Reflecting on ICPD30: The Importance of Involving Youth in Reproductive Health Programs and Decision Making

Knowledge SUCCESS interviewed global health professionals for a three-part series commemorating the 30th anniversary of the International Conference on Population and Development (ICPD). We asked their thoughts on the progress made since ICPD, the lessons learned, and the work that still needs to be done to fulfill the ICPD vision of inclusive reproductive health—programs and services that are equitable, accessible, and of high quality for all individuals and that are free from discrimination, coercion, or violence. The series shares excerpts from the interviews that underscore the importance of continuing to redefine what inclusivity means in reproductive health, ensuring that every person’s voice is heard and every community’s needs are met.

In this second interview, we share perspectives from Eva Roca, Implementation Research Advisor with the Center on Gender Equity and Health. Eva has collaborated with partners around the world to develop and refine context-specific, evidence-informed programs for adolescent girls.

The Impact of ICPD on Advancing Inclusive Reproductive Health

“ICPD really started the process. When I started working in public health, everyone in family planning and reproductive health was galvanized around ICPD. I feel like it really started pushing the whole world toward having commitments to doing better for women and girls. … The challenge remains when we think about women and girls as monolithic groups instead of thinking about the particular challenges faced by, say, married adolescents or Indigenous girls or girls in rural areas … We need more specificity and more focused programming that not only thinks about the different categories of girls and women who are not being reached by services, like very young adolescents, but also involves them in programming and decision making.”

An Example of Meaningful Youth Engagement and Decision Making

“When I worked at the Population Council, I worked on the Adolescent Girls Community of Practice, which helped incubate programs for marginalized girls around the world, such as Indigenous girls in the US and Guatemala, girls in rural South Africa, and girls in informal settlements in Kenya. The programs started with marginalized populations to make sure they were included in designing the programs to meet the needs they had in their lives. … it would be the first time that many of these girls had been asked anything about what they wanted, needed, and felt; the first time they were in the room to help co-design a program that was meant to meet their real, everyday needs—not only for their sexual and reproductive health but for all aspects of their lives. It was very powerful and some of that work got taken up by DREAMS [Determined, Resilient, Empowered, AIDS-free, Mentored and Safe, a PEPFAR-funded program], so it was able to expand to lots of other places and in a much bigger way.”

Success Factors for Meaningful Youth Engagement and Decision Making

“When I think of one of my favorite programs, it’s the Abriendo Oportunidades [“Opening Opportunities”] program, a program for Indigenous girls in the highlands of Guatemala (that has since expanded to other countries). It started out small, with just a cohort of girls, and now it’s a fully girl-led organization. … It has been going on since 2004; it’s a long process. I think one thing that the donor community needs to understand is the importance of long-term engagement. You can’t change the world in a two-year program cycle. You can get things started and lay the groundwork, but to really have a transformative program that is locally rooted and will still be there later, it’s going to take time.

“Another really important factor contributing to the success of the program in Guatemala and in other adolescent programs is having locally rooted mentors who are helping drive the program—girls from the community who are an attainable role model. Not just a superwoman from the community, but rather someone who may be 5 or 10 years older than the girls themselves who can be a role model. Having that involvement in programs is really key because it gives girls someone who they can trust, sort of like a big sister, instead of a teacher or mother figure. It builds a local infrastructure of girl leaders. As girls grow through the program, they themselves become mentors, helping the program to grow and expand.”

The Path to Inclusive Reproductive Health for All

“If we set up systems that only work for the people who already have access to whatever they need, then we have completely failed the original vision of ICPD. The vision is for reproductive health and justice for all women. When you set up systems that are working for marginalized girls, then most likely it’s going to work for all the other women. On the other hand, if you’re not deliberately reaching out and trying to make things work for people who are marginalized in some way, those groups are not going to have access. We’re just going to keep perpetuating disparities, which are going to show up in the data and in people’s lives. It’s going to have ripple effects in all the other areas of development … it matters for economies, it matters for the environment, it matters for everything. We have to start with making sure that marginalized people have access to what they need, because sexual and reproductive healthcare is foundational to achieving human rights and development.”