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A new study by the Berlin Institute for Population and Development shows the challenges young people in Africa face when it comes to realising their sexual and reproductive self-determination.
Africa is home to the largest youth population in the world: three out of five people on the continent are under the age of 25. Child marriage and early pregnancies remain widespread in many regions and the share of young people living with HIV is growing. A new study by the Berlin Institute for Population and Development sheds light on these and other critical issues for the reproductive and sexual self-determination of Africa’s youth generation—such as sexuality education, LGBTQI+ rights, contraceptive provision and youth-friendly health services. Based on interviews with youth activists and youth-led organisations in Nigeria, Zambia and Tanzania, the study highlights the biggest gaps in young people’s sexual and reproductive health and identifies key approaches to better support young Africans.
To start, young people in many African countries do not receive adequate sexuality education. However, teaching teenagers about their bodies and how to make healthy, empowered and informed decisions about sex, relationships and starting a family is a prerequisite for their self-determination. There are also major gaps in healthcare provision, including in the three focus countries of the study: In Nigeria, Tanzania and Zambia, most healthcare facilities fail to provide youth-friendly, confidential and respectful care to young people.
“Health facilities should provide services that are tailored to meet young people’s needs, such as a dedicated waiting room where they won’t run into relatives or neighbours asking them why they are at the clinic,” says Colette Rose, study author and project coordinator at the Berlin Institute. “In order to make health services youth-friendly, it is imperative to involve young people in their design and implementation, for example when it comes to opening hours.”
Healthcare is neither inclusive nor barrier-free
Particularly young people with disabilities and/or HIV as well as LGBTQI+ youth often experience discrimination when seeking health services, including contraception. For example, a 16-year-old with a visual impairment who needs a pregnancy test may find it challenging to get to and find her way around the clinic: usually there are no signs or information in Braille. In addition, because health workers often treat “more urgent” cases first, it is not uncommon for visibly queer and/or HIV-positive youth to be left sitting in the waiting room for many hours. Finally, once they see a medical professional, young people often have to endure demeaning comments or intrusive questions about why they are having sex at their age.
“Young people face many barriers when they seek healthcare,” explains Kristin Neufeld, co-author of the study. “If they are also treated disrespectfully on top of everything else, they may not return when they have health problems in the future. This can lead to undiagnosed and untreated sexually transmitted infections.”
No self-determination without poverty reduction
Poverty is an additional obstacle. For many young people, a pack of condoms or a bus ride to the nearest clinic is simply too expensive. Even parents often cannot afford to buy a package of menstrual pads for their daughters every month. And for single young mothers without a school degree, sex work is often the only viable option to secure a roof over their heads and food every day.
“Young people must be able to secure their livelihood in order to lead self-determined lives,” emphasises Kristin Neufeld. “That's why youth-focused projects promoting sexual and reproductive health and rights are usually more effective if they also help young people become financially independent.”
Effective projects often receive insufficient funding
Countless projects and initiatives already exist that aim to strengthen the sexual and reproductive health and rights of young Africans, but not all of them are equally effective. In this study, the Berlin Institute presents practical examples and recommendations that youth-led organisations and experts on the ground rate as particularly promising. The most effective interventions usually have in common that they were developed by or in consultation with young people.
“In order to meet young people’s preferences and needs, funders and project implementers must promote their participation as well as the inclusion of marginalised youth populations at all levels,” says Colette Rose from the Berlin Institute. “Youth-led organisations in Africa are already doing crucial work with promising results, but they are not yet receiving sufficient and sustainable funding.”
Nele Disselkamp, disselkamp@berlin-institut.org
EMBARGO 12.08.24 Press Release Youth in Africa Study
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