Youth Lead Advocacy For Sexual and Reproductive Health

Maria de Bruyn

Youth advocates at the 54th Commission on the Status of Women challenged a multi-generational, multinational audience to examine their own thinking about sexual and reproductive health and rights.

“Why do I do this work?  To get money? To get friends? To get some casual sex? To be happy?”

This question was posed to an inter-generational and multinational audience of about 120 delegates on the third day of the 54th UN Commission on the Status of Women meeting in New York. The questioner was Alexis Hernández, a Mexican member of the MenEngage Alliance, and he was asking his listeners why they were engaged in advocacy around sexual and reproductive rights. Alexis was joined by other young advocates during a session sponsored by the International Planned Parenthood Federation Western Hemisphere Region (IPPF-HR), Ipas, the Youth Coalition on Sexual and Reproductive Health (YC) and SIECUS (Sexuality Information and Education Council of the United States).

Imane Khachani, a Moroccan physician and member of the YC, began a dialogue between the delegates and panelists by reminding everyone of the importance of the ICPD Programme of Action and the Beijing Platform for Action, two documents adopted by governments worldwide some 15 years ago as guidelines for policies, programs and services related to health. These agreements ushered in an era in which sexual and reproductive health and rights (SRHR) became issues of concern and today young people are playing an ever greater role in SRHR advocacy.

Ghitra Antra, a Moroccan IPPF staffer working in Tunisia, spoke about 16-year-old Fatima, a young woman who became pregnant by an older man without ever having learned how impregnation occurs. Sent away by her parents to work in another city, she had chosen to keep her baby and sought the information and education she had so sorely lacked before becoming pregnant. Ghitra pointed out that her situation highlights the fact that many young people – especially girls – do not enjoy rights such as the right to information and education, to bodily integrity, and to choose the number and spacing of their children. We must do much more to enable young people to become aware of their rights, she said, especially through programs such as peer education where young people can share information and knowledge with other youth.

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Her comments elicited a question regarding whether Fatima really needed rights: “Did some law prevent her parents from educating her?” asked a middle-aged woman. A second delegate lamented the fact that some cultural educational systems, such as grandmothers educating granddaughters, have been lost and said they should be reinvigorated. Other delegates spoke about the need to involve religious leaders and parents so that they do offer correct information to young people. A fourth person’s observation that we do not choose the families into which we are born and that not everyone is fortunate enough to have educated parents who can – and want to – educate us about reproductive health was also echoed by Ghitra. She further pointed out that even school-goers do not always receive sexuality education in schools and considerable numbers of young women lack knowledge about sexuality and their bodies. Ghitra emphasized that gatherings of advocates should motivate people to form more partnerships to ensure these rights for youth – and that they should ensure young people are part of the networks as this will help promote sustainability of efforts.

Ariana Childs Graham, an American working for SIECUS, remarked that sexual rights (dealing with social issues such as relationships and gender) and reproductive rights (which pertain to more biological aspects of health) form a configuration of inalienable and indivisible rights. She cited guidance issued by UN Treaty Monitoring Committees to governments that explain how multiple agents are responsible for fulfilling rights. For example, the right to information must be promoted and guaranteed by parents, educators, schools and governments (e.g., school boards, Ministries of Education). In essence, ensuring that individuals enjoy their rights is a collective obligation.

Responses to Ariana included a question about whether any human rights treaties have guaranteed a right to abortion and a comment that the UN system is marked by hetero-normativity, which fails to recognize the rights of gay, lesbian and transgender individuals. A delegate from Japan also noted that speaking about rights can be difficult due to language problems – there is no translation for the term “reproductive rights” in Japanese. Ariana suggested that we accustom ourselves to thinking more about sexual orientation in terms of a continuum of preferences and desires for partners of various sexual and gender identities, rather than in terms of a dichotomy of gays/lesbians versus heterosexuals. It was pointed out that one international human rights treaty in Africa guarantees a right to abortion – the Protocol on the Rights of Women.

When Alexis addressed the crowd with his opening question, he also answered it for himself. “Am I here to become famous? Am I doing this so that I can look cool?” “No,” he said, “I’m doing it because it’s my responsibility as a young man and because I want to contribute to making the world a better place.” He noted that we all know some things are wrong in the world and we want to change that situation. This can be especially true for young people, so it is important for adults to enable them to participate and take leadership roles in advocacy.

Alexis commented on the fact that organizations like IPPF, which involves youth in the design, planning, implementation and evaluation of programs, have shown that interventions are more successful when they include young people in all those stages. He emphasized that when we talk about health for “all,” we must ensure that “all” includes everyone, male, female, and people of all sexual identities. Yet 90 percent of the delegates present at this session, he said, were women. And the 10 percent of men in the room were not necessarily all engaged in advocacy for rights; some were actually working to block rights for women.

He asked delegates to consider that motivating men to become engaged in promoting women’s rights may mean moving away from continual repetition of the negative ways in which men affect reproductive health and sexuality. Rather, he said, we should talk to men about what they can gain in working for women’s rights and improving sexual and reproductive health. Men need to ask themselves: “What do we lose if we don’t work on these issues?” It is through partnership between men and women, Alexis said, that we can truly achieve a different world.

A young man from Peru spoke out to emphasize his agreement with Alexis’ proposals. He remarked that men do not always completely understand women’s issues and exactly what they want, but many young men are willing to learn so that they can work together with women. A young woman asked Alexis if he would consider education on abstinence to be a part of comprehensive sexuality education. His response: “Yes, because young people must have the right of choice. But we also must acknowledge that abstinence is not 100 percent effective, so I would also recommend condoms.” Alexis concluded that steps needed to involve more young people in advocacy include: building inter-generational bridges, building cultural bridges, building bridges between men and women, and promoting inclusive, participatory and horizontal approaches since young people don’t like having things imposed on them.

LaToya Cadogan-Williams, president of a youth organization in Barbados, spoke to the issue of what “adult” organizations can do to enhance youth participation in advocacy and programs. First, she said, we must acknowledge that we have become too fixed on identifying “youth spaces” as particular locations, such as rooms at clinics. We need to broaden our thinking so that we see youth spaces as all kinds of places where young people interact: the barber shop or beauty parlor, a youth centre, the Internet, facebook and twitter. We must be willing to keep including new types of spaces as they are evolving all the time along with the young people. Doing this will enable us to reach out to more youth.

A second essential point, LaToya said, was to give young people spaces where they can act and not only talk. Letting them participate in a panel but then denying them the opportunity to carry out concrete activities is useless. Young people in leadership positions need to be accountable to other young people, but they must be enabled to become effective leaders by giving them the opportunity to practice; this can be through mentoring, internships, fellowships, and giving them access to the media. In addition, young people need some incentives, the least of which would be a pat on the back to acknowledge all their hard work.

LaToya concluded by saying that larger organizations should not just relegate young people to working on “youth issues.” Rather, they should mainstream a youth perspective into all their work so that they take into account how all aspects of their programs affect young people. This, rather than tokenism, is what youth want, she said to very loud applause.

It would be interesting to know how many delegates take heed of all the advice offered by our young colleagues and initiate changes where they work so that youth advocates can indeed participate in leading the way!

Commentary Human Rights

The Democratic National Convention Was a Remarkable Victory for Disabled People

s.e. smith

This year's convention included disabled people every evening, as part of a larger inclusive policy that made 2016 a banner year for disability rights activists.

Read more of our coverage of the Democratic National Convention here.

On Thursday night, Hillary Clinton formally accepted the Democratic Party’s nomination for president. Her speech included many of the elements one expects from a nominee, but there were some standout moments—like when she mentioned disability rights, which she did repeatedly.

Clinton integrated disability into her discussion of her record, talking about her work to ensure that disabled children have the right to go to school and bringing up the health-care needs of disabled youth. Her commentary reinforced the fact that she has always cared about disability issues, particularly in the context of children’s rights.

But she did more than that. She referenced shortages of mental health beds. She explicitly called out disability rights as necessary to defend. And at one point, she did not mention disability, which in itself was radical. When she outlined her plans for gun reform and clearly stated that she wanted to keep guns out of the hands of people who shouldn’t have them, she referenced people with criminal histories and terrorists, but not mentally ill people, who have been fighting a surge in stigma thanks to perennial (and wildly incorrect) assertions that mental illness causes violence. That omission was clearly deliberate, given the meticulous level of crafting that goes into writing one of the most important speeches of a presidential candidate’s career.

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The nominee’s speech would have been remarkable on its own, but what made it truly outstanding is that it was far from the first appearance of disability at this year’s Democratic National Convention (DNC). The convention included disabled people every evening as part of a larger inclusive policy that made 2016 a banner year for disability rights activists, who are used to being invisible. These kinds of appearances normalized disability, presenting it as a part of some people’s lives and a source of pride, not shame or misery.

On Monday, for example, disability rights activist Anastasia Somoza rolled out to give a sharp, compelling speech that didn’t cast disability in a tragic or exceptional light. She wasn’t the only wheelchair user to appear on the DNC stage—Paralympic athlete Mallory Weggemann led the pledge of allegiance on a different evening. Dynah Haubert, an attorney for Disability Rights Pennsylvania, took the stage on Tuesday. Nor were wheelchair users the only disabled people represented. Ryan Moore, a longtime friend of Clinton’s, spoke about health care and his experiences as a man with spondyloepiphyseal dysplasia congenital syndrome, a form of dwarfism. Connecticut Gov. Dannel Malloy talked about his learning disabilities. Musician Demi Lovato, who has bipolar disorder, took on mental health.

Former Iowa Democratic Sen. Tom Harkin, a nondisabled man who played an instrumental role in the push to pass the Americans with Disabilities Act (ADA) in 1990, taught the crowd sign language during a lively speech about the fight for disability rights on Tuesday, the 26th anniversary of the landmark legislation.

On Wednesday night, former Rep. Gabby Giffords (D-AZ) strode out onto the DNC stage in Philadelphia, smiling and waving at the crowd, to make a few short remarks. “Speaking is difficult for me,” she concluded, “but come January 2017 I want to say these two words: ‘Madam President.'” Her speech was about gun violence—a subject with which she’s intimately familiar after being shot in the head in 2011.

This level of representation is unprecedented. Some speakers, like Somoza, explicitly talked about disability rights, putting the subject in the spotlight in a way it’s never been at previous conventions. Others, like Giffords, came up on stage to talk about something else entirely—and happened to represent disability while they were at it. Similarly, Rep. Tammy Duckworth (D-IL), a decorated combat veteran and double amputee, talked about military policy.

This is a striking contrast from the treatment of disability at previous Democratic National Conventions: When disabled people have appeared, it’s often been in the form of a lackluster performance that objectifies disability, rather than celebrating it, as in 1996 when former actor Christopher Reeve framed disability as a medical tragedy.

Disability rights activists have spent decades fighting for this kind of representation. In 1992, two years after the passage of the ADA, the platform included just three mentions of disability. This year, the subject comes up in 36 instances, woven throughout the platform for an integrated approach to disability as a part of society, rather than as something that needs to be walled off into a tiny section of the platform, tokenized, and then dismissed.

In the intervening years, disabled people in the United States have fought for the enforcement of the ADA, and taken the right to independent living to court in 1999’s Olmsted v. L.C., which was namechecked in the 2000 platform and then forgotten. Disabled people advocated to have their rights in school codified with the Individuals with Disabilities Education Act (IDEA) in 2004, pushed for inclusion in 2010’s Affordable Care Act, and are fighting to pass the Community Choice Act and Disability Integration Act (DIA). Disability rights in the United States has come a long way since 1990’s infamous Capitol Crawl, in which disability rights activists dragged themselves up the steps of the U.S. Capitol, pleading with Congress to pass the ADA.

And as activists have pushed for progress in the courts and in Congress, disability rights have slowly become more prominent in the Democratic party platform. The ADA has been a consistent theme, appearing in every platform since 1992 alongside brief references to civil rights; historically, however, the focus has been on disability as a medical issue. The 1996 platform introduced Medicare, and health care in general, as issues important to the disability community, a refrain that was reiterated in years to come. In numerous years, Democrats addressed concerns about long-term care, in some cases positioning disabled people as objects of care rather than independent people. Disabled veterans have also played a recurring role in the platform’s discussion of military issues. But beyond these topics—again, often approached from a dehumanizing angle—and the occasional lip service to concerns about discrimination and equal rights, until the 2000s, education was the only really consistent disability issue.

In 2000, however, the Democrats went big, building on eight years under President Bill Clinton, and the influence of his then-first lady. For the first time, disability wasn’t simply lumped under “civil rights.” The platform explicitly called out the need for protection from disability hate crimes, but it also began to introduce the idea that there were other issues of relevance to the disability with a discussion of the digital divide and the obstacles that held disabled people back. Almost 30 years after the passage of the Rehabilitation Act of 1973, which barred disability discrimination by government agencies and contractors, the Democrats were starting to embrace issues like accessibility and independent living, which also played a prominent role in 2000.

It was a hint that the party was starting to think about disability issues in a serious way, especially when in 2008, the Democrats discussed the shameful delay on ratification of the United Nations’ Convention of the Rights of Persons with Disabilities, took on the Community Choice Act, talked about the need to enforce IDEA, and, again for the first time, explicitly addressed voting rights issues. By 2012, they were also calling out discriminatory voter ID laws and their disproportionate effect on the disabled community.

That’s tremendous, though incremental, progress.

And this week, the efforts of a generation of disability rights activists are on display everywhere in Philadelphia, where Daily News columnist Ronnie Polaneczky observed that accessibility is a top priority across the city. The DNC is providing expanded accessible seating, wheelchair charging stations, service dog relief areas, Braille materials, closed captioning, American Sign Language interpreters, medication refrigerators, and more. That’s radical inclusion at work, and the result of incredible efforts by disability rights organizers—including the 400 delegates who disclosed disabilities.

Those same organizers have been hounding the presidential candidates, holding them accountable on disability over and over again. They’ve brought up concerns about independent living, wage disparities, education, access to services, accessibility, hate crimes, reproductive rights, the “marriage penalty” and government benefits, and casual disablism in campaign rhetoric and practices. Advocates leaned on the Clinton campaign until it began captioning its content, for example. RespectAbility sent journalists out on the trail, #CriptheVote organized Twitter, and Rev Up encouraged people to register to vote and get involved. The disability community may be more explicitly politically active this year than ever before, and the DNC has been responding accordingly.

Clearly in consultation with disability rights activists, the Democrats have brought a host of new issues into this year’s platform, acknowledging that disabled people are part of U.S. society. Some of the many issues unique to this year’s platform include: abolition of the subminimum wage, concerns about economic opportunities with an explicitly intersectional discussion of the racial wealth gap, affordable housing, accessibility at the polls, the role of disability in the school-to-prison pipeline, and the need for more accurate Census data.

Notably, in a platform that has loudly called for a Hyde Amendment repeal and pushed for other abortion rights, the Democrats have also reinforced the need for access to reproductive health for disabled people, a revolutionary clause that’s gone virtually unnoticed.

This is a platform—and convention—of aggressive inclusion, and it reflects a victory for disabled people in the United States. It does still lack some components the disability community would like to see, like a shoutout to the DIA, which Clinton supports. This is, however, the start of what looks like a robust and real relationship between the Democrats and the disability rights community.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.