Expanding Access to Information, Education, Counselling and Services

Leading a healthy and productive life, given the challenges that many young people face, requires access to appropriate information, counselling and services, as well as the development of a broad range of decision-making and interpersonal skills. UNFPA has decades of experience in educating young people about various aspects of sexual and reproductive health, family life, interpersonal relationships and gender issues. The Fund promotes an interactive approach of teaching and learning that encourages the development of attitudes and skills that can lead to sound decision-making and responsible behaviour in these areas.

UNFPA advocates for and supports age-appropriate education that helps young people understand sexual changes as positive and natural aspects of their development. When young people are equipped with accurate and relevant information and education, when they have developed skills in decision-making and communication and have access to counselling and services that are non-judgmental and affordable, they are better able to

• Take advantage of educational and other opportunities that will affect their lifelong well-being
• Avoid unwanted pregnancies and unsafe abortion
• Protect themselves against sexually transmitted diseases including HIV/AIDS
• Improve their reproductive and sexual health, self-esteem and social participation

Barriers to getting appropriate information

Adolescents seek out information about sexuality and reproductive health from a variety of sources. Although parents and trusted adults have traditionally been the source of this information, in many settings, a large proportion of young people now rely on their peers or the entertainment or news media.

Embarrassment or shame may make young people reluctant to ask for information from the adults in their lives. Taboos, traditional beliefs or customs regarding premarital sexual relations may also inhibit young people from getting information. Girls, especially married adolescent girls, may be isolated from peers and from institutions where they could otherwise access information, counselling or services.

In many cultures, adolescents are not considered as being sexually active before marriage, even though they often may be. As a result, information and services may be withheld from them. Health providers, teachers, and other potential sources of support may discourage their questions or lack adequate training to deal with them appropriately. As a result of these barriers, misconceptions about reproductive health abound – as can be seen by the large numbers of young people who still harbour misconceptions about HIV/AIDS.

Building life skills

UNFPA espouses a "life skills" approach to education. This approach can build skills that can be useful throughout many aspects of life, using participatory and interactive methodologies. These may include, for example, role-playing, exploration of feelings, analysis of gender stereotyping, training in negotiation skills, and question and answer sessions. The idea is to foster critical thinking, problem-solving and interpersonal communications skills that can lead to informed, responsible and voluntary decisions. A life skills-based curriculum can enable young people to challenge harmful gender norms, resist peer pressure and critically assess mass media stereotypes. The idea is to empower them to make safe passage to adulthood.

A life-skills approach, with its emphasis on communication and decision-making, can be applied to many subjects, but it can be especially appropriate in the sensitive arena of sexual and reproductive health. Subject matter may range from reproductive biology and human development to emotions, gender stereotypes and relations, communication and negotiation, safer sexual health (including voluntary abstinence and use of protective methods to avoid pregnancy and sexually transmitted infections), HIV/AIDS, drug and alcohol addiction, violence and abuse, and mass media messages.

Providing appropriate information, shaping attitudes and building life skills can promote preventive and responsible behaviour and generate demand for reproductive health education and services. Studies have repeatedly shown that accurate information provided at the right age tends to delay the onset of sexual activity and fosters safer sexual behaviours. Well-designed educational programmes also address parents and communities, whose support can be an important element in their success.

The need for services and commodities

Even if young people have the information they need, they may find it impossible to take appropriate action to protect themselves unless appropriate commodities and services are available to them.

This is particularly true of adolescent girls, who may face barriers due to their low status in society and strict social mores regarding their roles and behaviours. Financial, attitudinal, logistical and unnecessary medical and legal barriers sometimes prevent adolescents from getting what they need to protect or care for themselves.

With the age of marriage increasing and sexual activity often occurring earlier, correct and consistent use of condoms for dual protection against pregnancy and infection can reduce the need for clinical services. But contraceptive use is still infrequent in most early sexual experiences. In surveys, adolescents indicate an unmet need for contraception that is more than twice as high as that of the general population.

High levels of unwanted pregnancy and unsafe abortion are further evidence of the large unmet need for family planning for this group. Women aged 15-19 account for at least one fourth of the estimated 20 million unsafe abortions performed each year.

Underserved groups with specific reproductive health service needs

Depending on their life circumstances, young people may need a range of sexual and reproductive health services.

For example, pregnant adolescents need medical attention given their higher risks of pregnancy complications, but often lack access to it – either because of poverty or geography. They may also be unaware of the risks they face or feel unwelcome using services largely established for older women. Their health, and the health of their babies, may depend on support services, pre- and post-natal care, and nutritional education and supplements they receive.

Married adolescent girls, who are often expected to begin childbearing shortly after marriage. Married girls in some parts of the world are also at high risk for contracting sexually transmitted diseases and HIV/AIDS, and may need screening and medical care. In some places they may be required to present spousal consent to use family planning services, and this may not be forthcoming if their husbands are not agreement with child spacing or delayed childbearing.

For girls who have been disabled by fistula as the result of obstructed labour, surgical repairs can be a life-saving measure, but hundreds of thousands of young women do not access to the procedure.

Adolescent refugees and internally displaced youth have special service needs as well. Because of the high rates of rape and forced pregnancy during wars and other crises, young women may urgently need specialized counselling, access to emergency contraception in a timely fashion. Those who are pregnant need obstetrical care and emergency services in case of complication.

Migrant young women, who are often exposed to sexual abuse or obliged to sell their bodies as a matter of survival, may have urgent needs for screening for sexually transmitted infections, sensitive counselling, treatment and referrals on gender violence, sexual abuse and rape.

The service needs of boys and young men have often been overlooked, but are critical to achieving reproductive health, gender equity and HIV-prevention goals.

To reach diverse groups of young people, UNFPA-supported programmes offer information, counselling and services both within and outside of the health clinic setting. In the face of the HIV/AIDS pandemic, for example, condoms and information on how to use them are made available in public places where young people gather, such as cafes and nightclubs or through street vending machines and vendors. Education and counselling by trained peers is taking place in a range of settings, from schools to malls, from sporting events to fast food outlets.

Broadening the range and accessibility of services

Since the ICPD in 1994, there has been an upsurge in efforts to provide appropriate education and services. A variety of models are being used to provide youth-friendly reproductive health services that honour privacy and confidentiality, offer convenient hours and locations, and keep fees affordable, among other features. Promising approaches to overcoming barriers associated with clinics include peer outreach, mobile clinics and programmes in schools and workplaces. Social marketing, which combines market research and advertising techniques with health promotion, shows considerable promise, especially in increasing the use of condoms. Condoms can be distributed through vending machines, kiosks, sporting events, nightclubs and other places young people gather.

UNFPA employs a multisectoral approach that considers reproductive and sexual health issues as one aspect of personal development, with linkages to a range of other health and social services. In some countries, for instance, youth centres offer recreational activities as well as counselling or guidance related to drug use, family problems, jobs, relationships, and reproductive health. In many cases, a reproductive health component can be added to ongoing activities, for example, vocational training, micro-credit projects and sports programmes.

Read more about UNFPA-supported projects to improve young people's access to information and services.

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