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Youth friendly services
 

 

Introduction

Definition of youth

Focusing Certain Concerns

Why the need to address youth & their concerns?

Youth Friendly Services - History & Concepts

Essential Ingredients to Youth Friendly Services

Guidelines of setting youth friendly services

Components of youth friendly services

Checklists in setting up Youth Friendly Services

Barriers to Youth Friendly Service

Glimpse of Youth Friendly Programs & Services in India

“Youth around the world stand poised on the brink of a new millennium. The current generation of 10-19 year olds are more than a billion strong, and will be the largest generation in history to make the transition from children to adults. They are coming of age in societies engaged in their own rapid, sometimes chaotic, transitions. How these adolescents take their place in a world evolving at breakneck speed will determine not only the future of their individual lives but also that of the entire planet”

 

Introduction

Today’s youngsters face a complex and fast changing world. Their emotional and physical well being safeguarded by the joint family systems and age old customs & values are being eroded by urbanization, rapid industrialization and the media revolution apart from being exposed to a variety of life styles and career choices.

The process of globalization and liberalization & influx of variety of communication channels have made it fairly simple for anyone to access the needed information on any issue. Young people, who are also a product of these changes, express an urge to understand themselves, their bodies, their instincts particularly about sexuality and reproduction. The yawning gap between what they wish to know and what are available needs to be examined and thus youth friendly services is just one right step in this direction.

 

Before understanding youth development it is very important to know, the words that makes the term. Who are youth? What is development? And what is known about youth development?

Definition of youth

All commonly used terms as adolescents, teenagers, youth, young adults, refer to young people who have begun, but not completed, the journey to adulthood – often defined in terms of independence that comes with employment, marriage and/ or establishing one’s own home. World Health Organization defines youth as “persons between 15 and 24 years and young people as those between 10 and 24 years”.

The period of adolescence, is characterized with sexuality being heightened due to a number of factors like–changes in the body and awareness about it, rise in the level of sex hormone, increased cultural emphasis on sex and rehearsal for adult gender role. Due to marked age gap one can see broad range, of needs and they vary from age to age. A 10year old child is not active sexually has different needs than an 18year or 24 years old.

 

Focusing Certain Concerns

The young people have several other needs besides reproductive and sexual health, pertaining to socio-cultural and economic development, which should be of great concern, as these affect their health and development in a significant manner.           

Youth are now being recognised as one of the underserved category and their reproductive and sexual health related issues exist without concrete action plan. There is yet a marked absence of reliable data and information, which is indicative of the priority given to this age group. Therefore, this requires intensive efforts on part of government and non-government organisations and also international organisations to consider these issues in their thrust areas and also in their policies and programme agenda.

As per the Census of India 1991, young people constitute about 30 percent of the total population of the country. Their rights to protection have not been met in a context where they are underserved and marginalized to access the resources and opportunities to develop physically, sexually, intellectually and emotionally. They are subject to violence, sexual exploitation and abuse besides poverty, unemployment, loneliness and lack of hope in the future. These situations make them leave their homes looking for employment in a different setting without family support. These young people may then face increased vulnerability to health hazards of various kinds, specially related to reproductive and sexual health. Approximately ten lakh children work and live on the streets in each of the four metropolitan cities of India[1]. The stark statistics indicates incomprehensible regional and rural/urban differentials. Over 50 percent of girls marry before 18 years; the percentage of early marriages in rural areas is more than double as compared with the urban areas. It is 58.6 percent in rural areas and 27.9 percent in urban areas. The incidence of young people marrying below 18 years is as high as 71.0 percent in Bihar and 68.3 percent in Rajasthan against 24.9 percent in Tamil Nadu and 17.0 in Kerala (National Family Health Survey 1998-99). This low age of marriage results in a typical reproductive pattern of ‘too early, too many’, in the context of pregnancy as being the index of women status in society.

 

Young people’s knowledge regarding reproductive and sexual health is limited, more so in rural areas. Most of the young girls do not have knowledge of puberty or menarche, till its onset and also are unaware of the physiological changes during their adolescence phase. There is a general belief that young people and unmarried individuals rarely engage in sexual relations, that sexual activity occurs overwhelmingly within the context of marriage, and is not a matter of concern. The issue of sexual behaviour of young people is highly sensitive and significant, and also very limited research and information is available in this regards in India[2]. The lack of proper information or negative perception and misinformation about the sexual and reproductive health often continue through the reproductive years[3]. The sexual behaviour among the young people is also in a state of flux, which is due to the influence of media, widespread availability of information and breakdown of traditional socio-cultural structures. This shift in sexual behaviour has generated fresh reproductive health issues particularly for girls like unintended pregnancy, maternal mortality, unsafe abortions, reproductive tract infections (RTIs), sexually transmitted diseases (STDs) and HIV/AIDS.


The main concerns that emerge are

·        Adolescents are sexually active before marriage but have very little information about reproductive anatomy, physiology, sex and contraception.

·        There is a high prevalence of reproductive tract infections and gynecological morbidity among adolescent women.

·        Instead of contraceptives, induced abortion- usually with unapproved practitioners with whom the risk of sepsis is high-is often used by unmarried girls to end a pregnancy, and by married adolescent girls to space pregnancies.

·        Existing reproductive health services do not serve adolescent well, whether unmarried or married, and services for gynecological problems are particularly under-utilized.

 

Why the need to address youth & their concerns?

 Dealing & addressing sexuality along with its associated concerns can be one of the most significant contributions for a healthy life especially for the young:

¨      Men & women do not live by biological instinct alone. They have the capacity to differentiate between good & evil, beautiful & ugly, right & wrong. They are expected to take decisions based on the social norms. Hence the need for value building.

¨      Society expects a responsible behavior from the children, & youngsters but do not even attempt to teach them about responsible sexuality.

¨      Most have conservative society & it is a social taboo to discuss issue of sexuality. However, the information is procured from cheap sources like X-rated films, pornographic magazines that may lead to wrong & confusing information.

¨      The youth not only need information but appropriate guidelines. And this need is heightened especially for concerns relating to seminal emissions, masturbation in boys & menarche in girls etc. The parents & educators must be well equipped to handle this.

¨      Protection from different sexual abuse.

¨      Coping with different facets of relationships.

 

Thus it is being strongly felt to provide young people with correct information’s on various issues of reproductive health. There is an urgent need to provide proper services for contraceptives, abortion, AIDS testing, STD treatments. It is being felt that if a common platform or centre should be developed were the young people can go without any hesitation and are provided with correct information’s on reproductive and sexual health & sexual rights that will help in healthy development of personality. Thus the concept of youth friendly service has emerged.

 

Youth Friendly Services - History & Concepts

Youth friendly services are certain centres, which meet certain standards (that include policies and   processes that support adolescents’ rights) and help the youth to meet their sexual and reproductive health needs in a friendly manner.

 

Youth friendly service was first started at Sweden. It was felt that number of unwanted pregnancies and abortion was increasing among young people although in the previous centuries in Sweden to talk about sexuality was forbidden. Slowly with the coming up of clinics and the number of youngster turning up at the clinics lobbying was done by the NGOs at govt level.

Beside Swedish program IPPF (international planned parenthood federation) and its partners, have recognized young people’s sexual rights, needs and responsibilities, address young people sexuality in holistic and positive way.

 

FPAs take on social and religious constraints, even in countries where sexuality is never mentioned. On Valentine’s Day, the Sri-Lankan FPA set up an exhibition in “Lover’s Park”, a meeting place for young couples. Volunteers from local schools- provided information on sexual health and relationships; many visitors had never received such information. China FPA is promoting the training of thousands of peer educators. The Ethiopia, Ghana, and Mozambique FPAs have set up clinics, which provide contraceptive services, management of STIs, counselling on sexuality and relationships, and treatment of minor illnesses.

 

The FPA India has started a youth movement in Jabalpur. A group of 20 youngsters (Young Inspirers) do street-plays on issues like AIDS, health and hygiene, reproductive health issues, gender issues and many more. This group is conducting training program on counselling skills for young people, parents, teachers, and community health worker. All these are done with the help of FPA.

IPPF with the help of Denmark ministry have set up clinics for young people in Botswana, Burundi, Tanzania, Senegal and Uganda*

*IPPF-MEETING YOUTH PEOPLE’S NEEDS.htm

 

With lots of awareness and information on reproductive health and sexual health the adolescents have started coming up with their opinions especially from developing countries. A study by the Washington –based International Center for research on women have come out that adolescents in Africa, Asia, Latin America and the Caribbean, recommends that reproductive health services for youth be private, confidential, affordable, accessible and staffed with sensitive providers**

The center set up by IPPF of South Africa, youth said the most important factors determining their choice of a clinic were staff attitudes, location and atmosphere, contraceptive methods available and clinic hours. ***

 

Essential Ingredients to Youth Friendly Services

Before setting up a centre it is very essential to observe that the centre has certain qualities, which will help youth in acquiring the services. Those qualities are -

·        Staff attitudes, which includes respect shown to the client irrespective of age, sex. 

      socio-economic, marital status.

·           Accessible location and a congenial atmosphere

·          Youth friendly hours of operation of the centre

·            Ethics of confidentiality and privacy.

·          Adequate time for interaction

·          Reasonability of price

·          Welcoming the drop-in clients

·          Availability of contraceptive methods

·          Availability of other services related to reproductive health according to ones culture norms and values.

·          Provision of education and information on all the above issues in a gender friendly manner

·          Benefits of other attractive services and entertainment channels apart form those catering to the reproductive and sexual health.

 

The centre has to decide at the administration level, which all services will they provide to young people.  These include –

·          Male and female range of reproductive health services

·          Information on contraceptives and offering appropriate contraceptives method

·          Screening and advice on nutrition and self-care issues

·          Sensitive counselling service, treatment of gender violence, STD specially AIDS

·          Various option preventing unwanted pregnancy.

·          Pregnancy test and follow up.

·          Support service to young mothers as well as post and pre natal care.

·          Referral services, which includes mental health services or trauma following incest, sexual abuse

**Weiss E, Whelan D, Gupta GR.  Vulnerability and opportunity: Adolescents and HIV/AIDS in the developing World. Washington :International Center for Research on Women, 1996.

***Transgrud R. Adolescent Reproductive Health in East and South Africa: Building Experience, four case studies- A Report prepared for the regional Adolescent Reproductive Health Network, USAID, REDO/ESA, Nairobi: Family care international, 1998.


Guidelines of setting youth friendly services


A Background note:

The most important aspect of youth friendly services is to restore the good qualities so that the centre can be an effective provider of services. It is very important for the participants to understand the importance of maintaining privacy and confidentiality. It is very important to know how to maintain the records of the clients who will be coming for the service and also to file them properly so that every thing is in order. It is also important to learn how the techniques of reporting.

While maintaining the qualities it is important to detect which are the places one can set up the YFS.  Since the issue may be sensitive and initially it may actually be difficult to mobilise the general group, one can set up the centre with the schools, at primary health centre, along with the paediatric unit in big hospitals and youth clubs etc. In rural India one can open information centre along with Non formal education, motivate the young leaders regarding the importance of the information on sexuality and make them channels in disseminating and providing services related to reproductive and sexual health.

 

Once these young leaders are motivated, they will help in the establishment of youth friendly information centres.

Slowly one can train these youngsters who in turn will train others. This small group of youngsters become the peer educator. Slowly one can take elder people into confidence. One can even develop linkages with Anganwadi worker and can use their place. While setting up a centre in rural India one has to keep it in mind that the centre should also provide some other services like non-formal education (NFE), sports, entertainment club so that girls can easily avail the actual service of YFS, otherwise the parents won’t send them or they wouldn’t come for the service due to the fear of societal norms.

Some important guidelines for establishing YFS are:

Identifying and involving important groups

q       Clearly identify the group to be served to avoid treating adolescents as a homogenous group. Services may need to be tailored.

q       Involve the target group of youth during the planning implementation, and evaluation of services

q       Involve leaders of groups important in the lives of adolescents, including parents, teachers coaches. These adults can playa “gatekeeper” roles in whether adolescents know about and use services

q       Involve leaders of other important community groups

 

Identifying and Removing Barriers

q       Remove logistical impediments to access to make services convenient and flexible.

q       Remove financial, informational, legal, or other barriers to access. Youth are more likely to use services if they are free or inexpensive.

q       Create a youth-friendly setting at sites that also serve adults. Youth may feel more comfortable if the waiting room contains posters and literature dealing with adolescent issues.

q       Ensure privacy and confidentiality. This is the most important point, which has to be kept in mind.

 

Components of youth friendly services

The components of YFS can be divided into the following broad categories:

Information with regards to reproductive sexual health.

This includes-

q       Anatomy and physiology of male and female system.

q       Sexuality and sex education among young people.

q       Contraceptives and various methods of usage.

q       Advice on nutrition and life skill management for adolescents and married young women.

q       Education and counselling on STD/AIDS, (cause, sign and symptoms, prevention), pregnancy, early childcare, gender relations, responsible behaviour family life and violence

q       Referral cases to all the above and also including mental health services related to reproductive and sexual health concerns and problems like abortion.

 

Services catering to reproductive sexual health

q       Male reproductive services (Contraceptive usage, vasectomy etc)

q       Female reproductive services (Contraceptive usage, pre, natal and post natal care, menstrual disorders etc)

q       Treatment of STDs, sexual abuse, incest etc

q       Testing, treating and care for those who are diagnosed with HIV/AIDS

q       Pregnancy testing and after care

q       Compassionate support services during Ante-natal, post-natal period as well as screening out high risk cases

q       Abortion services

q       Legal services for violence, abuse cases.

 

Counselling at youth friendly services

q       Train staff to refrain from judging. Fears of negative or harsh reactions from health providers may keep young people away from reproductive health services. In general the provider must be able to listen openly and honestly to young clients’ concerns and avoid treating adolescent sexuality as a disease.

q       Train staff to feel comfortable discussing adolescent concerns. Providers should be conversant in the social issues that young people face, including pressures to use drugs or have sexual intercourse.

q       Use role-playing to help adolescent’s practice negotiating skill, especially “saying no”.

q       Enlist peer educators, who, as young people themselves, are less likely to have prejudices that adult counsellors might have and are more likely to be in tune with adolescent concerns.

 

Checklists in setting up Youth Friendly Services

Checklists are tools to evaluate whether the services provided are working well or there is a need to bring any changes. But one need not to worry because at times the services that are provided depends upon local situation and access to resources and funding. The most important aspect is to find out what young people in your local area would like from a service. Checklist can be good way to start communication between young people and service providers.

 

Checklists can be used for

Staff recruitment and development

-         Staff are interviewed and recruited by a group of people, which includes young people.

-         Staffs are able to refer young people to other professionals who can help them

-         There is a trained counsellor or youth worker to help young people

-         Staff and volunteers are rewarded and appreciated so that they remain motivated to work with young people

-          There are co-ordination meetings between staff and young people in the programme.

 

Creating Effective Programmes

-         Different approaches are used for young men and young women where appropriate.

-         The programmes provide for the diversity of young people inn the community

-         Young people can be actively involved in the design, implementation and evaluation of programmes.

-         Young people are trained to manage programmes

-         Young people have access to programme funding.

 

Mechanisms for Continuity and sustainability

-         The centre can collect good publicity materials

-         The centre conducts outreach visits to places were young people hang around

-         One can have staff to do outreach visits


Barriers to Youth Friendly Service

Barriers can be seen in three categories. They are-

·        Logistical Barrier

·        Program related barrier.

·        Provider’s attitude as barrier.

Glimpse of Youth Friendly Programs & Services in India

India is the largest country in South Asia, covering more than three million square kilometres from the Himalayas in the north to the Indian Ocean in the south. The challenges of an ever-increasing population are daunting.

More than one-third of India’s population is under the age of 15. Child mortality is higher among girls than boys, reflecting gender differences in treatment and care. Until recently, most girls were not allowed to go to schools and often dropped out after primary level.

Young women are viewed in traditional roles, approximately 40 percent of all women aged 15-19 are married. Child bearing is expected soon after marriage to prove ones fertility and to bear a son. There are approximately 10 million pregnant adolescents and adolescent mothers throughout India.

 Due to cultural constraint it is very difficult to make the population realize the need for sexual education, the rights of adolescents. The denial of older generation puts the young people at risk of HIV/AIDs and unwanted pregnancies. This in turn increases the number of unsafe abortion and that results into maternal mortality, which is still very high.

 

All these problems resulted the Govt of India and some of the NGOs to think about it and to work on this. As a result they thought of creating some centers were the young people could enter without any fear or hesitation and get all the information, which they wanted related to reproductive health and sexuality & sexual rights of adolescents. Beside FPA the other sectors who are working on reproductive health and sexual health are-

 

Better life options program (BLP)- India

In 1987, CEDPA initiated a comprehensive, life skills development program to empower out-of –school young women, ages 12 to 20 in developing countries. Recent assessments done by CEDPA India have shown a mark improvement in educational attainment, vocational skills, economic empowerment, autonomy and self- confidence in the areas were they are working. Alumnae showed increase knowledge of contraception and reported increased use of contraceptives.

 

Related to HIV/AIDS   NACO (govt policy) has taken initiative in strategy some programs in India. They are-*

·        Family Health Awareness Campaigns.

·        Supportive environments for young women

·        Special media projects

·        Private sector involvement in HIV prevention

·        Legal action

·        Behaviour change communication

*Indian NGOS- NGOS in India.htm

 

To the Readers: Feel free to add up to this section. Youth Friendly Services in India is relatively a new concept – your knowledge on this issue will be well taken and incorporated. 



[1]     Adolescent Sexual and Reproductive Health: Going beyond existing approaches, by Doris D’Cruz-Grote

[2]     Adolescent Sexual and Reproductive Behaviour: A Review of the Evidence from India, by Shireen J Jejeebhoy.

[3]     India Country Paper, South Asia Conference on the Adolescent, July 1998, New Delhi, India

*     world health organization Fact sheet no 186, “Young People and Sexually Transmitted Diseases”, December 1997.

 

 

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