"The international Conference on Population and Development recognized in paragraph 7.3 that "full attention should be given to the promotion of mutually respectful and equitable gender relations and  ' particularly to meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality," talking into account the rights of the child to (have] access to information, privacy, confidentiality, respect and informed consent, as well as the 'responsibilities, rights and duties of parents and legal guardians to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the Convention on the Rights of the Child, and in conformity with the Convention on the Elimination of All Forms of Discrimination against Women, in all actions concerning children, the best interests of the child shall be the primary consideration. Support should be given to integral sexual education for young people with parental support and guidance that stresses the responsibility of males for their own sexuality and fertility and that help [s] them exercise their responsibilities. "

"States Parties (to the Convention on the Rights of the Child] recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and '"rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services. "   

Introduction

At present, adolescents, aged 10-19 constitute approximately 20% of the world’s population and about half of all individuals are younger than 25 yr. The reproductive health needs of this group have been either ignored or neglected by governments and societies, or adolescent health has been treated as indistinguishable from childhood health concerns. Adolescents have reproductive rights just as adult do and they are entitled to have their reproductive health needs met.

While the concept of youth varies across cultures, in recent years there has been increasing global agreement that adolescence is a distinct and important period in a person's life. In a joint statement, WHO, the United Nations Children's Fund (UNICEF) and the United Nations Population Fund (UNFPA) agreed that the term "adolescent" refers to people between the ages of 10 and 19. "Youth", defined as people between 15 and 24 years of age, and "young people," who are between 10 and 24 years old, they make up distinct yet overlapping categories. Although puberty often begins after age 10, young adolescents — particularly girls — in many social and cultural contexts are confronted with sexual and reproductive health issues around age 10, sometimes even earlier. They may be forced into early marriage, become victims of rape or incest. At some point during adolescence, many may decide to become sexually active, but lack access to information and services to prevent STIs and unwanted pregnancy.

Young people’s reproductive and sexual health can be defined as a state of complete physical, social and mental well being and not merely the absence of disease and infirmity, in all matters related to the reproductive system and to its’ processes and functions. Reproductive health therefore implies that people are able to have a satisfactory safe sex life and that they have capability to reproduce and the freedom to decide when and how often to do so.

This period is characterized by sexual and reproductive risk taking, putting young people at a risk of early and unwanted pregnancy and unsafe abortion and transmission of sexually transmitted diseases, including HIV. Therefore, it implies that young people and their gatekeepers have necessary information, education and service provision to make young people knowledgeable about sexuality and reproduction, encourage abstinence, promote gender equality and promote healthy and responsible sexual and reproductive behaviour.

Reproductive rights: ‘Embrace certain human rights that are already recognised in the national laws, international human rights documents and other consensus documents. These rights rests on the recognition of the basic rights of all couples and individuals to decide freely and responsibly the number spacing and timing of their children and to have information and means to do so, and the right to attain the highest standards of sexual and reproductive health. (Beijing platform for action-1995)

Reproductive and sexual rights are founded on many principles common to human rights that governments are obligated to respect such as:

v      Human dignity

v      Equality and non discrimination

v      Bodily integrity

v      Self determination

v      Privacy

v      Liberated and security of a person

v      The right of access to health care including reproductive health care.

Sex and Reproductive rights include:

v      Reproductive and Sexual health as a component of overall lifelong health.

v      Reproductive decision making including choice of marriage, family formation and determination of the no., timing and spacing of one’s children, and the right to information and the means to exercise these choices.

v      Equality and equity for women and men to enable individuals to make free and informed choices in all spheres of life free from gender discrimination (Right to choose: Reproductive right and reproductive health-UNFPA).

v      Sexual and reproductive security including freedom from sexual violence and coercion and the right to privacy.

Background

Adolescents' right to health, which includes reproductive health, was first internationally recognized in the Children's Rights Convention of 1990. By its terms, the provisions of the Children's Rights Convention generally apply to persons under 18 years of age. Article 24 recognizes children's right "to the enjoyment of the highest standard of health and to facilities for the treatment of illness and rehabilitation of health. It also requires States Parties to take appropriate measures "to develop family planning education and services. Further more, while the Children's Rights Convention requires States Parties to "respect the responsibilities, rights and duties of parents to provide appropriate direction and guidance in children's exercise of their rights, it clearly recognizes that in all matters, the best interests of the child take precedence and the child should be enabled to exercise his or her rights. The Children's Rights Convention was also the first international human rights treaty to explicitly recognize sexual violence and abuse, a major factor related to adolescents' reproductive and sexual health. In addition, the Children's Rights Convention addresses states' obligation to ensure children's privacy and their obligation to assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child. Full implementation of these provisions is highly relevant to adolescents' ability to determine their future lives, including when and whether to bear children.

At the ICPD and the Beijing Conference, governments again recognized and affirmed many of the reproductive rights articulated in the Children's Rights Convention. The consensus documents agreed to at those conferences contain chapters' devoted exclusively to adolescents who outline specific actions to better ensure protection and realization of adolescents' reproductive rights. However, there remains a significant gap between the provisions contained in these instruments and the reality of adolescents' reproductive health and lives.

The UN human rights treaty committees charged with overseeing such treaties' implementation have emphasized the need to recognize and respect the reproductive rights of adolescents. In particular, the Committee on the Rights of the Child (CRC) and CEDAW have consistently stressed the need for governments to ensure adolescents' reproductive rights. In its concluding observations on Belize, the CRC expressed its concern over the limited availability of programs and services in the area of adolescent health and, specifically reproductive health. The CRC recommended that Belize increase its efforts to promote and strengthen policies and programs on reproductive health education and counseling services for adolescents. CEDAW, in its concluding observations on Chile, expressed concern over the alarming levels of teenage pregnancy and lack of access to sexual education for adolescents. In its concluding observations on Australia, CEDAW specifically inquired into the availability of family planning and contraceptive advice for adolescents without parental consent. CEDAW further inquired into the availability of abortion for adolescents on the same basis as adult.

Vulnerability of Young Peoples’ Sexual and Reproductive Rights

The goal at ICPD Cairo to achieve universal access to reproductive health information and services by the year 2015 still eludes the young people. 

Young People often face reproductive health risks associated with the broader social and economic conditions of their lives. Factors such as access to basic health care, standard of living, social status and autonomy, and access to information and medical services all help to determine their reproductive health as well as their overall well-being.

Cultural factors also prevent them from fully enjoying their reproductive rights. In many cultures, there is a disparity in attitudes regarding the sexuality of young women and men, and the realities that confront them.  Conservative elements in society often do not acknowledge Young Peoples’ sexuality, especially that of unmarried girls. This situation leaves their needs unattended.  The reproductive rights of girls are also particularly vulnerable because they are more often subject to coercion in sexual relations. In addition, the consequences of unprotected sexual activity in young people are more onerous for young women than for their male peers.  For example, girls are more likely to interrupt their education due to early childbearing. Doing so has tremendous consequences for their lifelong social and economic status.      

Compounding the social and cultural factors that may prevent young people from exercising their reproductive rights are legal and policy barriers that have the same effect. For instance, some countries maintain burdensome restrictions for unmarried adolescents, either officially or in practice, on access to reproductive health services, including contraception and condoms to protect against STIs. South Africa offers two examples of such practices: the Child Care Act prohibits persons under the age of 15 from accessing contraceptives without the consent of their parent or guardian. Further more, the Medicines and Related Substances Control Act of 1965 provides for the sale of oral contraceptives to a person under the age of 16 years only if the sale is made pursuant to a prescription issued by a medical practitioner, or pursuant to a written order disclosing the purpose for which the substance will be used. Someone who the seller knows to be over the age of 16 years must sign it.

 In addition, numerous countries, including industrialized countries such as Denmark,  Italy, and Norway, requires parental consent for minors to obtain a legal abortion.

Adolescents' Rights in Laws and Policies

8Access to reproductive health care

Adolescent reproductive health care needs vary with culture, age, and marital status, but all adolescents need access to affordable, confidential, quality reproductive health services. This is particularly important for unmarried adolescents who may confront negative attitudes for being sexually active.

Due to controversies related to adolescent sexuality and the general lack of knowledge regarding the reproductive and sexual needs of this population, relatively few countries in the world have adequate reproductive health care services for young people. One example of a positive governmental initiative to address this issue is in Costa Rica, where a law relating to adolescents was passed

8Education

Education is a prerequisite for fulfilling the right to reproductive health. Education enables young people to obtain information that they can use to exercise and protect a range of interests and rights including their sexual and reproductive rights. Studies indicate that educated women are able to have a greater say in their reproductive lives than women will control her reproductive life. This has been demonstrated across many regions and cultures. Yet despite the numerous benefits associated with ensuring educational opportunities for young girls and women, many countries continue to lag in improving women’s education. Low school enrollment of girls is related primarily to enforcement of traditional roles and lack of economic resources. 

Along with formal education, it is equally important to provide young people with education about sexual and reproductive matters. Many countries resist such education in a formal setting under the erroneous assumption that educating adolescents about sexuality will encourage early sexual activity. On the contrary, studies indicate that sex education actually has the effect of delaying sexual activity.

8 Early marriage

Marriage contracted before the age of 18 is generally considered early marriage. Early marriage may negatively impact on a young woman's life by affecting her full development, particularly in terms of education, economic autonomy, and physical and psychological health. Most adolescents who marry young are pressured to begin childbearing prior to physiological maturity, this can lead to maternal mortality and morbidity.  Furthermore, when a child or adolescent is compelled to marry at a young age and she refuses to consent to sexual relations or is too young to consent knowingly thereto, such marriages may result in sexual violence. In many cultures where the female age of marriage remains low, there is also a significant age differential between the spouses, which often leads to relationships of greater dependence and powerlessness.

In addition to the cultural pressure or coercion adolescents may face to marry young, many women are pressured or coerced into marrying a man chosen for them. Some customs and religious beliefs condone forced marriage, child marriage, dowry and bride price arrangements, consanguineous marriage, polygamy, and polygyny. Many of these practices violate numerous international human rights instruments, such as the provisions in the Women's Convention and other instruments that provide that marriage shall be entered into only with the free and full consent of each spouse.

8Early childbearing and contraception

Adolescents are often not physiologically mature enough for childbearing, early childbearing is associated with high levels of maternal mortality and morbidity. The risks of early childbearing include hemorrhaging, anemia, malnutrition, delayed or obstructed labor, low birth weight, and death for the mother and/or the infant. Young adolescents are up to four times as likely as women over 20 to die from pregnancy-related causes. In addition to the decreased health risks, there are socio-economic benefits for delaying a pregnancy. A young woman who delays pregnancy has a better chance of furthering her education, thus acquiring skills and knowledge that will allow her to better take care of herself and her family.                                                                              

Due to the high level of sexual activity and unplanned pregnancy among adolescents, it is essential to ensure young people have access to contraceptives.  Unfortunately, many adolescents have little or no information about contraceptives and their proper use.

In an effort to make emergency contraceptives' more available to young people, France became the first country in the world to dispense emergency contraception pills through school. Although the nurses are advised to make efforts to inform the child's parents, they are not required to do so. French health and education officials hope the policy will help lower unwanted pregnancies among teenagers and reduce the country's abortion rate, which is among the highest in the European Union.

8Unsafe abortion

Adolescents worldwide are disproportionately victims of unsafe abortions due to their lower access than adults to quality, confidential reproductive health services and information, including contraception.  Adolescents are less likely than older women to have the social contacts, access to transportation, and financial means to obtain a safe abortion. Furthermore, adolescents tend to delay obtaining an abortion until after the first trimester and often seek help from non-medical providers, leading to higher rates of complications. In countries where abortion is illegal, highly restricted, or inaccessible to certain sectors of the population, adolescents have even less access due to additional restrictions on them, notably those requiring parental consent. At least 28 countries require parental authorization, although in several, including Denmark, Italy, and Norway, a minor may forgo parental consent if she seeks authorization from a court or hospital committee instead.

8HIV/AIDS and STIs

Of the 30 million people living with HIV in 1998, at least one-third were aged 10 to 24. Further more, around half of the 333 million new STIs each year are in people under 25 years. Young women are especially susceptible to STI transmission because they have fewer antibodies than older women, and the immaturity of their cervix increases the likelihood that exposure to the infectious agent will result in the disease being transmitted. In addition to the physiological factors putting young women at risk, adolescent girls are often more vulnerable to HIV/AIDS and STIs than their male counterparts due to factors such as sexual violence and exploitation, early sexual initiation, and inability to negotiate safe sex with partners, who are often older than they are.

In communities that lack contraceptive services at health facilities or that restrict adolescent access to male and female condoms, it is nearly impossible for adolescents to protect themselves from STIs, HIV, and unwanted pregnancies.

 8Sexual Violence :

Although there are relatively few studies regarding sexual violence against adolescents, those that have been conducted indicate that many adolescents around the world report that their first sexual experience was forced or coerced by an older partner and the majority of victims of sexual violence are adolescent girls. Most sexual violence is committed by acquaintance, family members, and authority figures, a crucial factor is the underreporting of such incidences. Health care providers and law enforcement agencies that are ill equipped to address such abuses compound the fear of reporting. Lack of information, combined with the often-low status of women in many societies; contribute to making adolescent girls one of the groups most vulnerable to sexual violence.

Conclusion

In the last five years governments around the world have increasingly taken action to promote the reproductive rights.

There is still much to be accomplished to fulfill the commitments made at Beijing. Government commitment to young peoples’ rights should be reflected in legal and policy reforms, which not only affect behavior, but also can, shape people’s understanding of equity and justice. The adoption of laws and policies should be accompanied by vigorous efforts to enforce and implement these measures.

Sexual and Reproductive health is a lifelong concern for both women and men, with specific issues that change over the course of people’s lives. The young people need early socialization in sexual responsibility to ensure that they know their rights and exercise them instead of suffering in silence, ignorance and shame. They need information and services that will enable them to be responsible in exercising their sexual and reproductive health rights. Yet unmarried Young people are often given short shrift or excluded from services.

There is a need to promote healthy sexual and family formation behaviour, women need protection from discrimination and positive moves towards equality. Both need reproductive health care suitable to their age and situation.

Sexual and Reproductive rights of young people:

v      The right to self-determination in the field of sexuality and reproduction.

v      The right to a full range of accessible and affordable services including contraception, safe legal abortion, HIV/AIDS/STDs screening.

v      The right to comprehensive sexual education at all levels.

v      The right to their own sexual orientation, experience and pleasure.

v      The right of young mothers to complete their education.

v      The right to all information on sexual and reproductive health rights.

v      The right to confidentiality concerning information about sexuality and reproduction.

v      Rights of the child

v      The right to non discrimination on the basis of age

Source : Dutch council on youth and participation

In many parts of the world, adolescents become sexually active at younger and younger ages. Most of them have little information about how to protect themselves from unwanted pregnancy or STDs. In addition many girls have sexual relationships with older boys and men and the power differences between the partners can prevent girls from making decisions freely with information they have.

Exercise of their reproductive rights strengthen women’s families as well as both in lessening time lost due to illness and the no. of untimely deaths,  and because planned children are wanted children and having fewer children means more of family’s resources are available for each.

Education of girls is a key factor in improving family health, reducing infant mortality and changing reproductive behaviour.

We are on the threshold of change where many concerned constituencies are moving forward to address the needs of youth – an important target group that has so far been by passed by all programmes.

Sexual and Reproductive Health should include : Promotive and preventive education on early pregnancy, RTIs, STIs (including HIV), unsafe abortions and early marriage, pursuing policies to eliminate  violence and biases against young people especially girls.

v      Achieving sexual and reproductive rights confers benefits on the economic and social life of the community and the future of the planet.

v      The health and security of the individual is recognized as important to both the individual and the community.