Thus reproductive health education and services for young adults attract public attention and generate public controversy. Religious leaders, politicians, educators, or parents may object to such programs. This opposition sometimes takes health professionals by surprise. Health professionals see such programs as intended to improve and protect health—a goal that they assume everyone shares. Health is not the first concern of many program opponents, however. They often see sexual behavior as a moral issue or as an issue of parental authority. They may argue that only parents or religious leaders should teach young people about sex, and they may consider health or education professionals to be inappropriate sources of information and guidance. Indeed, most adults agree that parents should inform their children about sex and guide their behavior. Also, in places as diverse as Kenya, Mexico, and Zaire, community leaders, too, have been respected sources of sexual education for generations (31, 40, 252, 256, 279). By comparison, organized programs that would share this responsibility are a new idea.

Therefore winning the support of the community—important to any social program—is both vital and challenging for reproductive health programs for young adults. Winning community support requires helping parents and leaders to understand health issues inherent in young adults' sexual behavior, to recognize the need for program action, to agree on solutions, and to work with and trust health professionals to carry them out (572).

Working with community leaders. Programs have won support from community and religious leaders by forming early alliances with sympathetic leaders, by showing that young adults' health needs are important, and by involving community leaders in program design and implementation. In Ethiopia, Kenya, and the Philippines, for example, ongoing programs inform adults in the community about the health needs of youth (200, 351, 449). In Mexico a program enlisted community leaders to serve as outreach workers in poor communities, thus giving these leaders direct contact with young adults' reproductive health concerns (219, 408). In Jamaica community leaders helped design health services and then joined in program activities and monitoring. As a result, the program was accepted in an area where community dissension had undermined previous efforts (503).

Health care professionals are community leaders, too, and deserve special attention. The Johns Hopkins Program for International Education in Reproductive Health (JHPIEGO) has worked with physicians in Latin America and elsewhere to set medical quality-of-care standards and build support for services for young adults (116).

Working with parents. One good way to work with parents is to give them the help and support that they want in guiding their children. Parents and young people often say that they want to talk together about sex, but most fail to do so (88, 174, 199, 229, 230, 249, 279, 343, 348, 444) (see sidebar, Where Do Young People Learn About Sex). Many parents delay talking to their children, perhaps because they feel ill-informed or embarrassed. Some fail to acknowledge that uncertainty is normal in learning to make sexual decisions and alienate their children by demanding rigid obedience. Others present sexuality in a negative way that their children do not find credible (31, 130, 174, 279, 392, 496, 527).

Several programs have helped parents communicate with their adolescent children. One US program made parents more aware of the social pressures on their children to be sexually active. Then parents rehearsed ways to help their children resist these pressures (68). In the Philippines the Foundation for Adolescent Development (FAD) produced a video to show parents that their communication with their children shapes the way that their children communicate with others (449). In a US school program, teachers gave students the assignment to talk to their parents about sexual abstinence and contraception. This approach bypassed parents' reluctance to start such conversations (260). As part of a larger effort to meet the needs of young adults, since 1986 the Zimbabwe National Family Planning Council (ZNFPC) has offered a Parent Education Program to help parents educate their adolescent children about human sexuality and reproductive health (594). In Tanzania community educators offer a manual to help parents discuss sexuality with their children (496).

Young adults endorse informing and helping parents. In research in Ghana and the US, young adults asked for programs to increase parental awareness of the pressures in their children's lives (102, 343).

Programs that value parents' concerns and seek their support can involve them at every stage of the project. Health programs for youth have surveyed parental opinions and attitudes before designing programs, have pre-tested material with parents, have set up advisory groups to elicit parents' advice on an ongoing basis, and have asked parents to evaluate the program (31, 325).