60 years ago, when the International Planned Parenthood Federation (IPPF) was first founded, the notion of family planning as a human right was hugely controversial. In many areas, the issue continues to be controversial, and the struggle to highlight the importance of family planning and sexual and reproductive health has been a difficult one. Indeed, a recent report from the UN Population Fund found that additional spending on family planning in poor countries could save them $11 billion a year and reported that government support for sexual and reproductive health has been diminishing in recent years.
Nevertheless, the issue of family planning has come on leaps and bounds since the mid-20th century, and at the forefront of this struggle has been the IPPF. Originally set up in 1952 by eight national family planning associations in India, the IPPF is now a federation of 152 Member Associations, working in 172 countries. In 2011, the IPPF delivered over 89 million sexual and reproductive health services worldwide. And the advocacy work performed alongside service intervention means the organisation has immense influence in shaping sexual health agendas across Africa and globally.
To mark the organisation’s 60th anniversary, Senior Advisor Doortje Braeken spoke to Think Africa Press about how the IPPF’s mission has developed since its founding and about a recent survey aimed at representing young people’s attitudes and concerns about sex across the African continent.
The IPPF started as an organisation of volunteer family planning agencies. From the beginning, we were a combination of organisations aimed at delivering services and promoting access to contraception, but we also fought for the rights of women to have access. It’s not enough to provide services; the environment must be conducive to providing access. IPPF was not a government-organisation but an NGO, therefore we could push boundaries.
In the 1970s and 1980s the organisation moved away from getting family planning to married women to focusing on the whole issue of sexual health. Our work is not just about pills or condoms but about the broad spectrum of sexual health. The idea that young people are sexual beings is at the forefront of our agenda now. We have shifted our thinking to seeing young people as our partners, and now work with a lot of people under 18. We have a world-unique requirement that 20% of the NGO’s board members must be below 24.
The IPPF was brave and unique in the move into the field of sexuality. People use contraceptives because their want to enjoy their sexuality without fearing the consequences. Our approach now is more holistic and rights-based, understanding how sexual rights translate to young people. In a way, young people should have the same sexual rights as adults but must be protected from any form of harm, such as abuse and non-consensual sex.
We are trying to translate the sexual rights of young people into the reality by working on a comprehensive sexuality education. So far, much HIV education has been fantastic, looking not only looking at health outcomes but also empowerment, understanding human rights violations and solidarity.
The beauty of our organisation is that it is a federation that works with organisations on the ground. These organisations are independent, but to be a member of IPPF, they must adhere to certain goals and management ideas.
The IPPF only works with the grassroots, maintaining high-quality services. This allows service providers to respond to young people's real lives in their many different contexts. Our organisation is there to fulfil the rights of our clients.
We wanted to know more about attitudes, practices and concerns about sex in Africa from the perspective of young people themselves. Data was collected from across four countries: South Africa, Namibia, Nigeria and Zimbabwe.
The survey really provoked the interest of young people; over 9,000 respondents participated within one week. The use of the mobile phone in collecting data was really important, highlighting that need to conduct research through mediums young people across the African continent connect with.
The survey revealed consistencies in some places and disparities elsewhere. Of concern is that 27% of young people in South Africa said they never use contraceptives, with the figure at 38% in Zimbabwe and Nigeria, and 24% of young people in Namibia.
On the issue of sex education, in all four countries, friends were a key main channel of information. Peers can be a source of misinformation and myths, but these findings mean that informal channels of education must not be dismissed. We need to find ways to include issues about rights in peer education projects, including friends and siblings. It is essential to develop good sexuality education in schools and to support parents. Formal education is key, but these findings show the importance of also using informal channels.
One of the most striking findings is that young people wanted to use contraceptives but could not get hold of them; information has been provided but there were problems with supply. It is unethical to give information without linking this to service provision. Policies must be in place to ensure that services are there and young people can access them. It is also essential to develop education programmes that ensure service providers are non-judgemental when dealing with young people.
Quantitative research is important, but we need to follow it up with in-depth understanding. We need to understand the meaning of terms in specific contexts and understand what researchers actually do.
The IPPF has invested in training young people as researchers. In Liberia and Sierra Leone, young mothers and pregnant girls have gone into the field with a camera to talk to their peers and conduct qualitative research. This gives honest and genuine answers essential to understand the needs of young people.
The questions that are not asked are around why young people have sex and about sexual diversity. HIV/AIDS programmes often talk about risks and problems. We need to engage with the more enjoyable aspects of sex, learning and engaging with young people to make sex safe.
Sex is often medicalised to an extent in sex education and HIV/AIDS programmes, but sex is more than a medical issue. If sex is about enjoyment, it becomes easier to talk about prevention via a different entry point. This process is characteristic of wider changes to the HIV policies from the 1980s, whereby policy was moved away from the education sector to the health sector. The shift meant that programmes needed outcomes, and whilst this approach opened a lot of doors, we now need a more comprehensive, gender-sensitive and sex-positive outlook to HIV/AIDS.
It’s important to realise that young people are sexual beings just like everyone else; we are there to put decisions into practice. There is sometimes a tendency to separate out HIV from other issues that impact on the sexual lives of young people. The IPPF is working to bring the whole context of sexuality together, reintegrating HIV/AIDS education with other issues that affect young people.
A biomedical approach which focuses on prevention can mean that we forget about all of those young people who are HIV-positive. We now need to focus on how to make the lives of young people ‘happy, healthy and hot’, putting these individuals back on our radar.
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