and this includes decisions relatingto their health and sexual and reproductive activity. In 16countries, at least 20 per cent o young women are notcurrently paid or their labour.31 Lack o fnancial resourcesand recognition o women’s rights make women dependent

on male amily members, to provide or them, and they haveless voice and decision-making power within the household.

Transactional sex, where girls and young women, usually,accept gits, introductions into social networks and eveneducation ees rom men in exchange or sex is common in

sub-Saharan Arican countries, and evidence shows it is anincreasingly popular way or young women to increase theirsocial status and gain access to resources.32 Dependence andlow levels o education cause imbalanced power dynamics inrelationships between women and men, which in turn makegirls and women more vulnerable than boys and men to poorsexual and reproductive health, to gender-based violence,

including sexual coercion, and to orced marriage.

FI 5: I reeNe N uN ee e 15-24, 2007

Source: UNICEF, UNAIDS, WHO, UNFPA (2008) Children and AIDS: Third stocktaking report. NY: UNICEF.

Swaziland

Botswana

Lesotho

South Africa

Zambia

Nambia

Zimbabwe

Mozambique

Malawi

Central AfricanRepublic

Cameroon

Uganda

Gabon

United Republicof Tanzania

COUNTRIES

WITH ADULT HIV

PREVALENCE

BETWEEN 5

AND 15%

COUNTRIES

WITH ADULT HIV

PREVALENCE

ABOVE 15%

0 25%

22.6

5.8

15.3

5.1

14.9

5.9

12.7

4.0

11.3

3.6

10.3

3.4

7.7

2.9

8.5

2.9

8.42.4

5.5

1.1

4.3

1.2

3.9

1.3

3.9

1.3

0.9

0.5

5% 10% 15% 20%

MaleMale

FemaleFemale






Case study: Maritania

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Married at 13, Faha was made to leaveschool as her husband would not allowher to attend. “I was sad to leaveschool,” she says, “I liked learning andseeing my riends.”

Faha wanted to fnish school and get a job, but her parents decided it wouldbe pointless or her to fnish school, aseven high school graduates can’t get jobs. Instead, a husband was ound, anolder man who could pay a good brideprice, and they were quickly married.

Ater her baby is born, Faha would liketo wait three years beore her nextchild. She will ask the midwie aboutcontraception. This is one decision Fahahopes to make or hersel.

“I was scared when Igot married. o one,not even my mother,told me about sex and

having children.”Faha, ae 15

Facts about girl brides¼ In South Asia and sub-Saharan Arica, 40-45 per cent o women

aged 20-24 were married as children33

¼ In countries like Bangladesh, Central Arican Republic, Chad, Guinea,Mali, and Niger, more than 60 per cent o women entered intomarriage or into a union beore their 18th birthday34

¼One in every 10 births worldwide is to a mother who is still hersela child35

¼One million inants born to young mothers die each year due to

complications rom pregnancy and childbirth

36




Case study: Bolivia

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Asonat is a non-governmentalmembership organization thatadvocates or young people’s rights,particularly their labour rights. One othe frst barriers that many childrenand young people ace is not having abirth certifcate: without this document,they cannot get an ID card, and this isrequired to attend school or to get a job

in the ormal sector. Asonat is workingwith the police to make it easier oryoung people to get ID cards, but this isa slow process.

Asonat also advocates to thegovernment to make employers respectyoung workers. Many employers keepadolescents working or very low wagesby keeping their ofcial documents, ithey have any, and employers avoidpaying work-related benefts by hiringand fring young people requently.

Many young people make money by

selling ood or other products in thestreet; they ace many risks includingloss o income in the event o ill health.

“In El Alto teenagers aren’t visible anddon’t have any rights – to dress, tohealth, to education and to work. The

uture depends on young peopleand they need tools! Asonat is anorganization ormed by young peopleto deend their rights. Their parentswork all day so they don’t see them –young people are by themselves sothey have to train themselves to get anincome – they need help and support.”Juan, 21, ounding member o Asonat

At the moment, Asonat is one othe ew organizations that provide

scholarships or young people to receiveskills or vocational training, such ashair dressing, electrical services andutilities maintenance. Young peoplewho come to Asonat are also reerredto Centro de Investigación, Educacióny Servicios (CIES), an IPPF MemberAssociation, where they can obtain reemedical services, including sexual andreproductive health inormation andservices.

Asonat also makes time to let youngpeople play. With a scholarship as aprize, Asonat organizes theatre andbreak-dancing activities where youngpeople can fnally let loose and have agood time.

“Countries shouldgive high priorityand attention to alldimensions of the

protection, survivaland development ofchildren and youth,particularly streetchildren and youth.”cpd proramme of tion, ararah 6.8






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When children and young people achieve higher levels oeducation, they are less likely to be poor, more likely tobe employed and they develop greater confdence andcapabilities in all areas o their lie. Young people in schoolbegin having sex later, and they also start childbearing later,which reduces the risk o pregnancy- and childbearing-relatedmorbidity and mortality38, and also leads to better inantsurvival. Importantly, the gains delivered by education inchildhood and adolescence – a once-in-a-lietime opportunity

– can never be replicated later in lie.

ducating girls pays ¼Closing the gender gap in education adds 0.5 percent to a country’s per capita GNP

¼An extra year o schooling or girls reducesertility by 5 to 10 per cent

¼ Each year o schooling increases a woman'sincome by 10 to 20 per cent

¼ Income earned and controlled by mothershas a 20 times greater eect on the health otheir children compared with the same income

controlled by athers

Source: UNICEF (nd) Adolescent girls. Available at:

http://www.unice.org/adolescence/index_girls.html. Accessed 19 May 2009.

In the long-term, delaying childbearing is key to sustainablepopulation growth because it lengthens the time betweengenerations and thus slows the phenomenon knownas ‘population momentum’. That is, the percentageo the population that is reproducing at a given time.Achieving stable population growth is crucial to developingsustainable societies that can meet the needs o all people.

Just as intellectual development shapes human lives, so do sexand reproduction. Sex and reproduction are central to ourlives, this is a basic truth. Here is another: young people aresexual beings. It should come as no surprise, thereore, thatsexuality education promotes individual well-being and theadvancement o broader societal and public health goals.Comprehensive sexuality education is perhaps the single mostimportant git that parents can oer to their children – and toadolescents everywhere – as they approach the age at which

they will begin to have sex.

Currently, many young people do not know that condomsprovide dual protection rom unwanted pregnancy and STIs,including HIV39, in act only 30-40 per cent o young peoplehad accurate knowledge about HIV in 2007.40 In the majorityo countries, young people are more likely to be using amodern method o contraception i they live in an urbanarea, have more education and are exposed to the mediaregularly.41

Comprehensive sexuality education empowers young people

to make inormed decisions to protect themselves romsexually transmitted inections and unintended pregnancies(and, by consequence, unsae abortion); it increases sel-esteem, thoughtul decision-making and negotiation skills;and it helps them to develop satisying and pleasurable sexuallives. The power o comprehensive sexuality education tochallenge traditional gender roles, including discriminationagainst women and girls, must not be underestimated. Theability o young people to exercise agency contributes to theircapacity to participate in society and to promote human rightsand civic participation.

To reach ar and wide, to reach adolescents everywhere,

comprehensive sexuality education must be mandatory in


http://www.unicef.org/adolescence/index_girls.html

http://www.unicef.org/adolescence/index_girls.html



“Sexuality is about a lot more than having sex. It is aboutthe social rules, economic structures, political battles andreligious ideologies that surround physical expressions ofintimacy and the relationships within which such intimacytakes place.”42

school, and governments must also ensure that this educationis delivered to marginalized youth who don’t attend school,

including those living on the street, migrants, trafcked youngpeople and others, through outreach and community-basedprogrammes.

Health providers and governments should also engagecommunity leaders, parents and the general public in sexualityeducation so they understand how the benefts reverberatethroughout young people’s lives, and so they can themselvesparticipate in creating a supportive environment o opennessand inclusion. Young people’s experiences o parentalconnectedness – eeling close to, cared about and lovedby a parent – are highly protective against risk behaviours

such as smoking, substance abuse, violence and unsae sex.“Connectedness is not so much an issue o doing activities

with parents but rather eeling that they can talk with theirparents, that their parents know what is going on in their lives

and that their parents are concerned about them.”43

When parents are absent or otherwise unable to provide thisconnectedness, young people, and especially marginalizedyoung people, beneft greatly rom community-basedprogrammes, such as mentorship schemes, clubs and sportsteams, where they engage with caring adults who help themeel that they belong. And while it is important to respectculture, it is only with the active support o key communityleaders that culture evolves to reverse harmul attitudesand traditions around adolescence, gender, sexuality andchildbearing.




cg yu-Fdy SVcS

Even i they want and know how to use condoms eectively,young people are unlikely to access services and to changetheir sexual behaviour unless they have access to a sae andconfdential health care provider who will treat them withdignity and respect their privacy. Girls and young women whoare vulnerable to coercive sex or sex work, or living in contextswhere contraception is not yet well accepted among men,may need guidance on negotiating condom use44, and othercontraceptives. Because o a range o actors, including ear,stigma and discrimination, young people in many contexts arereluctant to seek services even i they suspect they have anSTI or an unwanted pregnancy.45 In about hal o sub-Saharan

Arican countries, less than 30 per cent o unmarried, sexuallyactive young women (age 15-24) use a modern method ocontraception.46 Access to sexual and reproductive healthservices is inuenced by a wide range o issues that aectadolescents.

The evolving capacities o the child include his or herphysiological ability to reproduce, his or her psychologicalability to make inormed decisions about counselling andhealth care, and his or her emotional and social abilityto engage in sexual behaviours in accordance with theresponsibilities and roles that this entails.47

Access is ¼Aordable services and supplies, including relatedcosts such as transportation, loss o income andopportunity costs

¼Knowledge o the location o services and supplypoints and the range o services that are available

¼Ability to obtain the necessary services whenthey are requested, ree rom administrativerestrictions and obstacles (e.g., health providerrequiring the permission o a ather or husbandbeore providing contraceptives)

¼Availability o services within a reasonablegeographic distance and within physicallyaccessible acilities

¼Ability o individuals to act to obtain theservices they need and want, unconstrained bypsychological, attitudinal, cultural or social actors(e.g., stigma around HIV)

Source: Bertrand, JT, Hardee, K, Magnani, RJ, and Angle, MA (1995) Access,

Quality O Care and Medical Barriers In Family Planning Programs. International

Family Planning Perspectives, vol 21, no 2, pp 64 –74.

Whn i coms o isss sch as sxand podcion, yong popl ndhalh ca povids ha a awa andinfomd abo hi concns. I is no

nogh ha a svic is availabl, yongpopl nd yoh-findly svics.




“I used to go to school, but I stopped because of the baby.I didn’t choose, it just happened. It was just a mistakeanyway, it just happened.”yon mother, ambia48

One o the most undamental challenges aced by healthcare providers is the need to balance young people’s right toadequate protection with their right to participate in and takeresponsibility or the exercise o those decisions and actionswhich they are competent to take or themselves. Healthcare providers thereore need support, including proessionaldevelopment opportunities, to help guide them on how

to judge the capacity o the patient to best care or youngpeople. In many cases, health care providers already havesubstantial experience caring or young people rom a rights-based perspective; they should be trusted to deliver servicesappropriately.

The World Health Organization’s Collaborating Centre onAdolescent Health says “It is not sufcient simply to provideinormation… neither is it sufcient to provide access toservices… Rather, we must understand the processesthat motivate young people to adopt health-enhancing

behaviours and then build our interventions upon theseunderstandings.”49

Young people themselves have a crucial role in providing thisguidance.

Young people have a right to participate in the design,

delivery and evaluation o youth programmes and theirinvolvement is also a prerequisite to achieving programmeobjectives. Peer education programmes, or example, haveproven their eectiveness over many years and many othese programmes are run exclusively by adolescents andyoung adults. Young people have the energy and ideas weneed to make a lasting dierence. Policy-makers, programmemanagers and administrators, on the other hand, have aresponsibility to create an enabling environment so youngpeople can be leaders.

FI 6: uNet Nee r NtretIN N urreNt rrIe N eu tIe, uNrrIe WeN e 15–24IN eete uNtrIe, 2001–05

Source: USAID (2008) Youth reproductive and sexual health. DHS Comparative Reports 19. Calverton, USA: Macro International Inc.

26%

47%

27%

33%

23%

30%

18%

22%

12%

23%

50

40

30

20

10

0Benin

2001

Burkina Faso

2003

Moldova

2003

Dominican Republic

2002

Nicaragua

2001

PERCENTAGE

Currentlymarried

Sexuallyactive,

unmarried






Case study: anzania

B, cc

V WSYtiw,iyii-ii,ww-i.tiiiwiiiy

wkiw–65ywkiwi.50Wiiiiiiy,ywikiiiiwiiy.

More than 90 per cent o youngpeople know about contraception, butar ewer young people actually useit.51 Data show that only 8 per cent o

women aged 15–19 have discussedcontraception with a feld worker orhealth proessional.52 Young people arereluctant to use contraception becauseo pervasive myths about harmul side-aects, and the act that many healthcare providers will only provide theseservices and supplies to married adults.53 It is no coincidence, thereore, that everyyear thousands o young women areaced with unwanted pregnancies.

Abortion is illegal in Tanzania, but whenaced with a pregnancy that they cannotaord – fnancially or socially – youngwomen and adolescents have nooptions. Some private health providerswill provide a sae abortion, but only thewealthy can aord their ees.54 Evidence

shows that teenagers are particularlyvulnerable to unsae abortion.55 Incidentally, by law young women areexcluded rom school i they becomepregnant.

A study conducted rom 1999 to2002, in nine villages, revealed thatalthough most adolescents and youngadults opposed abortion, abortion waswidely attempted by ingesting laundrydetergent, chloroquine, ashes and

herbs.56 Most women who attemptedabortion were young, single, anddesperate. In addition to the personaltrauma and stress caused by theunwanted pregnancy and abortion,these women also experiencedopposition rom their partner, sexualexploitation by practitioners, serioushealth problems and social exclusion.

Although the goal o improvingaccess to amily planning services andsupplies is articulated in a number oTanzania’s national health strategiesand policies, this goal is oten tied tointerventions that ocus on maternaland child health.57 Thus, programmes

do not adequately address the needso young, single people. Governmentsmust be held to account or theirailure to meet the needs o youngpeople, and especially young women.Comprehensive amily planning servicesmust be available to ensure that inuture, these women do have a choice.And when that choice is abortion, allwomen, not only the wealthy, shouldhave access to sae abortion services.

¼ 65 per cent o Tanzanians are under 24 years o age58

¼One in every 24 women will die o pregnancy- or childbirth-relatedcauses, including unsae abortion, in her lietime59

¼ 86 per cent o married women, aged 15–49, who want to delay orstop childbearing are not using any method o contraception60

¼Among the poorest quintile, the total ertility rate is 7.8 children perwoman61

¼More than hal o 19-year-old women are already mothers or arepregnant with their irst child62




F, g d Sxuy

Involving young people rom all regions o the world, IPPFconvened a meeting to give young people the opportunity tovoice their experiences o their own sexual and reproductivehealth in religious contexts, and to learn about how to meetyoung people’s needs. Culture, religion and traditions aresome o the biggest obstacles in implementing sexual andreproductive health programmes or young people.The meeting provided a space or young people to talk, andto listen to each other, to share their concerns and considereach other’s dierent approaches to addressing sexualitywithin religious contexts. Young people said:

“My aith makes me eel connected to the most powerul orcein existence, it makes me eel comortable deep inside.My aith helps me to be more creative, more sel-confdent.”

“Faith and spirituality have their pros and cons. On one hand,it puts up a set o rules and regulations which i ollowedproperly, make you a better person. On the other hand, itcurbs growth o some issues which are necessary or thebetter upbringing o present-day adolescents.”

Young people’s sexuality is still contentious or many religiousinstitutions. Fundamentalist and other religious groups the

– Catholic Church and madrasas (Islamic schools) or example –have imposed tremendous barriers that prevent young people,particularly, rom obtaining inormation and services relatedto sex and reproduction. Currently, many religious teachingsdeny the pleasurable and positive aspects o sex and limitedguidelines or sexual education oten ocus on abstinencebeore marriage (although evidence shows this strategy hasbeen ineective in many settings).63 The reality is, youngpeople are sexual beings and many o them are religious aswell. There is a need or pragmatism, to address lie as it is

and not as it might be in an ideal world.

Each religion or aith must fnd a way o explaining andproviding guidance on issues o sex and sexual relationshipsamong young people, which supports rather than deniestheir experiences and needs. By highlighting strong values inaiths and religions, and overcoming stigma and stereotypesthat religious conventions perpetuate, communities andleaders can help improve young people’s access to sexual andreproductive health inormation and services, and so improvetheir health and well-being.

ong popl living in pdominanlyligios conxs fac challngsnavigaing hi faih wihin a wold ofdivgn vals and social inacions,

and al sxal isks. ing abl o askqsions and ngag in dialog abofaih, ligion and sxaliy is ccial.




yli is 22 ears ol an has been a resientof the aas corretional centre for Bos, inJakarta, for two an a half ears. e was ahtsellin marijana an estas (an amhetaminer). hroh a roramme whih is rn bthe nonesia planne parenthoo ssoiation,yli artiiates in lm-makin ativities anontribtes artiles to ‘proeo’, a maazine that isroe b the centre’s resients. he lms anartiles aress a wie rane of isses, inlinisssions an ebate aron safer se, onoms,famil lannin an hilren’s rihts.

“The activities have helped me build my self-condence. Although I still have four years andve months before I complete my sentence, I’vedecided I’d like to be a journalist. I feel happythat I’m developing valuable skills that will helpme rebuild my life once I’ve left the jail.”



yug pp’S uM gS

tii,iyiyiiy

Young people have the right to lie, liberty andto be ree o torture and cruel, inhuman anddegrading treatment.*

International Covenant on Civil and Political rights(1966)

Young people have the right to be protectedagainst all orms o discrimination or punishmenton the basis o the status, activities, expressed

opinions or belies.

Convention on the rights o the child (1989);Covenant on Civil and Political Rights (1966)

ti

Young people have the right to enjoy the highestattainable standard o physical and mental health,which includes the underlying determinants ohealth and access to sexual and reproductivehealth care

International Covenant on Economic, Social andCultural Rights (1966); International Conerence onPopulation and Development Programme o Action(1994)

tiii

Young people have the right to express opinionsreely

Convention on the Rights o the Child (1989)

Young people have the right to be equipped withthe knowledge and skills that will empower themto bring about change in their own lives and in

their communities


Young people have the right to participate indecision-making processes


Young people have the right to participate in thedevelopment and implementation o policies thatdetermine their welare, including their sexual andreproductive health

Convention on the Elimination o All Forms oDiscrimination against Women (1979); Conventionon the Rights o the Child (1989); InternationalConerence on Population and DevelopmentProgramme o Action (1994)

sii

Young people have the right to lie, liberty, securityo the person and bodily integrity

International Covenant on Civil and Political Rights(1966); Fourth World Conerence on WomenPlatorm or Action (1995)

Young people have the right to privacy, which isessential to the exercise o sexual autonomy

International Covenant on Civil and Political Rights(1966)

Young people have the right to confdentialityregarding sexual health services and care

International Covenant on Civil and Political Rights(1966)

Young people have the right to access inormationand education about sexual rights, sexualorientation, sexuality, social relationships andgender identity

International Conerence on Population andDevelopment Programme o Action (1994)

Young people have the right to choose whether ornot to marry and to ound and plan a amily

International Conerence on Population andDevelopment Programme o Action (1994);

Yogyakarta Principles (2006)

*Although the text o the conventions are not explicit, IPPF interprets this to mean protection rom sexual exploitation and abuse.




V, F d V:yug pp Vg W V

How this involvement takes place, to what extent and howmeaningul it really is, are hotly debated issues. Some groupseel consultation is sufcient, while others eel people livingwith HIV must be at the centre o programme design anddelivery.

The Love, Lie and HIV initiative – a collaboration betweenIPPF, UNFPA, Young Positives and national networks opeople living with HIV (PLHIV) – empowers young peopleliving with HIV (YPLHIV) by giving them the resources toproduce and deliver video messages about some o the issuesthey ace. More than 100 young people, rom DominicanRepublic, India, Mexico, Russia, South Arica and Swaziland,

have produced videos. Frank, honest and direct, these videosprovide a unique insight into the realities acing the lives oyoung people living with HIV. One o the most striking thingsrom these videos is the common concerns that aect youngpeople living with HIV. How easy is it to date someone whenyou are living with HIV? When should you disclose your HIVstatus to a prospective partner? How do you deal with stigma?Here are a ew o the young people who were involved andtheir stories:

Carlos, rom Santo Domingo in the Dominican Republic, eltisolated ater being diagnosed with HIV at a very early age. He

let home at 12 and lived on the streets. The very people whowere there to support him stigmatized him. His neighbours,

or instance, allocated him a specifc seat and glass, whichthey would disinect ater he let. Ater a very low period inhis lie where he contemplated suicide, he has since oundthe confdence to live with dignity and pride: “All I need toremember is keep moving orward, let people talk but go onwith my head held high – don’t pay them any attention.”

“I’ve dated people and I don’t tell them ‘til I see that it mightbe going somewhere, or ater they become a stable partneror I trust them enough to tell them.” – participant romMexico

“The relationship [with my parents] has changed tremendously

[since my HIV diagnosis]. Now I’m not sure whether it’s downto ignorance or discrimination, but there is a gap that isgrowing [between us].” – participant rom South Arica

By raising awareness o some o the specifc issues acingyoung people living with HIV, these videos demonstrate thatchange is possible, that stigma can be overcome and loveand HIV can be reconciled. The initiative also gives the youngparticipants the confdence and the basic skills to continueusing multimedia techniques to develop new and innovativetools or other advocacy campaigns.

f yas of mdioc pogamms andsvics, many of which xcldd h

vy popl hy w man o hlp,dvlopmn paciions ag ha hinvolvmn of popl living wih I isccial o h ffcivnss of any Ispons.64




Case study: uana

pMg MpWM,

Spc d cV SpSBy

ayi,iwiy19,yiww.66aiiyi,iyy-iyi,iii.

Reproductive Health Uganda (RHU)has drastically increased the number oyoung people it serves by establishing

multi-unctional youth centres.Serving as entry points to clinics, theyouth centres oer activities such assports, computers, dance, drama andradio activities. Clinical sta provideyouth-riendly services includingamily planning, counselling, testing,treatment and management o sexuallytransmitted inections, including HIV.The centres run discussion groups whereyoung people can debate issues such asgender roles and social responsibilities.

To reach more marginalized groups,RHU peer educators go out into thecommunity to provide inormation,education and communication materials,and distribute ree condoms. Theytarget vulnerable young people whowork as boda-boda drivers, shoe shiners,barbers, sex workers and mobile artists.These young people are transient, theyare continually looking or other work,something better to improve theirlivelihood. The peer educators also train

teachers and other community leadersto talk with students about sex andsexual health.

Now young people are more open totalking about sexuality, and they arenot shy to report that they are havingprotected sex. The most positiveoutcomes o their work, the peereducators say, can be captured in threeideas: empowerment, respect and civilresponsibility.

¼ 50 per cent o sexually active, unmarried young women are using aamily planning method

¼Children born to women under age 20 have a 30 per cent higherrisk o dying in their irst year than children born to women age20–29

¼Only 65 per cent o young people aged 15–19 know a source orcondoms

Source: Measure DHS (2003) MEASURE DHS+ Increases Efforts to Better Understand Adolescent Health.

DHS+ Dimensions, Vol 5, No 1, p2.

uganda is an xmly poo conywh many popl fac a ang of isks

o hi livlihood, halh and svival. thmdian ag fo yong womn o bginhaving sx is 16 yas, b maginalizdyong popl ofn bgin having sx ayong ags, and hy also nd o haviski sx.65




Case study: roe

yu dVcS c

Raising awareness among candidateMembers o the European Parliamento the importance o sexual andreproductive health and rights o youngpeople in the global South and theirneed or universal access to services andinormation is thereore a key aim oYouth Advocates in Action (YouAct).

YouAct organized a public hearing atthe European Parliament in 2008 toraise awareness o the unmet sexual and

reproductive health and rights needs oyoung people in the global South. Theyoung advocates expressed the urgentneed to include sexual and reproductivehealth programmes and policies oryoung people within the developmentpolicy o the European Union. They alsosubmitted a Statement to the Parliamentand collected hundreds o signaturescalling or decision makers to ‘Involve,Support and Commit’ to comprehensivesexuality education in the global Southand internationally.

To mark the ICPD+15 anniversaryin 2009, and building upon theirachievements at the EuropeanParliament, YouAct will launcha actsheet on comprehensivesexuality education in Europe and theimplementation o the Programme oAction and commitments that weremade at ICPD+5 and +10.

But eective advocacy isn’t easy, youngpeople need support to learn eective

techniques and to learn about how toreach decision makers. In cooperationwith national sexual and reproductivehealth and rights organizations, YouActconducted our training sessions in 2008and 2009 to build the capacity o youthadvocates rom six EU countries. Soonater, YouAct members and other youngpeople who participated in the trainingswere implementing advocacy activitiesand campaigns!

The young advocatesexpressed the urgentneed to include sexualand reproductivehealth programmesand policies for youngpeople within thedevelopment policy of

the uropean nion.

cas of h socs and innchy command as donos fo innaional

dvlopmn, eopan govnmnsand h eopan aliamn can hava powfl innc on h sxal andpodciv halh of yong popl in hglobal oh.




Case study: Sotheast sia

Budg yu dVccy

MVM

tYciiiiiyiiwkiwiiyiiwwiiiyiiiikiiiiyy.tyi…!

Eighteen participants rom China, India,Indonesia, Malaysia, Nepal, Pakistan,

Philippines, Singapore and Sri Lankaembarked on a un-flled and intensiveour-day journey during which YouthCoalition members shared their ownexperiences o national-level advocacyand worked to develop the participantscapacity on the ICPD Programme oAction. As the training progressed andadvocacy skills and technical knowledgedeveloped, so did the participants’confdence in being able to contributemeaningully to sexual and reproductiverights dialogue. The participants

departed with national Advocacy Action

Plans in hand and a desire to get moreyoung people inspired and motivatedto advocate or youth sexual andreproductive rights.

As the trainingprogressed andadvocacy skills andtechnical knowledgedeveloped, so didthe participants’condence in beingable to contributemeaningfully to sexualand reproductiverights dialogue.

The young activists wasted no time ingetting down to work. They translated

Youth Coalition resources into fvedierent languages and replicated

the training they had received orother young people in their homecountry. The participants also convenedover 10 national-level organizationsor a sexual and reproductive rightsawareness-raising campaign andormed a subcommittee to build uponthe momentum o the campaign andstrategize on advocacy initiatives.

The Youth Coalition now looks orwardto working with these advocates

in the next phase o their eorts: anational capacity-building Training oTrainers on sexual and reproductiverights, using radio journalism! Accessto inormation and resources empoweryoung people to become eectivesexual and reproductive rights advocatesor adolescents and youth. The YouthCoalition Southeast Asia training alumniare an example o the commitment,enthusiasm and skill young people canbring to the table when promotingand deending youth sexual and

reproductive rights.

Novmb 2008 shd in h ohoaliion’s s v gional aining

on h Innaional onfnc onoplaion and vlopmn in hohas sia gion.




hamion breakaner, dennis, 19, is a well-known re in his home town in Bosnia anerzeovina, eseiall in his native omaommnit. ow he is known for more thanhis anin. dennis is a eer eator, workinwith the ssoiation for Seal an erotiveealth xy’s green iht projet. e romotessafe se, bt also talks abot the imortaneof leasre an ositive seal relations amonvlnerable ros of on eole an witheole who have been trafke for sealeloitation.

“The parents do not understand the risk fortheir children, so I try to talk to them as well.They usually don’t listen to me because I’m ayoung person. But now, they seem to show memore respect because they understand that Ihave some knowledge that they don’t.”



cMMdS

th cn gnaion of yong poplis a gif ha holds h ky o a bighf. I commnds h followingacions o mpow yong popl andpomo hi dvlopmn, o givhm choic in mas of sxal andpodciv halh, and o nsha hy a abl o conib o hi

sociis in maningfl ways.

nae with on eole aseqal artners b roviinoortnities for them toartiiate in bli life an ineveloment ativities

¼¼ Encourage¼young¼people¼to¼participate¼in¼governance¼and¼public¼decision-making

¼¼ Involve¼young¼people¼in¼the¼design,¼implementation¼and¼evaluation¼of¼public¼health¼services

¼¼Create¼opportunities¼for¼young¼

people¼to¼innovate

¼¼ Involve¼young¼people¼as¼advocates,¼researchers¼and¼peer¼educators




¼¼ Expand¼and¼reinvigorate¼sexual¼and¼reproductive¼health¼policies¼and¼programmes¼to¼meet¼the¼needs¼of¼young¼people,¼including¼youth-friendly¼services¼that¼address¼local¼cultural¼and¼social¼factors

¼¼Make¼comprehensive¼sexuality¼education¼mandatory¼in¼school¼and¼invest¼in¼multi-sectoral¼sexuality¼education¼programmes¼to¼reach¼out-of-school¼youth

¼¼Train¼health¼practitioners,¼parents¼and¼others¼who¼engage¼with¼young¼people¼to¼provide¼youth-friendly¼services¼and¼to¼support¼young¼

people¼appropriately¼on¼issues¼related¼to¼sexual¼and¼reproductive¼health¼and¼rights

¼¼ Increase¼the¼number¼of¼entry¼points¼to¼sexual¼and¼reproductive¼health¼programmes¼by¼implementing¼an¼intersectoral¼approach

nvest in oth-frienl sealan rerotive healthrorammes an servies

tivel onfront nerlinsoial fators an ratiesthat threaten on eole’seveloment an eretateineqalit

¼¼ Enact¼and¼enforce¼laws¼to¼prevent¼child¼marriage

¼¼ Improve¼the¼quantity¼and¼quality¼of¼education,¼especially¼for¼girls;¼ensure¼that¼secondary¼and¼tertiary¼education¼is¼relevant¼for¼the¼skills¼needed¼in¼the¼workforce

¼¼ Implement¼job¼creation¼programmes¼and¼encourage¼flexibility¼in¼hiring¼and¼job¼mobility.¼Provide¼incentives¼to¼encourage¼private¼sector¼firms¼to¼invest¼in¼training¼young¼people¼and¼to¼increase¼gender¼equality¼in¼employment¼opportunities

¼¼ Support¼community-based¼support¼programmes¼for¼marginalized¼youth,¼such¼as¼mentorship¼programmes,¼sports¼and¼clubs




ccuS

We have made many gains – today more people arewealthier and healthier than in the past, but still, our goalso social justice, equity and development or all elude us. TheMillennium Development Goal (MDG) 5, to improve maternalhealth, has seen the slowest progress o all the MDGs, and yetit is in many ways the goal that oers the greatest potentialin human development or current and uture generations.It contributes signifcantly to the Goals on women’sempowerment, child mortality, universal education (especiallyor girls), HIV and AIDS, environmental sustainability, andultimately to poverty reduction. The International Conerenceor Population and Development Programme o Action,agreed by 179 countries in 1994, is a visionary plan or actionthat promised equality and improved sexual and reproductivehealth and rights or all. However, we have allen short ondelivery. In some countries, married women and couples haveseen their choices and quality o lie improve dramatically, butmarginalized groups including young people have been let

out.66 Why? What could we be doing better?

Every living adult has had to pass through adolescence toget to where they are now, and yet in ormulating plansor development world leaders seem to have orgottenthis stage in their lives. Adolescents and young people arelargely invisible in the MDGs, and thereore they are alsoignored in programme implementation. We have a goal ormothers, a goal or women, a goal or children, and a goalor the environment, but none or young people. At longlast, in 2006, we gained an indicator or young people – theadolescent pregnancy rate – under MDG 5b, universal access

to reproductive health. This is encouraging, but there is muchmore we can do.

Young people are not a problem but well over a billionresources that oer untapped potential or development.

The world’s young people represent

some of the most marginalizedand vulnerable people and, at thesame time, they are a group ofindividuals with ideas and spiritand passion, who have the powerand will to change the future.

In some countries, married women and couples have seentheir choices and quality o lie improve dramatically, butmarginalized groups including young people have been let

out.

66

Why? What could we be doing better?

Governments, leaders, policy makers and decision makershave a responsibility to work towards the equitabledistribution o power and resources, and in the currentgeneration o young people there is an incredible but time-bound opportunity to achieve this. With young people aspartners, today’s adult decision-makers have the chance torecast sex and sexuality as a positive orce or change anddevelopment, as a source o pleasure, an embodiment ohuman rights and an expression o sel. Young people willhelp us ensure individual, amily and community health andwell-being, sustainable communities and a sustainable planet.

To capture the unleashed potential o the young generation,we must act now – they will not wait!

s w sach fo pacical solions omndos, dsabilizing global poblms,i somims sms as hogh hcomplxiy and pac of facos byond o

conol will ovak s.






FcS

1 World Health Organization (2008) 10 acts on adolescenthealth. Available at: http://www.who.int/eatures/actfles/ adolescent_health/en/index.html . Accessed 13 May 2009.

2 UNICEF (2002) Adolescence. New York: UNICEF.3 UNFPA (2005) The State o the World Population 2005:

Adolescents Factsheet. New York: UNFPA.4 Chronic Poverty Research Centre (2008) The Chronic

Poverty Report 2008-09: Escaping Poverty Traps. Manchester: University o Manchester.

5 WHO (2008) Ibid.6 UNFPA (2005) Ibid.7 WHO (2008) Ibid.8 CSDH (2008) Closing the gap in a generation: Health equity

through action on the social determinants of health. Final report of the Commission on Social Determinants of Health.Geneva: WHO.

9 Cincotta R, Engelman R and Anastasion D (2003) TheSecurity Demographic: Population and Civil Conict After the Cold War . Washington, DC: Population Action

International.10 Inspire Foundation and ORYGEN Youth Health Research

Centre (2008) Bridging the Digital Divide: Young people’s perspectives on taking action. Research Report: Number 2,October. Melbourne, Aus.: Inspire Foundation.

11 Devereux, S and Sabates-Wheeler, R (2004) TransformativeSocial Protection. IDS Working Paper 232. Brighton:Institute o Development Studies.

12 Population Action International (2007) The Shape of Thingsto Come: Why Age Structure Matters to a Safer, MoreEquitable World . Washington, DC: PAI.

13 Ibid.14

Birdsall, N, Kelley and AC, Sinding, SW (2001)Population

Matters: Demographic Change, Economic Growth, and Poverty in the Developing World. Oxord, UK: OxordUniversity Press.

15 Ibid.16 Cincotta, R (2008) How democracies grow up. Foreign

Policy, March/April.17 Population Action International (2007) Ibid.18 Sneeringer, SE (2009) Fertility Transition in Sub-Saharan

Africa: A Comparative Analysis of Cohort Trends in 30Countries. DHS Comparative Reports No. 23. Calverton,Maryland,USA: ICF Macro.

19 Rutstein, SO (2002) Fertility Levels, Trends, and Differentials

1995-1999. DHS Comparative Reports No. 3. Calverton,

Maryland: ORC Macro.20 Speidel, JJ, Sinding, SW, Gillespie, DG, Maguire, E and

Neuse, M (2008) Making the Case for U.S. International Family Planning Assistance. Baltimore, US: Johns HopkinsSchool o Public Health.

21 WHO (2006) Preventing HIV/AIDS in Young People: ASystematic Review of the Evidence from Developing

Countries. WHO Technical Report Series 938. Geneva:WHO.

22 Murphy, E and Carr, D (2007) Powerful Partners: Adolescent Girls’ Education and Delayed Childbearing. Washington, DC: Population Reerence Bureau.

23 UNFPA (2009) Personal communication. 15 July 2009.24 United Nations (2008) The Millennium Development Goals

Report. New York: United Nations.25 UNFPA (nd) Breaking the cycle o sexually transmitted

inections. Available at: http://www.unpa.org/rh/stis.htm#women. Accessed 13 May 2009.

26 Ibid.

27 Singh, S, Wul, D, Hussain, R, Bankole, A and Sedgh, G(2009) Abortion Worldwide: A Decade o Uneven Progress.New York: Guttmacher Institute.

28 WHO (2006) Ibid.29 Department o Child and Adolescent Health and

Development (2007) Adolescent pregnancy: Unmet needsand undone deeds. Geneva: WHO.

30 USAID (2008) Youth reproductive and sexual health. DHS Comparative Reports 19. Calverton, USA: MacroInternational Inc.

31 WHO (1975) Education and Treatment in Human Sexuality:The Training of Health Professionals. Technical Report Series

No. 572. Geneva: WHO.32 Chatterji, M, Murray, N, London, D and Anglewicz, P(2004) The Factors Inuencing Transactional Sex AmongYoung Men and Women in 12 Sub-Saharan AfricanCountries. Policy Project. Washington, DC: USAID.

33 UNICEF (nd) Facts on children. Available at: http://www.unice.org/media/media_45451.html. Accessed 13 May2009.

34 UNICEF (nd) Child marriage. Available at: http://www.unice.org/protection/index_earlymarriage.html . Accessed15 May 2009.

35 Save the Children (2004) Children Having Children: State of the World’s Mothers 2004. London: Save the Children.

36 Ibid.


http://www.who.int/features/factfiles/adolescent_health/en/index.html


http://www.unicef.org/media/media_45451.html


http://www.unicef.org/protection/index_earlymarriage.html










37 Fuentes, F (2005) Bolivia. 7 December 2005. Znet. Availableat: http://www.zmag.org/znet/viewArticle/4805. Accessed25 July 2009.

38 USAID (2008) Ibid.39 UNFPA (nd) Breaking the cycle o sexually transmitted

inections. Available at: http://www.unpa.org/rh/stis.htm#women. Accessed 13 May 2009.

40 Mexico Youth Force (2007) Young people and HIV.Available at: http://youthaids2008.org/fles/Young%20People%20and%20HIV.pd. Accessed 21 May 2009.

41 USAID (2008) Ibid.42 Cornwall, A, Correa, S and Jolly, S (2008) Development

with a body: sexuality, human rights and development. London: Zed Books.

43 Blum, R W (2000) Positive Youth Development: ReducingRisk, Improving Health. WHO Collaborating Centre onAdolescent Health. Geneva: World Health Organization.

44 UNFPA (nd) Ibid.45 Ibid.

46 USAID (2008) Ibid.47 IPPF Western Hemisphere Region (2008) Young People’s

Sexual Rights. Meeting o the International PlannedParenthood Federation. New York: IPPF WHR.

48 IPPF (2009) 15andcounting campaign flm. London: IPPF.49 Blum, R W (2000) Ibid.50 USAID (2008) Ibid.51 MEASURE DHS (2007) The Future is in Our Hands:

Tanzanian Youth, Reproductive Health and HIV. DHS:Tanzania/US.

52 Population Reerence Bureau (2009) 2008 World Population Data Sheet. Washington, DC: PRB.

53Justesen, A, Kapiga, SH, and van Asten, HAGA (1992)Abortions in a Hospital Setting: Hidden Realities in Dar esSalaam, Tanzania. Studies in Family Planning, vol. 23, no. 5,pp. 325-329.

54 Plummer, ML, Wamoyi, J, Nyalali, K, Mshana, G, Shigongo,ZS, Ross, DA and Wight, D (2008) Aborting and suspendingpregnancy in rural Tanzania: An ethnography o youngpeople’s belies and practices. Studies in Family Planning,Dec 39(4):281-292.

55 Ibid.56 Ibid.57 Population Action International (2009) Reproductive Health

Supplies in Six Countries: Themes and entry points in

policies, systems and nancing. Washington, DC: PAI.

58 MEASURE DHS (2007) Ibid.59 Population Reerence Bureau (2009) Ibid.60 Ibid.61 Ibid.62 MEASURE DHS (2007) Ibid.63 O’Brien, J, Brown, S, Smith, W, Braeken, D and Ingham,

R (2009) Are we taking the pleasure out o sex? What a

comprehensive sexuality education program should looklike. Conscience, vol XXX, no 1.

64 Organisational Principles o the NGO Code o GoodPractice: Involvement o PLHIV and aected communities.Available at: www.hivcode.org/silo/fles/chapter-3.pd.Accessed 29 June 2009.

65 Measure DHS (2003) MEASURE DHS+ Increases Eorts toBetter Understand Adolescent Health. DHS+ Dimensions,Vol 5, No 1, p2.

66 MEASURE DHS (2006) Uganda: 2006 Demographic and Health Survey: Key Findings. MEASURE DHS: Kampala,Uganda.

67 USAID (2008) Ibid.


http://www.zmag.org/znet/viewArticle/4805

http://youthaids2008.org/files/Young%20People%20and%20HIV.pdf


http://www.hivcode.org/silo/files/chapter-3.pdf

http://www.hivcode.org/silo/files/chapter-3.pdf



http://www.zmag.org/znet/viewArticle/4805



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The World YWCA is a global networko women and young women leadingsocial and economic change in over120 countries. It advocates or peace, justice, human rights and care o theenvironment, and has been at theoreront o raising the status o women

or over a century. The World YWCAdevelops women’s leadership to fndlocal solutions to the global inequalitieswomen ace. Each year, it reachesmore than 25 million women and girlsthrough work in 22,000 communities.This grassroots development experienceshapes the organization’s globaladvocacy agenda. The World YWCAwork is inspired by Christian principlesand a commitment to women’s ulland equal participation in society. It is

a volunteer membership movementinclusive o women rom many aiths,backgrounds and cultures.

http://www.worldywca.ino

YouAct (European Youth Network onSexual and Reproductive Rights) is aEuropean youth – led organization,active in the feld o sexual andreproductive rights. Since its launch inLisbon 2004, YouAct has grown into awidely-recognized youth organization,

undertaking key advocacy, trainingand awareness raising activities onnational, European and internationallevels. YouAct works to empower youngpeople to take an active role in theircommunities and organizations and toadvocate or sexual and reproductiverights as human rights includingcomprehensive sexuality education,LGBTQ rights and young people’s rights.We believe that active and meaningulyouth participation is essential to

reach ull realization o these rights.We envision a world where sexualityis accepted as a positive aspect in lieand where the SRHR o young peopleare realized: young people have accessto accurate inormation and youthriendly services and can decide reelyabout all aspects o their sexuality andreproductive lives.

www.youact.org

The Youth Coalition or Sexualand Reproductive Rights is aninternational organization o youngpeople (ages 15-29 years) committed topromoting adolescent and youth sexualand reproductive rights at the national,regional and international levels.

We are made up o volunteers, students,researchers, lawyers, health careproessionals, educators, developmentworkers, and most importantly, weare all dedicated young activists. Weaim to ensure that the sexual andreproductive rights o all youngpeople are respected, guaranteed andpromoted, and we strive to securethe meaningul participation o youngpeople in decision – making that aectsour lives, by advocating, generating

knowledge, sharing inormation,building partnerships and training youngactivists globally.

www.youthcoalition.org

Front cover: I/hlo all – aiania 2005I/aah haw – tanzania 2007I/hlo all – Indonsia 2006

Page 7: I/ aon – Npal 2009Page 8: I/ aon – uganda 2009Page 9: ilinda raapaksha – i anka 2009Page 10: I/hlo all – lgaia 2006

Page 15: adaf NasimPage 18: I/hlo all – aiania 2005Page 21: I/hlo all – olivia 2009Page 23: I/hlo all – Indonsia 2006Page 24: IWr/do ay – azil 2007Page 26: I/aah haw – tanzania 2007Page 28: I/ aon – Npal 2009Page 29: I/hlo all – Indonsia 2006

Page 31: I/ba jons – ominicanrpblic 2005

Page 32: I/al ll – uganda 2007Page 33: I/hlo all – lgaia 2006Page 34: I/ aon – India 2005Page 35: nnis haovicPage 36: I/ aon – Npal 2009Page 39: I/ aon – Npal 2009

Page 43: I/jon pall – olombia 2006

Photography






Published in November 2009 by theInternational Planned

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Sd d dVSx, d yug pp 21S cuy

“he worl is now home to the larest eneration of aolesents in histor – 1.75 billion on eole between theaes of 10 an 24. oa’s on eole will inherit a worl

shaken b the eonomi risis an fain the fll imat of limate hane an rai olation rowth. t is vital thehave the knowlee, skills, an oortnities not onl torotet themselves bt to thrive an beome the leaers anvisionaries for the ftre. am elihte that ppF are taklinthese isses hea on an omin with lear answers to whit is so imortant to invest in on eole.”

Michael Foster, MP Parliamentary Under Secretary o State,

UK Department or International Development

Today’s young people are a vastly diverse group o individuals whose liecircumstances, including opportunities and obstacles to improve their lives, varysignifcantly. In this report we look at the lives o young people, their needs orcomprehensive sexual and reproductive health services, and their desires, in aglobal context that is presenting us with daunting challenges that will change theuture. Even in the ace o poverty, young people everywhere are an inexhaustiblesource o ideas, energy and optimism. Throughout history, they have brokenaway rom negative behavioural patterns and changed intergenerational cycles o

discrimination and poverty. As globalization accelerates the speed at which risksto health and home spread, building a world o empowered global citizens is anurgent and revolutionary challenge. It is a challenge we cannot aord to ignore.

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