Making it a Priority: Adolescents’ Health and Rights

“Adolescence is a time to support young peoples’ access to information, to education, to skills and to services that can result in a healthy and safe transition into adulthood,” said Sarah Barnes, Project Director of the Maternal Health Initiative, at a recent Wilson Center event on engaging youth and protecting their sexual and reproductive health and rights. “It’s time to make adolescents a priority,” said Barnes.

Adolescents are Assets

Adolescents should be treated “as assets rather than subjects,” said Preston Mitchum, Senior Legal and International Policy Analyst at Advocates for Youth. Adolescence presents a window of opportunity to lay down a solid foundation of positive behaviors and values to promote a safe and healthy lifestyle. “Those behaviors that are established in adolescence affect them across a life course,” said Cate Lane, Senior Technical Advisor of Adolescent and Youth Sexual and Reproductive Health at Pathfinder International.

In addition to healthy behaviors, social issues such as gender equality and discrimination based on sexual orientation can be introduced and addressed during this period. As adolescents get older, attitudes and biases become more difficult to change. “This is such an important time to talk to young people about gender roles and gender identities,” said Lane. Allowing youth to engage in open discussion in a safe and supportive environment can significantly normalize diversity across a generation, she said.

For young people, adolescence is not only a time of growth and development but also of new vulnerability to human rights abuses. Adolescents are especially at risk of child marriage, early pregnancy, HIV and other STIs, and mental health issues. Yet access to high quality, age-appropriate information and services are lacking. Comprehensive Sexuality Education (CSE) can protect them against these vulnerabilities. But it is inadequate or not available to millions of young people, both in and out of school.

Making Sexuality Education Comprehensive

“There is a huge gap between sexuality education and comprehensive sexuality education,” said Lada Nuzhna, a youth representative at Teenergizer!. Sexuality education that is comprehensive is rights-based, gender-focused, and age appropriate. The UN International Technical Guidance on Sexuality Education identifies eight key concepts that cover a wide range of topics relating to adolescents’ health and wellbeing. They are: relationships, rights, gender, violence, skills for health and well-being, the human body and development, sexuality and sexual behavior, and sexual and reproductive health.

The goal of CSE is to empower youth to be able to make informed decisions regarding their own sexual and reproductive health. Comprehensive sexuality education is “not only about knowledge—it’s about skills and attitudes,” said Dr. Ilya Zhukov, Global Focal Point for Comprehensive Sexuality Education at UNFPA. Many topics in CSE can be integrated with and reinforced by other school curricula, such as consent, peer influence, decision-making, communication, refusal, and negotiation skills.

“We have enough evidence that sexuality education works … it’s not some kind of pilot or fantasy,” said Zhukov. CSE does not lead to earlier sexual activity or riskier sexual behavior; in fact, it reduces it.

In practice, however, sexuality education in schools is not as comprehensive as it should be. When the Guttmacher Institute asked secondary school principals, teachers, and students in Ghana, Kenya, Peru, and Guatemala what CSE looks like in the classroom, researchers found that it fell short. Teaching was heavily focused on physiology rather than values and interpersonal skills, such as negotiating condom use with a partner. Information was also frequently inaccurate. Research from Guatemala found that 37 percent of teachers who teach about condoms emphasized that they are not effective in preventing STIs/HIV.  Three counties in Kenya use fear-based teaching with 6 in 10 teachers strongly emphasizing that sex is dangerous and immoral for young people.

“We really want the findings to get into the hands of those who can actually use them,” said Sarah Keogh, Senior Research Scientist at the Guttmacher Institute. The ministries of education in Ghana and Kenya have already used this research to strengthen their CSE curricula. “There’s a lot of good will out there,” said Keogh. Students are generally excited about CSE. Teachers want to teach it but are uncomfortable and lack the right training to overcome their own misconceptions. Contrary to popular belief, parents can be some of the most effective supporters of CSE, said Zhukov, and can therefore be a valuable resource in implementation.

One Size Does Not Fit All

“What do we mean by youth?” said Nuzhna, referring to the lack of diversity in the public perception of adolescents globally. They are often depicted as ethnically homogenous, straight boys and girls who have never left their countries or engaged in risky behaviors. “Our society doesn’t look like that,” said Nuzhna. A CSE program or health intervention that targets this limited demographic will overlook millions of young people with varied experiences.

“There’s no one size fits all—we have to be diverse and segmented and responsive to the needs of the young people that we are trying to reach,” said Lane.  It is paramount to include marginalized groups, such as LGBTQ, indigenous, and married adolescents, as well as young people living with HIV, disabilities, selling sex, injecting drugs, or in detention, to generate comprehensive research and programming for adolescents.

Marginalized groups are most at-risk of engaging in risky behaviors and experiencing poorer outcomes, but they are often largely forgotten or labeled “hard to reach.” “People need to stop calling communities ‘hard to reach’ simply because they don’t reach them,” said Mitchum. Efforts to improve adolescent health must focus on facilitating access to easily consumable health information and services, especially for adolescents who are not in school.

Facilities and providers must also be well-trained and adapted to working with the sensitive needs of these populations. “When a young person does decide to go into a health clinic, we need to ensure that this will not be their first and last experience,” said Nikoli Edwards, an Independent Senator from Trinidad and Tobago.

More than a Seat at the Table

Adolescents “are the experts when it comes to their own experiences,” said Edwards. Adults should be more receptive to partnerships with youth and avoid being patronizing or assuming they know what young people need. “It’s one thing to give them a seat at the table,” said Edwards, “but it’s far more important for them to have that seat be used effectively.” Young people should be actively included because they are informed on issues affecting their health and rights and may offer invaluable insights. Tokenism means missed opportunities to take advantage of what youth have to offer. “Nothing about us, for us, without us,” said Nuzhna.

Written by Elizabeth Wang.