LUSAKA, ZAMBIA – Natasha, a student in her third year at the University of Zambia in Lusaka, the capital, says she will never forget the way a health worker at a local clinic scolded her when she went there seeking sexual and reproductive health information and services.
Natasha, who declined to use her full name for privacy reasons, says she went to the clinic for information on contraception. But she says the nurses there said that they were reluctant to help her because she was not married and too young to be seeking family planning information and services.
“I had been reacting to the contraceptives that I had been taking, and when I went to the clinic and explained to the health worker what my problem was, she told me I was too young to be using contraception and that I should be abstaining because I am not married,” Natasha says.
Natasha says the health worker began to question her.
“She asked me why I was not abstaining [from sex] and I said that if she knew my parents she would have told them that I am a naughty and stupid girl,” she says.
Natasha says her experience with health worker was hurtful and will discourage her from going back.
“I felt so bad and so out of place that day,” Natasha says. “The nurse made me feel so guilty.”
She says her friends have had similar experiences when trying to obtain sexual and reproductive health care and information.
“When I told my friends about it, they asked me why I had even bothered to go the clinic because some of them had also experienced unfriendly treatment at different clinics as well,” she says.
In Zambia, young people say that health workers at clinics discourage them from obtaining sexual and reproductive health services because they aren’t married. Doctors and activists say more training is needed to make health workers more receptive to the younger generation. The government has acknowledged the gap in services for the young and has begun to develop a strategy to address it, as have multiple nongovernmental organizations, NGOs, and global campaigns.
Like in other countries around the world, the provision of sexual and reproductive health services to young people in Zambia – although legal – is still a sensitive issue. Yet it’s become an important topic as the country has been undergoing rapid population growth, which has put pressure on already overburdened socio-economic resources, especially in regards to education, health and food security, according to Muyambo Sipangule, Zambia’s deputy permanent representative to the United Nations.
High fertility levels have led to rapid population growth here, Sipangule said last month at the 44th Session of the U.N. Commission on Population and Development. Zambia’s population has grown from 5.6 million in 1980 to 13 million in October 2010, thanks to a high total fertility rate, or average number of births per woman, of 6.2 as of 2007.
Teenage pregnancy is also high in Zambia, with about three in 10 women beginning childbearing between ages 15 to 19, according to the most recent Zambia Demographic and Health Survey, ZDHS, from 2007. Overall, less than 35 percent of Zambians ages 15 to 19 had comprehensive knowledge of HIV/AIDS, according to the ZDHS, while more than 15 percent of the population here is HIV-positive.
The majority of young people surveyed said they knew of a condom source, but many say it is difficult to obtain sexual and reproductive health services. They say that health workers at clinics, hospitals and other health centers tend to be unfriendly toward them, making them less likely to return in the future for the information and services they need.
A nurse at the University Teaching Hospital, UTH, Zambia’s largest hospital, who requested anonymity to protect her job, says she doesn’t understand why a young person would seek family planning information. She says that young people who are unmarried should abstain from sexual activity.
“If these so-called young people were abstaining as they should, they would not have to go looking for health services that are meant for adults and married couples,” she says.
The nurse says that the media is to blame.
“The problem with young people is that they like to try what they watch on television,” she says.
Remmy Shawa, global youth coordinator for the World AIDS Campaign, which aims for universal, nondiscriminatory and nonjudgmental access to HIV prevention, treatment, care and support, says that non-youth-friendly health services are an obstacle to them attaining the care they need.
“Usually there is what is called age discrimination, where the health service provider – mostly an adult – believes that young people should not suffer from certain illnesses,” Shawa says. “So when a young person presents with such an illness, the provider becomes judgmental and sometimes tries to admonish that young person.”
He says this discourages them from seeking the care they need in the future when it comes to pregnancy, sexually transmitted infections, STIs, HIV/AIDS and more.
“Such interactions make it hard for that young person and many others to go back for those services,” he says.
Shawa attributed the non-youth-friendly health services to the linking of public health and morality by many service providers.
“In a country like Zambia, which is a Christian nation, a young person is supposed to stay away from sex [un]til marriage,” Shawa says. “Thus, if a young person goes to the clinic or any health center with an STI, then he/she is immoral in the eyes of most service providers.”
Shawa says that another problem is ignorance.
“Health service providers are simply ignorant about new developments and challenges that young people face,” Shawa says. “Hence, they find it hard to understand and relate with young people.”
A UTH doctor, who asked to remain anonymous to protect his job, says that the country lacks frequent and regular trainings and retrainings of health workers across the country on the importance of providing youth-friendly health services.
He says that improving their salaries and general working conditions could also help change the unfriendly attitudes displayed by some health workers.
Shawa says that more advocacy and awareness campaigns with service providers are needed to make health service providers more accommodating to young people.
“I believe that a youth-friendly service provider does not necessarily need to be a young person,” Shawa says. “Even an adult can be youth-friendly as long as they are trained on how to reach out to the young generation.”
Sipangule says the government has set up the Reproductive Health Commodity Security Committee and has begun to use community-based agents to increase the flow of reproductive health commodities, services and information around the country. He said modern family planning has gradually increased among married women, but that further effort and support were required to continue to increase access to and use of family planning services for women in rural areas and young people.
“Zambia recently carried out a situation analysis on reproductive health services for the adolescents and young people in the country, which identified the gaps, such as high teenage pregnancies, inadequate access to reproductive health services and information,” he said. “A strategy to address the gaps identified is being developed.”
Sipangule said the government had also recently revised its National Population Policy and was developing implementation framework, but asked for the United Nations’ continued support in its goal to lower the fertility rate.
In addition to global efforts, such as the World AIDS Campaign, Zambian NGOs, such as Youth Vision Zambia, a youth-led NGO in Lusaka dedicated to providing sexual and reproductive health information services to youth, are also working to educate and equip youth to protect themselves.
