Tackling barriers to adolescents’ Sexual Reproductive Health Rights

By DOROTHY CHISI-
ADOLESCENTS and young people are more vulnerable to health problems such as HIV/AIDS, Sexually Transmitted Infections (STIs) and poor nutrition than other categories of the population.
They often face various challenges, such as early and unprotected sex, sexual abuse, early marriages and pregnancies, drugs and alcohol abuse, unsafe cultural practices and poor mental health.
Although community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, adolescents in many countries still lack health services that are responsive to their needs of their rights for sexual reproductive health.
In Zambia, the population of young people below the age of 25 years is currently estimated at 67 per cent of the total population of the country.
This means young people are an overwhelming majority of the Zambian population.
Zambia adolescent birth rate is rated the fifth highest in sub-Saharan Africa where 44.7 per cent of women under 20 experience unplanned pregnancy.
According to the Universal Declaration of Human Rights, the World Health Organisation (WHO) recognises that ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.’
However, the barriers affecting access to Sexual Reproductive Health Rights (SRHR) are complex and multiple, with some linked to a combination of lack of resources and information, cultural norms or gender inequality.
Young people face a number of obstacles in accessing sexual and reproductive health services. These barriers relate to availability and accessibility as well as the quality of the services provided.
For example, laws and policies may limit young people’s access to services and contraceptives, and health centres may only address the needs of married women.
Embedded in social norms and gender inequality around young people and girls, sexuality means young people’s behaviour is controlled.
Youths may be stigmatised for being sexually active.
Due to their age, the youths’ ability to make decisions or express an opinion may not be respected.
All these make it difficult and often prevent the young people from accessing sexual and reproductive health services.
The Zambia AIDS Related Tuberculosis (ZAMBART) project is an internationally recognised TB/HIV research group in the world.
With some of its representatives sitting on the WHO, ZAMBART works with Yathu-Yathu project through a cluster-randomised trial to evaluate the impact of community based, peer-led sexual reproductive health services on knowledge of HIV status and coverage of key sexual reproductive health services among Adolescent and Young People (AYP) aged 15 to 24 in Lusaka’s Kanyama and Chipata townships.
This is because the 15 to 24 age group experiences a high burden of HIV and other STIs, and a high number of adolescent girls and young women have unplanned pregnancies.
Lusaka was particularly targeted for the project because of the HIV prevalence rates in local communities chosen for this study that are 6.4 per cent among women aged from 15 to 24, and 1.6 per cent amongst young men of the same age, rising rapidly thereafter.
The vision of the project is to contribute to global public health policy and practice through the generation of an evidence base by conducting high quality health research in Zambia.
ZAMBART’s Yathu-Yathu study manager Mwelwa Phiri said the interventions arm of the 14,872 AYP that consented to participate, 10,974 were reached, representing 73 per cent of those that accessed the hub services at least once.
Ms Phiri said of those who accessed the hub, 36.1 per cent were young men while 63.8 per cent were women.
She said overall, among the young people that accessed the hub services at least once, a similar proportion of young men accessed the services as young women, and it was revealed that the hubs were attractive to young people with an assurance of confidentiality.
“Provision of free menstrual hygiene products such as disposable and menstrual cups enabled equal access and reduced adolescent girls and young women’s expenditure on the products,” Ms Phiri said.
She further said in the control arm for the young people who had access only to the clinics, out of a total of 14,498, only 1,615 accessed services, representing 35.1 per cent men and 64.8 per cent women.
She said during the study period, most parents encouraged their adolescent children to access services from the hubs although some saw the provision of contraceptives and condoms as promoting sex among young people due to prevailing socio-cultural and religious beliefs.
Ms Phiri also said according to the study findings, HIV testing was the most accessed sexual and reproductive health service by both the young men and women targeted.
ZAMBART Deputy Director Research Qualitative Musonda Simwinga said qualitative research was also conducted to look at how young people and the peer support workers who were providing services, which revealed that the young people preferred hubs because of the reception and location.
Dr Simwinga said the services provided in the hubs had more young people accessing services than the clinics.
“Young people come from homes which are run by guardians and parents, but there are all these myths and misconceptions especially around contraceptives. So what we did during the study was to have dialogue meetings were we had young people and guardians sitting together to discuss issues surrounding SRHR,” he said.
Dr Simwinga said by bringing the guardians together, the service providers were able to dispel some of the myths and that it created a shift of opinion by some of the older people.
Dr Simwinga said the community engagement which was not only reactive but proactive in responding to questions, myths and misconceptions helped in ensuring that the study was well conducted.
He said this was done so as to conduct quality interdisciplinary health research on issues of public health importance in Zambia and contribute to improving health policy and practice leading to better health for all.
Yathu-Yathu project director research Professor Hellen Alyes said three months into the first year of the project’s implementation, hubs were closed due to COVID-19 and that resulted into service delivery adaptations.
Prof Alyes, who is also the Yathu-Yathu project principal investigator, said the main adaptation was limiting the number of participants that could be in the hub at any one time.
“As a result of COVID-19, Yathu-Yathu staff made more use of social media to provide sexual and reproductive health information,” she said.
Pro Alyaes said overall, the Yathu-Yathu project provided accessible, acceptable sexual and reproductive health services for the young people.
Prof Alyes said as a result of the interventions, many more young people accessed key sexual and reproductive health services and knowledge of HIV status was increased across all genders and age groups.
She said Yathu-Yathu intervention arm cost US$226,072, resulting in a cost per young person reaching US$17.30 compared to US$12.50 as the total cost of providing HIV test per young person tested in the hubs was US$21.88 compared to US$18.40 at the clinic.
Speaking at the launch of the dissemination of the project results recently, Ministry of Health Permanent Secretary Professor Lackson Kasonka said some adolescents lacked access to current health information and the ability to develop risk avoidance especially with regards to sexual and reproductive health.
Prof Kasonka said early sex debut does not only predispose young girls to HIV infection, but also compromised their opportunities to reach their full potential through education.
He said behaviour in the fight against HIV remained a source of concern as early sex debut was reported at 12.7 per cent in girls and 16.3 per cent in boys below the age of 15.
“The Ministry of Health has demonstrated empowerment of young people through educating them on health issues using multimedia platforms engaging them in the development of strategic documents, planning and implementation of health services,” he said.
When children and young people are informed about SRHR, they are equipped with the knowledge, confidence and skills to make autonomous and healthy decisions about their sexuality, bodies and relationships.
When young people receive positive support from parents, caregivers, teachers and community leaders, they grow up ready to handle complex experiences and that can help them to avoid the shame and pain related to sexuality, including accessing sexual and reproductive health services.
Improving the health and well-being of young people in Zambia and in neighbouring countries requires concerted efforts to provide SRHR services that are acceptable and accessible.