One more barrier to overcome

Since we began our programme in 1999, we have celebrated a healthy sexuality and a positive lifestyle for all young people in South Africa.

To be treated with respect by healthcare workers is an important part of that equation.

Early on we realised that the way young people are treated by healthcare workers impacts directly on whether or not they will access sexual and reproductive health services, and therefore on their odds of unintended pregnancies, untreated sexually transmitted infections, and HIV infection.

Where teenage pregnancy does occur, a recent study we conducted indicated that it is unplanned in three out of four cases.

There is clearly an unmet need for reproductive health services and fertility management for young people.

This often results in school dropouts, which are highest among young women in the Further Education and Training band.

It also results in unsafe termination of pregnancies. According to the Medical Research Council, 49% of abortions by 13- to 19-year-olds are unsafe and account for 23% of maternal deaths.

Addressing barriers to sexual and reproductive health services and rights could help with HIV, maternal mortality and other factors impacted by the health and connectedness of young mothers.

That’s why we work closely with the department of health to improve the youth-friendliness of the primary healthcare system. We’ve made some positive gains together, but much work remains to be done.

New HIV infections among young people have more than halved since the early days of the loveLife campaign.

They’re the ones who have been leading the remarkable change in our epidemic.

What we have seen over the past 14 years is that where there are still high rates of new infections, these tend to cluster around specific populations: informal settlements, farming communities and other vulnerable nodes.

This vulnerability is linked to many factors; an important one however is that informal settlements and farming communities are home to many of our country’s most mobile populations, people who are internal and cross-border migrants.

A study we conducted in Limpopo with young migrants from Zimbabwe, Mozambique and Lesotho revealed high levels of discrimination at primary healthcare level based on appearance, language and accent.

These barriers are in addition to the ones already reported by young people; being denied sexual and reproductive health services because they are “too young”, or having their privacy or confidentiality violated.

The migrants we spoke to described harmful health workerto- client communication dynamics, poor treatment and difficulty of access to information as some of the pertinent barriers.

Some of these young people reported a preference for paid services over free government services, if that at least meant overcoming interrogations about where they are from and what young people like them were doing having sex in the first place.

To reverse this situation, we promote young people’s active participation in clinic committees and clinic outreach activities.

The clinic can be a centre of community life, owned by the community and perceived as a valued asset.

We also promote peer-to-peer approaches and train healthcare workers to respond to key populations.

Improving the management of access with real management and monitoring systems deal with issues such as youth friendly hours and services, shorter waiting times and reducing discrimination based on age or nationality.

More attentive staff, assured confidentiality, as well as age and gendertargeted services will improve the access of health care services by all people.

The fact is that we cannot afford a healthcare system that turns away the most vulnerable groups.

The gains we can make from responding with a more youthcentred, migrant-centred approach are great and we need to get behind them as a nation urgently if we are to further reduce maternal mortality and HIV.

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