(September 2010) With almost half of the world's population under age 25, investments in young people are vital to improve economic and social outcomes and achieve the Millennium Development Goals (MDGs). Recognizing the importance of harnessing the energy and initiative of the world's youth to contribute to development efforts, the United Nations proclaimed Aug. 12, 2010, the start of an International Year of Youth. This proclamation offers new and exciting opportunities for governments, civil societies, individuals, and communities to create awareness about the diverse health needs of young people and develop effective policies that address these needs.

What are some of the challenges facing youth? How can greater policy and programmatic investments in adolescent reproductive health help countries mitigate these challenges and achieve the MDGs? How can policymakers, practitioners, and advocates work together to mobilize and engage new partners in youth development, including youth themselves?

During a PRB Discuss Online, Jenny Truong, youth reproductive health advisor at USAID; Alexandra Hervish, policy analyst at the Population Reference Bureau; and Brad Kerner, adolescent reproductive health senior specialist at Save the Children, answered questions from participants about the importance of investing in youth development and adolescent reproductive health policies and programs. This Discuss Online session was sponsored by the BRIDGE project, a cooperative agreement between USAID's Global Health Bureau and PRB.

Sept. 23, 2010 1 PM EDT

Transcript of Questions and Answers

Remi Akinmade: How can the developing countries leaders (especially Sub-Saharan Africa) attention be drawn to the mass unemployment of youths - leading to hunger, neglect and being used as instruments of violence to foment communal clashes, political unrest . . . ? Their future is being destroyed.
Brad Kerner: Maybe civil society can start putting more pressure on governments and making them more accountable for the survival and wellbeing of youth. This International Year of the Youth provides and excellent platform for this.
Alexandra Hervish: Please see my response to Sanjay Mishra. For addition information, see International Alert’s publication entitled Rethinking the nexus between youth, unemployment and conflict – Perspectives from Sri Lanka at http://www.international-alert.org/pdf/LEO_Sri_Lanka.pdf.

C S Radhakrishnan: The latest UN initiative to have yet another International Year of the Youth is timely. There seems to be an excessive weighting of the discussions on the sexual Health side. Without minimizing the need for such discussions, isn't it necessary that we address the problems of youth in coping with emotional problems of growth, need for a proper orientation towards social responsibility at the crucial stage of personality development of the young persons?
Jenny Truong: Dear C S, Thank you for your insights. The International Year of Youth is a fabulous opportunity to bring all issues to the attention. Reproductive health issues continue to be important because the risks of mortality and morbidity related to pregnancy and childbirth, particularly in sub-Saharan Africa, remain one of the highest risks for young women. Comprehensive sexuality education programs often address emotional issues related to growth and puberty. Various U. N Agencies have created guidance to help schools, teachers, and health educators design such curricula. See http://unesdoc.unesco.org/images/0018/001832/183281e.pdf  
Brad Kerner: Thanks for your insights. I agree with you, this is a very exciting time. Since 1999, we have been celebrating the International Youth Day on August 12, but to have a full year declared by the UN that focuses on Youth Development adds to the momentum we are currently experiencing. This momentum is signaled by an increased recognition of the role youth play in the development of their societies (viewing youth as assets and contributors) as well as increased investment in youth. As an Adolescent Sexual and Reproductive Health specialist, I am quite pleased by the US government's commitment to women and girls in their Global Health Initiative. It might seem that there is an excessive emphasis on the sexual and reproductive health side this year, but that is because we have some facts:
• Complications due to pregnancy and childbirth as well as unsafe abortions are still the number one killer of girls 15 to 19 years old with young women aged 15 to 19 are twice as likely to die in childbirth as adult women.
• Young people have the highest levels of unmet need for contraception; less than 5% of the poorest sexually active young people use modern contraceptive methods.
• Half of all new HIV infections occur in young people between the ages of 15 and 24.
These are just a few statistics but it is important to note that such negative sexual and reproductive health outcomes have economic and social consequences that affect young people throughout their lives, as well as their families and communities. I would also argue that working with youth on coping with emotional problems of growth and the need for a proper orientation towards social responsibility is all part of a young person's emotion, physical and sexual development. It's all linked together. So yes, young peoples' needs and contributions extend way beyond sexual and reproductive health. So go for it. This is the International Year of Youth. Create an event with youth that looks into these issues. See the UN framework for the year at: http://social.un.org/youthyear/unapproach.html
Alexandra Hervish: You bring up some very pertinent points. You are quite right that youth development is interdisciplinary. A holistic, life-cycle approach to youth development recognizes that the physical, emotional, and cognitive needs of young people evolve as they transition from childhood to adulthood. From this perspective, while discussions about sexual health often examine the physical elements of reproductive health, they are not necessarily exclusive of the cognitive and emotional aspects of adolescent development. Increasingly there are more and more integrated youth policies and programs that focus on the implications of gender on health, empowering young people to make healthy decisions and realize their personal goals, or developing young people’s life skills to respond to complex challenges in particular socio-cultural contexts. One example is Instituto Promundo, a Brazilian NGO that conducts research, promotes programs, and advocates for positive changes in gender norms and behaviors among individuals, families, and communities. For more information, visit http://www.promundo.org.br/en/.

Issa Almasarweh: Do you think that investing in youth implies revising education and training curricula to make them more relevant to developing countries and youth survival needs? Million of children and youth in these countries spent their whole summer learning how to memorize religious scripts they don't understand their meaning in stead of learning skills that will help them do their daily life duties, work, earn income and survive.
Brad Kerner: Dear Issa, Yes, I think we can definitely do a better job at making curricula more relevant to the needs of youth. When was the last time we talked to youth involved in our programs and initiatives to see what they like and don't like about what they are learning? Are we afraid of what we might hear? Moreover, so many national curricula are still void of health and development issues that would give children the real skills they need in their lives. When these issues are included in a national curriculum, especially sexual and reproductive heath topics, training for teachers often fail to adequately prepare them to comfortably address and teach these issues. There are lots of great resources out there on how to integrate SRH issues for youth from a religious perspective. Check them out: http://info.k4health.org/youthwg/trainingmaterials.shtml
Alexandra Hervish: Thank you for your question. Looking at education from a holistic perspective, basic life-skills training on livelihood and workforce development, sexual and reproductive health, and the transition from childhood to adulthood can prepare young people to contribute to national development and improve their lives. While life skills education does not necessarily need to replace formal school curricula, it certainly offers a complementary type of learning. It can build young people's skills in problem-solving, leadership, decision-making, interpersonal communication, self-awareness, and coping with challenging situations. It can provide information about how to participate in civic life, protect oneself from HIV, or manage money. When considering life skills education programs, it is important to define which skills should be taught, why they need to be taught, and how they are used in particular life situations. In addition, life skills programs require an understanding of the local context and the realities in which young people live their lives. While formal schools may offer one learning environment, it may be more effective to offer non-formal or informal programs to reach the large numbers of young people who are not in school.
Jenny Truong: Thank you Issa for your question. I agree with you that curricula have to be made relevant in order for them to be effective at imparting knowledge and skills that will help them earn income and not just survive, but flourish. See the link I included in my response to C S.

jin in: This timely and exactly what we need to focus on. Unfortunately in too many societies, youth are NOT valued, particularly girls. It's why I started a global organization dedicated to girls' leadership development AND a "glocal" (think global, act local) social change MOVEMENT to value and invest in the world's poorest girls. Thus, how can we work towards transforming traditional societies to first value young people esp girls? If you have models/recommendations, I'd be delighted to learn. Thank you.
Jenny Truong: Dear Jin: Congratulations on your "glocal" social change movement! I think you're exactly right that this needs to be a movement, and know that you are part of one. There are many organizations who are dedicated to the same goals you are. A lot can be done when we share the successes we achieved and challenges we face. I second Brad's suggestion to check out the Girl Effect and the Coalition for Adolescent girls – you'll be glad you did!
Alexandra Hervish: Thank you for your important question. Transforming the position of youth, especially girls, involves understanding their lives, challenges, and opportunities. Part of this process includes educating families and communities and creating awareness about how young people can contribute positively to development. In a sensitized and enabling environment, it is easier to promote youth and girl leadership, allowing youth to be agents of change. A great example of an organization that supports community-led development and has empowered communities to bring about change for young people is Tostan. For example, Tostan has been very successful in raising awareness about female genital mutilation and placing communities in charge of the decision-making process. For more information, visit http://www.tostan.org/.  
Brad Kerner: Well, it sounds like you should be teaching us as your experiences would be so helpful to the global community who cares about girls. I love that you focus on girls' leadership development and call it a global social change movement! Because that is what we really need, first families, then communities, that countries to start to see the value of girls and how they have so much to contribute to society. I don't personally know models but I think you can find all your answers at: http://www.girleffect.org/. Watch the opening video. It will give you the chills and make you cry; then it will inspire you to keep on doing your amazing work. Then, within the site, you can find many resources to help you with your work. Also consider joining the Coalition for Adolescent Girls and share all that you are doing because you might have the solution we are all looking for! http://www.coalitionforadolescentgirls.org/  

Dr. Anima Sharma: As we all know, curent demographic trends show an inclination towards the increase in the youth population, especially in the developing countries. Children and youths are the future of the society hence we also see a global trend of investing resources on the youths and making youth centered programmes, policies and development strategies. The focus of all these are usually health and education. These are the important areas for the healthy development but as a Social Scientist I am also concerned about the restoration of non-material, cultural aspects. Youth is the most vulnerable phase of life, which determines the future trends of not only one's own life but the entire social system. Hence, I think we need to inculcate the basic values and virtues of humanity in them. The youths are becoming independent, which is good but with that they are also becoming insensitive towards their duties and responsibilities. In several cases I have found that they lack basic civic sense, patriotic values and spirit of fulfilling the expectations of others. There are studies suggesting that modernization and industrialization has brought tremendous change in the social structure and social system, which has affected the psychological growth of all the people across the demographic borders but youths in particular. Hence, I want to suggest that would it not be better that rather than focussing on their physical growth only we should also focus on their psycho-social development to make their personality balanced, wholistically?
Brad Kerner: Dear Dr. Sharma, Yes, you are correct about the demographic trends. Today's generation of young people is the largest in history — nearly half of the world’s population is under the age of twenty-five. This large demographic of young people presents the world with an unprecedented opportunity to accelerate economic development and reduce poverty. I do not think anyone would argue with you, that we need to invest in young people's psycho-social development from a holistic perspective. We all have examples when youth, with the support of caring adults, have created civic movements that benefit all. And in doing so, youth have gained life-long skills. But I would like to turn your question back to you: Do youth lack basic civic sense, patriotic values and spirit of fulfilling expectations of others? Or are they picking up these values from the adults and society's resistance to change? I think we need to challenge ourselves as adults and question what kind of role models are we being for young people. I also think we need to challenge what the "expectations" are of young people. I think it is great if youth challenge certain social expectations; like the expectation of girls to marry early, bear many children and serve her family and husband before developing her own capacities. These are expectations worth challenging through social movements like the one our colleague, Jin In, is trying to do.
Jenny Truong: Dr. Sharma, thanks for your questions. You're right about the demographic transition and its implications for the large population of young people that need to have access to education and health information and services. The world is constantly modernizing and will constantly change the environment in which generations of young people grow, mature, gain values, and form opinions about their role in society. What remains are the social networks in place, which includes this requires engaging parents, family members and community members. You might appreciate "Growing Up Global", a comprehensive compilation of essays of how the transition to adulthood has changed in the past twenty years http://www.nap.edu/catalog.php?record_id=11174  
Alexandra Hervish: Thank you for your question. Please see my response to Issa Almasarweh on holistic youth development.

Sanjay Mishra: Investment in youth needs to be increased or reanalyzed the ways and methods it has been done as of now. If we look at trends, in Africa lots of youths are deprived of technical education which can efficiently make them able to earn livelihood therefore, HIV/AIDS prevalence is still high, child mortality is staggering high, malaria, malnutrition and hunger a giant issue. Besides in central and north/west Africa - due to low investment in education - mass-killings and other blasphemous events are happening. Similarly in Asia/South East Asia more or less the situation is same. So is there any specific measurement to prevent youths from going in hands of illegal mentors who are converting them into a mass killer or deviating them from the mainstream of the society? Also what is the current global investment trends in the these affected societies?
Brad Kerner: Dear Sanjay, This is a hard question for me to answer as my professional career has truly been focuses on Adolescent Sexual and Reproductive Health. But it does seem that with an increased investment in giving young people economic skills and making education and trainings relevant to their lives and the job market, while improving employments rates, is just one (simplified) solution to making young people feel less marginalized and contributors to their societies. When more young people have money in their hands and are contributing to an economically stable society, and feel values and mentors by pro-social adults, they will be less likely to fill their hands with stones. I use this example, because it seems like this is the image the media wants us to see; frustrates and violent youth throwing stones and crating chaos. But we all know this does not represent the actions of all youth, but possibly a shared frustration. I would love to hear other peoples thought on this as this is a tough debate that one should have over a very long meal with good food and friends!
Jenny Truong: Sanjay: While I am not an expert in violence prevention and have not worked directly young people in conflict settings, we know that having at least one caring adult in a young person's life makes a difference. Many international studies have shown that young people who are close to one adult, whether it be a parent, aunt, grandmother, teacher or religious leader, are more likely to have positive outcomes, including more likely to stay in school and to avoid risky behaviors.
Alexandra Hervish: Thank you for your question. You highlight an interesting issue that has garnered greater attention from the international community: the relationship between young people and violence. Large numbers of young people are not necessarily a destabilizing force in society; in fact, young people play a critical role in achieving sustainable peace. Yet in some contexts, jobless youth – particularly young men – who have few opportunities to participate meaningfully in society are recruitment targets for individuals engaged in extremist or violent activities. Other factors may shape decisions to engage in violence, including social exclusion, discrimination, or gender, political, or geographic identities. From a broad perspective, it is critical to create an enabling environment that supports positive and constructive roles for youth. This includes providing educational and economic opportunities, skills training, and reproductive health programming for young people. The Inter-Agency Network for Education in Emergencies' (INEE) Adolescent and Youth Task Team (AYTT) is comprised of a group of individuals from UN-agencies, international and national NGOs, practitioners, researchers and policymakers who work together to ensure a coordinated, evidence-based response to the needs of adolescents and youth affected by crisis. You can learn more about the Task Team here: http://www.ineesite.org/index.php/post/adolescence_and_youth_task_team/. In addition, the United Nations Development Program published a document about youth and violent conflict, which includes a review of policy frameworks and programming. It can be found here: http://www.undp.org/cpr/whats_new/UNDP_Youth_PN.pdf.  

Dr. Victoria I. Ngomuo: Youth population without any activity to do in developing countries is increasing. This is due to lack of financial support in developing the activities for those trained and unemployed ones as well as for those uneducated ones. How can we talk on youth development, if even the possible agricultural activities in these countries cannot been employed for providing employment and industrial development due to lack of technical and finacial support to even develop agricultural activities and industries in rural areas for sustainance?
Brad Kerner: Dear Dr. Victoria, I think we do need to get better at how we invest in the livelihoods of young people. And I really wish we had a youth livelihoods expert as a part of this discussion. There two US based organizations that do great youth livelihoods work: Making Cents International and International Youth Foundation. My own organization, Save the Children, has also embarked on a project called Youth Save, which will look at new models of economic strengthening activities for youth. Through my work on Sexual and Reproductive Health, I have seen health programs that want to also work on livelihood development of young people but they often fail to be successful. I think this is because sexual and reproductive health should stick to what they are good at, SRH, and link up with other organizations that have the expertise in programming livelihoods activities with youth. I have also seen livelihoods initiatives fail when youth are given seed money to start up an income generating activity, then profits from the first cycle of their income generating scheme is not reinvested. But I also have seen Village Savings and Loans groups with youth that have been very successful as well as micro-lending institutions who have adopted more youth-friendly policies and mentor youth they are lending to. I have a lot to learn as to what makes one intervention more successful than the other but my sense is that the Village Savings and Loans groups are appropriate because of the incentive to pay back the loan and receive a large micro-loan. We all need to learn more about economic strengthening and what types of interventions are appropriate depending on individuals' level of poverty. I learn more and more about this everyday from some amazing colleagues here at Save the Children.
Jenny Truong: Dr. Ngomuo, thank you for your question. I agree that any youth development approach needs to include discussions about how young people can gain employment in both agricultural and industrial settings. Governments can play an important role. First they can consider how to ensure young people can stay in school long enough so that they can gain the appropriate knowledge and skills, have opportunities to enter the labor market, and once in, be able to move to new jobs and earn new skills.
Alexandra Hervish: This question is outside of my expertise. Rural economies do offer an opportunity to generate employment, particularly for young people. However, appropriate training, professional development, and technical and vocational education are needed to provide young people with the proper skills and knowledge. Addressing barriers such as insufficient numeracy and literacy skills requires the collaboration of donors, governments, and communities to improve young people's access to general education opportunities whether it is through formal or non-formal education systems. Perhaps most importantly, it is critical to invest in agriculture in ways the meet the demand of young people's aspirations. This factor is especially important for girls and young women who have limited social and business networks.

Dr. Victoria I. Ngomuo: The development gap between the developed and developing countries is extremely high and the most affected ones are the youth migrating from rural areas to urban areas seeking for green pastures. Why can't the developed and industrialised countries assist in developing the agricultural and industrial sector in rural developing counties for betterness of youth future?
Jenny Truong: Dr. Ngumuo, I wish my colleagues at USAID who work in agriculture and workforce development could join this discussion as I think the programs they would tell you about would interest you. This is an important area of priority for the agency and I am confident that these issues have particular priority because they relate to youth. See http://www.usaid.gov/our_work/economic_growth_and_trade/
Brad Kerner: Thank you for this question. I fear the answer to your question is more difficult than I can formulate and can become political. And I think all of us who have worked in International Development ask these same questions. I will not attempt to pretend I am an expert on this subject, but thanks for raising this issue.
Alexandra Hervish: Thank you for your question. Again, agricultural development is outside of my area of expertise. You are right that creating better employment opportunities for youth requires greater investment in the agricultural and industrial economies. It is also important to match the technical skills of youth to labor market demands. As mentioned earlier, this requires delivering education and training opportunities for young people and addressing existing discrimination in the labor market. Recognizing the place of the informal economy is also important, especially when considering what economic opportunities are available for young women. Informal jobs do offer more economic options for youth, but low earnings and unsafe working conditions provide limited economic security. Thus incorporating vulnerable populations into value chains and strengthening microenterprises is important to improve youth employment opportunities. An example of an organization utilizing a value chain approach to improve growth opportunities for adolescent girls is Cadno Emerging Enterprises (http://www.cardnoem.com/Services.aspx?ServiceID=82c370e5-ee36-46ac-baa8-02674af5dab9&Article=Microenterprises%3A+Incorporating+Vulnerable+Populations+into+Value+Chains).  

Dr. Benson Gabriel: The issue of youth is a growing concern for some of us especially in developing countries. Several challenges face the youth. Unfortunately, most of these are man-made. Now how do we address the challenge of our parents' inability to accept that youth are not necessarily infants but can have the capacity for independent decisons? How do we address the inability of our parents to accept the present is different from the past and as such, their ways are not longer the ways of the youth? In other words, how do we address the inability of our parents especially in Africa to accept that they need to change their perceptions abut how youth should be allowed to grow - not necessary according to their wishes?
Jenny Truong: Dr. Gabriel, thank you for your insights and questions. Parents can be one of the most powerful agents of change for their children. There are various programs working to help parents communicate better with their children, particularly in healthy decision-making. See this guide from the World Health Organization for examples of models: http://www.who.int/child_adolescent_health/documents/9789241595841/en/index.html  
Brad Kerner: First, I think a good frame work of thinking is what is laid out in the Convention on the Rights of the Child and is known as the “Evolving Capacity of a Child”. This concept is embodied by the idea that as children grow, have new life experiences and acquire enhanced competencies, there is a diminishing need for protection and a greater capacity of children (i.e. children means those up to the age of 18 in the case of the CRC) to take responsibility for decisions affecting their lives. This all has to be contextualized and take into account that children in different environments and cultures face a diverse set of life experiences, and will acquire competencies at different ages. So yes, in many of the countries we all work in, the adolescent life stage is completely ignored and children are expected to turn into adults without recognizing the process and transition they must go through, included a gradual independence to make decisions for them selves. I am not sure if I can directly answer your question of how we can work with parents so they realize that things are changing and youth need more independence, but I think it is a "two-way street". There is so much young people can learn from caring adults and their parents, and so much these adults can learn from children. Approaches that can help bridge this gap, I think will me most successful in having norm change and adults who understand the evolving capacities of their own children.
Alexandra Hervish: Thank you for your question. Part of this transformation involves educating and creating awareness among parents about the needs, challenges, and aspirations of young people. Obviously, community-led engagement will vary depending on the local context.

Kofi Awusabo-Asare: The title of the presentation, A Call to Action, sum up what is needed. But sexual and reproductive health is one dimension of the debate. What I would like to hear is the strategies needed to engage young people so that they are active participants of the "Call".
Jenny Truong: Getting the perspectives of youth is so vital to designing programs that are relevant, in demand and successful. Several organizations have developed guidance and models for how best to do this, including USAID's YouthNet Participation Guide and Restless Development. http://www.fhi.org/en/youth/youthnet/rhtrainmat/ypguide.htm and http://www.restlessdevelopment.org/youth-participation-guide. In August 2010, President Obama also met with 115 young leaders from 46 sub-Saharan African nations at the White House to encourage youth leaders to act in strengthening their communities and nations' futures. This is one exciting event that I hope will lead to further opportunities to engage youth as active participants.
Brad Kerner: HHMMM…maybe we can collectively work on a summation of a "Call to Action" after this debate is finished with the participation of youth. But the UN has a strategic framework for the International Year of the Youth which can help guide our call to action, particularly how to engage youth. See below. Personally, I am quite fond of UNFPA's work in engaging youth in their work and their youth fellows program that they host each year from around the world in New York at UNFPA's headquarters. This incredible group of young people are always far more articulate at advocating for the needs of young people…so maybe we should task them with summing up what is needed. http://social.un.org/youthyear/unapproach.html
1. Create awareness (increase commitment and investment in youth)
• Increase recognition of youth development as a smart investment by the public and private sectors
• Advocate for the recognition of young people's contributions to national and community development and to achieving the MDGs
• Promote understanding of inequalities amongst youth and how to effectively address the needs of the most disadvantaged
• Foster research and knowledge building on youth to better inform youth policies and programmes
2. Mobilize and engage (increase youth participation and partnerships)
• Institutionalize mechanisms for youth participation in decision-making processes
• Support youth-led organizations and initiatives to enhance their contribution to society
• Strengthen networks and partnerships among Governments, youth-led organizations, academia, civil society organizations, the private sector, the media and the UN system, to enhance commitment and support for holistic youth development
3. Connect and build bridges (increase intercultural understanding among youth)
• Promote youth interactions, networks and partnerships across cultures
• Empower and support youth as agents of social inclusion and peace
Alexandra Hervish: This is a fantastic question and a topic we are all eager to discuss. The UN International Year of Youth offers a fantastic platform for young people to make their voices heard as global citizens. I think as policymakers, researchers, and practitioners, we need to support these efforts and find ways to actively integrate young people’s perspectives in our work. How often do we see young people at academic or professional conferences, international summits, or donor meetings? These are all opportunities for young people to inform us about their experiences and the most effective ways we can support their development.

harriet mitteldorf: Shouldn't they be shown how the value of individuals is reduced by their having more than 1-2 children?
Jenny Truong: Family size is an important consideration for any individual. When we talk about family planning, we need to think about the contraception needs for adolescents. Programs should work to ensure that young people have access to information and services about if, when, and how many children they want to have. Important messages including waiting until age 18 to become pregnant and waiting at least 2 years between pregnancies.
Alexandra Hervish: Harriet: Thanks for your question. Adolescents have really diverse experiences when it comes to their sexual and reproductive health. Some youth are married and having sex while others are sexually active but unmarried. Programs that provide family planning and reproductive health services for young people can help them make informed decisions about when to have children and how many children to have. Two organizations that are tackling these issues are ABT Associates and EngenderHealth. ABT Associates has launched a program in India called "Saathiya" ("trusted partner" in Hindi) to help young married couples make informed choices about when to start childbearing and how many children to have. As a public-private partnership, ABT Associates is working with Indian System of Medicine providers (ISMPs), offering them training to strengthen their family planning knowledge and counseling skills. For more information, visit: http://www.abtassociates.com/page.cfm?PageID=40629. Similarly, EngenderHealth is working in Nepal to address the unique health needs of young married couples. EngenderHealth worked in the Southeastern part of Nepal where early marriage is common and there is pressure to have children quickly. They trained peer educators to provide reproductive health information to their families and friends and used the media to provide information about family planning, pregnancy, delivery, and postnatal care. At the same time, EngenderHealth worked with parents, in-laws, religious leaders, and other influential community members to increase support for reproductive health services for young married couples. For more information, visit: http://www.engenderhealth.org/our-countries/asia-near-east/nepal.php#married.  
Brad Kerner: When I read your question, I think you are saying “there so many benefits to limiting the number of children women have”. Agreed, and we should teach young people about these benefits, including how early pregnancy can disrupt a girls educational and economic opportunities and further propel her into poverty. But when dealing with youth SRH, we need to also highlight the benefits of delaying and spacing pregnancies. These are the facts: Globally, 14 million adolescent pregnancies happen every year. 60% of married adolescents reported that their first birth was either mistimed or unintended. (Married Adolescents: No Place for Safety. WHO and UNFPA, 2006.) Compared to older women, girls in their teens are twice as likely to die from pregnancy and child birth-related causes; Babies of adolescent mothers face a 50% higher risk of dying before age 1 compared to babies born to women in their twenties.5 So delaying teen pregnancies actually becomes of the up most importance. In so many countries where we work, this means delaying early marriage (a deeply ingrained social norm) and ending sexual violence against girls (an issue far too many people so not want to address). For girls who are already mothers, we need to also focus on spacing of the next child and helping get that girl back into school. Here is how Healthy Timing and Spacing of Pregnancies is defined by the Extending Service Delivery Project, but do go to their website to download their briefs, leaflets, training materials and case studies…as well as the evidence base for this intervention. After having a baby, you should wait at least 2 years before trying to get pregnant because mothers who wait 2 years are less likely to die in childbirth, their newborns are less likely to die, be underweight or be born prematurely and their babies grow up bigger, stronger and healthier. If you've had a miscarriage or abortion, you should wait at least 6 months before trying to get pregnant again because scientific studies show that a woman who waits is less likely to have a miscarriage, premature birth, or small or underweight baby and waiting 6 months protects the pregnant woman's health and the health of her baby. All the evidence on the Healthy Timing and Spacing of Pregnancies, widely known know as HTSP, can be found at the Extending Service Delivery website. http://www.esdproj.org/site/PageServer?pagename=Themes_Spacing_Research  

Tyjen Tsai: Evidence shows that youth think that having sex is a significant rite of passage from adolescence to adulthood, especially in countries in sub-Saharan Africa, where there is acceptance of sexual violence. What are some strategies to counter these peer pressures and social norms?
Alexandra Hervish: Thanks for the great question, Tyjen. I think for many young people, it is challenging to communicate openly and honestly about sex. A lack of communication can easily fuel misconceptions about young people's sexual behavior - "all my friends are having sex but me" or "I just have to accept that my boyfriend will not use a condom" (to name a few). While parents may be considered by some to be the logical source of information about sex for young people, many parents do not discuss the topic with their children due to embarrassment. Peer education and peer counseling can offer support for young people to learn about healthy sexual behavior while challenging peer attitudes that promote risky behavior. When I was conducting research on young people's attitudes toward HIV prevention education in Bangladesh, almost all of the adolescents said they felt most comfortable communicating with their friends about HIV/AIDS and sex. Instead of pressuring each other to experiment, they tried to combat some of the stigma associated with talking freely about HIV and sex, emphasizing that open discussion is needed to protect their health. I think the combination of open communication, a safe environment to talk, and positive peer interactions is one way to increase young people's confidence to resist peer pressure. Of course, this is just one example...there are many other strategies!
Brad Kerner: Thanks Tyjen, I really like this question since SRH is more of my expertise. I used to work in a clinic counseling adolescent boys on sexual and reproductive health issues. I always found it so interesting how perception is everything. So, I would ask a 14 year old boy, "Are you sexually active?" and his answer was usually "Yes." Then I would ask, "Do you think that over 50% of your friends your age are sexually active?", the answer to this question was almost always "Yes." It was always such a relief for these boys when I told them that I counsel a lot of boys their age and very few were actually sexually active. And that often, there are a very few boys who were sexually active but because of the "positive" attention they received from peers, it gives off a perception that everyone is sexually active (and that you are "cool" is you are). So this is a roundabout answer to your question. One strategy to dealing with peer pressure is breaking down young peoples perceptions of who is and is not sexually active (by choice). Combining this with skill building to negotiate and challenge friends that are peer pressuring them is also key. This also reminds me of the "Sugar Daddy" study from Kenya conducted by the Poverty Action Lab at the Massachusetts Institute of Technology. They found that a simple 30 minute intervention that showed girls the relative risk of getting HIV from sexual partners of different ages actual got them to change the profile of their sexual partners (they stopped having sex with older men). The connection I see here (an untested hypothesis) is that maybe if we also give information on the actual rates of consensual sexual activity, maybe young people will also realize that not everyone is having sex, making it easier to resist peer pressure and challenge the social norm (as least for boys) that you are more of a man if you are sexually active.
Jenny Truong: Thanks, Tyjen for this question. Reducing sexual violence, including among young people, requires strategies that engage everyone: young boys, girls, men and women. Organizations such as Instituto Promundo and the International Center for Research on Women (ICRW) have done extensive work on gender-based violence and studied its effects on health. The age at which young people first engage in sex also has implications. Data from the World Health Organization tells us that the younger a woman is when she first has sex, the greater likelihood that it was coercive. See this site for links to presentations on the topic of sexual violence against minors. http://www.igwg.org/Events/SexualViolenceAgainstMinors.aspx  

DAVID KINYUA: Africans understand their youth issues well. What lacks is adequate financial resources to spport Youth Empoerment programmes. Are you aware of richer countries willing to support Africa's youth development initiatives without necessarily telling us what to do?
Brad Kerner: I'd like to turn that question back to you? What do you think? Again, a fun debate we could have over a nice meal sometime (smile).
Alexandra Hervish: Thank you David. I think your question offers a great opportunity to explore youth development programs that are happening in the field, at the grassroots level. If we can create arguments that are based on work that is happened "on the ground", offering evidence about what works, and more importantly, what doesn't work, it can propel us to gain even more support at the national and international level for youth development policies and programs. I encourage you to share your understanding of youth issues in Africa and to keep the dialogue alive after this event.
Jenny Truong: USAID is always interested in knowing about programs that work and innovations that have results from the field. My colleagues who work in our field offices in Africa involve local officials, including Ministry of Health, Youth, Sports, Gender, non-governmental organizational representatives, and local community organizations when planning for programs. So, yes, we welcome your ideas, your opinions, and your recommendations on how we can best improve young people’s transitions to adulthood!

Yinka Shokunbi: The UN initiative is welcomed but how can the youths hold their leaders accountable whenever the promises made are unfulfilled? In Nigeria so many youths are out of School due to unfulfilled promises while scores are unemployed and live in abject poverty and thus are engaged in unhealthy lifestyles due to unfavorable environment..yet, time ticks away for this generation.
Jenny Truong: Dear Yinka, this is an excellent question without easy answers. We know these issues are particularly daunting because of the 45 million young people in Nigeria. I know of various organizations that try to address this issue including Advocates for Youth, those supported by the Summit Foundation, and the International Women's Health Coalition. Strategies include working with young people to provide them training, skills, and resources to communicate to leaders the importance of social services for young people as well as work with other youth directly.
Brad Kerner: The group I know who is the best at this is The Youth Coalition: Working Internationally for Sexual and Reproductive Rights. This is a group by youth, for youth. I have met many youth coalition members and I am always impressed by their advocacy skills and the way they approach these issues. They also have many amazing documents that can help youth build the skills in their countries to hold their governments accountable. I just checked the website and they have over 10 advocacy training documents, focused on SRH but are applicable to all youth issues. http://www.youthcoalition.org/site08/html/index.php