A Matter of Justice

“Family planning? Reproductive health? Doesn’t that distract us from more urgent issues of poverty and inequity?”

I hear that question quite often from both political conservatives as well as progressives. And when the issue is related to adolescents and young people, people will say: “What we need are more schools, more jobs.”

I have no quarrel with such arguments, but often, too, I think there’s an element of myopia in thinking that young people don’t need programs around reproductive and sexual health. In fact, I’d propose that tackling problems around young people’s reproductive and sexual health is itself a matter of social justice.

Let’s start with the health situation of young people. Especially in Third World settings, these are survivors, people who have hurdled the many challenges of early childhood, particularly malnutrition and infectious diseases.

We don’t often think of teenagers as vulnerable to health problems, but they are, except that the pattern of risks now changes. With males, the main risks cluster around mental health, substance abuse (which relates ultimately to mental health), accidents and sexually transmitted infections. For females, the risks are even more very clearly related to reproductive and sexual health.

The problems emerge even among those who are not yet sexually active. The onset of menstruation brings problems like iron-deficiency anemia, especially among young girls who are already disadvantaged by poverty and gender discrimination. Menstruation also means fluctuations in hormones, which, accompanied by other anatomical changes, result in endogenous infections of the reproductive tract.

For those who become sexually active, the risks now include sexually transmitted infections (STIs), including HIV/AIDS. In the Philippines, the highest number of reported HIV infections is found in females aged 15 to 24. (In contrast, among males, the infection rates are highest in older men.) People deny these risks because they think it applies only to sex workers and to the “promiscuous,” but the reality is that many infections will take place among young girls forced into marriage because of a premarital pregnancy. Because they’re married, they downplay their risks for these STIs even if their husbands are philandering, and the chances are usually higher that they are, these young grooms often unhappy with having been forced into the marriage.

We forget, too, that in the Philippines, more than 100,000 births each year are to girls below the age of 20, each birth presenting specific risks because of the mother’s young age. The children of these young mothers also face more formidable challenges for survival, since their mothers are inexperienced, and tend to have fewer economic resources to raise the child.

These births are simplistically blamed on young people’s “promiscuity” and “raging hormones” (you’d be surprised at how many of the pregnancies occurred after only one encounter), followed of course by the couple being marched off into a shotgun wedding. Talk about jumping out of the frying pan into the fire -- the births come each year. Some of the births to girls in the 15- to 19-year-old age group are already their third or fourth.

Conservatives argue that sex education programs entice the young to have sex. They insist that sex education is best done within the family, but most Filipino families prefer silence on the issue, a silence that can bring about disastrous consequences. Talk with doctors serving in rural areas and they’ll tell you of parents bringing in a child who’s pregnant, but the parents themselves are still in denial.

We saw, too, recently, that case of a 12-year-old suicide in Davao City, with possible sexual abuse. If we had strong sexual and reproductive health programs, the girl would have been in a better position to defend herself or, if the abuse could not be prevented, to be able to look for help.

Hanging ovaries

Sexually active or not, young Filipinos need reproductive and sexual health programs. I’m not referring to those “hanging ovaries” sex education classes where the class giggles through a boring lecture with anatomical charts showing disembodied penises, uteri and ovaries. Young people need the most basic of education; many young girls and boys don’t even know the basics of sexual hygiene. They need to know bodies belong to people, in relationships, with values that will either put them at risk, or protect them, from unwanted pregnancies, from sexually transmitted infections. They need to know that sexual and reproductive health relates to other healthy practices, and that means avoiding junk foods, smoking, drinking, drugs.

We know that young people suffer from poor health because of poverty, which means limited access to information and services. But in the case of reproductive and sexual health, the converse is also true: poor reproductive health contributes to a worsening of poverty. Think of the young couple who starts having a family when they can barely support themselves. That’s an end to schooling, an end to opportunities for better jobs. In many cases, it can also mean young people being driven into new situations of risks such as sex work.

So, on one hand, often in the name of morality, we deny our young reproductive and sexual health programs. On the other hand, we exploit the young’s sexuality to sell products: our billboards, our television screens are filled with happy, healthy faces and bodies endorsing everything from cell phones to soft drinks.

Space, options

I’ve wondered if our ambivalence with young people’s sexuality reflects our fear of young people. We see them mainly in terms of raging, uncontrollable hormones, and yet shamelessly use them for entertainment, for advertising -- or for outright sale.

We talk about how young people are our future and indeed they are. But by de-sexualizing them, we convert them into mere commodities, their value perceived in market terms. Why worry about family planning, I’ve heard commentators, when we can export more Filipinos to bring in more dollars?

When we oppose sex education and family planning for the young, we also betray our own condescending views about them. We don’t want to see them as being mature enough to handle options, to make wise decisions about their bodies and their lives. The ones who will suffer the most are the ones who are young, and poor, because their lack of options will lead to new vicious cycles of powerlessness and poverty.

Ultimately, reproductive and sexual health is about young people’s rights. Denying those rights is the worst form of social injustice.

(This column is a modified version of a plenary paper I presented last month at the 4th Asia Pacific Conference on Reproductive and Sexual Health, held in India.)


Source: Article by Michael L. Tan in Pinoy Kasi column in the Philippine Daily Inquirer, November 28, 2007

Stop AIDS. Keep the Promise.

World AIDS Day is a day when people from around the world come together within a single effort. This year, the global theme of World AIDS Day is leadership within the slogan Stop AIDS. Keep the Promise.

The annual UNAIDS/WHO 2006 AIDS Epidemic Update, reports on the latest developments in the global AIDS epidemic, providing the most recent estimates of the epidemic's scope and human toll and explores new trends in the epidemic's evolution.

According to the report 39.5 million people are now living with HIV. There were 4.3 million new infections in 2006 with 2.8 million (65%) of these occurring in sub-Saharan Africa and important increases in Eastern Europe and Central Asia, where there are some indications that infection rates have risen by more than 50% since 2004. In 2006, 2.9 million people died of AIDS-related illnesses.

Why the theme of leadership?
Since the beginning of the epidemic, experience has clearly demonstrated that significant advances in the response to HIV have been achieved when there is strong and committed leadership. Leaders are distinguished by their action, innovation and vision; their personal example and engagement of others; and their perseverance in the face of obstacles and challenges. However, leaders are often not those in the highest offices. Leadership must be demonstrated at every level to get ahead of the disease - in families, in communities, in countries and internationally. Much of the best leadership on AIDS has been demonstrated within civil society organisations challenging the status quo. Making leadership the theme of the next two World AIDS Days will help encourage leadership on AIDS within all levels and sectors of society. We hope it will inspire and foster champions within a range of different groups and networks at local and international levels.

Leadership as a theme follows and builds on the 2006 theme of accountability. In 2006 a number of milestones were reached where accountability was particularly crucial. It was the year of the United Nations High Level Meeting on AIDS, which reviewed the progress on the 2001 Declaration of Commitment on HIV and AIDS - an important blueprint for reaching the Millennium Development Goals on AIDS. 2006 marked the fifth year anniversary of the African Abuja Declaration. 2006 was also the year in which national targets were set, or should have been set, by governments for achieving universal access to prevention, treatment, support and care by 2010. In addition, at 2006's International AIDS Conference, “accountability “ was the buzzword throughout the global forum, reflecting the conference's theme, “Time to Deliver”.

Despite the efforts to hold leaders accountable in 2006, progress in halting HIV is falling far short of targets. Over 25 million people have died of AIDS so far, and 4.3 million people were infected with HIV in 2006. The spread of HIV is accelerating with more people infected in 2006 than in any previous year. This is despite the number of promises by world leaders to provide services to curb the rates of infection and to bring down death rates. The G8 leaders must deliver on their commitments to AIDS. In other high level meetings, governments of rich countries promised to increase the spending on development aid to 0.7 percent of their annual budget. Only a handful of countries have done so. In the Abuja Declaration, African leaders committed to allocating 15 percent of their budgets to health. This has happened in just one or two countries, with only one-third of African countries spending over 10 percent. Promises are not being kept because there is a lack of leadership at every level.