Reproductive health education and services for adolescents in Mexico
Presented by Dr. José A. Aguilar Cil, MEXFAM, Mexico City, Mexico.
Young people aged 10-19 account for 25% of Mexico’s population of 88 million, and as is the case throughout the world, many are sexually active at a young age. A survey conducted among middle-to-higher education students found that the average age at first intercourse was 15.7 years for boys and 17.0 years for girls, and that 60% of pregnancies among adolescents are unwanted. Yet, to varying degrees, societies tend to deny or not acknowledge that many young people are sexually active when they are, limiting access to reproductive health services, information about pregnancy and disease prevention, or even to an informed adult to talk about sex. Social norms that make it difficult to openly discuss sex and sexuality put young girls (and boys) at greater risk during this period which can be fraught with a whole array of reproductive health problems such as early pregnancy and premature parenthood, illegal abortion, sexual abuse, and STDs including HIV infection.
For these reasons, in addition to the fact that sex education was not being offered in schools, the Mexican Family Planning Foundation (MEXFAM) decided to put the results of a number of surveys to use and tackle some of the issues facing Mexican youth. In its first attempt, between 1986 and 1988, Gente Joven (the name given to this youth-centred initiative) established 13 adolescent centres that scheduled activities for young people. However, an evaluation revealed shortcomings including the fact that a limited number of already highly motivated young people were being reached at a high cost. This experience also gave a realistic profile of Mexican adolescents. For example, first intercourse often takes place in an unforeseen and unplanned fashion, with only one out of six young people using a contraceptive method at this time.
Using insights from these three years Gente Joven closed its centres and began reaching out to adolescents from all walks of life, and in different settings (e.g. schools, factories and on the street). Five themes were chosen for a basic package of materials that could be adapted to a variety of settings, sub-groups of adolescents, and types of media. The five themes were; family communication, puberty and the human life process, sexuality, STDs (including HIV), and early pregnancy and contraception.
In schools, five two-hour long educational sessions are held on five consecutive days in order to capitalize on the fact that one module leads into the next. The emphasis in factories and other work sites is given to discussions, debate, and analysis of issues and decision-making about family planning and sexual behaviour. Whenever the average age of workers is between 15 and 20, an adapted and sometimes condensed version of the school course is given. To reach street kids who are mostly unemployed school drop-outs, an alliance was formed between MEXFAM and the Popular Youth Council. This council has its origins in the 1980s, when members from 30 youth gangs came together to try to reduce conflicts with the police and carry out educational work that would benefit the community. This NGO’s approach is to disseminate information through music, theatre and discussions. Seventeen coordinators (MEXFAM staff) direct the street youth programme, assisted by over 1500 peer educators who provide information on reproductive and sexual health and refer youths to appropriate medical and counselling services. Peers also distribute condoms to adolescents over 16 and will provide them to adolescents under 16 if directly asked.
Because of its popularity, the Gente Joven programme began using radio as a vehicle for communicating information on sexuality, family planning and health, on ways of improving communication with others, and on the important role affection plays in human, including sexual relations. By 1993, one hundred, 25-minute programmes were produced (Table 2).
Gente Joven programme on reproductive health for adolescents - a MEXFAM initiative
One of the key features of this programme, which is only partially and briefly described here, has been its “reach”. Since its inception, 600000 adolescents, 300000 parents and 16000 professionals in direct contact with adolescents have participated in training, courses, or other forms of communication about HIV/AIDS. Though not rigorously evaluated, anecdotal information points to a reduction in the number of unwanted pregnancies and number of children desired.
As Gente Joven has evolved, so has the realization that gender differences are a major factor contributing to the discrepancy between knowing about safe sex and practising safe sex, including abstinence. For example, in a study about AIDS prevention among adolescents, the difference between the social roles of girls and boys and ambivalence regarding condom use became quite clear. The programme has now introduced gender sensitivity into its training courses and has begun conducting courses in which boys and girls meet separately to discuss their particular concerns (which research showed were different), and are then brought together for further discussion.
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