My interest in reproductive health and rights began when I was 19 years old and studying for my Bachelor's degree in health promotion at the University of Zimbabwe. After having lived on campus for a year, I realized that my fellow students were facing multiple barriers to accessing sexual and reproductive health (SRH) services. I quickly joined the University student body, hoping to address some of the challenges. I was elected for the position of Health Officer for two consecutive years, disseminating behavior change messages, distributing contraceptives and encouraging voluntary HIV counseling and testing among my peers.
|Sexual and reproductive health and rights remain an unfinished part of the Millennium Development Goals and should be central on the post-2015 development agenda.
After graduation, I joined Concern Worldwide, an international non-governmental organization (NGO) working to increase the availability, affordability and uptake of key HIV/AIDS preventive and SRH services in Zimbabwe. Through this experience I realized that the reproductive health challenges experienced by young people at my university were only the tip of the iceberg.
The biggest challenge of my job was working on adolescent reproductive health and rights. In Zimbabwe, adolescents were not expected to be sexually active unless they were married. This was a belief held by parents, teachers, religious leaders, services providers, local authorities and key community leaders. "Abstinence until marriage" was a community norm; it was taboo to even talk about SRH for young people.
Nevertheless, local level statistics indicated that many young people were engaging in premarital sex. Many were vulnerable to HIV infection, especially adolescent girls, a risk heightened by common cultural practices such as child marriage and child pledging. Due to these social, cultural and religious barriers, there was high unmet need for contraceptives among young people. All of these coupled with limited knowledge on SRH, high youth unemployment, poverty and gender inequalities, led to an exacerbated risk of sexually transmitted infections (STIs) and unwanted pregnancies among adolescents within these communities.
Coming face to face with these challenges cemented my interest in improving reproductive health and rights, especially among young people. At Concern Worldwide, we worked closely with schools to establish Action AIDS Clubs that provided age appropriate health education and promotion activities to in-school adolescents within marginalized areas of the country. We also encouraged parent to child communication as a way of trying to deal with the social, cultural and religious barriers for youth.
Out of school youth were the most difficult to reach due to their high mobility and other issues such as unemployment and lack of income. We encouraged peer education on safer sex and gender equity using drama, music, poetry and dance as means of communication. We took advantage of every community gathering as an opportunity to sensitize youth on health seeking behaviors, chief among them using contraceptives and seeking early treatment of STIs. Other key messages were aimed at reducing underage sexual encounters, correct and consistent use of condoms, reducing teen pregnancies and dropouts.
Additionally we reached out to out of school youth through "Hot Spot" campaigns. Hot spots were areas where adolescents usually engage in risky behaviors, such as gold panning areas, beer halls and farms. Other Hot Spots were seasonal, like during cotton harvesting and auction seasons when risky behaviors increased due to the surges in business, mobility and gatherings.
We would also assist women and girls to start up safe and sustainable income generating activities in order for them to have access and control of their personal financial resources. This economic independence also empowered women and girls to be less vulnerable to sexual exploitation and risky behaviors such as sex work. We also noticed an improved uptake of reproductive health services. This approach seemed like a magic bullet.
Disparities in access to reproductive health services for youth, and young women in particular, were and still are unjustified. This is what has motivated me to join the Global Health Corps (GHC), a movement of young leaders dedicated to reducing health inequities. Through the GHC fellowship, I joined UNAIDS and Together for Girls as a Policy and Program Officer based in Washington, D.C..
According to the most recent UNAIDS global AIDS report, young people ages 15 to 25 accounted for 39% of all new HIV infections globally in 2013. In 2012, an estimated 2.1 million adolescents were living with HIV and 780,000 youth were newly infected with HIV, of which 560,000 were from Sub- Saharan Africa. This is a manifestation of all the challenges that young people are experiencing related to sexual and reproductive health services.
UNAIDS is committed to reversing the epidemic within this very vulnerable age group, and last year, they resolved to double their prevention and treatment efforts among young people. These developments have energized me to work on age-related barriers to SRH services among youth, and I am currently reviewing how country-level age of consent laws impact young people's access to HIV testing, counselling and treatment, as well as to broader SRH care.
Sexual and reproductive health and rights remain an unfinished part of the Millennium Development Goals and should be central on the post-2015 development agenda. I believe that all countries have an obligation to respect the SRH rights of everyone as stipulated in the Cairo 1994 International Conference on Population Development. SRH is an important component of overall health and essential for social, economic and human development. In line with these guiding principles, programs and policies should address socio-economic, political and cultural obstacles that hinder adolescents, women and girls from gaining their reproductive freedoms.
Kudakwashe Dube is a Global Health Corps Fellow and Policy and Program Officer at UNAIDS/Together For Girls.