Sexual relations among young people in developing countries: evidence from WHO case studies.

Since the late 1980s the UNDP/UNFPA/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (“the Programme”)has supported a number of social science research initiatives on under-investigated areas of sexual and reproductive health care. Four of these initiativeson the dynamics of contraceptive use the determinants and consequences of induced abortion sexual behaviour and the role of men also covered the needs and perceptions of young people. These four initiatives comprised 146 research projects and of these 34 studies in 20 countries in Africa Asia and Latin America addressed young people including adolescents (aged 10-19 years) and youth (aged 15-24 years). Fieldwork for these case studies was conducted chiefly between 1992 and 1996. A summary review of the studies is now available from the Programme. The studies cover a variety of sociocultural settings. In some premarital sexual activity is taboo using contraception is forbidden among unmarried youth and abortion is viewed as the only solution to premarital pregnancy among adolescents. In others premarital pregnancy may be condoned and childbearing among unmarried women is not unknown. Most studies focus on unmarried youth. However some focus on special groups such as pregnant young women or those who have terminated a pregnancy young reproductive health seekers in general or young clients of services for sexually transmitted infections (STIs). Many common themes emerge from these studies. In every setting sexual activity begins during adolescence among many young people. Much of this activity is risky contraceptive use is often erratic and unwanted pregnancy and unsafe abortions are observed in many settings. Sexual relations may be forced. There are wide gender-based differences in sexual conduct and in the ability to negotiate sexual activity and contraceptive use. Despite this relatively few young people think they are at risk of disease or unwanted pregnancy. Awareness of safe sex practices seems to be superficial and misinformation regarding the risks and consequences of unsafe sex is wide- spread. This paper reviews these and other findings discusses their implications for policies and programmes and highlights research gaps. For the sake of consistency the term youthis used to refer to young people of all ages between 10 and 24. A number of recommendations are offered on the basis of the summary review of these case studies. These include programmatic recommendations to build negotiation skills dispel misconceptions counter sexual violence involve young people in programme design tailor fertility regulation services to meet young people’s needs and communicate the message that every unprotected sexual act risks disease and unwanted pregnancy. The review suggests a need for more in-depth behavioural research on the perspectives and experiences of youth in different settings. It points to the need to study positive outcomes in addition to risk assessment and stresses that research should explore the ways in which gender roles and power imbalances affect life skills among youth and how social constraints make young women particularly vulnerable and unlikely to exercise choices relating to their sexual and reproductive lives. Research is also needed to document how young women can exercise greater autonomy. (excerpt)