In many sub-Saharan African societies, a combination of social taboos, lack of resources and infrastructure make it difficult for adolescents to access sex education aimed at improving knowledge and reducing risk-asociated sex.
Increased investment in adolescent and reproductive health is a critical public health priority that can contribute to wider development goals, because it allows adolescents to become healthy, productive adults.
A recent study in four African countries revealed that although adolescents are highly aware of sexual and reproductive health issues, they lack the information and skills needed to protect themselves against HIV, unintended pregnancy and unwanted sex.
According to the Guttmacher Institute study, Protecting the Next Generation in sub-Saharan Africa: Learning From Adolescents to Prevent HIV and Unintended Pregnancy, only about half of 15-19 year olds across four Africa countries – Burkina Faso, Ghana, Malawi and Uganda – have received any sex education at school.
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The report describes high rates of unintended pregnancy and unsafe abortion among adolescents in sub-Saharan Africa due to unmet sexual and reproductive health care needs. Adolescents make up 23 percent of sub-Saharan Africa’s population, and the report asserts that investing to meet their sexual and reproductive health needs is a “sensible long-term public health priority.”
“Preventing ill health and promoting healthy sexual behaviour gives young people the chance to have the healthy lives they deserve and the opportunity to grow into productive, contributing members of society,” states the report.
In the absence of proper interventions to equip adolescents with appropriate sexual and reproductive health education, the lives of young men and women continue to be cut short by preventable diseases.
Due to widespread silence surrounding sexual matters, many adolescents make uninformed decisions about sexual choices. Data from the four-country study shows that many adolescents do not use contraceptives, have experienced unwanted sex, have multiple or much older partners and lack adequate knowledge about avoiding sexually-transmitted infections (STIs) and pregnancy.
“More than 90% of 15-19 year olds have heard of HIV, yet fewer than 40% of adolescents in this age group can both correctly identify ways of preventing transmission of HIV and reject common misconceptions about HIV transmission,” says the report. “The proportion who know of STIs other than HIV is low in Burkina Faso and Ghana (31-56%), but much higher in Malawi and Uganda (71-82%)”.
According to the report, young people in the region urgently need gender-related as well as reproductive health education. It is not enough to teach adolescents only the theory and moral aspects of sex – they also need life skills to deal with practical situations.
Denying that young people engage in sexual activity is a recipe for disaster and the report argues that comprehensive sex education is effective in improving knowledge and reducing sexual risk behaviors – but that it does not increase sexual behaviour, as many falsey believe.
The study recommends that school curricula should provide comprehensive, accurate sexual and reproductive health information and should not be exclusively focused on the 'abstinence-until-marriage' approach, because evidence shows that the latter does not lead to protective behaviours. Furthermore, teachers need to have adequate training in sex education so that they can provide sex education. More importantly, sex education must be targeted at younger adolescents in order to reach people before their sexual debut.
The health care system must also be designed in a way that meets the sexual and reproductive health needs of adolescents. Youth-friendly corners were young people can receive STI testing and treatment need to be integrated into the health care system. Equally important is the need to ensure that adolescents have access to a range of contraceptive methods, especially the male condom.
Mobilizing local communities is critical to get support for interventions to address sex education gaps. In sub-Saharan Africa the media, and in particular radio, can be a powerful way to spread sexual health messages that are tailor-made to meet the diverse needs of adolescents.
Adolescents need to be provided with a multi-dimensional set of tools that help them to delay sexual debut if possible, resist pressure to engage in unwanted sex, and to practice safer sex, says the report.