Adolescent Reproductive Health Policy: Progress and Problems

1. Adolescent Reproductive Health Policy: Progress and Problems James Rosen October 15, 2001

2. Adolescent Reproductive Health: Why Care? • 1.7 billion youth ages 10 to 24 • 13 million births to adolescent girls • half of new HIV infections to youth

3. What is ARH Policy? • Policy: A statement of general concern about a particular need or problem, the intention to do something, and the guidelines for action • ARH Policy = RH Policy + Youth Policy

4. What is ARH? • IEC and counseling on sex, RH, parenthood • IEC and services for pregnancy prevention • HIV/AIDS/STI prevention and treatment • Abortion care • Pregnancy care

5. ARH Efforts Aim to: • Reduce sexual activity, postpone sex, promote abstinence • reduce sexual partners • increase contraceptive use • lower pregnancy rates • lower STI rates • improve nutritional status

6. Constitutional provisions; laws; rules and regulations; executive orders; decrees official goals, budgets, plans, programs and statements Formal standards and guidelines standards for health professionals de facto operational policies Types of ARH Policies

7. ARH Policies by Function

8. Youth Policy = ARH Policy? Influences on ARH Behavior:

9. Policies Matter Because They: • Improve young people’s access to information and service • Improve self-esteem and self-confidence to use services • Improve their life choices that affect motivation to use services

10. Policy Barriers

11. The ARH Policy Environment • Improving, but still not great • Shifting from youth as problem to youth as asset • Shifting from control of sexuality to guaranteeing rights

12. International Policies • 1985: Int’l Declaration on Youth • 1989: Convention on Rights of the Child • 1994: ICPD • 1995: Beijing Women’s Conference

13. ICPD on Adolescents The Rationale: “[ARH] efforts [are] uniquely important for the health of young women and their children, for women’s self- determination and, in many countries, or efforts to slow the momentum of population growth.” (7.41)

14. ICPD on Adolescents Actions: “Countries should, where appropriate, remove legal, regulatory and social barriers to RH information and care for adolescents” (7.45) “Governments, in collaboration with NGOs, are urged to meet the special needs of adolescents and to establish appropriate programs to respond to these needs.” (7.47)

15. Do Int’l Agreements Matter? • To legitimize government action • For advocacy by NGOs and other proponents of ARH care

16. National Policies • Broad youth policies: 150 countries • Comprehensive ARH policies: far fewer countries • Some sort of positive policy: almost all countries (but bad policies are still widespread)

17. 42% of girls 15 to 19 pregnant or already have given birth 92% of girls under female genital cutting 29% of single women and 5% of married women 15 to 19 use contraception 22% of girls < 15 married 41% of boys and 27% of girls in primary school Mali ARH Facts

18. Mali: ARH Policy Environment • National Population Policy • National Youth RH Policy • National Youth Policy • Sex Education • FGC • Abortion • Education

19. Barriers to Policy Implementation • ARH policies remain controversial • Political will is lacking • Funding is inadequate

20. 1998 -- National Youth Policy 1999 -- Presidential Decree on Youth 1998 -- National Youth Policy 2000 -- Youth Law Case Studies: Bolivia and the DR Bolivia Dominican Republic

21. Ingredient: Support from the Top Despite the informality of the National Technical Committee, no minister would say to their technical staff ‘I don’t want you to go to a meeting called by the First Lady.’ Norine Jewell, Policy Advisor, The Futures Group International

22. Ingredient: Intersectoral Coordination The key to our achievements is intersectoral coordination, which, by the way, is the most difficult part of the process. It is easier to coordinate with tens of thousands of youth than to coordinate with ten institutions. Juan Jose Guzman, National Youth Office, Dominican Republic

23. Ingredient: A Focal Point What you need to lead the process is an agency with a broad vision. It is important that youth issues not be monopolized by a single sector, for example health or sports. Jose Maria Pantoja, Office of Family and Generational Affairs, Bolivia

24. Ingredient: Steady Outside Help The whole thing would not have been possible without the support of the Pan American Health Organization. When we started the process, no one believed in it, not even many of us. It was the permanent technical assistance that kept the process moving forward. Juan Jose Guzman, National Youth Office, Dominican Republic

25. Ingredient: Youth Involvement One of the main reasons we were able to keep the process moving forward when the government changed was the pressure from the young people who had participated in the process from the beginning. Gladys Pozo, Pathfinder, Bolivia The emphasis on youth participation in policy development allowed the discussions to move beyond the purely technical. They became a forum where youth could discuss their needs. That’s far different from the way policies are usually defined—by technicians in a technical way without the participation of the principal beneficiaries of the policies. Maritza Romero, Pan American Health Organization

26. Ingredient: Good Information Having good data on youth needs and behaviors and collecting information on existing programs early in the process of policy development was extremely helpful to youth advocates—for defining problems and priorities and to push their agenda. Nancy Murray, Policy Advisor, FOCUS on Young Adults Program

27. Ingredient: Seizing the Moment You had a lining up of the planets a year or two ago. You had USAID interested in youth, you had the Europeans, you had UNFPA, UNICEF, PAHO. So you had the resources. You have a nice situation now where people are interested in collaborating and there is enough money flowing that you can complement and not duplicate efforts. Paul Schenkel, USAID, Dominican Republic

28. Ingredient: Mobilizing the The Youth Vote Like children and mothers, youth has become one of those no-lose issues for politicians. Youth represent potential votes, now and even more in the future. Remedios Ruiz, ALEPH, Dominican Republic

29. Ingredient: Involving Civil Society Government agencies are constrained because they need to adhere to government policies. They can’t always respond to the real issues and needs of youth. Civil society, by contrast, has the flexibility to introduce and promote youth issues. Indiana Barinas, Ministry of Health, Dominican Republic

30. Success: How do You Spell? The ultimate test of successful policy is that it measurably advances program access and use.

31. Success: How do You Measure? • Drop in U.S. teen pregnancy rate??? • Drop in HIV incidence among youth in Uganda???

32. Improved coordination and dialogue Improved the funding environment--but still not good ARH program still small, but growing Local implementation still nascent, but encouraging ARH program expanding Success in Bolivia and the DR? Bolivia:Maybe The DR:Maybe

33. Conclusions • Policies do matter (mostly) • We are moving in the right direction

34. Conclusions • We need better evaluation of policy impact • We need better policy implementation