Sarah Spencer was a recent Global Affairs Canada intern with the Gender, Health and Justice Research Unit in Cape Town, in partnership with Dalhousie University’s International Development Studies.
As the global development community embarks upon its journey to 2030 guided by the Sustainable Development Goals (SDGs), it does so seeking to reduce maternal mortality (SDG 3.1), neo-natal and under-5 mortalities (SDG 3.2), to end the epidemics of AIDS and hepatitis (SDG 3.3), and to ensure universal access to sexual and reproductive health (SRH) services (SDG 3.7). In order to achieve success with these goals, however, there must be a significant and global shift in how we interact with adolescents when we deal with their sexual and reproductive education and access to health services.
I’ve been fortunate enough to have spent the last six months conducting research at the University of Cape Town’s Gender, Health and Justice Research Unit. My core research project has been on a five-country assessment of the laws and policies affecting access to adolescent sexual and reproductive health services. Through this research I’ve become aware of just how much stigma adolescents can confront when seeking services or to fulfill their sexual and reproductive health rights in their respective countries, cities, and communities. That is, whether or not a government has provided in law for minors to confidentially access condoms and/or contraception; testing and treatment for STIs and HIV; family planning services, pregnancy testing, and abortion and post-abortal care; and/or medical support following a sexual assault (including access to emergency contraception and post-exposure prophylaxis), the realisation of a country’s laws is highly dependent upon service providers, policy makers, and general social mores.
This, however, is not an issue limited to developing countries or communities. While adolescents around the world are confronted with varying laws and policies related to their sexual and reproductive health and rights, there is a constant element that affects if and how young people access these: the stigma of sex. Think about it this way: if you are a fourteen year old engaging in sex, how comfortable are you seeking health services – either preventative, such as condoms, or curative, such as treatment for an STI or termination of an unplanned pregnancy? How much do minors know about their sexual and health rights and the laws upholding these? And, even where these rights do exist and adolescents know them, how comfortable will a fourteen year old be fighting for these if a health worker has denied them when to do so exposes you as being sexually active? Moreover, if you are in a small community where you are likely to know your service provider beyond a medical capacity, or that health service provider knows your parents/guardians, how does that not affect your level of comfort in seeking out such services? Of course, that assumes that adolescents know that they should be attempting to access these services and how and where to find them. More often than not, young people aren’t provided a space or a level of empowerment to talk about and engage in sex in a safe and responsible way. It’s not enough to set a legal age of consent to sex and hope that adolescents will know and respect it; evidence suggests that adolescents are having sex. So, how do we help them do so safely?
There is an unfortunate and dangerous taboo around sex that transcends political borders, language, and culture. Even in liberal societies and communities, there is a general discomfort to talking openly about sex, regardless of age. It is something I think we all move past in varying degrees as we mature, but that doesn’t help adolescents to realise their sexual and reproductive health and rights. And it will severely impact the development community’s ability to meet the aforementioned SDG health targets.
This realisation has reinforced for me that it is not enough to re-write laws and synchronise government policies with such laws. Rather, it is increasingly important as we move to achieving the SDGs that we create the opportunities for adolescents to speak up and assert their rights to access such vital health services. And integral to this is to changing the way that we all talk about and interact with issues related to sex – locally, nationally, and internationally.