What’s Youth Got to Do With It? Investing in Youth Sexual and Reproductive Health

“Half of the world’s population is under 30 – any development agenda would have to address their needs, including their health needs, as part of accomplishing development goals,” said Jennifer Adams, deputy assistant administrator at USAID’s Bureau for Global Health, at the Wilson Center on September 24.

Failing to address youth sexual and reproductive needs has tremendous impacts on communities and families. Young women who give birth before age 18 face significant health risks, said Alisa Mautner Cameron, deputy director of USAID’s Office of Population and Reproductive Health. Complications during pregnancy and childbirth are the second leading cause of death for 15-to-19-year-old girls globally.

But effective sexual and reproductive health programming can help mitigate these risks. “When we enable girls and young women to delay their first pregnancy through voluntary family planning programs, they can stay in school longer, join the workforce, and raise a healthier family,” Cameron said.

These are issues that are being “directly addressed” by world leaders, said Adams, who had just returned from the 69th Session of the UN General Assembly in New York, including discussions with leaders from the Sahel who are concerned about youth populations.

Côte d’Ivoire, for example, has criminalized teachers responsible for impregnating students, a major shift in addressing youth rights in the country, Adams said (previously the girls were simply expelled).

“We’ve made tremendous progress and at the same time we have really not come nearly as far as we need to,” said Nina Hasen, HIV prevention technical advisor in the Office of the U.S. Global AIDS Coordinator.

Knowledge Gaps

One of the first steps, Hasen said, is addressing the lack of knowledge that youth have about HIV/AIDS. Half of new HIV infections occur between the ages of 15 and 24. Even in countries where HIV prevalence is very high, including Mozambique, Zambia, and Lesotho, knowledge of HIV among young people is less than 50 percent, she said.

According to UNICEF, comprehensive knowledge of HIV means that someone can correctly identify two ways of preventing sexual transmission, reject the two most common local misconceptions, and know that a healthy-looking person can transmit HIV.

Not only are young people largely uninformed, but organizations trying to target them also lack key information about how to do so effectively.

Rita Badiani, Mozambique country representative for Pathfinder International, pointed out that in Pathfinder’s Geração Biz program, government data made it difficult to target the youth they wanted to reach. “The health information system actually made adolescents and youth invisible due to the lack of disaggregation for this age group in the system,” she said.

Disaggregating data by sex and five-year bands would be ideal, Hasen said, but would raise costs and increase the complexity for implementing organizations. “This is a huge lift,” she said, “but if we don’t understand what’s happening, we’re not really going to understand whether or not we’re really breaking the back in the epidemic in this population.”

The surveys used to gather data also use a very “overgeneralized notion of sex,” Hasen said. “If your first sexual experience was being assaulted or was being abused by a member of your family and someone asks you, ‘How many partners have you had?’ That’s a very different answer from your mind than from our mind.”

Listening to Young People

Dr. Catherine Baye, a public relations officer for the International Youth Alliance on Family Planning, a co-sponsor for the event, said that youth engagement should be front and center in any program addressing sexual and reproductive needs.

“Youth know what youth need,” she said, highlighting examples of her experiences working with young people as a physician in Cameroon. Baye said that many young women came to her clinic because she was like them, and they “expected somebody to understand with them and feel what they were feeling.”

Young people may be “a population in need…but the solution is within us as well,” Baye said. Approximately 350 youth delegates attended the International Conference on Family Planning last year, for example, demonstrating their eagerness to be involved.

A youth-centered focus is also critical to helping countries reap the benefits of the demographic dividend, Cameron said, referring to the phenomenon where declining population growth ratescreate a higher ratio of workers to non-workers for a period. Getting to that point requires improved access to health services for young people but also better educational and vocational opportunities. “The demographic dividend is not a guarantee; it’s an opportunity, a window, where if these things happen, and you have this mix, you can take advantage…which will drive poverty reduction in these nations.”

Engaging Both Genders

Designing programs that do reach young people requires sensitivity to their unique needs. “Youth are not one entity,” said Cameron, and programs targeting youth cannot leave gender out of the discussion.

In some contexts it can be challenging to engage young women in open conversations about sexual and reproductive health, said Badiani. In the Geração Biz program, for instance, young women were more likely to drop out of the program or to be prohibited from attending. Pathfinder had to develop specific strategies to encourage female participation, including encouraging young women to become peer educators, she said.

Hasen also raised the need for male engagement in youth sexual and reproductive health programs. Past PEPFAR programs, the President’s Emergency Plan for AIDS Relief, have easily engaged men in community outreach programs, but “when you look at who goes to get health care, it’s women,” she said. “I think the dividing line is the clinic versus the community.” Closing this divide, getting more young men into clinics, will help ensure that men are not left behind, suffering themselves while promulgating preventable diseases.

Leveraging Partnerships

Each of the panelists highlighted the importance of partnerships in achieving long-term goals for youth sexual and reproductive health. Donors, governments, community leaders, and beneficiaries all play key roles in ensuring that programs are successful.

“We can’t achieve an AIDS-free generation just with PEPFAR dollars,” Hasen said, “and even if we had all the money in the world, it wouldn’t work if we didn’t really have partner governments and other stakeholders that were going there with us.”

Cameron said partnership is a key component of USAID’s Family Planning 2020 program as well. “Countries themselves are active partners in this and I think this will be one of the things that helps really drive the success of Family Planning 2020’s vision.”

Likewise, engaging with youth, donors, and government officials was an “essential” component of Pathfinder’s Geração Biz program, Badiani said.

“New Reality in Global Health”

As world population grows, so does the need for youth-friendly family planning services. “Addressing the needs of a large youth population is our new reality in global health,” Cameron said.

Investing in family planning and reproductive health services for youth today can yield both immediate and future benefits, Cameron said. But reaping those benefits requires financial support as well as political will and a “high level of global coordination.”

“I think the most important principle is, ‘does it work?’” Hasen said. A recent study from the Copenhagen Consensus Center suggests investment in reproductive health does. A group of economists ranked proposed development goals based on their potential to “do the most good” relative to their costs. Family planning came in the top five with a “phenomenal rating,” meaning the economists found robust evidence that the return on investment could be more than 15 times the cost.

“There’s a world of things that are right to do, and then within that world, there’s a subset of things that are right to do but also work, and that’s where we really have to focus,” said Hasen.

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Drafted by Heather Randall, edited by Schuyler Null and Sandeep Bathala.