Young people need more contraceptive options — and more room at the discussion table

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Young people need more contraceptive options — and more room at the discussion table

By Cleopatra Shiella Makura, AVAC Fellow 2019

When I hear the phrase “reproductive health,” I find myself having a flashback to each time I was at a clinic either by myself or with someone else. From that I try to understand how and why I get scared about the whole topic, and to my surprise, sometimes I can’t even understand why I get scared. I ask myself this question: Is it worth it to go to the clinic or hospital to get reproductive health services?

Reproductive health is defined as a state of complete physical, mental, and social well-being in all matters relating to the reproductive system. It implies that people can have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

Sixty-two percent of Zimbabwe’s population is young people below the age of 25. Growing up talking about sex was taboo, and one could only get sex-related information from friends and the theoretical information one gets from school is either too scientific or half-baked. Sex education is mostly delivered by tutors and teachers who are almost your parents’ age and the culture clearly defines every adult taking the parental role in society, and schools and colleges are part of society.

Most young people are aware of basic sexual education, however they lack the realities. It is very difficult for young women and girls to decide when they have sex and how. Zimbabwe’s 2012 Violence Against Children Survey found that 7 out of 10 girls did not plan their first sexual encounter. Because our culture hands the decision and initiation of sex to men, young girls and women do not decide when and how to have sex. Usually when we are talking about sex education, it’s that moment of flashback and realising the mistakes which would have already been made.

Nowadays, most young people are afraid of getting pregnant rather than contracting HIV. The first thing on a young girl’s mind after unprotected sex is how to prevent pregnancy rather than HIV and other sexually transmitted infections. This can contribute to young women and girls in Zimbabwe at the age of 15 to 17 having an HIV prevalence of 2.7%, a figure that sharply rises to 13.9% in the 23 to 24 age range, according to 2017 data. Adolescents in Zimbabwe face challenges such as teenage pregnancy, sexually transmitted infections including HIV, unsafe abortions, child marriage, and lack of access to sexual and reproductive health information services.

The golden question is: Why are young people not accessing services? The main barrier to accessing reproductive health services is a lack of youth-friendly services. It’s very interesting that most health workers are trained on how to treat adolescents by people who are far older than adolescents, and who really do not understand the feelings and thoughts of adolescents. Most meetings and youth-friendly packages are based on speculations about how young people want to be treated. There is little to no involvement of young people on matters that affect them.

It is vital to include young people when designing programs which affect them. However, involvement has been tailored to mean showcasing a young person in a room. What we need is a whole group of young people in the room. Young people have different needs and a one-size-fits-all approach does not work. On top of that, we need young people’s voices to be documented. We are sick and tired of attending meetings and contributing our needs, but when information is documented, our voices are not included. Again, nothing for us without us.

Cultural beliefs heighten the risks and worsen the vulnerabilities of young people. Adolescent girls are often already at a disadvantage due to gender discrimination. Young women and girls must overcome not only the crisis of culture itself, but also potential abuse, violence, and exploitation, which can compromise their development and violate their rights. Because of these vulnerabilities, young women need different HIV prevention options.

As a young woman walks her journey of life, abstinence can work at one moment but then there comes a point when abstinence cannot work, and condoms can protect her instead. However, there may be a point when condoms cannot work due to negotiation issues, and pre-exposure prophylaxis can work. But taking a pill every day when you are not sick can be tiresome, and one might prefer the dapivirine ring as it gives a woman power and control. And still others would prefer an implant or an injection.

There is a need for different HIV prevention methods for young people to use. Because if we acknowledge everyone’s needs together, we can end the HIV epidemic.

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