Ward Cates MD, MPH, is president emeritus and distinguished scientist at FHI 360, one of the largest nonprofit organizations in international public health and development, with field activities in more than 60 countries. He has worked to improve youth sexual and reproductive health throughout his nearly four-decade career.
During the month of July 2012, two landmark gatherings advanced our global agenda in sexual and reproductive health. The Family Planning Summit was held in London on July 11. Co-hosted by the UK Government and the Bill and Melinda Gates Foundation, the Summit’s goal was to offer millions of vulnerable women around the world renewed hope that they will soon have the means to determine the timing and spacing of their pregnancies through access to modern family planning methods. The AIDS 2012 Conference was held in Washington DC from July 22-27. Organized by the International AIDS Society, AIDS 2012 was a multitrack, week-long convention of 24,000 attendees, including heads of state, celebrities, philanthropists, researchers, activists, and people living with HIV and AIDS. Their optimistic vision is to attain an AIDS-free generation.
Youth provide the common denominator for achieving the sexual and reproductive health (SRH) goals of both these conferences. FHI 360 uses five fundamental principles to design research and implement SRH programs for youth:
- Youth are Assets to society and are capable of practicing positive, life-affirming SRH behaviors when equipped with accurate information plus problem solving and decision-making skills.
- Youth Participation is Critical: youth must be full partners in SRH programs if they are to have real impact.
- Human Rights are Youth Rights: youth should live free from violence and discrimination and with access to services that permit them to live healthy, productive lives.
- Gender Equity Promotes Good Reproductive Health through responsible sexuality and mutual respect between the sexes.
- Building on Existing Capacity Improves Sustainability and helps to achieve high quality SRH/HIV programs for youth.
Instilling youth with values based on sexual health, rather than sexual disease, will pay future dividends for all of us. This requires partnering with young people and fostering youth leadership. Consulting with and involving youth from the outset of educational initiatives will help develop trust and alliances across generations. Efforts to build young people’s SRH capacities in advocacy, communication and peer education–among other issues–are also effective approaches to ensuring education on sexual and reproductive health.
Youth networks can serve as trainers in these areas. Many young people work at community/municipal levels using various media, such as radio, video, writing and theatre. Partnerships that train peer educators can expand the reach of education on sexual and reproductive health to young people out of school. The establishment of clubs for discussing and providing peer education in primary and secondary schools can also help set sexual health values.
Building support at the local level among parents, teachers and community leaders is critical for sustainability when working with youth. On-going advocacy, technical and financial support, and capacity-building of government bodies in charge of educational curricula, teachers, youth networks and youth-led led organizations provide a reinforcing platform for youth programs.
Sexual and reproductive health education is one of the key priorities identified by the United Nations’ initiative to develop a global action plan on youth. Data are clear that age-appropriate SRH curricula do not lead to earlier sexual activity. The most effective programs in education on SRH are those that provide correct information, clarify values and reinforce positive attitudes. In addition, strengthening decision-making and communication skills add practical value to youth transitioning into responsible adulthood.
Development of SRH curricula must be based on cultural context. Norms on gender and sexuality, equality, empowerment, non-discrimination and respect for diversity are scarcely addressed in most SRH programs. Yet curricula that take gender and power relations into account have been shown to positively affect health-related behaviors (e.g., age at first intercourse, number of sexual partners, use of condoms and contraception,), health outcomes (e.g., lower rates of sexually transmitted infections) and non-health outcomes (e.g., student performance, parenting and critical thinking skills). Additionally, many programs do not provide scientifically accurate information about relevant psychosocial and health topics. Nor do they invest in visually engaging materials that provide young people with such information in ways that are age-appropriate.
One challenge to education on SRH is its limited reach to out-of-school youth and other groups of marginalized young people. Many young people most in need of information and education are not enrolled in any educational programs. Girls and young women especially often drop out of school at an early age because of various social and economic factors. Therefore, SRH education needs to begin at a young age and continue through adolescence to reinforce messages over time with age-appropriate content and methodology.
To conclude, I believe we proactively need to set our global priority for investing in the sexual and reproductive health of the world’s youth. As the saying goes, today is the first day of the rest of our lives, and the best value for money comes from strengthening youth.