Putting Sexuality Back into Comprehensive Sexuality Education: making the case for a rights-based, sex-positive approach

Introduction
This discussion paper builds on IPPF’s report ‘Everyone’s right to know: delivering comprehensive sexuality education for all young people’ 2, launched at the Women Deliver conference in May 2016. The report recommends that high quality CSE should be delivered to all young people and explores the evidence supporting the provision of sexuality education both in and outside of schools.
The report notes that globally, sexuality education is patchy, and where it is provided, tends to “emphasize potential negative health risks, as opposed to seeing young people as sexual beings and recognizing the positive aspects of sexuality.” IPPF has long stated that “sexuality, and pleasure deriving from it, is a central aspect of being human, whether or not a person chooses to reproduce”3 and has supported young people’s right to access education which goes beyond a mere biology lesson to incorporate sexual pleasure and wellbeing as a crucial part of life.

IPPF took the initiative to develop this discussion paper after advocates and programmers identified a pattern whereby sexuality was becoming marginalised within, or entirely excluded from, CSE programmes and advocacy efforts. After decades of concerted advocacy for CSE, efforts are yielding real results. Global resolutions such as the International Conference on Population and Development (ICPD) have recognised that effective sexuality education programmes are crucial for realising the human rights of children and young people. The Sustainable Development Goals (SDGs) provide for access to sexual and reproductive health information and education, and investment in building knowledge of human rights, gender equality and global citizenship – all core elements of CSE programming. However, sexuality, arguably the ‘linchpin’ of CSE, is notably absent.

IPPF is committed to ensuring that CSE is rights-based and sex- positive but we know that taking this approach can be challenging for many educators and programmers involved in CSE in and outside school settings. The purpose of this discussion paper is to spark reflection on the importance of maintaining the focus on sexuality as we work together to advance implementation of CSE programmes locally, nationally, regionally and globally. We aim to remind our community of educators, programmers and advocates that ultimately sexuality education programmes aim to support and empower adolescents to make free and informed choices about their sexuality, recognising that expressions of sexuality are a core part of the human experience, and as complex and deserving of attention as any other aspect of our lives.

We want to move away from an “instrumentalist” approach that frames CSE as a means to an end. Instead, we believe that sexuality education programmes are worth investment and thoughtful implementation because of the fact that they empower, build self-esteem, competence and confidence and lead to better health and well-being for the individual young people they reach. Children and young people have a right to education and good health. In-school CSE programmes paired with accessible youth-friendly health services have been shown to be not only cost-effective, but also cost saving for governments.4 However, these benefits to budgets and the smooth running of health systems should be seen as additional, rather than the primary reason for undertaking CSE programmes.

Read the full article here…

Intersections between Youth and Reproductive Health Supplies: A Report to the Reproductive Health Supplies Coalition

Executive Summary

Commissioned by the Reproductive Health Supplies Coalition (RHSC), this report aims to help its members better understand young people’s needs for reproductive health supplies with a view towards framing future actions to ensure optimal and equitable access. It explores the supply-related barriers that impede access to the contraceptive services young people desire and need. The evidence presented here makes it possible to identify these barriers, understand better the variables that contribute to them, and target future youth-focused initiatives.

As key components of its Strategy 2015-2025, the RHSC emphasises the importance of four key pillars: availability, equity, quality and choice. In this report, specific emphasis is placed upon the pillar of equity, and in particular on the financial and product barriers that impede access to reproductive health supplies. The findings in this report lay out a comprehensive set of interventions which are themselves derived from best practices in the field. These hold out the potential to help young people demand and monitor the services and supplies that meet their needs.

Young people’s access to commodities is hampered by a number of factors including restrictive policies, provider attitudes, cultural barriers, and/or social and financial vulnerability, the relative importance of which often depends on the local or national context. In some cases, the key obstacles may be enshrined in law. In others, the greatest obstacles may be the way laws are interpreted.

Common wisdom holds that young people’s sexual activity is largely sporadic and unplanned. They often prefer short term methods (pills, injectables, condoms) which can be cheaper. Nevertheless, Long-Acting Reversible Contraception (LARCs) can be appropriate for this group and yield cost savings through fewer visits and follow-up. If used routinely over time, short terms methods work out to be more expensive as evidenced in the higher cost per Couple Years of Protection.

Although many programmes focus upon unmarried youth, young married women may also benefit from increased use of LARCs to postpone their first birth and space their second and subsequent births. Family disapproval, however, may make it hard for them to access services; so integrating family planning with postpartum care or childhood immunisation services may serve as effective strategies to increase access.

Other underserved groups include marginalized and vulnerable youth who are often difficult to reach. Young people living with HIV, for example, often experience discrimination at health centres because of their HIV status. And youth in emergency or humanitarian crisis situations must often deal with the effects of uncertain supply chains. Even if young people manage to access services, societal disapproval, provider bias or supply chain disruptions prevent them from getting the method they need or want. Stockouts may have an especially pernicious effect on young people as they often do not have the time, cash or autonomy to seek alternative supply sources and therefore quickly become discouraged.

Policymakers, providers, and both community and religious leaders have expressed reservations about the suitability of Emergency Contraception (EC) for youth. EC is not widely available in many settings and is not on the National Essential Medicines List of most developing countries; and yet it holds out unique benefits for young victims of sexual assault and can decrease unsafe abortion and reproductive morbidity and mortality. It is, therefore, crucial that EC be included in political agendas that address both commodities and reproductive rights.

With regard to service provision and delivery channels, many young people seem to prefer to access their family planning methods via the private sector. They perceive it to be more discreet and to provide a better quality of care. A Total Market Approach (TMA) can support private sector provision whilst building up a public sector that is youth friendly. Voucher systems and social marketing can make commodities more affordable via franchises and other outlets where quality is assured. In addition, peer education and community outreach can bring supplies to specific groups who may be marginal or vulnerable. All of that, coupled with rights-based life-skills training could increase uptake.

Young people’s needs and preferences should be considered in the design and implementation of their services and the development of new technologies. Making sure these services include life skills training can also enhance the likelihood young people will apply the reproductive health information they acquire even when society disapproves.

Evidence-based advocacy, carried out collectively by engaging multiple partners, is the best tool for mobilising the resources needed to improve contraceptive availability and service provision.

The interface between youth and reproductive supplies is complex. It encompasses a list of barriers ranging from policies, service delivery protocols, to cultural and legal obstacles. Enhancing young people’s access to commodities should be a priority within countries’ health and development agendas. In addition, youth involvement in the design, implementation and evaluation of relevant policies and
services will be crucial in ensuring ownership and optimal impact.

Specific recommendations on the way forward are given at the end of this report. They include the need for task-shifting and the inclusion of emergency contraception in national Essential Medicines Lists. They also include recommendations for national policies to provide youth-friendly services, including to those under the age of 16. They recommend that young people actively participate in the design of service provision programmes at all levels (through family planning associations, health facilities, and community organizations) to ensure their needs are represented. And lastly, this report highlights the need for appropriate pre- and in-service training to overcome provider biases, and to ensure that providers have the necessary skill sets to adequate stocks of a broad range of contraceptive commodities.
Read the full report here…

A Statistical Snapshot of Violence against Adolescent Girls

Overview

Every 10 minutes, somewhere in the world, an adolescent girl dies as a result of violence. Yet these deaths represent only the most extreme and irrevocable assaults in a long continuum of violence faced by adolescent girls on a daily basis, usually at the hands of people closest to them – caregivers, peers and intimate partners.

Violence can take many forms, including physical, sexual and emotional violence, and varies in its severity. While all adolescents may experience violence, being a girl presents unique vulnerabilities
– some with consequences that can last a lifetime . Gender discrimination, norms and practices mean that adolescent girls are likely to experience certain forms of violence, such as sexual violence, at much higher rates than boys. Girls are also more likely to be exposed to certain harmful practices, such as child marriage and female genital mutilation/cutting (FGM/C) – both of which are direct manifestations of gender inequality.

Puberty intensifies the vulnerability of girls to violence. During the transition into womanhood, sexuality and gender roles begin to assume greater importance in how adolescent girls are viewed socially. Fr many girls, the first experience of sexual intercourse is unwanted or even coerced. Young brides face especially high risks of physical, emotional and sexual violence along with curtailed personal freedom and decision-making power. Puberty is also a time in which girls are more likely to engage in risky behaviours – such as drug and alcohol abuse and unprotected, unsafe sex – that increase their susceptibility to violence. Girls’ low status in society and within the family, along with the tendency of men and boys to wield power, especially over girls’ sexuality, are key factors in the high rates of violence against adolescent girls. When such factors remain at play into adulthood, they tend to reinforce recurring patterns of violence and the restrictions placed upon women.

Gender inequality contributes not only to the pervasiveness of violence against girls, but also to its acceptability. In some societies, for example, sexual violence, child marriage and FGM/C are not regarded as forms of violence, or even as problems to be addressed. And many girls themselves do not identify these violations as violence or abuse.

The right of adolescent girls to be protected from all forms of violence and discrimination is guaranteed under the convention on the rights of the child, its optional protocols and the convention on the elimination of all forms of violence against women. Moreover, many countries have legal frameworks that make sexual and physical violence against girls punishable by law. Similarly, child marriage and FGM/C are legally prohibited in many countries where these harmful practices still prevail. Ending the cycle of violence against adolescent girls, however, requires more than the passage and enforcement of laws and conventions. Systems and services need to be reoriented with a view to reducing the risk of harm to girls. For example, transportation options that emphasize safety and accessibility to girls need to be provided. Similarly, lighting, water and sanitation services need to be structured to give girls greater mobility and access to schooling, enabling them to establish essential daily routines.

Most importantly, girls must be empowered with the knowledge, skills, resources and options they need to reach their potential and serve as their own advocates. Educating girls and boys in an environment that is responsive to gender differences and free from all forms of violence, neglect and abuse is a key strategy in breaking the cycle of violence. Providing adolescent girls with life skills education can help them develop critical thinking, build self-esteem, communicate and negotiate effectively, and solve problems in a cooperative way. It can also build skills required to cope with violence if and when it does occur

Helping reduce girls’ vulnerabilities and expand their opportunities, including increasing their access to social, health and economic resources, is an integral component of empowerment.

Ending violence against adolescent girls involves action at every level. Governments, the private sector, civil society organizations, communities and ordinary individuals all have a role to play in stopping the cycle of violence and in contributing to the empowerment of adolescent girls .

Read the full article here…

1 … 76 77 78 79 80 … 100