Healthy Sexual Growth and Development in Marginalised Youth: Rights, Responsibilities and Life Skills
Welcome to a special edition of Reform Matters. This edition is the first in a three part series of newsletters on sexual and reproductive rights and responsibility in adolescents.
Sexual and reproductive health is increasingly a matter of concern as there remains a high number of sexually active teens nationally, causing the reported cases of the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) to rise. Marginalised youth in Jamaica are faced with numerous social issues including poverty, violence, pronounced behavioural problems, recklessness, peer pressure, substance abuse, neglect, physical and sexual abuse and sexual/reproductive issues. For sexual and reproductive health issues in particular, there is a lack of knowledge, lack of comprehensive sex education and poor access to youth-friendly, confidential and comprehensive healthcare as well as limited ability to negotiate condom use leading to high infection rates of HIV and AIDS, teenage pregnancy and school drop-outs.
Adolescent boys and girls are among the most at risk for HIV infection due to a prevailing culture of multiple sex partnerships and inconsistent condom use. Jamaican adolescent girls especially, remain a high risk group for contracting HIV and AIDS. There has been a 100% increase in the rate of sexually transmitted infections (STIs) among adolescent girls from 2004. A Jamaican adolescent girl between 10 and 19 years is three times more likely to become infected with HIV than a boy of the same age. This may be as a result of early sexual initiation and high rates of forced sex reported by adolescent girls, as well as transactional sex – the high rate of sex with older men for financial gain especially those who are infected with HIV, along with prevalent unsafe sexual practices. Over 170, 000 sexually active adolescents are engaged in transactional sex. Persons under 19 years account for almost 10 percent of all reported AIDS cases while 20 percent are in the 20-29 years group having been suspected of contracting HIV in their adolescent years.
Key Issues and Statistics
· A Jamaican adolescent girl between 10 and 19 years is three times more likely to become infected with HIV than a boy of the same age
·15-19 age group, four times as many girls than boys have reported cases of AIDS
·AIDS-related deaths among adolescents between the ages of 10 and 19 increased by 50% between 2005 and 2012, rising from 71,000 to 110,000
·Culture of multi partner relationships and inconsistent condom use among adolescents especially girls (UNICEF).
·42.6% of 15-24 age group participate in transactional sex
·The average age of sexual initiation is 14.5 years for males and 15.8 years for females. Fifty percent (50%) of adolescent boys and 17-20% of girls have had sex by age 15 (UNICEF, Jamaica, 2013).
·Most girls (70 percent) reported using a contraceptive method at first sex, but almost 45 percent of boys did not use a condom at first sex.
·According to the Ministry of Health statistics, adolescent pregnancy in the 15-19 age group contributes to 15% of the total fertility rate among women in Jamaica.
·The high fertility rate among Jamaican adolescents sees the country having the fourth highest fertility rate in the Caribbean.
·Forty percent (40%) of all women have a child by age 20 and 80% say children were mistimed or unwanted (UNICEF Jamaica, 2013).
Teenage pregnancy and HIV and AIDS
Hundreds of Jamaican adolescent girls are believed to be among the almost 16 million worldwide who the United Nations Population Fund (UNFPA) says become pregnant each year due to a lack of access to sexual and reproductive health services. In Jamaica, girls constitute the 50.7% of the female Jamaican population who are often disproportionately affected by reproductive ill-health and issues of inequality in access to power and resources. The result of this is unplanned and unwanted pregnancies. While the 2008 Jamaica Reproductive Health Survey (RHS) illustrates that births per 1,000 females between the ages of 15 and 19 years have declined from 137 in 1975 to 72 in 2008, indicating that fewer teenagers are becoming pregnant, the level of teenage pregnancies in Jamaica remain high.
Unplanned and mistimed pregnancies also indicate that a significant portion of teenagers are failing to take precautionary measures to protect themselves from contracting HIV and AIDS. Teenage pregnancies also present the problem of maternal mortality as young girls are more likely to die during childbirth as their bodies are not mature enough to have children; an issue exacerbated by the fact that Jamaica’s maternal mortality ratio stands at 89/100,000, a far cry from 23/100,000 set by the Millennium Development Goal (MDG) which would require a ¾ reduction in the country’s maternal mortality. A contributing factor to the country’s high maternal mortality may be the criminalising of abortion resulting in unsafe termination of pregnancy, a leading cause of death among adolescent girls.
Teenage pregnancy is not solely a public health problem but also one of social and economic proportions. ‘Motherhood in childhood’ perpetuates a cycle of poverty and dependent citizens as teenage pregnancy most times disrupts a young adolescent girl’s education as an immediate consequence of getting pregnant is expulsion from school; and it also increases dependency on the country’s welfare system and affects prospects for national growth by increasing draw-downs from health, welfare and social services. This presents a challenge to society and the state to protect a growing vulnerable group that many times does not have the opportunity of stable homes and effective parenting.
Sexual and Reproductive Health and Human Rights
Sexual and reproductive health is a human right, essential to human development and to the achievement of the MDGs. There is ambiguity and mixed messages coupled with personal and religious beliefs of some adults including lawmakers, parents and health professionals which have resulted in an unwillingness to provide youth access to voluntary family planning and reproductive health services. Many youth are misguided and misinformed about sexual and reproductive health. This can be attributed to parents not educating their children about sexual issues, receiving misinformation from peers as well as being exposed to graphic and violent sexual messages in the media and from their immediate surroundings; and these messages often depict male prowess and female submissiveness while most times being disrespectful to the latter. With the introduction of Health and Family Life Education (HFLE) curriculum in schools, there have been some inroads made on the issue of sexual awareness, attitudes and behaviour modification of young people but with the high prevalence of HIV infections and teenage pregnancies, especially in light of the findings of the 2012 National Knowledge Attitude, Practice and Behaviour (KAPB) which shows that there have been significant increases in risky behaviours of multiple partnerships, transactional sex and no improvements in inconsistent condom use, more work needs to be done especially from a rights and responsibility perspective.
There is a clear need for education on the importance of sexual and reproductive rights and their relation to overall human rights. Greater focus has now been placed on the rights and responsibility approach for the promotion and protection of sexual and reproductive health issues by non-governmental organisations (NGOs) such as Caribbean Vulnerable Communities (CVC), Jamaican Family Planning Association (FAMPLAN Jamaica) and Jamaicans for Justice (JFJ).
Sexual and reproductive rights represent a specific set of human rights which govern the ability to engage in a mutually satisfying, safe relationship free from coercion and violence and without fear of infection or pregnancy, able to regulate fertility without adverse or dangerous consequences. The realisation of sexual and reproductive rights is premised upon the fulfilment of those rights already recognised in international human rights instruments including the International Covenant on Economic, Social and Cultural Rights (ICECSR), the International Covenant on Civil and Political Rights (ICCPR), the UN Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the UN Convention on the Rights of the Child (CRC). These rights include the right to life and survival; right to the highest attainable standard of health; right to liberty and the security of person; right to be free from cruel, inhuman or degrading treatment; right to privacy; right to participation; right to non-discrimination (on the basis of sex, sexual orientation, age, health status/disability) and in the allocation of resources to health services and in their availability and accessibility; right to freedom from violence; right to information and of access to information; right to education. Denying marginalised youth their right to realise healthy sexual growth and development means that these aforementioned rights are in turn, affected, and HIV and AIDS incidence, and the adverse outcomes will continue to increase.
Domestic Policy and Legislation
Under the Sexual Offences Act, the age of consent for sex is 16 years and recently there have been discussions to have it raised to 18. The age of consent is geared towards restricting children at a certain stage from wilfully engaging in what is believed should be an adult activity – sex as well as protecting them from being abused. As children go through puberty (between 9 and 16), they will experience physical and emotional changes and they will be curious about sex and their bodies. Some will seek outlets for exploration and discovering new things about themselves and specifically their bodies. No legal age of consent can confer on a teen when they should begin to have sexual feelings and urges. These feelings and urges will begin from the time changes are noticed in the body. As a result, comprehensive education on not just puberty and abstinence, but on sexual and reproductive health rights, responsibility and skills, including the different types of contraceptives, is key in adolescent development to thwart the spread of HIV, AIDS other sexually transmitted infections (STIs) and teenage pregnancies.
Despite the fact that the aforementioned piece of legislation protects minors from sexual abuse, what is absent from it is the recognition of adolescents’ sexual and reproductive rights and the precedence the best interest of the child needs to take over the legal age of consent. The development of the Access to Contraceptive Policy for Minors was designed to fill the gap left by the legislation, allowing for health care providers to attend to the needs of persons under 16 years to access contraceptive services if it is in their best interest. Therefore, health professionals would have the discretion to provide guidance to teens on such matters in the form of counselling, contraceptive advice, followed by treatment. However, this policy put healthcare providers in an uncertain position due to it contradicting the law that superseded it.
The laws relating to children not only stipulate the age of consent for sex but also indicate that anyone who has information which causes him/her to suspect that a child is being sexually ill-treated should report it to the Office of the Children’s Registry. This then means that if a child were to seek contraceptive services from a healthcare provider, then that healthcare provider would know that that the child is having under age sex, hence being statutorily raped or sexually abused. Owing to this incongruence, there have been discussions at the decision-making level to possibly revise the existing policy and legislation affecting the sexual and reproductive health of minors.
Gender Bias and Contraceptives
In Jamaica, there has consistently been gender bias in regards to counselling on sexual and reproductive health matters. Research conducted by Crawford, McGrowder and Crawford has shown that boys are able to access counselling about issues such as contraception easier than girls. The study revealed that 95% of girls surveyed as compared to 14% of boys face challenges in obtaining contraceptives.
There are some who think that teaching a child about contraceptives encourages that minor to have sex. However, sexual and reproductive health educators see it as equipping minors with necessary information needed for the future as well as for the present as minors are sometimes thrust into sexual situations prematurely.
Socioeconomic Needs and Sex
Economic necessities such as needing lunch money for school may for instance, place teenagers in compromising situations where they decide to barter sex for money. In situations like these, where under age sex is entwined in a complex socioeconomic web with no simple or immediate solution, and whereby the child will continue to have sex as a means to an end, no matter what is said to him/her, then the best interest of the child (which most times is safe sex to prevent the contraction of HIV, AIDS or teen pregnancy) has to be prioritised over abstinence. These situations also complicate the issue of negotiating condom use due to the power relations which place the teenagers who are in need at a disadvantage.
Transactional sex resulting from paucity helps to perpetuate the cycle of children being born into poverty in Jamaica as for example, girls grow into women who decide to become pregnant to maintain relationships with men who many times shirk parental duties. This lack of independence and self-worth presents a fundamental problem to modeling a society that is empowered.
Youth development, participation and empowerment are therefore crucial to sexual and reproductive health issues. Sexual and reproductive health matters should be growing concerns to all stakeholders in the development of youth. Neglecting or discriminating against vulnerable groups such as marginalised youth either through policies, laws or actions will only destabilise global efforts to fight the HIV and AIDS epidemic across all sectors of the society, lead to unwanted socio-economic issues and in turn, affect national development. If marginalised youth get rights and responsibility based information, life skills (social and interpersonal, cognitive and emotional coping skills), as well as the opportunities and services they need to handle the sexual and reproductive issues affecting them, then their confidence will be built, resilience increased and their vulnerability, reduced.
The next issue will focus on JFJ’s pilot project in children’s homes.
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About Jamaicans For Justice:
Founded in 1999, Jamaicans for Justice (JFJ) is a non-profit,
non-partisan, non-violent citizens’ rights action organisation advocating for transparency, accountability and overall good governance in state affairs.
JAMAICANS FOR JUSTICE
2 Fagan Avenue, Kingston 8, Jamaica, W.I.
Tel: (876) 755-4524-6
Fax: (876) 755-4355
Facebook: Jamaicans For Justice (JFJ)
 Reproductive Health Survey (RHS), Jamaica, 2008 UNICEF
 Reproductive Health Survey (RHS), Jamaica, 2008 UNICEF
 In November 2013, the Minister of Education, Ronnie Thwaites stated that it would be mandatory for schools girls who got pregnant to be readmitted into the mainstream education system after completing their time at the Woman Centre of Jamaica
HIV Epidemic Update: Facts and Figures 2012
 Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum
 International Planned Parenthood Federation Charter on Reproductive Rights. 2003