Reduce legal and informal restrictions. The age of consent for medical treatment is as low as 14 years in parts of Canada and New Zealand but as high as 18 years in South Africa. In some places, such as the United Kingdom, the legal age of consent for medical procedures is lower than for voting or entering legal contracts (371). Because of the controversy surrounding advice and treatment for minors, many health departments and school boards take the conservative position of denying services or programs to young people who are legally minors.

Many young adults find it difficult to obtain guarantees of confidentiality. If young people do not have the legal right to choose or consent to reproductive health care, they can be denied confidentiality. Moreover, where sexual intercourse is illegal for minors, some argue that health care providers who offer minors contraceptive advice or methods are condoning illegal acts (2, 22, 197). At the level of program policy rather than law, some parents insist that they should be present or be notified if their children seek reproductive health care. They argue that young people are too immature to understand medical advice or to make health decisions, and they require their parents' guidance.

Requirements of spousal consent, too, can deny confidentiality even to married young people. When women marry young, their husbands, families, or health professionals may not acknowledge their right to make their own decisions about reproductive health.

Many young adults are not willing to use services unless they are confidential, however. Young adults are often shy and uncertain, and they fear ridicule and disapproval. For example, in a US study 30% of sexually active women younger than age 19 said that would not go to a reproductive health clinic because they feared that their parents would find out (565). Many advocates for young people recommend that health professionals encourage young people to talk to their parents but still meet young people's health needs whether or not their parents can be involved (2).

Many young people find it easier to buy supplies such as condoms and spermicides than to go to a clinic or counselor. Thus laws and policy that allow sales of contraceptives to young adults and unmarried people are important. At the same time, other ways to distribute contraceptives should be available, particularly to those who cannot find a place to buy them or who cannot afford them.

Change hostile, judgmental, or reluctant attitudes. Even where law and policy give young adults access to reproductive health information and care, hostile or reluctant individuals may stand in the way. Teachers or health care providers may strongly disapprove of young adults who are sexually active or even those who seek just information about sexuality. They may think that, instead, they should tell young people how to behave. Others may feel uncomfortable discussing reproductive health with young people or offering them services. Authoritarian strictures and embarrassment will not help young people develop a positive attitude towards sexual responsibility, however (346).

To avoid prejudices, clinic managers need to give their staffs clear guidance about how to treat young clients. Providers also need to recognize and reassess their own feelings. In an Italian clinic, for example, some providers scolded young clients and told them to change their behavior (110). In Senegal nurses' aides who screened women at family planning clinic entrances turned away young unmarried women (393). In South Africa clinic staff refused to answer young clients' questions (5). In all three cases clinic managers trained the providers to serve young people politely, in part by helping the providers become aware of their own feelings about sexuality among young adults. In particular, counselors must understand that they will not be effective if they dictate to young people what to do. Instead, they must help them make responsible decisions for themselves.

Teachers may feel even less comfortable discussing reproductive health than health care providers would feel, and they may fear criticism from parents. They usually need extra support and training to teach FLE material. For example, in Kenya many school principals and teachers oppose teaching about contraception. As a result, only about 16% of school FLE courses discuss contraceptives, even though the government supports FLE courses as a way to reduce pregnancy (320).

Programs can address teachers' reluctance and help them face criticism. A Mexican program involved teachers in program design, trained them in presenting the material, met with them regularly as they taught the material, and met with parents periodically to answer questions. As a result, teachers became more convinced of the value of the course and more willing to teach it (482).

Some teachers are not appropriate sexuality educators, however. Focus-group research in an African country, for example, found that some male teachers pressured female students into sexual intercourse (41, 444).