With 75% of the population under 25 years of age, Kenya faces a challenge addressing the problems and needs of a youthful population. To help guide programs and activities, in 1994 Johns Hopkins Population Communication Services conducted a national survey of 1,476 youth ages 15 to 19 and 2,894 adults ages 20 to 54. The same questions were asked of both groups, providing an opportunity to compare points of view.

The survey revealed that adolescents and adults had many views in common. For example, both expected that there would be a long gap between onset of sexual activity and marriage. When asked, "In your opinion what is the best age for a boy to play sex for the first time?" adults said, on average, 20.4 years, while the young people said 19.6 years. When asked in a separate question, "What do you think is the best age for a boy to get married?" adults said 25.4 years, while the young people said 25.5 years. Answers about girls were similar. Adults said 18.2 years was the right age for a girl to start having sex, while young people said 17.9 years. Yet, when asked at what age she should marry, adults suggested 20.8 years, while young people said 21.4 years. In other words, both groups expected boys to commence sexual relations nearly five years before they married, and they expected girls to initiate sexual activities two to three years before they married.

Despite these responses, a majority of both adults and young people disapproved of sex before marriage. Only one-quarter of the adults and young people said it was acceptable for boys to start sexual relations before marriage. They had even more conservative opinions about girls—only 15% of adults and 20% of young people said it would be acceptable for a girl to have sex before marriage.

These findings suggest widespread conflicting attitudes about sex and marriage. On one hand, respondents place sex chronologically before marriage, and yet, on the other, they disapprove of premarital sex. The 1993 Kenya Demographic and Health Survey found that in reality sexual activity often does occur before marriage. In all 5-year age groups between ages 25 and 49, women married on average one to three years after sexual onset. For example, the median age at first sex among women ages 25 to 29 was 17.0 years, while the median age at first marriage was 19.5 years. Thus the expectations of young people and adults about sex and marriage are fairly accurate (247), but a majority of both groups say that they disapprove of what is actually happening.

Young people and adults in Kenya appear to have similar views about a number of other issues. For example, 67% of adults agreed that teenagers should receive contraceptives if they need them, and 64% of the youth felt the same way. Similarly, 79% of the adults said that young people should receive sex education in schools, and 75% of the young people agreed.

To assess communication between parents and their children, both groups were asked whether they had talked to each other in the past 12 months about any of a list of topics. Adults and youth agreed on the levels of discussion, but most had discussed only school work and careers. Despite their importance to young people's futures, reproductive health topics, particularly contraceptives, were the least discussed (see Figure 2).

While the concurrence of adults' and young people's views maynot be typical of other countries, the survey findings suggest that young people and adults in Kenya may not be as far apart as is often feared. The two groups appear to hold similar views and face similar conflicts. With greater communication, parents and children may discover that they have much in common and can resolve some conflicts.

Karungari Kiragu, Ph.D., is in the Research and Evaluation Division of the Johns Hopkins Center for Communication Programs.

Question 1: Today people are starting sex much younger than previous generations.
TRUE ___ FALSE ___

Question 2: Most young people in developing countries are having sex.
TRUE ___ FALSE ___

Question 3: Today more young adults start sex before marriage than in the past.
TRUE ___ FALSE ___

Question 4: For young adults, STDs pose more risk than ever.
TRUE ___ FALSE ___

Question 5: Economic and Social Structure in developing countries still accommodates early parenthood.
TRUE ___ FALSE ___

Question 6: Teenage boys are responsible for nearly all the unplanned pregnancies among young women.
TRUE ___ FALSE ___

Question 1: Today people are starting sex much younger than previous generations.
False. In most countries median age at first sex has not changed over the last several decades, and in some countries it is actually higher today than among older generations (see Chapter 1.3 and Table 2).

Question 2. Most young people are having sex.
False. The majority of unmarried young people, especially in developing countries, are not sexually active. Most of those whoare sexually active are married (see Figure 1, Tables 3 and 4).

Question 3: Today more young adults start sex before marriage.
True. Among previous generations sex was largely confined to marriage, whereas today young people marry later, and thus more are having sex before marriage. This change puts many young people at risk for STDs including AIDS as well as for unplanned pregnancy.

Question 4. For young adults, STDs pose more risk than ever.
True. Sexually active young adults are particularly vulnerable to sexually transmitted diseases, and in some countries they have among the highest STD rates of any age group. With the advent of AIDS, the possible consequences of sexually transmitted infection are multiplied. At least half of those infected with the AIDS-causing virus HIV are under age 25 (see Chapter 2.1).

Question 5: Economic and social structure in developing countries still accommodates early parenthood.
False. Early parenthood often ends a young woman's schooling, and the economic consequences may persist for a lifetime as economies increasingly demand trained workers (see Chapter 2.5). While some traditional cultures encourage early childbearing, most condemn pregnancy before marriage and punish girls who become pregnant.

Question 6: Teenage boys are responsible for nearly all the unplanned pregnancies among young women.
False. Large proportions of pregnancies among women under age 20 are caused by men who are older—often much older (288, 304, 342). In the US, 7 of every 10 children born to teenage women are fathered by men over age 20 (105, 308, 401). The percentage is much higher for girls under age 15. Furthermore, substantial numbers of young people, especially younger women, are coerced into sex (17, 63) (see Chapter 2.2).

What Do Young People Think?

Going Beyond Assumptions

Young men have been largely left out of efforts to address the health and social consequences of early sexual intercourse. Girls receive most of the attention, whether positive, in the form of programs and services, or negative, in the form of social disapproval and punishment. Successfully addressing the consequences of young adults' sexual activity requires including both young women and young men.

Boys and Sex: Off the Hook but in the Dark

Boys' sexual behavior and attitudes reflect the double standard that exists in most societies—tacitly approving and even encouraging premarital sexual activity for young men and extramarital sexual activity for older men, while disapproving of and often punishing such behavior in girls and women (13, 334). Boys may be encouraged by peers and even family members to become sexually active or to go to prostitutes, while girls are admonished to remain chaste (502, 555).

In nearly all societies young men usually face fewer repercussions than girls do when unplanned pregnancy occurs outside marriage. In some societies fathering a child, even while very young or outside marriage, gives a young man prestige (157, 376). Not surprisingly, boys are less likely than girls to worry about unintended pregnancy (513).

In general, boys know less about sexuality, pregnancy, and contraception than girls do, even when they have equal access to sex education (140). While girls in many societies receive information from mothers or aunts, boys are less likely to talk to family members about sexual matters. Most rely on friends or the mass media for information (310, 362) (see sidebar, Where Do Young People Learn About Sex?). Furthermore, peer pressure appears to influence boys' sexual behavior and contraceptive use more strongly than girls' (255).

Social Norms: Defining Masculinity

The stereotype of young men today is of irresponsible sexual partners who fail to show concern for their partners' well-being or for any children that they father (9, 70, 322, 568). Blaming young men and labeling them "irresponsible," however, without recognizing and meeting their needs is no more successful at changing behavior than is punishing girls. Rarely are young men (or young women) shown clear examples of what male responsibility means, and rarely is sexual responsibility included in definitions of masculinity (383). Too often boys see only examples, often in their own families, of irresponsible or abusive behavior towards women and girls. When these issues are not addressed as a young man begins his sexual life, he may develop unhealthy and irresponsible behavior patterns that can be more difficult to change later in life.

Reaching Out to Young Men

• Accurate and relevant information about sexuality and reproductive health, including full information about their own risk of acquiring STDs and how to avoid STDs.
• Access to contraceptives and STD services where they feel comfortable and accepted. Like girls, boys feel embarrassed at clinics and fear that their visits will not be kept confidential (187). Even where programs exist for girls, services for boys are scarce (145, 268). Special efforts may be needed to reach groups at especially high risk for STDs, such as street children worldwide or the young male assistants of long-distance truck drivers in Africa (354, 403). Providers accustomed to working with women must develop skills to work with young men as well. Specially trained providers, particularly men, may be needed to reach some young men and boys.
• Encouragement to delay sexual activity until they are better prepared to cope with emotional, contraceptive, and health needs. Such a behavior change requires influencing not just the way boys perceive masculinity but also the way that society, including parents, role models, and girlfriends, defines masculinity.
• Education and jobs that encourage delaying fatherhood (9).
• Communication skills to talk honestly with girlfriends about sex and contraception as well as negotiation skills necessary to refuse unwelcome sex (422).
• Images of masculinity that are not tied to sexual prowess or fatherhood. Programs and society in general need to find ways to teach and model responsibility for young men. Some studies have found that when young men believe that they share responsibility for preventing pregnancy, they are more likely to use condoms (396, 457).

Parents, policy-makers, and program managers debate whether schools should teach young people about sex and reproduction or should leave that to families. Meanwhile, young men and women around the world say that they learn about sex not from their schools or families but instead from their friends, other peers, and books, magazines, and the mass media (39, 72, 283, 294, 307, 361, 390). Much of the information young people learn from these sources is misleading, incomplete, or wrong. Around the world young people say that they learned too little, too late about sex and sexuality.

From Parents and Other Family Members?

From School Programs?

From the Mass Media?

The images prevailing in the entertainment media imply that sex is largely risk-free, that everyone is doing it, and that planning for protection spoils romance. In the US the average young adult sees 15,000 sexual references on television each year, and fewer than 175 of these mention contraception (465). The impact is not limited to the US. Many US television programs are dubbed into other languages and aired around the world. Some innovative projects are trying to counter common mass-media images of sex through appealing and entertaining programming that present more responsible and realistic models for healthy behavior. (See supplement, Reaching Young Adults Through Entertainment, included with this issue.)

Peers and Friends Named Most Often

Friends may be an even more important source for young men than for young women (505, 527). In Quito, Ecuador, and Santiago, Chile, more young men named friends as their primary source of information than any other source, while young women tended to name their mothers. Because friends and peers are so influential, some health programs are training young people to work as peer educators (see Reach out to young people wherever they are in Chapter 5.2).

Naming Sources Is Not Enough

Thus understanding how young people learn about sex is not as simple as asking them to name information sources. Furthermore, differences in survey questions affect young people's responses and make comparisons difficult. For example, some studies ask about sources of knowledge of reproductive biology, while others ask about sources of information about sexuality and family planning. Some ask for a single source of information, while others asked respondents to rank multiple sources. Better understanding the influences that various information sources exert on young people's values, attitudes, and perceptions of behavioral norms might help programs not only to increase knowledge but also to influence behavior.

The recent United Nations conferences on population and on women both urged that young people be given better protection from harm and better access to resources including reproductive health care. The United Nations International Conference on Population and Development (ICPD), held in Cairo in 1994, urged member countries to take these actions (Chapter VI, Section B):

• Protect youth from disease, malnutrition, and other effects of poverty;
• Ensure equal opportunities for boys and girls;
• Address the neglect and exploitation of young people, including sexual exploitation;
• Enact and enforce laws prohibiting abuse of children;
• Enact and enforce laws banning child marriages;
• Eliminate discrimination against pregnant young women;
• Protect children harmed by armed conflict or disaster;
• Ensure the future of youth by providing education, training, employment, housing, and health care;
• Support organizations that assist young people;
• Involve youth in programs that affect their lives; and
• Protect the reproductive and sexual health of young people by providing access to information and confidential services (485).

If they are sexually active, young people need to use effective contraceptives to avoid unintended pregnancies and unsafe abortion. Many sexually active young people do not have a mutually monogamous relationship and so need to use condoms to avoid sexually transmitted diseases (STDs). Young people's needs can vary greatly, and family planning providers can best help young clients when they understand each client's specific situation.

A World Health Organization (WHO) scientific working group recently advised that youth alone does not constitute a medical reason to avoid any contraceptive method. Even where some health concerns related to young age exist, the advantages of avoiding pregnancy generally outweigh theoretical or proven risks (543). Of course, many of the same method- specific eligibility criteria that apply to older clients apply to young people (57, 193, 543). Some conditions, such as circulatory system diseases, that might limit the use of some methods are rare among young people, however.

Social and personal factors related to young age do influence choice of methods. By discussing the circumstances of the young person's sexual activity in a caring, confidential, and nonjudgmental manner, providers can assess a young person's contraceptive needs and STD risk. Providers and counselors should be alert to the possibility of sexual abuse and develop policies for helping clients who are abused (463).

Abstinence

Barrier Methods

Condoms often are more readily available to young people than other methods. Condoms can be purchased at pharmacies, markets, and other shops without prescriptions and may be available free of charge at family planning clinics and youth centers or from outreach workers and peer educators (388). Young adults should use prelubricated condoms, if available, to prevent tearing and to reduce possible discomfort for the young woman (278, 531).

When family planning providers supply condoms to young adults, they should explain condom use clearly, repeating the instructions, and, optimally, demonstrating condom use by opening a package and unrolling a condom onto a model, a stick, or similar object (278). Concise, illus- trated, and explicit printed instructions can reinforce the verbal instructions and demonstration (5, 278). Providers can encourage young men to practice putting on a condom when alone.

Spermicides. Ideally, spermicides should be used with condoms for extra protection if a condom breaks or slips during intercourse. Spermicides used alone, although not as effective as condoms used consistently, provide some protection and are under a woman's control. Other barrier methods, including the diaphragm, cervical cap, and female condom, generally prevent pregnancy somewhat more effectively than spermicides and also protect against STDs to a degree.

Hormonal Methods

Combined oral contraceptives (COCs). WHO and other guidelines do not recommend restricting use of the Pill solely because of young age (26, 111, 543). Where oral contraceptives are available from multiple sources without prescription, they may be easier to obtain than other hormonal methods (388). Some young women, however, like their older counterparts, have trouble remembering to take a pill daily or may run out of pills before obtaining more cycles (388, 467). Providers can help by explaining what to do about missed pills. Also, they can suggest that women link taking the pill with some other daily routine and can provide multiple 28-day cycles instead of 21-day cycles (347, 483). All Pill users, including young women, need to be told about common possible physical effects such as nausea and mild headache and advised that these are not signs of danger.

Oral contraceptives for emergency contraception. Several regimens of COCs can be used soon after sex to prevent pregnancy (48). Postcoital contraception can be achieved with COCs containing 50 mg of ethinyl estradiol plus the progestin levonorgestrel by taking two pills within 72 hours (3 days) after unprotected sex and two more pills 12 hours later (559); or, with COCs containing less than 50 mg of ethinyl estradiol plus levonorgestrel, by taking four pills within 72 hours (3 days) after unprotected sex and four more pills 12 hours later. It is assumed that COCs containing other progestins also are effective, but these pills have not been studied as postcoital contraceptives. No medical conditions other than established pregnancy rule out use of COCs as emergency contraception (543).

Postcoital oral contraception is not a substitute for other family planning methods, but it can be crucial for preventing pregnancy when a young woman has been coerced or raped; had sex without using contraceptives; had a condom break or an IUD come out of place; or has run out of contraceptives. A woman's request for emergency contraception constitutes a crucial opportunity to help her choose an appropriate ongoing method of contraception.

Postcoital contraceptives seem to prevent about three-fourths of pregnancies that would otherwise occur (33, 151, 208, 481, 560). Common side effects include nausea and earlier menstrual bleeding (506). If a woman vomits within one hour after taking the pills, she should take another dose if possible.

Progestin-only oral contraceptives. Also called minipills, these are suitable for young mothers who want to use a hormonal method while they are lactating, which itself offers some protection against pregnancy (388). For other women, lesser effectiveness and common breakthrough bleeding may make them a second choice to COCs (386, 388).

Injectables and implants. Progestin-only injectables and implants are very effective and require no daily pill-taking or action at intercourse. Injections are required only every three months for Depo-Provera® or every two months for Noristerat®. Norplant® implants, once inserted, can be used for up to five years. Monthly injectables, which contain both a progestin and an estrogen, are available in some areas, particularly in Latin America. (See Population Reports, Decisions for Norplant Programs, K-4, November 1992, and New Era for Injectables, K-5, August 1995.) Users need to understand the changes in menstrual bleeding that progestin-only methods are likely to cause (287, 315, 388). Both methods require access to providers, and good quality of services is important. In most countries injectables—and those who can provide them—are more readily available than implants. Also, young women who want to stop using injectables can simply forego additional injections, while those using Norplant implants must have the capsules removed by a specifically trained provider. Until implant services become widely available, finding someone who can remove the implants could be a problem, especially for young women who move. Because pregnancy rates increase with time and may be higher among younger than older women (182), young women should have their Norplant implants removed, and, if desired, replaced, at the end of five years to avoid the risk of ectopic pregnancy (217). Norplant implants reduce the absolute risk of ectopic pregnancy substantially, but, when pregnancy does occur, it is more likely to be ectopic than for users of other methods or no method at all (315).

Intrauterine Devices

Traditional Methods

Suitable or not, however, traditional methods are often the methods that young adults know about and use most (144, 204, 254, 306, 338, 358). For example, a 1989 survey in Ecuador found that 20% of unmarried sexually active women ages 15 to 24 used the Pill, but twice as many relied on periodic abstinence (144). The young and unmarried may rely on traditional methods more heavily than older groups because of real or perceived lack of access to supplies and services or inability to plan ahead. Often, however, young people are poorly informed about these methods and simply guess about the fertile period (39, 255, 307).

Young people should have access to information, instruction, and advice on periodic abstinence and withdrawal. They also need to know, however, that effectiveness depends greatly on the user. Providers should not underestimate the potential effectiveness of these methods nor completely discourage young people from using them, since they provide some protection and are already widely used (437). Providers need to contrast these methods with folk methods, such as having sex standing up or douching after sex, which do not prevent pregnancy.

For further information about contraception for young adults, see: Choosing a Contraceptive: Considerations for Youth, chart from Population Action International (388); Contraceptive Options for Teenagers by Robert A. Hatcher (192); and Teen Contraception in the 1990s by Amy E. Pollack (386).

1. Identify and assess your audience. Early efforts to serve young adults assumed that this group was homogeneous—and that adult professionals knew what was best for them. Both assumptions proved faulty. There are profound differences among young people, even within the same country or region (see Chapter 1). These differences require different responses from programs.
    Programs can develop the appropriate responses only when they learn from the intended clientele. This is especially true with young adults, who often constitute a subculture of their own, with their own points of view, values, and even vocabulary. What do they want to know, and how do they want to learn it? What guidance and services do they need and want? Whom will they trust? The answers cannot overrule professional judgment, but they are an important starting point. When programs fail to consult potential clients, they leave gaps between what young people want and what programs offer. For example, in Kenya and Nigeria students found lessons on reproductive physiology irrelevant. They wanted to learn more about "the safe period" and pregnancy prevention (39).

2. Field-test plans and products. Initial research with clients is not enough. Specific plans, services, and messages should be tested—often repeatedly—with the group to be served. For example, in the US some family planning clinics lamented the dearth of young clients, but it took a study to point out the problems: the clinics required appointments, had long waits for services, and were seldom open when young people were out of school.

3. Integrate and collaborate—but wisely. Integrating a desirable new service into an ongoing program can attract new clients and increase overall use of services. Integration, however, may render a controversial program element, such as services for young adults, minimal and ineffective, especially if the real purpose of integration is to sanitize the controversial component. This occurred at one point in the development of sex education. Sexuality issues were merged into the broader—and more acceptable—family life education (FLE). FLE courses proliferated, but in some cases coverage of sexual matters was much reduced or even lost. A newer approach, "life planning," which combines family and vocational planning, tries to create a politically acceptable package while keeping the sexuality and family planning component strong. Integration must be carefully considered: Will it help or hinder meeting the main program objective?
    Collaboration, as contrasted with integration, can help to reach new and larger audiences. For example, the Planned Parenthood Association of Thailand has helped the government FLE project reach close to one million students—80% of those in public secondary schools (228). Choosing collaborators with political strength can be key, especially when serving young adults is new and controversial.

4. Communication and outreach: twin tactics. Communicating with young adults has special importance. They are learning about sex and developing values. At the same time they are influenced by peers, subject to conflicting influences, and very selective about whom they trust. Programs can reach young adults through strategic use of mass media and outreach.
    Through careful choice of spokespersons and mass media, programs can address young audiences with messages of sexual responsibility, as has been done in Latin America, Nigeria, the Philippines, and elsewhere (see supplement, Reaching Young Adults Through Entertainment).
    At the same time, program personnel, too, must reach out to young adults. In Mexico trained workers who traveled to schools and other places that young people gather proved more effective and more cost-effective at reaching boys than a youth center (479). Outreach may be the only way to reach some groups, such as street children and commercial sex workers as well as young men.

5. Consider the cultural context—but don't be ruled by it. It is axiomatic that each project needs to take account of its specific cultural setting. At the same time, however, cultural practices and values should not be accepted simply because they are traditional. Some practices, such as female genital mutilation, are clearly harmful and need to be addressed (see supplement, Female Genital Mutilation: A Reproductive Health Concern). Less tangible are harmful attitudes, machismo, and double standards about sexual behavior, authoritarian attitudes towards youth, and youth's own fatalism that ill-health or personal calamities are unavoidable (472). Given that social and cultural influences make more difference to young adults' health than biological conditions, enabling young adults to make good health decisions should be a major program objective.

6. Don't promise more than you can deliver. Many pro-grams set objectives too optimistically. Ambitious objectives may attract donors but can lead to disappointment later. In setting objectives, remember: First, public health campaigns take time—even decades—to change attitudes and behavior on a large scale. Donors' desire for statistically significant reductions in pregnancy rates during a youth project of one to five years is not always realistic; meeting intermediate objectives is more feasible. Second, if reducing the incidence of pregnancy is a goal, education and counseling must be linked to family planning services. Too many programs have succeeded in educating clients but, for lack of services, failed to reduce pregnancy rates.

7. Use policy to enable; don't let it be a barrier. Laws and policy do not always determine or precede social change, and they often are ignored if they are not consonant with cultural realities. Still, legislation and policy can educate the public to the importance of reproductive health and encourage support for healthy behavior. Where policy statements or attempts to legislate might create a backlash, however, programs for young adults often can proceed slowly but steadily without enabling legislation. In other situations no activities are possible without legal underpinnings, and in the long run public debate helps make social change possible. In either case, advocates must arm themselves with facts, arguments, and relevant experiences from similar settings.

8. Take risks and commit to change. Bold leaders are greatly needed to advocate meeting young adults' reproductive health needs. Such leaders take risks and, while acknowledging the importance of culture and tradition, make a commitment to change. Many programs fail for lack of courage to keep up public advocacy on new or sensitive issues. One risk worth taking is providing information to young people early—ideally before they first have sexual intercourse. Few programs have been willing to do so, even though studies show that these programs have the best results (see Chapter 4.2).

9. Involve young people in planning and implementing programs. Another risk worth taking is letting young people speak for themselves by involving them in program design. Although young adults in every region have served as "peer educators," involving young adults in designing programs is a new idea in many places. Young adults can provide insight relevant to program design for the same reasons that they succeed as peer educators: They speak their peers' "language" and understand what motivates them (134).
    Young people can argue convincingly for change in their changing world, and they can take action. For example, moved by the death of a fellow student after unsafe abortion, medical students at the University of Ibadan in Nigeria started the MUDAFEM project (Multidimensional Approach to Adolescents' Fertility Management) (16).

10. Respect the young people that you serve. Program content and delivery should respect young adults' perceptions and preferences. Young people need nonjudgmental, confidential, and caring professionals. Educators and service providers, however, too often take a moralistic and condemnatory attitude toward young people. Sure ways to lose young people's trust are to ignore their needs, exclude them from project planning, and preach "what's good for them."
    Full and equal respect for young women is absolutely crucial. While every project should ensure gender equality, some projects must work especially hard to overcome the impact of discrimination in the culture at large. In every country young women suffer from lack of self-esteem. In some countries young women also suffer physical illness and nutritional deficiencies due to unequal treatment (316).
    In the long run educational and service programs for young adults will thrive where community norms support openness and respect. Such norms encourage communication within the family and in the community. These new norms will allow programs to go beyond simplistic campaigns that only condemn unhealthy behavior and instead to deal with the complexity of young adults' educational and developmental needs. Together, programs and communities can help young people find their way to healthy and safe behavior.

Judith Senderowitz, M.A., founded the Center for Population Options (now Advocates for Youth) and served as its president for 12 years. Under her leadership the organization pioneered many approaches to improving the health of young people including "life planning" education, the use of entertainment to inform youth, school-based clinics, and the International Center on Adolescent Fertility. Recently, she has worked with the World Bank and the United Nations Population Fund on youth issues.

Parents can...

• Make sure that they themselves are well-informed about reproductive health matters;
• Talk with their children about reproductive health and sexual responsibility and answer all their questions fully and accurately;
• Listen to their children compassionately, without dismissing their concerns as childish or condemning their questions as improper;
• Appeal for and support national, community, and in-school efforts to provide young adults with reproductive health information and services;
• Encourage the health, safety, and intellectual development of their daughters as well as their sons, and encourage their sense of self-esteem;
• Teach their sons that it is irresponsible to make a girl pregnant if they are not ready to marry or support her and the child; and
• Adopt responsible sexual behavior themselves, especially toward children.

Political leaders can enact and enforce laws and policies that...

• Improve young people's access to reproductive health information and services;
• Prohibit the abuse of young people, including sexual abuse and female genital mutilation;
• Prohibit child marriage and raise the minimum legal age at marriage;
• Make public statements that emphasize the importance of young adults' reproductive health;
• Endorse and support realistic, compassionate solutions to young adults' problems;
• Insist that the news and entertainment media provide more responsible coverage and treatment of sexual behavior; and
• Increase commitment to keeping girls in school.

Community and religious leaderscan...

• Urge understanding, compassion, and concern for young people;
• Make the community aware that there are social as well as personal causes of young people's reproductive health problems;
• Inform themselves and others about young people's health needs;
• Initiate efforts to provide young people with reproductive health information and services;
• Advocate and organize substantial reproductive health programs in schools;
• Condemn a double standard that encourages boys' sexual activity while punishing girls'; and
• Call for responsible depiction of sexuality in the mass media.

Leaders of reproductive health programs can...

• Establish health care protocols that meet the needs of young adults;
• Be sensitive to the concerns of the community while acting as advocates for meeting young adults' needs;
• Involve young people in program design, delivery, and evaluation;
• Train health care providers to offer high-quality care to young adults in a nonjudgmental, confidential manner;
• Make clear to staff and the public that young clients are welcome and that their care has high priority;
• Provide information and services at times and in ways that are acceptable and convenient for young adults;
• Remove other unnecessary barriers to services, including limits on access to contraceptives for reasons of age or marital status;
• Help the mass media inform the public about sexuality and reproduction accurately and encourage the entertainment media to depict sexual behavior responsibly; and
• Know where to refer young people for more information and health services.

The mass media can...

• Stop glorifying irresponsible sex;
• In entertainment, depict people who benefit from using contraceptives and otherwise behaving responsibly in sexual matters;
• In news coverage and other infor-mational formats, provide accurate information and healthy guidance about reproductive health and contraceptives, and make the public aware of young people's health needs;
• Provide free air time or space for messages that inform young adults and encourage healthy behavior; and
• Address parents with accurate information and guidance on talking with their adolescent children.

Educators can...

• Develop school curricula that give students age-appropriate information about reproductive health;
• Train and support teachers so that they can teach about reproductive health and contraception accurately and comfortably; and
• Facilitate better communication about sexuality and contraception between students and their parents.

And young adults themselves can...

• Work with parents, community leaders, teachers, and health care providers to design mutually acceptable approaches to meeting their own reproductive health needs;
• Act responsibly in sexual matters, for their own sake and that of others; and
• In sexual situations, respect the rights, wishes, and concerns of others, including use of contraceptives to avoid unwanted pregnancies and ofcondoms for STD protection.