On Thursday afternoon, I attended the ICC workshop “Contested Terrain: Analyzing and Challenging Conflicting Frameworks for Adolescent HIV and Sexual and Reproductive Health Services.” By the way, when I say “ICC workshop,” I mean it was located inside the International Convention Center, so you needed to be registered with a name badge in order to attend, unlike many of the Global Village sessions I have reported on so far. To read more about the panel members, check out the session’s programme page.

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I would like to note that even though this workshop was focused on adolescents, I was the only teenager in the room for the entire session.

The workshop started with a presentation on the findings of the Harmonisation of the Legal Environment on Adolescent Sexual and Reproductive Health in Eastern and Southern Africa. The study was backed by UNFPA and the University of Pretoria.

The study looked at Malawi, Mozambique, Namibia, Zambia and Zimbabwe, and their legislation concerning adolescent sexual and reproductive health and rights (ASRHR), but more specifically, the purpose of the study was to uncover how much service providers know about the law and policy frameworks for ASRHR. The study looked at the following themes and how they were expressed in law, practice, and understanding:

  • Age of consent for sexual activity
  • Age of consent for marriage
  • Age of consent for and access to medication or treatment (i.e. HIV-related care, pregnancy termination, other sexual and reproductive health care)
  • Prevalence of forced sterilization
  • Protection for victims of sexual abuse/assault
  • Comprehensive sexual health education
  • Criminalization of same-sex activity

Karabo Ozah walked the audience through a few key topics from the study. She started with the age of consent for marriage. Only 6 of the countries in the study had a marriage age of 18 years old, without exception. However, customary laws can complicate the marriage age. In some countries, the age is different for males and females. In Malawi specifically, the legislation sets the age of consent for marriage at 18, but the constitution sets it at 15. Additionally, the age of consent for marriage is not always the same as the age of consent for treatment or medication, which can complicate access to proper SRHR.

Then she talked about the criminalization of consensual sex between adolescents. Some countries criminalize “defilement,” and in these cases it is mostly young males who are convicted and suffer legal consequences. The study often found that counselors felt they had to report sexual activity among teenagers, even if it was consensual, and would breach confidentiality. The study recommended that comprehensive sexual education be given to adolescents so they can make their own informed decisions.

Next was the age of consent for medical treatment, such as HIV treatment or contraception. The study found that some of the countries had an age of consent for HIV testing. The study recommended for legislation to guarantee the confidentiality of all test results, and offer pre- and post-HIV test counseling.

For reproductive health services, there was very little legislation concerning the right to access these services. In many countries, abortion is criminalized, which drives many women and girls to unsafe abortions. There are a few exceptions already in places, but some of the countries are currently working on expanding access to legal abortions. The study recommended that legislation follow a human rights approach and make comprehensive, full-range sexual and reproductive health services available to all. It also recommended the creation of youth clinics with services, a trained staff, and clear guidelines on confidentiality as well as making abortion not subject to an age of consent or parental consent.

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Slides describing recommendations for legislative protections of access to reproductive health services

Many of the countries in the study criminalize sexual diversity. In fact, some homosexual acts are more criminalized when between persons under the age of 18, rather than adults. Some countries only criminalize male same-sex activity. Since gay and bisexual men and other men who have sex with men (MSM) are a key population in preventing the spread of HIV, criminalization of homosexual activities only makes it harder to deliver services and care to the people who need it the most. Those who may be at high-risk of exposure to HIV may not come forward to get the care and testing they need if there is fear of legal consequences. The study recommended the decriminalization of same-sex relationships and homosexuality, as well as greater research among transgender and intersex adolescents.

Finally, comprehensive sex education (CSE). Many of the countries had legislation concerning CSE, but no curricula is specified. Because of this, an abstinence-only focus is often used. In some areas, information concerning HIV/AIDS is disseminated to students earlier than other sexual and reproductive health information. Currently, there is debate about what the word “comprehensive” means, and moving forward to create the curricula becomes incredibly difficult when the legal framework can be interpreted in different ways. The study highlights the need to evaluate current CSE curricula and ensure it aligns with international standards. It also recommended the need for sexuality education to be its own stand-alone subject (as opposed to rolled into a different core subject) and include materials that are developed from a human-rights based approach and tailored to various ages.

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Slide with recommendations for comprehensive sexual education

Dr. Alexandra Müller presented a slide that focused on why adolescents (12-18 year olds) are special in the conversation about sexuality and SRHR. She said, “Adolescent sexuality is really contested,” and went on to describe some of the ways in which people are trying to strike a balance between protecting adolescents from exploitation and emancipatory practices with good education. She said these are “inherently moral questions [we] have to grapple with.”

Dr. Müller went on to describe the finding from the side of the study that conducted qualitative interviews with service providers to uncover what their knowledge of the legislation and legal framework for adolescent SRHR. These specific people’s knowledge is particularly important because service providers are adolescent’s main source of health information and can either provide the service, or turn adolescents away. Here’s some of the main findings:

  • Many service providers overestimated their obligation to report potentially-illegal activity adolescents confide in them about. This means they are unable to fully safeguard their patients and clients.
  • Sometimes, providers linked the age of consent to sexual activity to the age of consent to marriage.
  • There was confusion on illegality of same-sex activity; some providers thought homosexuality was illegal, as opposed homosexual activity. As one of the panel members said, “There’s a huge difference between ‘what I’m doing is illegal’ and ‘who I am is illegal.’” The confusion of identity and behavior can lead to inaccurate reporting and unfair treatment in the clinic.
  • Sometimes providers project their own morality onto their understanding of the laws.

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“Way Forward” slide at conclusion of presentation on study

In concluding the explanation of the study findings, the panel presented some of their more general recommendations, one of which was “Include Adolescents.” As an adolescent, I like this approach, but was concerned because many other recommendations had been made throughout the study. No adolescents were on the panel, and no adolescent opinions were taken into account when creating the recommendations.

The session then moved into a fishbowl discussion. Two microphones were available and a few members of the panel sat at a table and invited the audience members to come and join them at the table if they wanted to contribute to the conversation. This is where it starts to get a little crazy.

One of the first people to sit at the table was an older woman, and she expressed her concerns about trusting adolescents to make their own decisions. She cited the physical immaturity and “mental instability” of young adults, saying they do not know themselves well enough and have “identity crises” and therefore cannot be trusted with information about sexual health.

Before the fishbowl, I was thoroughly enjoying how informative the session was. But when someone starts speaking on behalf adolescents and saying we can’t be trusted to make decisions about our own bodies? Well, needless to say, I got mad. I was shaking I was so mad, and that made taking notes very very difficult.

But the women at the table didn’t stop. She goes on to say that teenagers are naive and “regret most of their decisions.” My reaction was roughly: !???!?!?!?!?!!??!? This might have been the part where I hit my head on the table. The only decision in my life that I regret is not walking up to that table and joining the conversation sooner. Many other people expressed how they would like to see adolescents have more access to sexual health services, but I gotta be honest that this one woman had really gotten to me.

By the time I got up the courage to sit down and pick up a microphone, the woman had left the room, but I still wanted to make a general point about how access to comprehensive sexual education and human-rights based sexual and reproductive care has affected me.

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I introduced myself, and I made it very clear that my experience is one of a middle-class white girl from a wealthy city, who attended a liberal school and grew up with a mother who worked in HIV/AIDS service programs. My experience does not speak for all adolescents, but as the youngest person in the room, I knew my perspective deserved a place at the table.

I have grown up having conversations about sex, STDs, sexual health, and HIV at the dinner table. I have always felt comfortable approaching my mother with questions about my body, reproductive health, relationships, and where I can learn more. I can’t even name all the books that have crossed our bookshelf across the years that talked about human reproduction, puberty, sexuality, and how to have safe and consensual sex. This was not true for many of my friends and peers. At my school, we received sexual education our freshman year and while it wasn’t perfect, it meant I went to a school where we could have conversations and questions about sex and sexuality. You could get free condoms from the school counselor – no questions asked! We had school presentations on consent, sexual violence, and how we could get help if we needed it. Both the open conversations at home and safe environment I had at school are not enjoyed by all adolescents, not even all those I grew up with. I grew up with an immense amount of privilege concerning access to sexual and reproductive health information and care and I know that privilege will continue into my adult life. I have been empowered to ask questions, get information and make decisions about sex and sexual health. It means I can be safe, happy and healthy. However, I know other kids my age who have not had this same access to information and care – and have suffered the consequences.

The fact of the matter is that teenagers will have sex. No number of laws or bans on healthcare access will stop teenager’s natural curiosity about their sexuality. Often, teenagers do not have the same access to information about safe sex or sexual health care as adults, but they can still suffer the same consequences (i.e. unintended pregnancy or STIs). So to say that teenagers are naive or unable to make their own decisions, only makes us feel less welcome in the conversation and puts us at higher risk.

I told my story of uninhibited access to information and freedom to ask for care at the session, and I’m glad I found the courage to do so. While it was only anecdotal evidence, I’m glad that I, as a 17 year old, had the chance to be part of a conversation about adolescent sexual reproductive health and rights. I only hope that in the future, a more diverse collection of teenage voices can be heard and a variety of stories shared. The best way forward is the inclusive way, as teenagers are just as much (if not the greatest) stakeholders in the legislation concerning our rights. How can we meaningfully include adolescents in program development? How can we ethically consult adolescents on how best to serve them? And how do we work together to keep adolescents all across the world safe, happy and healthy when it comes to sexual and reproductive health?

If you want to learn more about the topic from this study, check out The Gender Health and Justice Research Unit.

Research brief citation: Müller, A., Spencer, S., Malunga, A. & Daskilewicz, K. (2016). “You can see there is no harmony between policies”: service providers’ knowledge on the law and policy framework governing adolescent HIV and sexual and reproductive healthcare in Zimbabwe (Research Brief). Cape Town: GHJRU, UCT.