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Strategy Session III.2
World Education Forum
Dakar, Senegal 26-28 April 2000
Promoting population and reproductive health,
especially among young people, through basic education
Issues Paper
Original : English
1. Adolescent sexual and reproductive health as a global issue
The dimensions of sexual and reproductive health problems affecting adolescents world-wide cannot be over-emphasised. Adolescence, i.e. ages 10-19, signifies an often difficult transition period captured in the phrase "No longer children, not yet adults". This period is characterised by physical, emotional and social changes that require understanding and ability to deal with them. Today's adolescents experience an earlier onset of puberty and sexual activity; often have no knowledge about their sexuality and consequences of their sexual behavior; are exposed early to sexually transmitted diseases (STD); are highly vulnerable to substance abuse (tobacco, alcohol, other drugs); have high risks of pregnancy and abortion; are victims of sexual violence, exploitation, prostitution, discrimination and crisis; are frequently alienated from parents and communities or living in disrupted family situations; and are generally lacking in appropriate life skills in order to cope with social and economic pressures and make informed, responsible choices.
Certain facts about today's adolescents are very worrying:

About 17 million young women between the ages of 15 and 19 give birth each year, accounting for more than 10% of all births world-wide;

An estimated 4.4 million abortions are sought by adolescent girls each year;

Of the sexually active adolescents, only 17 percent use contraceptives or condoms to prevent pregnancy or infection by HIV/AIDS and other STD;

An estimated one in twenty adolescents each year contract STD, which often go untreated; more than 50% of new HIV infections occur among 15-24 year-olds.
The 12th of October 1999 marked the "Day of the 6 Billion", i.e. 6 billion people on earth, nearly half of them under age 25 and more than a billion between 15 and 24 -- the largest number of young people ever. And they will be the parents of the next generation.
In most parts of the world, adolescents have been a neglected group in health and family planning programmes. They are often not regarded as sexually active before entering marriage, therefore they have been denied access to services by law or policy. However, earlier physical maturity, urbanisation, poverty, exposure to various media and other factors predispose adolescents to engage in premarital sexual activity, usually without the intent to have children. Often, the consequences of their sexual behaviour (pregnancy, STD, abortion, abandonment, social stigma, etc.) result in a serious damage to their self-esteem, which can negatively impact on their opportunities for individual growth and development.
How best to address the sexual and reproductive health needs of adolescents is a matter for serious discussion and decision within each country. It has often proved difficult to reconcile the educational and protective role of parents with the desire and capacity of young people to make their own decisions as they grow towards adulthood. It is also difficult to define the appropriate role of society in mediating what is viewed as primarily a family matter.
Failing to deal with these issues, however, incurs a high cost in ill health, wasted life opportunities and social disruption. There is strong evidence that offering informed choices to young people promotes safer sexual practices and reduces unplanned pregnancies and STD infection rates. On this basis, many countries are designing programmes for young people that include adolescent sexual and reproductive health issues and that recognise the importance of involving young people in designing programmes that affect their lives and their future. Some programmes have successfully shown that adolescents are receptive to new ideas and are keen to make the most of their interest and energy to influence public debate and national decisions on the issues that affect them.
2. The ICPD Programme of Action on Adolescents
The Programme of Action adopted at the International Conference on Population and Development (ICPD) in 1994 recognised the urgent needs of adolescents and called on countries to (a) address adolescent sexual and reproductive health issues, included unwanted pregnancy, unsafe abortion and sexually transmitted diseases, including HIV/AIDS, through the promotion of responsible and healthy reproductive and sexual behaviour, including voluntary abstinence, and the provision of appropriate services and counselling specifically suitable for this age group; and (b) substantially reduce all adolescent pregnancies (para7.44) Moreover, the Programme of Action affirms that:
"Countries, with the support of the international community, should protect and promote the rights of adolescents to reproductive health education, information and care and greatly reduce the number of adolescent pregnancies." (Para 7.46)

"Sexually active adolescents will require special family planning information, counselling and services, and those who become pregnancy will require special support from their families and community during pregnancy and early childcare." (Para 7.47)

"Governments and non-governmental organizations should promote programmes directed to the education of parents, with the objective of improving the interaction of parents and children to enable parents to comply better with their educational duties to support the process of maturation of their children, particularly in the areas of sexual behaviour and reproductive health." (Para 7.48)
On 2 July 1999, the 21st special session of the General Assembly adopted several recommendations for the further implementation of the Programme of Action (AJS-2 l/5/Add. 1). Governments reaffirmed their commitment to make every effort to implement the Programme of Action in regard to adolescent sexual and reproductive health. The document stresses the importance of recognising the needs of adolescents and addressing inequities and inequalities due to poverty, gender and other factors, and to safeguard their rights to information, counselling and services. Specifically, it called on governments, in collaboration with civil society, including non-governmental organizations, funding agencies and the United Nations system to:
- Provide appropriate, specific, user-friendly and accessible services to address their reproductive and sexual health needs, including reproductive health education, information, counselling and health promotion strategies; these services should safeguard their rights to privacy, confidentiality and informed consent, respecting their cultural values and religious beliefs..." (Para 73a)

- Develop at national and other levels, as appropriate, action plans for adolescents and youth, based on gender equity and equality, that cover education, professional and vocational training and income-generating opportunities; (Para 73(c)

- Involve adolescents and youth themselves in the design and implementation of such information and services; (Para 73 (c)

- Recognise the central role of families, parents and other legal guardians in education their children and shaping their attitudes; and ensure that parents are educated about and involved in providing sexual and reproductive health information consistent; (Para 73 (e)

- Ensure that programmes and attitudes of health-care providers do not restrict the access of adolescents to appropriate services and the information they need, including for the prevention and treatment of sexually transmitted diseases, HIV/AIDS, and sexual violence and abuse: (Para (73(f)

- Consult with non-governmental organizations including youth organizations in evaluating programmes and documenting experiences; developing data-collection systems to monitor progress; and widely disseminating information on program-mes and their impact on young people's sexual and reproductive health; (Para 75)

- Include at all levels of formal and non-formal schooling education about popula-tion and health issues, including sexual and reproductive health ( Para 350a)
Evidence shows that when young people are equipped with accurate information and relevant education, and have access to counselling and other services that are non-judgmental, comprehensive and affordable, they are better able to avoid unwanted pregnancies, protect themselves against STD/HIV/AIDS, care for their sexual and reproductive health, and take advantage of educational and other opportunities that will affect their lifelong well-being. Furthermore, UNFPA believes that with proper guidance and education, adolescents can be a powerful positive force for social change.
3. Some key programme areas
Since the ICPD in 1994, there has been a greater awareness among different actors of the need to address youth issues. To translate this heightened interest into concrete actions is a challenge. Towards this end, the following key programme areas may be considered at the interregional, regional and country levels to ensure the effectiveness and sustainability of educational interventions:
i) Advocacy to influence policy and programme changes that promote adolescent sexual and reproductive health. Special attention should be given to measures to eliminate discriminatory and harmful traditional practices and all forms of violence, especially those against adolescent girls and boys. It is also essential to advocate for increased investments and greater resource mobilisation in support of adolescent sexual and reproductive health programmes. Because of the sensitivity of these issues, advocacy is particularly needed to help build consensus, inform public discussion, generate support for such programmes, and establish and strengthen partnerships among government institutions, civil society, the private sector, as well as multilateral and bilateral partners. It is important to sensitise all relevant stakeholders to the potential and need to promote population goals and reproductive health programmes through basic education in and outside the school.

ii) Information, education, communication (IEC). No matter how good policies are, they remain ineffective until they are translated into community and individual actions. IEC is needed to provide appropriate knowledge and understanding of sexual and reproductive health issues to adolescents and those who work with them. IEC programmes can also be directed at parents and other adults whose actions bear on adolescents. IEC strategies need to cover population/family life education, life skills education, and sexuality education both in- and out-of-school. Issues such as gender inequities, violence, male responsibility and empowerment need to be addressed in IEC programmes.

iii) Services. Another area that needs to be strengthened is the provision of "adolescent-friendly" or "youth-friendly" services that respond to a number of important questions. In which settings should services for adolescents be delivered: in health centres, schools, community centres, etc.? How are issues of confidentiality, privacy, respect, and informed consent to be dealt with in programmes for adolescents? Are there treatment and counselling services for STD/HIV/AIDS? Should there be separate services for adolescents? Or should they be integrated into existing health services? How are the specific needs of boys and those of girls to be taken into account? What other services are needed for adolescents in special circumstances, crisis situations, victims of violence, members of marginalized groups, etc.?

iv) Research. There are no standard answers to many of these questions. More research is needed to establish benchmarks, analyse data, and evaluate various interventions, especially their impact. There is a need for baseline studies, operational research and socio-cultural studies, which can serve as a basis for strengthening educational programme design, implementation, monitoring and evaluation. Special attention is needed to develop gender-based and age-based indicators for monitoring and evaluation. Attention should also be given to the dissemination and use of research results to design more effective and strategic educational interventions.

v) Capacity-building is needed to accelerate and reinforce efforts in all of the foregoing programme areas. In some cases, this could be built into existing or planned basic education programmes. In other cases, special purpose seminars, skills training workshops, and other activities to build knowledge and skills of teachers, service providers, parents, community leaders, and youth leaders could be designed to support programmes addressing adolescent sexual and reproductive health issues. Each of these broad programme areas deserves particular attention at national level by the several government services concerned, along with other actors (NGOs, the media, business community, etc.) but also at community level where the problems are most keenly felt. This Strategy Session is called on to identify the areas and kinds of helpful interventions that deserve priority attention by the international partners working with countries to expand and improve the provision of basic education.