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ALL ABOUT THE YOUTH WEEK

'Every young person should have access to comprehensive sexuality education and youth friendly health services'

“Good quality peer education can make a big difference” DR. VENKATRAMAN CHANDRA-MOULI

“Culture speak is everywhere” ESTHER MIEDEMA

INDEX

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15 COLOFON ‘Share! All about the Youth Week’ is a publication of Share-Net International.

This magazine is made by Magazine on the Spot: Editing: Julie de Graaf, Andy Fuller Design: Nanda Alderliefste Photography: Sanneke Fisser, Susan Huider, Edwin Weers

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FOREWORD

From left to right: Karen ‘t Hooft, Meike Stieglis and Kimberley Meijers

Dear reader, Welcome to the Share-Net Youth Week magazine where we look back on a very inspiring and lively Share-Net Youth week! During the week, we welcomed 42 national and international guest speakers and 260 participants from over 40 organisations and universities.

Our joint effort was to link comprehensive sexuality education and youth-friendly health services to broader discussions on gender, gender-based violence and sustainable development. During heated debates, we discussed the effectiveness of peer education and asked critical questions about the influence of culture on our work. Participants engaged in hands-on activities to determine what they understand by the term ‘youth’ and to define their role as a young researcher.

In this magazine you can read about the best practices we shared, the lessons we learned from one another’s experiences and the main findings for the way forward.

Overall, everyone agreed that we shouldn’t only talk about commitments, but that we need to turn the talk into implementation. During the Youth Week we can proudly say that we made a strong start.

We wish you happy reading!

On behalf of the working groups on CSE and YFHS, the Share-Net Secretariat, Karen ‘t Hooft, Meike Stieglis and Kimberley Meijers

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REACTIONS

High expectations Experts from all over the world flew in to experience, share and participate in the Share-Net Youth Week. What are their hopes and expectations for the week?

Silvia Jongeling, Technical Advisor and Trainer Sexual and Reproductive Health at Rutgers “I’m working on youth participation and comprehensive sexuality education, so I’m here to see whether I could do things differently or more effectively. I’m curious to learn about new and innovative ways to communicate with young people. And, of course, I hope to be inspired by listening to people with different views and perspectives.”

Douglas Call, Managing Director PSI/Europe “This week presents a unique opportunity to gather many implementers, activists and donors together and take stock of the state of the art of implementation science around sexual and reproductive health. It is also an opportunity to see where are we, what have we learned and where we go from here. We will exchange ideas and share things that are exciting to us, so we can learn from each other. We should also talk about where the funding is going, what the priorities of the donors are and what pressures the donors are under. Because at the end of the day, you can’t do this without financial support.”

Shuchi Karim, PhD, Consultant, Institute of Social Studies “We are here with such a mix of people from all sectors that are interested or engaged in sexual and reproductive health and rights. I expect and hope that this week we will somehow find common ground, even though we tend to go back to our own projects and siloed work. I hope that we find ground for collaboration and resource sharing.

However, the most desired impact would be for us to stop thinking about our work in an abstract manner. We should realise people are not numbers, patterns or graphs we are talking about, but real young people with real lives. What we do, individually or collectively, actually has a life or death consequence for a young person somewhere in the world. So that is what I want people to take home from this week; I want the human component to find it’s way back into policies.”

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THEME 1

Youth Friendly Health Services

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INTERVIEW

4 questions with...

Dr. Venkatraman Chandra-Mouli, Scientist with the Department of Reproductive Health and Research, World Health Organization

1. W hat do we talk about when we talk about youth or adolescent friendly health services?

“The WHO defines adolescent friendly health services by using a quality of care framework. First of all, these are services that are easily available to adolescents. Finally, adolescents need to be able to obtain the services they want and the services need to be provided in the right way, in order to produce the results they were intended for.”

2. Y ou say we need to challenge our assumptions.

Why is that?

“We know that adolescents face challenges in obtaining the health services they need. We have learned how to overcome some of these obstacles, but we have made limited progress in reaching them with sexual and reproductive health services. We made even less progress in providing them with other health services like mental health services, services around HPV, abortion access, menstruation pains. The list is endless. That is why we need a new agenda for addressing health matters amongst adolescents.”

3. How do we achieve that?

“Well, we know what doesn’t work: separate services for adolescents are neither necessary, nor scalable or sustainable. We must make existing health services more adolescent friendly, guaranteeing them non-judgmental places.

What also doesn’t work is a one size fits all approach.

One approach doesn’t meet the needs and preferences of all adolescents. Thirdly, one-off training is not enough to make health workers adolescent friendly. It only yields limited and short term effects. The best way to build competencies is through group problem solving combined with supervision.”

4 Do we know what works?

“Yes, three main things. One of them is to involve adolescents more.

We need more data on peer education, because our thesis is that good quality peer education can make a big difference. The second thing is we need to measure our programmes. We need much more investments in monitoring and evaluation. Thirdly, we need to move beyond boutique programmes to large scale and sustained programmes. And that is beginning to happen! We had a meeting in Geneva where we brought together fourteen middle and lower income countries that have scaled up their adolescent health programmes. We call them the first generation of scaled up programmes and they are making a big difference in the lives of adolescents all over the world.”

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'We need a new agenda.'

PANEL DISCUSSION

PANEL DISCUSSION:

why do we need to look beyond clinics and training?

Anne Parker (MSI)

Miranda van Reeuwijk (Rutgers)

Laura Hurley (IPPF)

"Adolescent Friendly Health Services (AFHS) is no longer about a physical space where people come. For us at MSI it is more of a concept; it is about a place you can come and won't be turned away, a place where you will be treated with respect by the service providers, where there is effective communication with the right message. It is a place where adolescents will have a good and positive experience."

"We have seen that the strategies that work are the strategies where the people who reach out to adolescents really know their target group. They know where to find them, they know how to bring the services to them and how to communicate that the services are for them. They advertise and they mobilise.

They combine information with service delivery and bring those two together very effectively."

"It is all about the adolescents. If we really work with young people, we might find that their needs and wants aren't necessarily what we thought they were or what we'd like them to be. We need to be adapting, be quite broad and think about health realistically. We need to be providing, and really hearing what young people want and need in their lives and in their sex lives."

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WORKSHOPS

2 rounds of workshops about You ROUND

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PROMISING SERVICE DELIVERY APPROACHES

WORKSHOP:

Eco-system approach: Linking community actors & young clients to increase uptake of services Two companies: one wanting to reach and deliver health and educational services to remote areas through micro-entrepreneurship and tablets. The other building a reward-based platform powered by technology that motivates consumers to make a positive choice and gives them the power to access and deliver aid on their own terms. In a brief and enthusiastic presentation Healthy Entrepreneurs founder Joost van Engens and Triggerise’s Marylou Kupfer and Anna Allen explained what their respective companies are all about. Afterwards, they asked the workshop participants to break up in two groups and discuss how these tools could be used in their fields of expertise. The room was instantly filled with conversation. Some participants were sceptical about the technical challenges and possible ulterior motives, while others immediately thought of areas and projects that could greatly benefit from using these tools. What was the overall conclusion? Everyone seemed to agree that the tools are innovative, intriguing and opened up a whole new world of possibilities.

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WORKSHOP: Reaching out with the right service: co-designing mobile health services for youth & The details matters: contraceptives as accessible youth friendly products A PARTICIPANT Lindsay Van Clief, Content Developer at Love Matters - RNW Media “In the first part of the workshop the Reproductive Health Supplies Coalition gave a broad overview of the work that they do and some of the interesting projects and innovations that they’re working on. In the second part PSI/Mozambique described a successful project they created with a youth-centered design. Both projects were interesting. It was beneficial to see and hear about the learnings, best practices and failures of others so we can take them back into our own work.”

WORKSHOPS

th Friendly Health Services (YFHS) ROUND

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SERVICE DELIVERY AND QUALITY ASSURANCE

3 workshops, 3 participants 1 question: What did you think?

JOS DUSSELJEE, Manager Inter­ national Department at Rutgers WORKSHOP: Performance based financing and Youth Friendly Health Services “A lot of, at times intriguing, information was given that demonstrated the powerful effect of results based financing. It is a demanding mechanism and the link to promoting YFHS is still being further developed. There seems relevant potential here – it would be worthwhile to see it explored further.”

YVONNE AKINYI OCHIENG, Peer Educator at dance4Life WORKSHOP: Increasing Access & Quality of YFHS for Young Key Populations: People who use drugs in Ukraine & Motivational Intervention approach to reach MSM in Bangladesh “It was an insightful workshop. It helped to be able to understand motivational approaches that can be used to reach the vulnerable youth, inclusive of drug users.”

WORKSHOP: Effective youth driven community-based service delivery: the potential of Peer Provision A PRESENTER Quraish Matovu, Project Officer at Reproductive Health Uganda “Our workshop is about the integration of sexual and reproductive health services and information by paying attention to gender and linkages. I hope participants will gain insights into practices that have worked in different parts of the world and understanding the advantages of integrating education, service delivery and research.”

NIKÉ BUIJZE, AMID trainee policy officer at the Ministry of Foreign Affairs WORKSHOP: Youth-led monitoring & social accountability - The Uganda example “I liked the open and interesting discussion during the workshop. The setting of the chairs in an intimate circle was perfect for this. The most important message was that the only people who can tell if health services are youth friendly, are the young people themselves. Their voices need to be taken much more seriously.”

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VISUAL ARTIST

Mick Dijsselbloem, Doodle Artist, captured the day on Youth Friendly Health Services in a single image.

Dr. Chandra-Mouli was talking about the mental health of boys and girls in India.

What if a boy wants to be a girl? Or what if he prefers boys over girls? It does not matter where you live in the world because

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this is a global issue. Boys and girls all over the world face the same challenges when it comes to gender (identity) and sexual orientation. The debate about gender equality is infinite. The image visualizes that the

border between boys and girls will always be there. The question you may ask yourself is what those borders are and how we deal with them.

SRHR RESEARCH

Young researchers Meet the next generation! Four promising and upcoming new voices in SRHR research:

WHO: Belén Giaquinta, Master student, Argentina WHAT: “For my Master’s thesis I did a discursive exploration of representations of child marriage, particularly in relation to concepts of gender, age, race, sexuality, agency and vulnerability, and their material consequences.”

WHY: “For a while now, I have felt uneasiness or discomfort with how child marriage was discussed in campaigns, news and even in literature. Exploring the discourse was a way for me to explore where that discomfort was coming from. Hopefully, this research encourages practitioners on the issue to question the claims of ‘truth’ we invoke about child marriage, and ultimately actually engage with the limits of the discourse we are promoting.”

WHO: Dewi Keppy, Graduate International Development Studies, the Netherlands WHAT: “I did research on working with orphaned and vulnerable children affected directly or indirectly by HIV in the Khayelitsha township in Cape Town, South Africa.”

WHY: “From an academic point of view it was an important graduate research project. The research is a part of advocating for children’s rights in international policy making. I’m really motivated to work in and for international development and children’s rights.”

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SRHR RESEARCH

>>Young researchers WHO: Anna Page, Freelance research and policy consultant, the Netherlands WHAT: “For my Master’s programme in International Development Studies I did research in rural western Kenya with a group of young people participating in youth SRHR programmes. I looked at participation and social inclusion.”

WHY: “The topic was inspired by my previous experience in participatory research and involving end beneficiaries in programming and advocacy. Research findings are being used by partner organisations in Kenya and Netherlands to inform future programming about involving wider community stakeholders in understanding meaningful youth participation.”

WHO: Vernon Mochache, PhD student, Kenya WHAT: “I studied the social structure and cultural norms of a rural coastal communities to try and understand whether and how these influence sexual and reproductive health outcomes.”

WHY: “Of course I hope to successfully complete my PhD! Also, it is a chance to influence policy discussions around access and the utilisation of SRHR services for Kenyan women. This research is important in attempting to help policymakers and practitioners understand how to improve access to and utilisation of SRHR services for the community.”

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THEME 2

Comprehensive Sexuality Education

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TALKING ABOUT CSE

Diving deep - conceptualising education for SRHR Esther Miedema is a researcher and lecturer at the Amsterdam Institute for Social Science Research of the University of Amsterdam.

She talks about the role of morality, health, rights and culture in understanding HIV and AIDS related education.

How did you prepare for your research on understanding HIV and AIDS related education in Mozambique?

and scientifically informed, building on notions of rights.”

“To conduct my research I had developed a tripartite framework in which the first approach was reviewing the literature on HIV and AIDS related education initiatives around the world. The second one was the reviewing and clustering of commonly used terms. The third was being moralistically

“Armed with this framework, I went to Mozambique where I conducted interviews for seven months. I spoke with adolescents, analysed documents and talked with educators, policymakers and staff. I noticed culture speak was everywhere. Seeing all of this and the different ways culture is under-

stood, my research led me to a quadripartite framework for understanding HIV and AIDS related education.”

What happened next?

What does the quadripartite framework entail?

“The fourth approach would be a culturalist approach, whereby solutions for the epidemic are sought in combinations of the traditional and the modern.”

Setting the Scene Yvonne Akinyi Ochieng, Peer Educator Kenya, dance4Life: “Despite the progress that has been made in SHRH since the ICPD conference, many young people still face challenges. Many young people still lack information and comprehensive sexuality education. We have 1.8 billion young people in this world, but many people still don’t think that giving them this information is important.

We also face challenges in situations where our parents don’t want to listen or talk about our SHRH rights. Maybe that is because of our culture, where talking about sex is a taboo. We need to address those issues, because every young person should have access to comprehensive sexuality education and SHRH rights.

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For me, the tipping point came when my best friend got pregnant and didn’t tell anyone. She was the ideal straight-A student; I wanted to be like her. But now she was pregnant and she couldn’t tell her father. When she was called to the university, she had to undergo an abortion and during that process she died... I still ask myself: what if this girl was more knowledgeable about sexuality? What if she could have had access to abortion care facilities? Maybe she would still be alive today; maybe she would be a doctor.

We need to remember: these challenges are real. We have made some progress, but there is still much we have to do.”

TALKING ABOUT CSE

"Lately, Comprehensive Sexuality Education (CSE) in Uganda has come under a lot of attack. But since the start of the so-called "Stop-CSE" campaign, Rutgers and the SRHR Alliance have been in touch with a number of professionals.

We have urged teachers and peer educators to keep strong and remain committed in their work. And, most importantly, young people too have been fully involved in this process." – Anslem Wandega, Country Representative of Rutgers Uganda.

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WORKSHOPS

2 rounds of workshops about Com ROUND

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LINKING SCHOOLS TO YFHS & THE PARTICIPATION OF (VERY) YOUNG PEOPLE

WORKSHOP: Linking schools to youth friendly health services in Malawi Participants learned all about the Healthy Young People Project - working towards a supportive sexual and reproductive health environment.

The workshop was presented by Willeke Kempkes (ICCO) and Miriam Groenhof (STOP AIDS NOW!). Their main message? “Yes we can support people to visit SHRH services and increase uptake of those services by including the community, involving community leaders, parents, schools and teachers in the development and delivery of a programme.” They talked about a pilot project linking six primary schools in the Lilongwe and Mzimba districts in Malawi to SHRH service providers. Afterwards, the workshop participants talked about their experiences in the field and shared methodologies, best practices and problems they’d encountered.

As one participant said: “We could be learning a lot from sharing our findings and research, but sometimes it's complicated. We are allies and enemies at the same time; we’re struggling for the same money and want to implement our own interventions. We should think about how we can learn more from each other, without being in each other’s ways.”

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WORKSHOP: The Power of Peer Education A PARTICIPANT Jeanette Slootbeek, International Consultant on Sexual Health and Sexual Rights “Dance4Life gave a presentation, we had a discussion about the advantages and disadvantages of peer education and we did an exercise of how dance4Life works with young people. The exercise was really interesting: we formed a line with six volunteers and we each got a different part, playing someone living in Kenya. Then we got asked ten questions and for every “yes” we had to take one step forward, for every “no” a step backwards. My role was that of a very privileged and macho business man with a wife, three kids and two girlfriends. I could answer every question with yes, ended up at the front of the room. The volunteer who played a divorced mother living in the slums with a young son ended up at the back of the room. It was confronting and interesting to have such a visual representation of the challenges people face.”

WORKSHOPS

prehensive Sexuality Education (CSE) ROUND

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THE ROLE OF GENDER AND POWER IN RELATION TO CSE AND YOUNG PEOPLE'S HEALTH

3 workshops, 3 participants 1 question: What did you think?

KOEN BÖHM, Country Programmes Manager at dance4Life WORKSHOP: Empowering young girls?

Questioning assumptions about early marriage, gender & the role of CSE “The workshop was about the drivers behind early marriage; socio-economic, traditional values and the agency girls have themselves in this. The focus on the agency girls in Indonesia have and that they themselves rely towards marriage was insightful. Often they have reasons themselves to marry young and the big questions is: how to tackle this?”

JAN REYNDERS, independent Senior Consultant for Gender Justice, engaging men, SRHR and Sustainable Development.

WORKSHOP: Gender-transformative working: empowering girls AND boys “To see men and boys as part of the solution, instead as part of the problem, must be an integral part of CSE. This was the first workshop I attended that paid positive attention to the position of men and boys. If they realise that they also ‘benefit’ from CSE and a gender transformative approach they will want to make an effort for gender justice and give up their privileges.”

WORKSHOP: CSE for young adolescents A PRESENTER Christine de Vries, Health Expert at Cordaid “Our workshop is about young people, age 10 - 14, who deal with things like teen pregnancies and sexual exploitation. This vulnerable group needs CSE at a young age so they’re aware of children’s rights, child protection, anticonception and where to get help. My hope is that the workshop will shed a light on the enormous problems this group faces. It is not good enough to focus your efforts solely on adolescents from fifteen and older.

We will share ideas how to effectively reach the younger group, develop programmes for and do research on them. It might be hard, but it’s really important.”

CHIARA BOCKSTAHLER, student of International Development Studies at Wageningen University WORKSHOP: Pleasure of sex “It was super interesting to get an insight into how Love Matters operates. Especially for me as a young internet user I surprisingly never thought about challenges you can face as a mentor of such an online forum about pleasure and sexual information. Therefore it was a very enriching workshop which triggered me to think more about how to enable safe online discussion spaces about sexuality for the youth. I especially liked the way the Love Matters workshop leaders involved their audience by inviting them to look through their eyes. Thanks to Love Matters for their great work!”

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VISUAL ARTIST

Mick Dijsselbloem, Doodle Artist, captured the day on Comprehensive Sexuality Education in a single image.

Culture is a way of life. The interaction between morality, religion and science defines a person. Somehow boys and girls are the

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same (shirt pattern Yvonne) because they all aks themself what's the right thing to do.

In the image, morality flows into religion

and science. The question then arises: what do religion and science mean for the sexual morality of youth?

CONCLUSIONS

Main conclusions and highlights of the days During the week, each day we concluded with a summarized wrap-up of the main conclusions and highlights of the day. You can find short films of these talks here tinyurl.com/yfhscse.

Some key findings can be used as handles for a way forward in turning our thoughts and discussions in implementation and action. We made a good start, now it is time for action!

Invest in a very strong capacity building and support system for the providers of Youth Friendly Health Services and Comprehensive Sexuality Education. Consider involving health providers as much as young people in contextualizing or researching programmes and new ideas. Also, involve the broader community in development and implementation of programmes to ensure support for youth is in place to seek access to YFHS. Tailor service delivery strategies to the target groups you are trying to reach and actively bring contraception and SRH services to young people in attractive ways. Successful strategies combine information (demand creation) with service provision and creating support of the environment for young people’s access and use of these.

Do not disregard Peer Education as a whole, but use the strengths of peers to enhance programming by creating support systems to deliver effective interventions. Re-evaluate the role of peers in programming and make best use of their strengths by no longer seeing them as pure educators, but more in a role of peer leader or facilitator.

Promote/Train young people as SRHR researchers: We need to capitalise on young people who are fresh in the field and are open to new ideas and hypotheses. Youth participatory research in SRHR is important not only as a broader human rights issue but because young people are the experts on their own lives and can better penetrate their kin networks to get more authentic data than adult researcher.

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CONCLUSIONS Expand our focus to ‘hard to reach’ children (especially children with disabilities, children in conflict and processes of migration). Dedicated discussion on how to include these groups in CSE and YFHS need to be organised.

Make use of a Gender-Power-Rights framework: both CSE and YFHS need to be embedded in a holistic approach to young people's development and bring gender to the centre of attention in its interventions. This needs to start early, and therefore reframing or at least rearticulating CSE and its relevant YFHS to suit young adolescents is needed.

This also requires active and integrated participation of parents in particular, and community in general.

Involve young people meaningfully in the design, delivery and M&E of programmes (including services) and research. Peer provision and youth-led monitoring & social accountability are promising examples.

Organise CSE champions and put a protocol in place with details on how opposition can be prevented and managed. Here lies the strength for success in dealing with resistance to CSE. At the same time, it remains important to protect young people involved as researchers/educators from possible negative impact of resistance.

Translate knowledge to practice: ‘context aware, knowledgebased approach’- which is generated through more socioanthropological and locally driven research and discourses.

Synthesised and nuanced analysis are key to form knowledge which must become the ground or basis for program designs and implementation.

Practice in reflexivity: We need to question the concepts we take for granted and 'problematize the obvious'.

Move the SRHR agenda forward by making new partnerships and cross-sectoral/regional alliances and link up to other Sustainable Development Goals beyond goal 3 and 5. Work in an alliance to create opportunities for multi-component programmes. If you actively link between the components, you create synergetic results.

Avoid approaching culture as a static ‘barrier’ to implementation. Rather, invite constructive dialogue (with providers, young people, communities) on how to context-sensitively approach discussions of and programmes on sexual health.

Make an effort to actively lobby for long-term funding for (research) projects, as inspiring change takes time.

More information: share-netinternational.org