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Learning from Young People in Developing Countries: Evidence from WHO studies

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Title: Learning from Young People in Developing Countries: Evidence from WHO studies


1
Learning from Young People in Developing
Countries Evidence from WHO studies
  • International Symposium on
  • Youth Friendly Sexual and Reproductive Health
    Services
  • 1-3 March 2006
  • Ankara, Turkey
  • Iqbal H. Shah
  • Department of Reproductive Health and Research
  • World Health Organization
  • 1211 Geneva 27
  • Switzerland
  • Tel 41-22-791.33.32
  • Fax 41-22-791.41.71
  • Email shahi_at_who.int
  • www.who.int/reproductive-health/adolescent

2
The growing numbers.
World
Developing regions
Developed regions
Source UN, 2005
3
Doubling the size of youth population in Africa
in every 25 years
Source UN, 2005
4
Definitions
Adolescence
0
10
19
Years of age
15
24
Youth
Young people
5
Percentage of young people reporting premarital
sexual activity selected WHO studies
Source Brown et al., 2001
6
Unmet Need for Family Planning among Women 15-19
20-24 Average for Five Regions Based on 45
DHS Countries, 1998-2001
Data Source DHS
7
Childbearing during adolescence 14.3 million
births each year among women 15-19
  • Developed countries 1.3 million
  • Asia 5.7
    million
  • Sub-Saharan Africa 4.5 million
  • North Africa/Middles East 1.0 million
  • Latin America/Caribbean 1.8 million

Source Alan Guttmacher Institute, 1998
8
Estimated percentage of unsafe abortions among
women 15-24 year, 2000
Total number of unsafe abortions 19
million Unsafe abortions among women 15-24 7.6
million
of total unsafe abortions
Source Shah Aahman, 2004
9
Percentage of young people reporting forced
sexual initiation, selected population-based
surveys, 1993-1999
  • Country Age group Percentage reporting first
    sexual intercourse as forced
    Women Men
  • Cameroon 12-25 37 30
  • Caribbean 10-18 48 32 (9 countries)
  • Ghana 12-24 21 5
  • Mozambique 13-18 19 7
  • New Zealand Birth cohort 7 0.2
  • Peru 16-17 40 11
  • South Africa 15-18 28 6
  • Tanzania 12-19 29 7
  • USA 15-24 9 -

Source WHO, 2002
10
Other health risks to young people
  • Each year over one million youth (15-24) contract
    curable STIs
  • Each year 2.2 million young people (10-24)
    contract HIV people
  • Each year, 100, 000 commit suicide (40 have tried
    in the last 5 minutes)

11
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12
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13
ASRH Initiative topics by country
  • Sexual attitudes, risk behaviours and their
    determinants 22 (Brazil, Cape Verde, China (3),
    Colombia, Croatia, Cuba (2), Ghana, India (2),
    Iran, Mexico (2), Paraguay, Peru, Poland, Syria,
    Tanzania, Turkey, South Africa)
  • Dual protection 3 (Colombia, Indonesia, Kenya)
  • Unwanted pregnancy and consequences 2 (Brazil,
    Kenya)
  • Sexual coercion 3 (Indonesia, Nigeria,
    Philippines)
  • Health seeking behaviour and quality of care and
    provider perspectives 10 (Argentina, Bangladesh,
    Brazil, China (2, including 1 multicentric, Lao
    PDR, Myanmar (2), Nepal, Thailand)
  • Interventions 3 (Chile, China (2))

14
Is casual sex ok?
15
Casual sex experience
16
Percentage of young people reporting two or more
sexual partners selected WHO studies
Source Brown et al., WHO, 2001
17
Acceptance of gender based double standards
  • All men are just like that. I think they have a
    lot of sex urge. (Schoolgirls and factory
    workers, Bangkok, Thailand).
  • Men should have experiencewomen do not need
    experience (female university student, Dumaguete
    City, Philippines).
  • If a man does not get quite a lot of experience
    before marriage hell want even more after.
    (female university student, Dumaguete City,
    Philippines).
  • No-one wants a woman who has had sexual
    experience. (schoolgirls and factory workers,
    Bangkok, Thailand).
  • The man can go with many women and not lose his
    reputation, but if the woman does the same thing
    with men they will always say bad things about
    her (low-income young women, Buenos Aires,
    Argentina).

18
The difficult lessons
  • Entrapped by culture, deep-rooted traditions, and
    norms
  • Child and teen-age marriages
  • Gender double standards
  • Taboos on adolescent sexuality
  • Interventions
  • Behaviour change works, but not always
  • Costly, not always scaled up nor sustained
  • Integration to promote youth health
  • Increase knowledge, develop skills, healthy
    attitudes
  • Improve social environment
  • Increase access to and utilization of youth
    programmes and health services

19
ChallengesAddressing social norms, taboos and
gender double standards
20
Youth-friendly sexual and reproductive health
services (SRH) youth perspectives
  • Privacy and confidentiality
  • "Image" of services (for married people only)
  • Stigma and "shame" (especially when sex is
    coercive)
  • Providers' attitudes
  • Fragmentation of services
  • Fear of medical procedures
  • Lack of information
  • Waiting time
  • Cost
  • Inconvenient location (i.e., not close to
    teaching and work sites)

21
Youth-friendly SRH services Conclusions
  • Address cultural taboos and norms
  • Provide integrated services addressing diverse
    ASRH needs
  • Deal with SRH "myths" and misperceptions
  • Ensure privacy and confidentiality
  • Educate health and other personnel
  • Clinical services (cost, location,
    client-provider interaction)
  • Beyond the clinic expanding outreach
    (pharmacies, kiosks, retail stores, schools,
    mobile units, youth centres)

22
"Adolescents are also widely underserved for life
skills, nutrition information, education and
employment opportunities, and sexual and
reproductive health information and
services"Jaffrey D. Sachs, Director, UN
Millennium Project UN Development Programme,
2005, Investing in Development A practical Plan
to achieve the Millennium Development Goals
  • Investing in adolescent health and development

23
References
  • Alan Guttmacher Institute, 1998, Into a New
    World Young women's sexual and reproductive
    lives, New York The Alan Guttmacher Institute.
  • Brown AD, Jejeebhoy SJ, Shah I, Yount KM, 2001,
    Sexual relations among young people in developing
    countries evidence from WHO case studies,
    Geneva World Health Organization.
  • Global Youth Tobacco Survey Collaborating Group,
    2003, Differences in Worldwide Tobacco Use by
    Gender findings from the Global Youth Tobacco
    Survey, Journal of School Health, 73(6) 207-215.
  • Shah I and Aahman E., 2004, Age patterns of
    unsafe abortion in Developing country regions,
    Reproductive Health Matters, Special Issue on
    Abortion Law, Policy and Practice (edited by
    Berer M.), 12 (24) 9-17.
  • United Nations, 2005, World Population Prospects
    The 2004 Revision, New York The United Nations.
  • World Health Organization, 2002, World Report on
    Violence and Health, Geneva World Health
    Organization.
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