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Study of Young People’s Sexual and Reproductive Health and Rights in the Arab States and Iran Sponsors: UNICEF, UNAIDS,

Study of Young People’s Sexual and Reproductive Health and Rights in the Arab States and Iran Sponsors: UNICEF, UNAIDS, UNFPA. The study aimed to:. Analyze all available information on young people’s sexual and reproductive health and rights (YPSRHR)

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Study of Young People’s Sexual and Reproductive Health and Rights in the Arab States and Iran Sponsors: UNICEF, UNAIDS,

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  1. Study of Young People’s Sexual and Reproductive Health and Rights in the Arab States and IranSponsors: UNICEF, UNAIDS, UNFPA

  2. The study aimed to: • Analyze all available information on young people’s sexual and reproductive health and rights (YPSRHR) • Provide recommendations for YPSRHR policies and programs • Identify crucial missing information

  3. This presentation • CONTEXT: Socio-economic and political • PROTECTIVE FACTORS • RISK FACTORS • SEVEN SPECIFIC ISSUES • A WORD ON SRH SERVICES IN THE REGION • CHALLENGES FOR THE FUTURE • FOUR RECOMMENDATIONS

  4. 1. CONTEXT

  5. Young people’s context: Social Change • Rapid social change affects young people • urbanization • migration • breakdown of extended family networks • rising age at marriage & educational levels • rising unemployment • exposure to global media • widening generation gaps • changing gender roles

  6. Socio-economic Context • Low-income and rural youth suffer from • e.g. lower levels of education; earlier age of marriage; situations that put them at risk for HIV/AIDS and reproductive health problems • Economic stresses • Rising unemployment among youth • Higher costs of living/housing • Higher hopes for standard of living related to • exposure to media • higher educational levels

  7. Political Context • Conflict creates risks: • e.g. Palestine (early marriage), Sudan (HIV/AIDS),Iraq (violence against young women), and refugees in several countries • Few organizations addressing YPSRH • Political reluctance to support • SRH programs for young people in general • HIV-related research and programs for highly vulnerable groups: • CSWs, MSMs, IDUs, street children, prisoners • Participation of young people limited in most countries and institutions

  8. 2. PROTECTIVE FACTORS

  9. What protects young people’s health? • Strong family solidarity • Increasing age at marriage prevents too early childbearing • Rising levels of education • Greater communication/access to electronic media – common language • make possible greater access to SRH information • Religious values that in some instances positively promote SRH

  10. 3. RISK FACTORS

  11. What creates health risks for young people? • Pockets of early marriage in most countries • Rising marriage age increases risks from pre-marital sexual activity • Rural migrants to university especially at risk • Stigma on unmarried sex a barrier to service use, especially for women • Poverty increases many risks

  12. What creates health risks for young people? • Discrimination against women • FGM/C in four countries • Girls’ mobility and access to opportunities limited in more traditional contexts • Physical and sexual violence widely reported • Not enough information • Substance abuse in some countries (IDUs) • Generation gap • No communication with supportive adults on SRH isues

  13. 4. SEVEN SPECIFIC SRH ISSUES

  14. Issue 1. Highly vulnerable groups --SRH issues urgent but unstudied • Young married girls under age 18 • Labor migrants -- male and female • Refugees and young people in conflict situations • Street children • Youth in detention • In both youth facilities & adult prisons • Young men who have sex with men (MSMs) • Commerical sex workers (CSWs) • Women in summer or temporary marriages, & their children

  15. Issue 2. Marriage Patterns: SRH Implications • Rising age of marriage both protective and risk factor • Medical virginity tests and hymen repair operations • Higher risk of men acquiring STIs, including HIV • Pockets of early marriage (most countries) and polygamy (some countries) • Declining but still high incidence of marriages among cousins • Protects against violence against young wives? • Higher numbers of unmarried women • Rise in non-conventional marriage • Temporary marriages in Iran, ‘urfi marriage in Egypt • summer marriages

  16. Issue 3. Maternal Mortality • Maternal deaths concentrated in Yemen, Djibouti, Morocco, Egypt and Sudan • Early marriage and stunting in childhood are factors • Anemia in pregnancy high across region • No regional data on relationship between induced abortion and maternal mortality

  17. Issue 4. Unwanted Pregnancy and Abortion • Very little data on unmet need for family planning in this age group • Young girls who marry early face strong pressure to bear children • Unsafe induced abortion known to occur with often severe health consequences • Unmarried girls may face violence if family knows they are pregnant • Survey of suicides in Algeria (1980s) showed 30% were unmarried and pregnant

  18. Issue 5. Sexually Transmitted Infections (STIs) • WHO: 600,000 infections per year but underreporting (esp. women and youth) • Most reported: trichomoniasis, gonorrhea and syphilis • Around 74,000 STIs (5 countries, all ages) (2002) • Study in Morocco: 40% of STIs among 15 – 29 year-olds

  19. Issue 6. HIV/AIDS and Young People • Very little data on HIV/AIDS related knowledge, attitudes, and behavior • Widespread reports of premarital sexual activity, at least in urban areas, but little research • Estimated new HIV infections (2003): 75,000 • Main modes of transmission: Heterosexual, IDU • Most women develop AIDS at younger age (25 – 29) than men (35 – 39) • Some vulnerable groups mainly young: CSWs, IDUs, street children, labor migrants, MSM

  20. Issue 7. Substance Abuse • % of IDUs among total regional AIDS cases from 2% in 1999 to 9% in 2002. • Libya: IDU is main HIV transmission mode • Iran: 1.2-1.6 million drug users • 12 – 16% are intravenous drug users (IDUs) • 10% start before 15 years old • Many IDUs young and in prison, where HIV infection rate is 8% • Government has addressed problem with harm reduction

  21. 5. SRH SERVICES IN THE REGION

  22. Do Services Meet Needs? • Widespread lack of adequate YPSRH services for married & unmarried • Existing programs small-scale and not studied well enough to know if they work • Few programs for vulnerable groups • No country-wide SRH education in schools • A few examples of country-wide programs • E.g. Iran Premarital Counseling and Hotline • E.g. Egypt AIDS Hot-Line

  23. Why is there so little SRH education and services? • Social & political resistance to addressing SRH among young people • SRH risks are rising, but too little information • Many political leaders find the topic too sensitive • Will not even support research • Service providers and teachers judgmental about sexual activity among unmarried young people

  24. 6. CHALLENGES FOR THE FUTURE

  25. Major YPSRHR Challenges in Region • Creating willingness among government leaders to address YPSRHR issues • Controversies on SRH issues have negative effect on political leaders • Integration of YPSRHR into stable government and NGO programs • Need long-term programs, not short-term projects • large numbers of young people are constantly coming of age

  26. Challenges: Serving the Unmarried • Political opposition to provision of services and of adequate SRH education in schools • Many services designed for unmarried are under-used, with high cost per person served, unless they focus on community outreach • Youth Centers • Clinic-based « youth-friendly » services • Reasons: • Girls cannot afford to be identified as sexually active • Boys do not tend to go to clinics or doctors

  27. 7. FOUR RECOMMENDATIONS

  28. Recommendation Number Zero: Breaking the Silence • A basic need is to break the taboos on speaking about YPSRHR & reduce the generation gap through • Communities’ and young people’s involvement in identifying needs and designing programs • Educational programs involving both generations • Media – popular shows incorporate YPSRHR

  29. Recommendation 1: All Programs should be “Youth-friendly” • Encourage young people’s participation in decisions and design • Give top priority to private, confidential, and non-judgmental services and counseling • Respond to young people’s preferences • Preferred services channel often pharmacies & private doctors • Respond to young people’s barriers to access • financial, emotional (due to stigma), gender (girls’ lack of mobility, stigma on sexual activity), hours, legal (age of consent laws)

  30. Recommendation 2: Go for the numbers! • Education (by adults and peers) in SRH and gender where young people are congregated in large numbers • Schools and universities • Sports programs • Military • Youth development programs & groups (scouts, vocational training, etc.) • Religious youth programs and organizations • Community-based NGO programs

  31. Recommendation 3: Media and Entertainment Education • Entertainment education-- apt for breaking silence, dialogue, and peer education • Create or reproduce high quality media education products for SRH education programs • Other cultural events that stimulate discussion • Media-based strategies • Need for stable partnerships with media outlets or shows • Based on analysis of outlets/shows young people listen to • One-shot campaigns expensive, effects don’t last • Marketing and “youth-friendly” pharmacies • to make condoms and emergency contraception more accessible

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