The concept "youth-friendly services" have been being used for several years now by SRH programs but it is not always easy to capture what it is in practice. Too often, organizations embark on providing youth-friendly services as an additional activity to simply include on list of their program and don't carefully explore their readiness to listen to young people's complex and diverse voices in the matter.
Young people usually face new and peculiar challenges, which require appropriate support for them to survive and grow into healthy and responsible adults. These challenges are largely related to vulnerability to risks associated with behavior change, which could have life-long implications on health, social and economic life of their life. In this respect, it is generally recognized that appropriate planning and management of young people’s health has significant potential to contribute to overall socio-economic development at both country and global levels.
It is hard enough to get a Malawian university student to tell you whether they use condoms or not, even worse to gauge whether they use them correctly and consistently. But in a country where poverty is believed to be the leading cause of HIV infections and early pregnancies, the issue of condom use is probably the last thing on people’s minds.
But recent research commissioned by UNFPA and the Ministry of Youth and Sports indicates it is not only poverty that is responsible for high HIV infections and fertility rates. Rather, it is the low condom use among Malawi youth. The research was conducted in 2011, but earlier in 2010, a UNAids Report mentioned low condom use as one of the factors that contributes to high HIV infections.
“Major factors in the transmission of HIV in Malawi are poverty, low literacy levels, high rates of casual and transactional unprotected sex, particularly among youth between the ages of 15 and 24 and low levels of male and female condom use,” reads the report in part.
Similarly, the 2010 Malawi Demographic Health Survey (DHS) says: “For young men, HIV prevalence is slightly higher for those who report not using a condom at their last sexual intercourse compared with young men who report using a condom,” reads DHS in part.
Based on these statistics and research findings, the Ministry of Youth and Sports will next month launch a Condomise Malawi Campaign to increase condom use among the youth and reduce unplanned pregnancies and HIV infections.
Deus Lupenga, principal youth officer in the Ministry of Youth, said the campaign will run with funding from UNFPA.
“The Ministry of Youth and Sports, in collaboration with UNFPA commissioned a study in 2011 to assess factors that contribute to low condom use among young people. The Condomise Campaign is aimed at increasing condom use among the youth and ultimately reducing unplanned pregnancies and HIV infection,” said Deus Lupenga during a media briefing on the campaign in Blantyre last week.
But why focus on the youth?
Malawi has a youthful population. According to the National Statistical Office, 73.8 percent of the country’s population is below the age of 30.
That is not all—the country holds the dubious distinction of having the highest rate of teenage births in the Sub-Saharan Region. Known as adolescent fertility, Malawi’s teen birth rate is 193 per 1000 girls, compared to countries such as Zimbabwe and South Africa which are at 101 per 1000 and 54 per 1000 girls, respectively. The teenage birth rate measures the number of live births to 15-19 year olds.
With such sobering figures, surely, Malawi’s high rates cannot be ignored.
Overcoming cultural barriers
The Condomise Campaign is advocating for increased condom use because the condom offers dual protection against sexually transmitted infections such as HIV, syphilis, gonorrhea and chlamydia, as well as unwanted pregnancies.
Early pregnancy rates are high partly due to cultural and religious values that encourage abstinence and promote condom-free #sex education among youths.
While describing condom use as “one of the most effective strategies for combating the spread of HIV”, the 2010 DHS admits the cultural challenges that stand in the way.
“Educating youth about condoms is sometimes controversial, with some people believing it promotes early sexual initiation,” reads the document.
And in justifying why the Condomise Campaign is focusing on tertiary institutions, principal HIV and Aids officer in the Department of Nutrition, HIV and Aids Khataza Chawanda said: “Policy does not allow for condom distribution in primary and secondary schools, only universities.”
Ironically, one of the reasons girls are dropping out of primary and secondary schools in Malawi is early pregnancies.
Thus, poverty and poor sex education combine to lead to risky sexual behaviour among the youth in Malawi. This is why, although the 2010 DHS says 79 percent of young women and 89 percent of young men know where they can obtain a condom, the youth are not always free to access and use them consistently and correctly.
According to Wilfred Lichapa, chief youth officer in the Ministry of Youth, the Condomise Malawi Campaign is targeting university students because they are easy to reach.
“Universities have been sidelined for a long time in as far as these programmes are concerned, yet university students are future decision makers and so they also need to be protected. Most districts have youth clubs and other avenues through which youths can access condoms, but university students do not usually have these facilities,” said Lichapa.
Chawanda said locally-branded condoms called Silver Touch, which are more appealing to the youth, will be distributed during the campaign.
“The condoms will be distributed to select university campuses and also in hot spots of six impact districts such as Blantyre, Lilongwe, Mangochi, Mzuzu and Karonga that the campaign is targeting,” she said.
Women and girls at risk
Although the country’s average HIV prevalence rate is at 10.6 percent, 12.9 percent of women are living with HIV compared to 8.1 percent of men, according to 2010 DHS. This means women and girls are more vulnerable to the Aids-causing virus than their male counterparts, yet this gender is the most disadvantaged when it comes to condom use.
Malawi introduced the female condom in 1997, with UNFPA scaling up promotions by making it available in hairdressing salons, but acceptance has been slow.
The 2010 DHS indicates that less than one percent of women use the female condom. Yet the one critical advantage of the female condom is that it is the only available technology for HIV prevention that women can initiate and control.
Random interviews conducted in the streets of Blantyre revealed that very few women have ever used a female condom, with many not knowing where to find them.
Acknowledging the gap in access to contraceptives, including condoms, among youths, Vice-President Khumbo Kachali said at the 2012 London Family Planning Summit that government would raise Malawi’s Contraceptive Prevalence Rate (CPR) to 60 percent by 2020 “with a focused increase on those aged 15 to 24 years.”
With increased condom use among the youth, government would be on track to meeting its goal of reducing unplanned pregnancies and STIs.
As the Condomise Malawi Campaign runs from September 16-30, government’s goal should be to ensure that the condoms are available to the youth even after the campaign is over, and more importantly, that they reach their target.
Accessible community Youth Friendly Health Services is critical to providing and fulfilling the rights of adolescents and young people in accessing health services that are acceptable , affordable, appropriate to their needs and that offers information to make informed decisions regarding their health.
In areas where Youth Friendly Health Services (YFHS) Program is making tremendous impact there is clear linkages between the health facilities, YFHS providers, community leaders, youth - as peer educators, youth community based distribution agents, youth organizations & clubs. In Traditional Authority Katuli, Mangochi which is part of the UN Joint Program on Adolescent Girls. The program takes a holistic approach in addressing the challenges facing adolescent girls (10-19 years) by proposing and implementing integrated investments in formal education, vocational training, reproductive and related general health care and protection from violence, abuse and exploitation for young people particularly adolescent girls.
Investments in adolescent girls’ health are paying off in Katuli. Katuli Health Center has integrated YFHS in their various services delivery points and departments in the facility. The center has a room/space designated for young people center where health services in addition to SRH are offered. Peer education sessions are also held every 2 to 3 days the data collected feeds into the center’s planning processes. The center has a policy that ensures the youth do not queue when they come for services, thus giving them easy access. in addition Youth community based distribution agents are available and attached to the center and are supervised by the Health Surveillance Agent (HSA). The inter-linkages that exist between different organizations such as Banja La Mtsogolo, UNFPA, Ministry of Health, adolescent girls, schools, communities, the health facility, youth clubs/organizations, YFHS providers, parents, clinicians and HSA is impressive and proving its effectiveness in ensuring increased SRH/FP information among adolescent girls and beyond.
In Katuli Youth Community Based Distribution Agents (YCBDAs) have been instrumental in raising the demand, access and use of contraceptives and SRH information among adolescent girls, boys and the community at large. Not only has the demand and uptake of condoms, pills risen but also long acting reversible contraceptives such as Implants, intrauterine Device (IUDs) through their referrals to the health center and outreach clinics. Adolescents girls in Katuli area are now more knowledgeable about their SRH rights. The area is also seeing a decrease in the number of adolescent pregnancies and school dropouts. The YCBDAs’ coverage is big which furthers illustrates the dedication and great spirit of these young people as they work as volunteers, despite having difficulties in transport due to the coverage area. However they each manage to see and counsel between 15 – 20 clients each week.
When asked what motivates them – they said:
“I want my community to reduce school dropouts due to adolescent pregnancy and to enable youth to become productive citizen with sustainable income”
A male YCBDAs said “as a young man it is our role to not just impregnate young women but rather to be part of the solution and increase awareness on SRH information and services to adolescent girls”
YCBDAs in katuli are one of the means of encouraging positive factors (factors that reduce the impact of negative behavior or promote healthy alternatives) that influence sexual and reproductive behavior early in life and are strengthening the social economic development of their fellow young people.
These YCBDAs are energetic, passionate, knowledgeable, action oriented youth volunteers that humble you at how much they are able to achieve. They are happy to do what they can to support their fellow youth. We need to support these exceptional young people in their work; by further building their skills.
some of the YCBDAs in Traditional Authority Katuli
There are over 600 million girls in the world today, more than 500 million of them in developing countries. They are shaping humanity’s present and future. The opportunities and choices girls have during adolescence will enable them to begin adulthood as empowered, active citizens.
With the right skills and opportunities, they can invest in themselves, in their families and their communities. However, pregnancy jeopardizes the rights, health, education and potential of far too many adolescent girls, robbing them of a better future.
About 16 million girls aged 15-19 give birth each year, and complications from pregnancy and child birth are the leading cause of death among girls in this age group, especially in developing countries.
Adolescent pregnancy is not just a health issue, it is a development issue. It is deeply rooted in poverty, gender inequality, violence, child and forced marriage, power imbalances between adolescent girls and their male partners, lack of education, and the failure of systems and institutions to protect their rights. To bring these issues to global attention, this year’s World Population Day is focusing on adolescent pregnancy.
Breaking the cycle of adolescent pregnancy requires commitment from nations, communities and individuals in both developed and developing countries to invest in adolescent girls. Governments should enact and enforce national laws that raise the age of marriage to 18 and should promote community-based efforts that support girls’ rights and prevent child marriage and its consequences.
Adolescents and youth must be provided with age-appropriate comprehensive sexuality education to develop the knowledge and skills they need to protect their health throughout their lives. However, education and information are not enough. Good quality reproductive health services must also be readily available in order for adolescents to make informed choices and be healthy.
At the local level, communities should provide the infrastructure to deliver reproductive health care in a youth-friendly and sensitive way.
Underlying all these efforts is the understanding that the dignity and human rights of adolescent girls must be respected, protected and fulfilled. Today, we call on governments, the international community and all stakeholders involved to take measures that enable adolescent girls to make responsible life choices and to provide the necessary support for them in cases when their rights are threatened. Every young girl, regardless of where she lives, or her economic circumstances, has the right to fulfill her human potential. Today, too many girls are denied that right. We can change that, and we must.
No one is powerless. We all yield power however some harness it better than others. Skills to use power for personal or communal gain are inherent and learned – horned to perfection. Youth and adolescence as an age group is generalized with negative connotations of power – power over youth for gains by those who wield it. However the blame for such a process and outcomes is always laid on the youth though clear paths of manipulation and influence can be highlighted.
Power within youth as individuals and as groups is often not celebrated, harnessed, realized and promoted; it’s easy to wonder why? because if the power within youth was championed, young people would work together as an organized group, with a common goal and a strong resounding voice. Youth would effectively take their rightful place as key stakeholders and partners in matters of national development. However our communities have systems and norms that do not appreciate the ideas and the change that youth can bring thus young people internalize perceptions about themselves that they are powerless and as such cannot push and demand for the change they want to see. The power dynamics and laws are not understood and utilized to their best by youth.
When a baby is born in a family – each member of the family lives to make the baby’s life as smooth as possible. When the baby cries everyone is worried and try’s to find out what’s wrong to make it better. If as babies we have such power as to rule a household of grown-ups; what more when we grow older? What happens to our self-assurance in the power we have? What happens in the self-confidence to negotiate and work with others? What happens to our natural instinct’s to dominant and influence?
As adolescents and youth we need to consciously learn about the power dynamics that govern our lives and change; by learning and unlearning who, what , how, when power is wielded and it’s gains –we can facilitate the kind of transformative change we want to see