By Caroline Kabiru, Head of Urbanization and Wellbeing Program and Jessica Brinton, Working Group Program Coordinator, APHRC
“Young people are having sex. And we, as leaders, have to get over our discomfort & confront the reality.” -Kate Gilmore (UNFPA) at the 2013 International Conference on Family Planning
This year at the 2013 International Conference on Family Planning 3,500 delegates joined together to discuss the serious challenges of providing quality sexual and reproductive health (SRH) services to women and men around the world and to discuss how the development community can ensure that efforts to achieve gender equity, quality healthcare, reduction of unintended pregnancies and elimination of early marriage are successful. Like most major conferences, several key themes tend to emerge and this year, the importance of focusing on the SRH needs of young people including very young adolescents stood out as a recurring theme.
Researchers at the African Population and Health Research Center (APHRC) have conducted extensive research on multiple dimensions of youth and adolescent health, including education, sexual and reproductive health, and resilience, and these research highlights wide range of factors that drive young people’s health and wellbeing. It was therefore exciting to note the emphasis on the needs of young people and the calls for multi-sectoral action and meaningful youth involvement in decision making to ensure that all young people live healthy and productive lives.
Ethiopia was the perfect host country for these discussions. On the one hand, Ethiopia has been a leader in providing SRH services through utilizing a complex network of Health Extension Workers (HEWs), improvements in the supply chains for stocking contraceptives and having backup providers when stock outs do occur, infrastructure improvements, among other initiatives which have led to a considerable increase in the use of modern contraceptives from 6% in 2000 to 27% in 2011. On the other hand, today in rural Ethiopia 20% of girls are married before age 15, and almost 50% are married before age 18, which presents a significant challenge because of the vulnerability of these young girls to poor sexual and reproductive health. The Ethiopian government, development partners, and non-governmental organizations recognize the significant health risks (as well as the potential economic losses) that are being incurred by these young girls entering into early marriages.
During the conference, information was shared about several programs designed to address the SRH challenges faced by young people. One of these, Berhane Hewan (“Light for Eve” in Amharic) provides an outstanding example of the benefits of comprehensive approaches to ensure positive youth development. Berhane Hewan, a program funded by USAID and implemented by Population Council and the Amhara Regional Bureau of Women, Children, and Youth Affairs, has adopted a comprehensive approach to SRH challenges targeting both married and unmarried women in rural communities in Ethiopia. The program uses a combination of community awareness, financial support to families to cover educational expenses for girls (about $6 per year in school for supplies), conditional transfers (in this case a goat or sheep) if girls remain unmarried and in school, and a focus on girls’ clubs for married girls. The results of the initial phase were very positive: girls aged 10-14 in the project sites were one-tenth as likely to be married and three times more likely to be in school compared to girls in the control site, and three times more likely to be in school. In addition, married girls in the project site were three times more likely to be using contraception compared to their married peers in the control site.
We couldn’t agree more with the concept of this program – the SRH challenges that young people face are often driven by structural factors, such as pervasive poverty and limited educational opportunities, which means that interventions must go beyond simply raising awareness as is often the case. The structural nature of these underlying factors requires inputs from different actors. As Kate Gilmore, Deputy Director of UNFPA stated in one panel, we must deal with the young people’s SRH challenges in a multi-sectoral approach that includes the Ministries of Health, Finance and Planning. In other words, young people’s sexual and reproductive health is not a health issue; it is first and foremost a development issue.