IPPF s Approach The Netherlands: Sexual and Reproductive Health and Young people: is it a paradise

1. IPPF�s ApproachThe Netherlands: Sexual and Reproductive Health and Young people: is it a paradise?  Reaching Sexually-active Youth with Contraception:  Learning from Experience and Moving Forward November 18, 2003Doortje Braeken Senior Adviser Adolescents/Youth IPPF, London

2. Why do unwanted teenage pregnancies occur?� Education Children/ young people not given enough information Children/young people are given mixed messages about sex and relationships (ABC) Sexuality information often does not reach the 125 million children who have never seen the inside of a school

3. �Why do unwanted teenage pregnancies occur?� Services and contraceptive use Contraceptives are difficult to access and not properly explained Barriers to accessing sexual health services (socio-economic)

4. �Why do unwanted teenage pregnancies occur? Social reasons Sexual abuse Early marriage Early marriage of girls is common in many parts of the world and there is pressure on girls to marry early and have children soon after Girls may lack the power, confidence and skills and knowledge to refuse sex. Violence against girls is widespread. Sexual abuse and rape are widespread around the world both in war torn countries such as Rwanda and Bosnia as well as in prosperous nations such as the USA. Between � and 1/3 of all women and girls living in the European Union are subject to male violence Girls may resort to having sex to pay for school fees or food. Early marriage of girls is common in many parts of the world and there is pressure on girls to marry early and have children soon after Girls may lack the power, confidence and skills and knowledge to refuse sex. Violence against girls is widespread. Sexual abuse and rape are widespread around the world both in war torn countries such as Rwanda and Bosnia as well as in prosperous nations such as the USA. Between � and 1/3 of all women and girls living in the European Union are subject to male violence Girls may resort to having sex to pay for school fees or food.

5. IPPF�s Approach IPPF is committed to a rights based approach to young people�s sexual and reproductive health. This means: Adolescents are people not problems Knowledge linked to access to services engenders safer behaviour Equity is the key to good relationships this means respecting young peoples opinions and choices.

6. An example: the Netherlands First some images: Paradise or Sodom and Gomorrah

10. Some facts fromthe Netherlands

11. Contraceptive use at first sexual intercourse Use of contraceptives: 85% Use of condoms : 72% Use of pill : 24 % Use of condoms+ pill: 24%

12. Use of contraceptives during last sexual intercourse

13. Contraceptive use of young people In 2000 sexually active youth: systematically used condoms: 68 % systematically used condoms and pills: 27% sometimes used condoms: 31% never used condoms: 17%

14. The Dutch paradox: Merchants and Clergy Men Compartmentalisation Pragmatism Freedom � Control

15. Acceptance of FP In 1960s: high birth rate (20/1000) compared with Western European countries: discussion on overpopulation Rapid change in traditional values and family relations and start of the sexual revolution (unplanned pregnancy, STIs) Shift from predominantly agricultural to an industrial society The democratizing process at all levels of society Rapid economic growth; foundation welfare state with social security Decline of influence of church on public and personal life Introduction of mass media (TV!) on a large scale Pressure groups: FPA: (middle 1960s: more than 200.000 members), and women End 1960s: acceptance FP by Family Doctors

16. The Netherlands: A 'contraceptive' paradise 1961: introduction of the pill; in 1963 officially registered 1971: FP in national public health insurance system: pill, IUD and diaphragm free available 1973: contraceptive sterilisation in national public health insurance system (male and female) abortion tolerated by court and government since 1972 in 1984: legislation of abortion 

17. Netherlands: Pragmatic approach to young people� wide ranging information and education on sexuality and relationships positive political climate towards sexuality education Average age of first intercourse older than other European countries, in USA average age of 1st intercourse 1 year younger Openness to discuss sexual issues widely available and easily accessible services WHY? evidence from the Netherlands illustrates that access to a wider range of information and services for young people does not lead to promiscuity, but in fact increases the average age of first sex and reduces levels of teenage pregnancy. In the Netherlands young people start having sexual intercourse, on average, at the age of 17.7, whilst those in the USA initiate sexual intercourse at an average of 16.3 year (Berne & Huberman, 1999). The United States adolescent birth rate is 13 times higher than the Netherlands, and their teenage abortion rate (26.8 per 1000) is over six times higher (4.2 per 1000) (Berne & Huberman, 1999). It should be noted that in the USA the political climate for sex education is on the whole negative with a strong emphasis on abstinence only and there is a large diversity from state to state in the type of programmes offered.evidence from the Netherlands illustrates that access to a wider range of information and services for young people does not lead to promiscuity, but in fact increases the average age of first sex and reduces levels of teenage pregnancy. In the Netherlands young people start having sexual intercourse, on average, at the age of 17.7, whilst those in the USA initiate sexual intercourse at an average of 16.3 year (Berne & Huberman, 1999). The United States adolescent birth rate is 13 times higher than the Netherlands, and their teenage abortion rate (26.8 per 1000) is over six times higher (4.2 per 1000) (Berne & Huberman, 1999). It should be noted that in the USA the political climate for sex education is on the whole negative with a strong emphasis on abstinence only and there is a large diversity from state to state in the type of programmes offered.

18. Youth policy Promoting self-reliance Increased opportunities Confidence in strength and capacity Age of consent

19. Approaches to SRH & youth in  the Netherlands Less time and effort to prevent sexual activity; More time and effort to education and empowerment Efficacy: not only on a programmatic level, But more on a political and policy making level Access to information and services: Contextualising and acknowledging the importance of sexuality, sexual health and sexual rights

20. Attitudes of Family and Community Low rate of �working� mothers Strict rules Pragmatism: restrictive permissiveness Experimentation seen as natural and healthy

21. Results: S&RH in the Netherlands Open discussion and explicit information Widely available and easily accessible services Individual decision making Care and prevention instead of punishment

22. Sexuality Education Policies Freedom of education No national sexuality education curriculum Compulsory target goals Part of Biology and Care and/or integrated in different subjects General philosophy: not so much to teach but to talk about sexuality No anti-sex education lobby exists Almost all primary and secondary schools offer sexuality education

23. � sexuality education gives young people not only the medical and health knowledge, but also the skills to negotiate relationships is closely linked with access to contraceptives, sexual health services and counselling for adolescents addresses emotional and physical side of sex helps young people to make informed choices Part of the success of the Dutch approach lies in the space that has been created for frank open discussion and explicit information. This openness ranges from schools, families to television programmes. Such an open approach to information is coupled with widely available and easily accessible services A key component to the success of the Dutch approach is that sexuality education goes beyond a narrow focus on the biological facts of life, by giving young people not only the medical and health knowledge they need, but the skills to negotiate relationships and understand the emotional as well as physical side of sex. This coupled with access to contraceptives, sexual health services and counselling for adolescents has helped young people to make informed choices. The evidence from the Netherlands illustrates that access to a wider range of information and services for young people does not lead to promiscuity, but in fact increases the average age of first sex and reduces levels of teenage pregnancy. Part of the success of the Dutch approach lies in the space that has been created for frank open discussion and explicit information. This openness ranges from schools, families to television programmes. Such an open approach to information is coupled with widely available and easily accessible services A key component to the success of the Dutch approach is that sexuality education goes beyond a narrow focus on the biological facts of life, by giving young people not only the medical and health knowledge they need, but the skills to negotiate relationships and understand the emotional as well as physical side of sex. This coupled with access to contraceptives, sexual health services and counselling for adolescents has helped young people to make informed choices. The evidence from the Netherlands illustrates that access to a wider range of information and services for young people does not lead to promiscuity, but in fact increases the average age of first sex and reduces levels of teenage pregnancy.

24. Youth services Role of family doctor Partnerships between government and ngo s FPA with a network of youth friendly �houses� Linkages between education system and care system

25. Rutgers Stichting

26. Rutgers House Confidentiality Anonymity Choice of service provider No moral judgement Friendly non medical atmosphere Walk-in hours and appointments Good referral systems Close collaboration with community

27. Linking with research Qualitative Research example contraceptive acceptance among young girls Understanding of sexuality and contraceptives Relationship with partner Self efficacy

28. Conclusions Permissiveness: acceptance of adolescents� sexuality Openness: open discussion at all levels: family, school, media, peer group Responsibility: emphasis on individual responsibility Equity; equal rights/ acceptance of individual sexual preference Result: high motivation for sexual health and prevention - Love - Respect - Tolerance - Equity - Responsibility

29. adol.165/youth Key Future Actions for IPPFAdolescents/young people as one of its A�s Promote adolescent/youth rights Promote participation in governance and decision making Strengthen programming : linking education/information with services Address gender inequity

30. adol.169 Key Future Actions Improve accessibility and quality of ARH services Integrated, comprehensive and youth friendly approach Emergency contraception Addressing the needs of vulnerable groups including young people living with HIV, survivors of sexual abuse, young people with physical/mental handicap , young gays and lesbians

31. Key Future Actions Systematising youth centres or other models for youth services Developing condom promotion � sexy, non-coercive, contextual access to condoms Researching barriers to access for SRH services for young people