#ICPD25: A young person’s take on SRHR as an essential element of Universal Health Coverage
During the 25th anniversary of the International Conference on Population and Development (ICPD) from Cairo to Nairobi, I was given a chance to represent the youth in a signature session titled: “SRHR as an essential element of Universal Health Coverage.”
The session was chaired by Dr. Tedros Adhanom, Director-General of World Health Organization, but his remarks was delivered by a colleague. It was moderated by self-proclaimed youth ally (one of my favorite person in the panel) Professor Nana Poku, Executive Director of HEARD and Vice-Chancellor and Principal of the University KwaZulu-Natal. The panelists who joined me were Vice President of Liberia H.E Jewel Howard Taylor; Minister of International Development Cooperation, Sweden, Peter Eriksson; First Lady of North Macedonia, Elizabeta Gjorgievska; InterParliamentary Union President and Senator of Mexico, Ms Gabriela Cuevas Barron; and Ms. Buky Williams, CEO, Education as a Vaccine, Nigeria (with the best encouragements, she told me to be who I wanna be in the panel).
The session highlighted the progress as well as the gaps in achieving universal access to SRHR. It aims to present evidence and analysis on the need to adapt the ICPD agenda to a changed and changing world, reflecting new science and evidence, new opportunities, innovations and new challenges from different stakeholders’ perspectives especially those of adolescents.
Inequities in young people’s access to SRH information and services remain a challenge in many countries; what are the issues that we cannot shy away from when it comes to what young people want? What are some key actions to eliminate the barriers?
“The fundamental aspect that we should all agree on, is that human rights shall never be negotiated. Not in any way and in any levels. Not even on young people. It is our right to access SRHR information and services.
The Philippines has landmarked the Universal Healthcare Act and just finalized last June 2019 its Implementing Rules and Regulations. One time, when I visited a public hospital in Manila and did the rounds in a teenage mother clinic, a 16 year old adolescent just gave birth. The cost of her delivery is covered through her mother’s government health insurance, or what we call the PhilHealth. However, her mother’s government health insurance couldn’t cover the cost of the infant’s newborn screening because the legally-recognized dependent of the insurance are only the “children” of the Philhealth holder. The infant is technically a grandchild of the government health insurance holder. The family’s income is below poverty line and they purposely went to this government hospital with the assumption that the government health insurance will cover everything that her pregnancy needed. This is just a simple adolescent reproductive health service that we have overlooked.
In the global arena, we are aware and we recognize what the comprehensive life course approach means. But the question is, is it translated right and enough? The translation of the word “comprehensive,” how do we ensure implementation on a local level? How inclusive can comprehensive mean?
The life course approach is a good strategy to characterize and emphasize that as adolescents and young people we have a unique and different set of interventions and SRHR needs. Adolescents is a key population on SRHR. There should be sustainable change through the understanding of our learning processes and behavior change as we age.
We also have to ensure that young people have agency. For example, we outcry and affirm, yes, #SheDecides about her body and her life, but do this comprehensive approach recognizes that having informed decision is only possible especially for young girls, if they are better equipped with age-appropriate and intersectional Comprehensive Sexuality Education, and a tantamount understanding of their agency towards their bodies? Data says not all young girls has the capacity for informed choice.
All of these shall be answerable by a complete grasp of our specific context. Where are the young people? We need to be clear on who we are reaching. Some young people are out of school, in urban and rural poor. Some are indigenous youth, young people with disabilities, young LGBTQIA, young people in humanitarian settings. Each has their own specific need that we cannot generalize as inequities of all young people. We made gains throughout the 25 years, but we are still far from reaching the unreached. Being a young person is already being vulnerable, what more if you belong to any of these categories. We are not a monolithic homogenous sector, that’s why I call on everyone here to understand our specific needs and do something about it concretely. Please consider our generation not only as partners but as experts. Consult us thoroughly in all levels of engagement, make us understand the technicalities, make us understand what happens with our bodies, and in making us understand, please be patient with dealing with us, be friendly, and most specially be responsive to our concerns.
SRHR as an element of UHC, shouldn’t just be mere interlinkages but encompasses what affects what, and what are not talked about. Neglect one element, your UHC implementation fails. For example, there’s already a mental health crisis in young people, what more when SRHR needs are not met.
Being blinded of the urgency of what’s happening now is actually a form of structural violence against young people. UHC will never be met if stigma is still there against adolescents. We listed all these SRHR interventions, we have this, we have that, but as long as young people are discriminated in visiting clinics, being tagged lacking moral decadence because at a young age were having sex, age of sexual consent isn’t proactively talked about; we don’t recognize unsafe abortions are happening and still think abortion is a criminal act; UHC will never be realized.
Dependents of dependents should be covered as well because a young person is still a dependent in different terms of healthcare. If we want everyone to be protected, no one must be left behind. We must ensure a humane and respectful care and treatment regardless of condition, belief, culture, SOGIE, and social class.”
Consult us thoroughly in all levels of engagement, make us understand the technicalities, make us understand what happens with our bodies, and in making us understand, please be patient with dealing with us, be friendly, and most especially be responsive to our concerns.
How the governments and CSOs, including youth organisations can accelerate the progress and what is your vision to translate the commitments in impact-oriented actions?
“Women’s issues’ are actually ‘everyone’s issues’. In the Philippines, we have dramatically gained and passed several laws that complement and of relevance to the Responsible Parenthood and Reproductive Health Law but the full extent of the laws are not in their advantageous form. We have yet to implement CSE and our UHC law and despite all these policies, there are still 500 adolescents who give birth everyday and there are 36 new HIV cases everyday in the Philippines.
What I have noticed is that most of the time, government actors and development workers fall short- sighted. Funding and financing mechanisms has led us working in silos. HIV response is characterized and done differently relative to the teenage pregnancy response. But both are SRHR concerns. Condom use is one way to address the rising number of both issues; how can we comprehensively talk about Universal Health Coverage if we are used on tackling issues in silos?
Financing is very much needed. Data-driven and needs-based interventions and programs must be in place. We can no longer push programs based on belief. Neglect in real- time data on unsafe abortions and its importance has led to multiple barriers on SRHR interventions.
The culture of educators and health service providers must change, and the key in changing the next generation is the critical engagement of young professionals. We should treat this as a youth service delivery network which is adept to the needs and concerns of the youth today. In public and private universities throughout different countries, curriculums for medicine, education, social work, and other healthcare-related degrees shall be composed of integrated classes specifically on primary care and SRHR. Young people feel comfortable talking to other young people about their situation, therefore young professionals, young healthcare workers, young teachers and youth peer educators shall work together for the realization of this.
I also think, we needed to have a scorecard or a national standard monitoring & evaluation tool specifically intended and directed to young people if we are actually achieving the targets of SRHR&UHC.
If we want to achieve equity, we need to adjust to the context of our people, adjust to their needs, who are they and where they are. This is only vehemently possible with unwavering political will and uncompromised adherence to institutional mandates. SRHR as an element of UHC is far from perfect and from what we expect. Each one of us must work together to ensure the full version of UHC that the YOUNG PEOPLE need.”
Only when this structural violence of SRHR access among young people is addressed through UHC implementation then every young girl can say that SheDecides with her future, her body and her rights.
First, extremely grateful for SheDecides for supporting young people to build a world that is better, stronger and safer.
Moreover, I would like to thank Ann Starrs, Director of Family Planning Division, Bill and Melinda Gates Foundation for suggesting my name to be part of this promising panel. I can’t thank her enough for believing in such a young person like me. I hope a lot of executive level programmers are as youth friendly as she is!
And most importantly, my greatest gratitude to Anneka Knutsson, UNFPA Headquarters, Chief of Sexual and Reproductive Health, for putting up such a great panel and for assisting my endless questions, giving me encouragement to be more than unapologetic and courageous as a young person as I can be.
Jona Turalde is currently an anthropology student and sexual and reproductive health and rights youth advocate from the Philippines. She champions the SheDecides movement, she’s also a member and she co-founded the Philippines chapter of IYAFP and she’s an aspiring feminist anthropologist in 10 years time after she retire from youth advocacy. She likes political films and original filipino music.
