Title: Learning from Young People in Developing Countries: Evidence from WHO studies
1Learning 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
2The growing numbers.
World
Developing regions
Developed regions
Source UN, 2005
3Doubling the size of youth population in Africa
in every 25 years
Source UN, 2005
4Definitions
Adolescence
0
10
19
Years of age
15
24
Youth
Young people
5Percentage of young people reporting premarital
sexual activity selected WHO studies
Source Brown et al., 2001
6Unmet Need for Family Planning among Women 15-19
20-24 Average for Five Regions Based on 45
DHS Countries, 1998-2001
Data Source DHS
7Childbearing 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
8Estimated 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
9Percentage 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
10Other 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)
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13ASRH 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))
14Is casual sex ok?
15Casual sex experience
16Percentage of young people reporting two or more
sexual partners selected WHO studies
Source Brown et al., WHO, 2001
17Acceptance 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).
18The 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
19ChallengesAddressing social norms, taboos and
gender double standards
20Youth-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)
21Youth-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
23References
-
- 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.