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Sexual health services for adolescents

Nicaragua | Two 16 year old students receive information about sexual health in a family planning clinic for a school project, but other young people are often not given adequate information about sexual health / Jenny Matthews - Panos pics

Many young people worldwide face obstacles in accessing sexual and reproductive health information and services. Sometimes services may not exist at all or where they exist, the services are not affordable to young people or are opposed by adults. Here a Panos London editor offers an insight into some of the areas to explore around the issue.

Our audio programme – Uganda: love is not evil – explored the provision of sexual health services for teenagers in Uganda, where opinion is divided on whether it is better to teach them to abstain from sex or to give them contraceptive advice.

Ideas to explore

  • What do teenagers think about sexuality issues and the availability of sexual health services? 
  • Are abstinence campaigns prevalent in your community? Have they had an effect on how teenagers behave? Do teenagers feel stigmatised seeking contraceptives or sexual health advice?
  • Which social actors in your country promote access to sexual and reproductive health facilities?
  • Where does your government stand on measure to reduce sexually transmitted infections amongst teenagers? Are these strategies working? Ask an expert or researcher to assess the success or anticipated success of these.
  • Is there access to sexual health care facilities in rural environments in your country? Can you send a reporter to a rural area to find out how services compare to urban areas?
  • What do parents and grandparents think about the younger generation? How has sex information and education changed? What do they wish they had known when they were younger? What mistakes do they think they made?
  • Is there a need for more adolescent sexual reproductive health services?
  • Is there a confidentiality agreement between teenagers and sexual health services or can parents find out about their child's sexual wellbeing without their permission?

The journalist's perspective

This feature looks at young people and what they think about their bodies in light of existing threats and policies. I chose to focus on the Naguru Teenage Centre because this is one of the most popular groups in Uganda where young people can shed their fears and express themselves without any inhibitions. I don't think I would have succeeded in talking to them in the way I did outside this centre.

The story is rooted in the need to raise awareness that teenage sentiments and attitudes have transformed over the last few years. The whole language around sexual health has changed – for example, a lot of slang is being used to keep young people informed about the issues that surround them.

Teenagers today are more positive about life than when I was young. Back then, when a teenager became pregnant the immediate recourse would be abortion or even suicide, because the wrath from their parents would be difficult to cope with. I see many teenagers today who cope with being pregnant, give birth and even go back to school.

Teenagers today have a lot more freedom. They are far more informed than I was, when even information about menstruation was strictly confined to biology classes. Now teenagers have access to the internet, the music industry has developed, there is at least one drama theatre in every area, and there is a lot of information flowing down to them. Social inhibitions are also a thing of the past. Today teenagers feel free to express themselves.

Machrine is deputy editor at the Uganda Radio Network. She also works as a media trainer, and contributed to Uganda's first ever media syllabus through its national diploma in journalism. In January 2005 she was awarded first prize in the economic development category of the US Embassy in Uganda's radio awards.

Detailed background notes

Many young people worldwide face obstacles in accessing sexual and reproductive health information and services. Sometimes services may not exist at all or where they exist, the services are not affordable to young people or are opposed by adults.

Adolescents often get their information from both traditional and modern sources. In Uganda, the senga (a traditional channel for sex education to be passed from older to younger women) still exists. However, the sex education provided is limited – issues such as maintaining one's virginity before marriage and labia elongation are commonly discussed.

Some of these traditional systems of communicating information about sex are weakening; peer groups, schools, churches, the media, traditional health practitioners, and NGOs have emerged as the most prominent sources of health information for young people in Uganda. Additionally, various international and national organisations have developed interventions aimed at behaviour change and service delivery strategies for adolescents.

Abstinence as a form of prevention against sexually transmitted infections has been commended by many traditional practitioners and church leaders. But some critics have described this as a "backlash against human rights" and in particular sexual and reproductive rights. They argue that conservative attitudes towards sexuality have led to US government funding restrictions for services for sex workers, and promotion of sex education programmes focusing on abstinence as opposed to more comprehensive approaches that explore contraception comprehensively, particularly in Africa.

The US government's fund for HIV prevention, PEPFAR, recommends that one third of funds go to abstinence-only programmes. Some have defended this decision, for example using Uganda as a ‘success story' based on abstinence. But many studies have found that for HIV education to be effective it must be comprehensive, providing information on a variety of prevention strategies (including condom use) to enable people to take informed decisions.

In Uganda, efforts to reduce adolescent reproductive health problems – including the incidence of HIV/AIDS, other sexually transmitted infections and unwanted pregnancy – have seen the promotion of ‘youth-friendly" services to encourage teenagers to seek help and advice. These services include counselling, contraceptive services, post-abortion care, Voluntary Counselling and Testing (VCT), and STI information and management, including referrals.

However, studies show that most of the sexual and reproductive health services in Uganda are not youth friendly and have not attracted many adolescent clients. Some academics observe that even when services are offered, adolescents are not accessing the services due to lack of confidentiality, rudeness among service providers, ignorance about the existence of these services and fear of embarrassment.

Additionally, most sexual and reproductive health services are still located in urban areas, with remote and rural areas lacking facilities. 

Uganda facts and figures

  • 76 per cent of young women and 63 per cent of young men are worried about getting HIV/AIDS
  • The condom is the most commonly used method among sexually active adolescents who are using a contraceptive method
  • 2 in 5 sexually active young men and unmarried sexually active young women currently use no contraceptive method; about half of each of these groups uses the male condom
  • The two main reasons adolescents did not use a condom the last time they had sex were that they did not have one and that they "felt safe"
  • Only 11 per cent of married young women use the condom; 71 per cent use no contraceptive method
  • Nearly 90 per cent have personally known someone who has died of AIDS

[Source: Guttmacher Institute, July 2006]

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