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“We’re not even ready to be thinking about planning families now,” says 22-year-old Bisrat. “We’re too busy trying to finish school and get life started. We are planning our futures.”
I met Bisrat, an aspiring Ethiopian musician, at an IntraHealth International-sponsored Beat Making Lab training session in Addis Ababa in June. (More on this event here.) Bisrat shared these thoughts with me when I asked her if she and her friends ever talk about “family planning.”
“We don’t really talk about that,” she said. “We do talk about wanting to get our diplomas and find good jobs. And maybe getting married someday.”
Bisrat and other young adults I talked with in Ethiopia—and the opinions of adolescents in other countries in which IntraHealth works—have made me think this year about how we in the global health community think and talk about adolescents and reproductive health.
Maybe we’ve got it all wrong when we talk to 14-year-olds, 18-year-olds, and even 22-year-olds, about “family planning.” Maybe we need to refocus our communications on what matters to them. They’re not ready to plan families yet, but they do want to make sure that they become pregnant only when they are ready to have children—and not before. Today is World Contraception Day, and the theme of “It’s your life; it’s your future” is centered on engaging young people to think about their options and their futures. World Contraception Day has the vision of a world in which every pregnancy is wanted. One of its major goals is to improve awareness of contraception and enable people, especially young people, to make informed decisions about their reproductive health.
The world today has the largest population of youth in history—we have more than three billion people under the age of 25 and more than 1 billion between the ages of 15 and 24. More than 80% percent of 15- to 25-year-olds live in developing countries. And every year more than 14 million births occur among adolescent women in these countries. Some of these births are planned, but a large proportion of them are not.
The decisions that young people make every day, including decisions about sex and reproductive health, have an impact on their own lives. But collectively, their decisions will also influence global health, population, and development throughout the 21st century and beyond. Young people often cannot make informed decisions about reproductive health. Many lack access to education and information. Societal values around childbearing, family size, and the rights of young people can limit their access to knowledge about contraception. Another common barrier is access to youth-friendly health services, including health workers who can provide information and services without bias, especially for unmarried young people. As the Guttmacher Institute notes, “Contraceptive services should be responsive to the special needs of adolescent women, be provided in a manner that does not stigmatize sexually active adolescents, and be offered in a respectful and confidential way.”
Not all adolescents are unmarried, of course. In developing countries, many are married. And some of them wish to become pregnant. On average, about one-third of married adolescents in low- and lower-middle-income countries who want to avoid pregnancy use a modern method of contraception, compared with 58% in upper-middle- and high-income countries.
World Contraception Day promotes a vision in which every pregnancy is intended, every birth eagerly anticipated. This vision will only be realized if the needs of young people are met. Reducing unintended pregnancies among young women could help increase their access to educational and employment opportunities. This would, in turn, contribute to sustainable socio-economic development, reduce poverty, and move us toward a more equitable world.
During this year’s International Conference on Family Planning, which will take place in Addis Ababa, Ethiopia, in November, a strong delegation of young people from around the world will have a voice. And if my discussions with Bisrat and other youth are any indication, they will not be shy about making their voices heard. They will expect the global health community to really listen to them and take their needs seriously—not to preach. These young people might not even want to talk about “family planning” and may instead choose to talk about sexual health. Let’s have the conversation on their terms. Let’s listen to them. And let’s not let them down.
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