Adolescent Reproductive Health Policy: Progress and Problems

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

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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

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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

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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

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Types of ARH Policies

• 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

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ARH Policies by Function
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Youth Policy ARH Policy?
Influences on ARH Behavior
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Policies Matter Because They

• Improve young peoples access to information and
  service
  
• Improve self-esteem and self-confidence to use
  services
  
• Improve their life choices that affect motivation
  to use services

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Policy Barriers
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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

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International Policies

• 1985 Intl Declaration on Youth
• 1989 Convention on Rights of the Child
• 1994 ICPD
• 1995 Beijing Womens Conference

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ICPD on Adolescents
The Rationale ARH efforts are uniquely i
mportant for the health of young women and their
children, for womens self- determination and, in
many countries, or efforts to
slow the momentum of population growth. (7.41)
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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 an
d to establish appropriate programs to respond to
these needs. (7.47)
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Do Intl Agreements Matter?

• To legitimize government action
• For advocacy by NGOs and other proponents of ARH
  care

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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)

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Mali ARH Facts

• 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
• 41 of boys and 27 of girls in primary school

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Mali ARH Policy Environment

• National Population Policy
• National Youth RH Policy
• National Youth Policy
• Sex Education
• FGC
• Abortion
• Education

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Barriers to Policy Implementation

• ARH policies remain controversial
• Political will is lacking
• Funding is inadequate

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Case Studies Bolivia and the DR
Bolivia
Dominican Republic

• 1998 -- National Youth Policy
• 1999 -- Presidential Decree on Youth

• 1998 -- National Youth Policy
• 2000 -- Youth Law

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Ingredient Support from the Top
Despite the informality of the National Technical
Committee, no minister would say to their
technical staff I dont want you to go to a
meeting called by the First Lady. Norine
Jewell, Policy Advisor, The Futures Group
International
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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
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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
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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
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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 de
velopment allowed the discussions to move beyond
the purely technical. They became a forum where
youth could discuss their needs. Thats far
different from the way policies are usually
definedby technicians in a technical way without
the participation of the principal beneficiaries
of the policies. Maritza Romero, Pan American
Health Organization
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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 advocatesfor defining
problems and priorities and to push their agenda.
Nancy Murray, Policy Advisor, FOCUS on Young
Adults Program
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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
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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
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Ingredient Involving Civil Society
Government agencies are constrained because they
need to adhere to government policies. They
cant 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
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Success How do You Spell?
The ultimate test of successful policy is that it
measurably advances program access and use.
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Success How do You Measure?

• Drop in U.S. teen pregnancy rate???
• Drop in HIV incidence among youth in Uganda???

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Success in Bolivia and the DR?
Bolivia Maybe
The DR Maybe

• 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

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Conclusions

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

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Conclusions

• We need better evaluation of policy impact
• We need better policy implementation