Adolescents and Reproductive Health Care -- Information, Education and Communication

Information, Education and Communication

As the largest-ever generation of young people enters adulthood, education and information can affect when they marry, how many children they will have, and the well-being of their future families and the nations in which they live. For young women, the right to exercise greater control over their sexual and reproductive lives, free of coercion, discrimination and violence, is the key to a better future.

All young people are not the same. Many are sexually active and many are not; some are already married and some are not. Some live at home and others are on their own, even at an early age. Many go to school and many do not; some are in crisis or difficult circumstances. While their situations vary, all young people need and want information about their sexuality, their reproductive health, and how they can plan their families.

In many parts of the world, school curricula are highly theoretical and not closely related to everyday life. Channels of communication between teachers and students are hierarchical, and discussion is limited. The concept of guidance and counselling from teachers to students is also lacking. School programmes may fail to address certain sensitive issues because parents, educators, religious leaders or policy makers may be reluctant to address them. Consequently, many youth-oriented programmes do not offer the information and services that are needed, and education on sexuality, women's health, family planning and nutrition is limited. Various UNFPA-supported programmes are working to overcome these constraints.

Studies show that family life education should begin early, in some countries even before adolescence, to help young people through the years when they are learning about their sexuality and beginning to be interested in sexual matters. Messages for sexually active youth should be different from messages for youth who have not initiated sexual activity and should be as specific as possible. One study in Albania, for example, showed that youth wanted information on such practical matters as how to avoid condom breakage and how to obtain emergency contraception.

In Burundi, UNFPA, in cooperation with WHO, UNICEF and an international NGO, began a reproductive health campaign in 1999 directed at adolescents in two pilot provinces with plans to expand to 10 more provinces in 2000. The programme was designed using the results of a knowledge, attitudes and practice (KAP) survey that was conducted among young people in 1998 and a new national adolescent reproductive health strategy adopted by the Government in 1999. The pilot programme includes training that promotes a climate of openness and straightforwardness in dealing with young people's questions about sexuality and reproductive health.

In Iran, UNFPA supported the Ministry of Education in conducting research on teaching reproductive health and sexuality to students aged 17-24 in evening classes. As a result of the research, the focus of the classes shifted from general population issues to a more direct approach in which students were provided with information on sensitive reproductive matters. A booklet and accompanying poster on successful marriage were developed and printed. With UNFPA assistance, another booklet was published jointly by the Ministry of Education and the Ministry of Health. This booklet, designed for adolescent girls, included information on puberty.

In its programme of assistance to the Palestinian people in 1999, the Fund worked with the Palestinian Authority to integrate reproductive health and gender issues into school curricula, adult education, teacher training and youth education programmes. Eighty teachers and supervisors were trained on the most effective techniques for communicating messages on reproductive health and gender to students and, as a result, they have become strong community advocates. The Fund also helped produce four booklets and a teacher's guide on reproductive health for adult education. Seventy youth leaders were trained to act as peer counsellors, and a telephone hot line was established to provide counselling services to young people. UNFPA also helped organize summer camps for underprivileged youth living on the West Bank. The youth programme reached many young men and women and created participatory forums for peer-to-peer discussion on issues that were formerly taboo.

Similar programmes have been implemented else-where in the Arab States region, including Egypt, Syria and Yemen. Regional programmes have been devised to train leaders of the Boy Scouts and Girl Guides to serve as peer counsellors. The regional workshops have had a "cascade" effect in that the trained participants then conduct similar workshops at the national level, producing gender- sensitive information and education materials on adolescent reproductive health.

Young People's Health and Education Issues

One person in six is between the ages of 15 and 24. They need information and services to protect their reproductive health and their futures.

* Two million young girls face female genital mutilation each year.

* Only 76 per cent of girls, compared to 96 per cent of boys, receive some level of primary schooling. Of the 130 million children who are not in school, two thirds are girls.

* One in every 10 births worldwide is to a teenage mother. In least-developed countries, one in six births is to a young woman aged 15 to 19.

* In most African countries, three quarters of women become sexually active during their teenage years. In Latin America and the Caribbean, the age pattern is somewhat older. In more-developed countries, more than 50 per cent of young women are sexually active before age 18.

* At least one in 10 abortions worldwide occurs among women aged 15 to 19. More than 4.4 million adolescent women undergo abortions every year; 40 per cent of these abortions are performed under unsafe conditions.

* Each day 500,000 young people are infected with a sexually transmitted disease.

* Half of all HIV infections – 8,000 a day – occur in people under the age of 25. Girls are being infected by older men: a new study supported by UNAIDS and WHO found HIV infection rates of 15 to 23 per cent among girls 15 to 19 years old, 26 to 40 per cent among men aged 25 or more, and just 3 to 4 per cent among 15- to 19-year-old boys.

* Of all age groups, the unmet need for contraception is greatest among sexually active young people.

Actions to Meet Young People's Needs

Specific actions can help young people avoid unwanted and too-early pregnancy, reduce recourse to abortion, and prevent the spread of sexually transmitted diseases such as HIV/AIDS. Moreover, respecting their rights to health and education will prepare them for lives as responsible and productive adults. Increasingly, young men are the target of efforts to promote responsible sexual behaviour and reproductive health. Programmes for young people endeavour to:

* Improve accessibility of health services and information;

* Offer sensitive and respectful counselling in a youth-friendly environment;

* Involve parents, teachers and community leaders;

* Increase sex education in schools and other settings (many studies have shown that sex education does not lead to promiscuity).

Finding ways to reach young people is a priority. In the vast majority of its country programmes, UNFPA supports information and education programmes both in and out of school. In 1999, UNFPA worked with the Government of Viet Nam to identify different "entry points" where youth can be engaged. Reproductive health issues were integrated into secondary school curricula; counselling centres, youth clubs and "Café Condom" shops were established; a live phone-in programme on adolescent reproductive health was broadcast; communication campaigns were conducted through the mass media; and new information and education materials were developed. As a result, both in- and out-of-school adolescents are being provided with reproductive health information that is more tailored to their specific needs.

In Albania, UNFPA supported a variety of information campaigns for young people that included advertising, radio shows and billboards to promote responsible behaviour. The country office supported a series of peer education seminars, delivered in an "open, humorous and friendly style", which were extremely well received, generating a demand for future seminars. UNFPA also supported a social marketing scheme for condoms through pharmacies as well as other, non-traditional, outlets.

UNFPA strives to involve adolescents themselves in designing programmes that concern them. For example, in Ecuador, youth have developed their own educational materials, including booklets on adolescent sexuality, sexual relations, adolescent pregnancy and contraceptives. The problem of domestic violence has been taken up by young people as a priority. A youth drama group, formed through a UNFPA-supported project in Quito, has used this theme for several of its plays. The participation of young men, and their willingness to consider the gender dimension and how it affects women in their culture, has been encouraging.

In Morocco, the Ministry of Youth and Sports has developed an innovative approach that involves youth clubs. The young people created their own materials, including songs, dramas, puppet shows and other imaginative ways to deliver messages on family planning, sexually transmitted diseases (STDs) and HIV/AIDS, family life and sexual education. Young people, like these teenagers from Juárez, Mexico, need to learn about responsible sexual behaviour. Photo: Viviain Moos.In Indonesia, the participation of youth in the development of information and education materials has been extremely important and successful, as has the use of outreach peer educators. However, the outreach workers have so far been limited to urban areas. In provincial areas, the use of family counselling groups in conjunction with reproductive health programmes in schools has been found to be more effective. In the country's new adolescent reproductive health project, young people will play a key role in planning and implementation.

Increasingly, UNFPA support is being given to projects that use new information technologies to reach young people. In Romania, for example, the Fund provided assistance to a national foundation to develop an interactive game on CD-ROM dealing with the prevention of STDs and HIV/AIDS, which is being distributed free of charge to schools. Our web site, which we are constantly upgrading, also provides information to young people and allows them to give feedback.

Sex Before Marriage Not Appropriate For Youth, Messages Tell Indonesian Adolescents

Increasing teenage pregnancy rates have prompted non-governmental organizations, supported by UNFPA, to train young people to provide reproductive health information and services to their peers.

UNFPA helps to promote responsible behaviour by supporting the production of information and education materials to advise adolescents. The materials also try to reach parents, policy makers and community leaders. The Fund's partners are the Indonesian Planned Parenthood Association (IPPA) and the National Family Planning Coordinating Board (BKKBN). They work under the theme, "Having sex before marriage is not appropriate among youth." Specific messages stress, for example, "Responsible relationships between boys and girls," "The world of youth is free, but there are limitations," and "Youth must get correct and clear information about sexuality."