From a young person’s eyes, Family Planning as we know it has been a subject for old married women who have had enough children for the family to bear financially. It’s viewed as a topic championed by elderly health care workers waiting for their age-mates to come and receive guidance and services for them to manage their fertility. We see it as a social privilege for married women, who are considered as having the ‘right’ to access sexual healthcare to support their ‘acceptable’ sexual activity.
Family Planning for young people has been a battle against social condemnation, ignorance and neglect at the detriment of the health and future of young people. It’s a perilous area characterized by under-informing by teachers and parents for fear of giving young people the tools to experiment; and the filling of that knowledge gap with hazardous information from ill-informed peers, fantastical movies and magazines. It’s a matter of smuggling condoms in books for fear of discovery, and out-smarting till operators with cunning speech to justify the inclusion of condoms in a young person’s grocery. It’s a secretive affair of sneaking into clinics and youth centers to get pills, advice and other commodities whilst suffering accusing glances from older patrons and harsh prejudicial rebuke from health workers who believe that a young woman who has never been pregnant cannot use family planning and occasionally threaten to share private information with parents and guardians who are their friends.
We undoubtedly live in a society that makes it difficult for young people to realize their sexual reproductive health and rights particularly regarding family planning. We must realize that there is more to family planning than we have perceived, and at this time and point in our nation it has become imperative for us to enable young people to make healthy reproductive choices. One young columnist wrote, “When people can plan their families, they can plan their lives. They can plan to beat poverty. They can plan on healthier mothers and children. They can plan to gain equality for women.” Family Planning for young people is a call to social conscience, individual reason and collective action.
A Call to Conscience:
Young people are having sex, with 39% of females and 30% of males aged between 18 and 19 years reporting having had sexual intercourse before age 18. In addition to this, 92% of sexually active girls aged 15-19 are already in some form of marital union. Despite these relatively high levels of sexual activity, contraceptive use among girls aged 15 to 19 years is alarmingly low with only 38% of them using contraceptives and they have a higher than average unmet need for family planning of 17%. As a result, by age 19, nearly half (48%) of girls have started child bearing (ZDHS 2010-11).
We must understand that teenage pregnancy has great risks for young people, especially young women below 19 years whose reproductive systems will still be developing. The risk of maternal death is twice as high for girls aged 15 to 19 years than for women in their 20s, and five times higher for girls aged 10 to 14 years. They are more likely to experience complications during labour, including heavy bleeding, infection and eclampsia because they are not physically ready for childbirth. Their bodies are not fully developed and their pelvises are smaller, so they are more prone to suffer obstructed labour and obstetric fistula. In addition to this, babies born to young mothers are at great risk; if a mother is under 18 years; her baby’s chance of dying in the first year of life is 60% higher than that of a baby born to a mother older than 19 years (Every Woman’s Right Report – Save the Children 2012).
Tragically, close to 40% of our teenage mothers are delivering their babies at home and some 14% never receive any form of antenatal care. The lives of mothers and their children lie in limbo and are often lost because of our failure as a society and as a nation to avail our young people with information, skills and services for them to make healthy reproductive health choices.
A Call to Reason:
Access to Family planning information and services does not seek to grant a license to young people to engage in early sexual activity, instead it’s an effort to build the capacity of young people and avail the necessary tools to them so that they make responsible sexual decisions to protect their health and that of their future children. It allows us to realize a return on the investment made by parents and government in providing education to young people by enabling them to complete their education and find decent employment that will make it possible for them to support their families. It would be unforgiveable for a nation or parent to make a 13 year investment on the education of a child only to hold back the services and information that would prevent them from having an unplanned pregnancy and dying from the complications of pregnancy and childbirth.
Investing in family planning also makes developmental sense, given the need for the country to fulfil its targets under the Millennium Development Goals. Progress on MDG 4 on countering child mortality and MDG 5 on reducing maternal mortality by 75% and achieving universal access to reproductive health are greatly reliant on the advancement of family planning for young people. If young women delay pregnancy, it gives their bodies more time to develop thereby reducing the risk of maternal mortality and granting their babies a greater chance to survive. MDG Target 5b on universal access to reproductive health gives specific focus to reducing adolescent birth rate, unmet need for family planning and increasing contraceptive prevalence rates. In addition to this, increased uptake of family planning will allow both young men and women to make academic progress and increase their prospects of eradicating household poverty and countering gender inequality.
A Call to Action:
In view of the immense benefits of investing in family planning for young people, a tactful approach must be adopted that allows for the comprehensive enhancement of the capacity of young people to plan their families. The first step to this rests in ensuring access by young people to reproductive health information through comprehensive sexuality and life-skills education in schools and in tertiary institutions, as well as through peer-to-peer education and facility based youth friendly services. Such education must equip young people with the competencies necessary to negotiate for safer sex, abstain and over-come peer pressure as well as drug and alcohol abuse. It must tackle myths, misconceptions and negative preconceptions about family planning, and inform young people on correct use of family planning methods as well as where to get related services.
Secondly, a deliberate focus must be directed to the empowerment of girls and young women through increasing their access to education and economic opportunities. Investing in girls’ education programs will allow for girls to stay longer in school, resulting in greater control over household resources, increased ability to communicate with their partners and greater awareness of existing health services. Availing of economic opportunities on the other hand will increase the disposable income available to young women and ensure the realization of family planning through a greater ability to procure relevant reproductive health commodities.
Thirdly, we must lobby for the transformation of harmful and retrogressive cultural norms limiting advancement of the family planning agenda. Early marriages and intergenerational relationships must be discouraged, given the difficulties experienced by young women in negotiating for safer sex or the use of contraceptives in such unions. Young men must be actively engaged in family planning programs to foster understanding and greater flexibility in making decisions on family planning with current and future sexual partners. In addition to this, families and other social structures like churches must be equipped with information and skills for them to transfer accurate family planning information to young people and counter the stigma attached to such important discussions.
Fourthly, youth friendly services must be decentralized and made affordable to the maximum extent possible whilst all health service staff must be trained in the provision of youth friendly services. Particular attention must be paid to areas with high rates of teenage pregnancy and low contraceptive prevalence, especially in rural areas. In an effort to ensure convenience and consistency of the standard of youth friendly services, a supermarket (one stop shop) approach must be considered, which integrates a holistic range of sexual and reproductive health services in one youth friendly space.
Finally, as young people we must take full responsibility for our sexual reproductive health and take deliberate steps to ensure planned families. Lets seek comprehensive information from health facilities and peer educators on the importance and means to prevent early pregnancy, space births and limit the number of children we have. We must also take further steps to utilize critical SRH services including contraceptives like condoms and pills, antenatal care during pregnancy, and skilled health care during delivery of babies. Apart from these immediate measures, we should engage ourselves in gainful economic activities and make full use of educational opportunities for long term benefits in enabling us to appreciate the need and increase our capacity to take up family planning services.
In conclusion, our focus as a nation must be to ensure that every pregnancy is wanted and that young people have children when they are emotionally, physically, financially and socially prepared to do so. Re-invigorating efforts to increase access to family planning and fulfilling unmet need holds the key to saving babies’ lives and preventing adolescent girls from dying in childbirth. The decision lies in our hands, and young people will continue to look to us to enable them to make informed choices in safeguarding their sexual reproductive health and rights, and I choose to ACT!
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