If decades of efforts to protect the sexual and reproductive health of young people have taught the global community anything, it’s that enhancing access to services—and improving the quality of these services—is not enough. You can scale up services, but if you don’t also consider the issues and barriers that affect a young person’s decision and ability to use these services, you won’t achieve real improvements.
If an adolescent girl doesn’t feel safe or that her confidentiality will be protected, she will not go to a local clinic to get contraception, even if the services are free. If she is not empowered, socially and economically, she may not be able to ensure her partner uses condoms or get out of a risky relationship.
That’s why it’s critical to address the factors that affect adolescent sexual and reproductive health—everything from girls’ self-esteem to their relationships with their parents to the national laws that dictate what they can or cannot do. Building this kind of an environment is a growing priority and there are several key elements and promising approaches according to a recent article in the Journal of Adolescent Health.
Factors at the individual, relationship, community, and societal levels impact the health of young people in various ways and should be addressed. At the individual level, we should focus on empowering girls and vulnerable individuals by building their social and economic assets. At the relationship level, we should help build relationships that support and reinforce positive behavior, involving intimate partners and peers. At the community level, we need to create social support for adolescents, engaging members of neighborhoods, schools, and workplaces. And at the societal level, we have to establish and enforce laws and policies that promote human rights and gender equality.
Only when all of these aspects are considered can young people realize their sexual and reproductive rights.
In their article, the authors identify 11 essential elements for creating an environment conducive to adolescent sexual and reproductive health:
- Economic empowerment initiatives for girls and women
- Work with men and boys to promote gender equity
- Safe spaces for adolescent girls
- Education, especially secondary
- Parental engagement
- Partner-oriented programs
- Peer-focused programs
- Mentors and positive role models
- Mobilization of adults and community leaders
- Laws and policies to protect human rights
- Media campaigns and large-scale communications to motivate discussions about adolescent sexual and reproductive health
Not only are these elements beneficial in their own right, but they contribute to an overall supportive setting—what the authors call an “enabling environment” for adolescent sexual and reproductive health. Although building an enabling environment is an emerging area of study, in many ways we already know what to do and how to move forward. The authors identify some key interventions that have been implemented and evaluated in diverse settings. One of the first rigorously-evaluated projects to delay marriage in Sub-Saharan Africa, Berhane Hewan in Ethiopia, combined activities like community conversations with parents and religious leaders with support for girls to remain in school. The project resulted in significant improvements: girls aged 10-14 were one-tenth as likely to be married and three times as likely to still be in school. Married girls were three times more likely to use family planning.
In Nigeria, the Girls’ Power Initiative, a longtime IWHC partner, develops girls’ skills and confidence by working with them as well as by training government officials, media professionals, educators, and health care workers on gender sensitization. The initiative played a significant role in passing Nigeria’s National Sexuality Education Curriculum and has become an international model for educating adolescent girls and young women about human rights and gender equality.
On a broader social scale, we need more laws and policies that promote and protect the rights of adolescents, which enable them to make informed decisions about their own lives, with the support of their families and communities.
It’s often said that young people are impressionable, and they are. They are influenced by their peers, by the media, by role models. We have to consider all of these influences and other factors—like their economic independence and education—when trying to empower them to realize their sexual and reproductive health rights.
This blog post is the fourth of a five-part series summarizing the research featured in the January 2015 special supplement to the Journal of Adolescent Health. The supplement reviews the progress on adolescent sexual and reproductive health and rights since the 1994 International Conference on Population and Development.