By Sarah Han, MPH | August 25, 2023
Youth-Centered Health Designer, ETR
Picture a young person nervously entering the only clinic in their small town, seeking STI testing. They recognize folks in the waiting room. They feel panic about their parents finding out. They are anxious about whether their provider will respect their identity or sexuality. They might even leave before receiving care, fearing judgment and lack of confidentiality.
This scenario is all too common for adolescents worldwide. Young people face multiple challenges in accessing sexual and reproductive health (SRH) services, with stigma from providers and staff and compromised confidentiality and privacy as key barriers.
In July, I was a part of a globally representative advisory group of young professionals at Women Deliver 2023 in Rwanda for the Measuring Youth Sexual and Reproductive Health (MY SRH) Initiative led by Metrics for Management. The MY SRH Initiative brought together inspiring individuals from all over the world, including young doctors, gender advocates, pharmacists, digital privacy activists, lawyers, global health ambassadors, and youth engagement experts.
Despite being from all walks of life, we trusted each other to share our unique perspectives and personal stories, both in working with youth and navigating SRH ourselves. It struck me how universal these experiences are, highlighting the urgency of adopting a youth-centered approach to improve SRH services.
Through the MY SRH Initiative, our goal is to create an evidence-based tool for assessing the quality and accessibility of SRH services to identify how to improve those services for young people. Together we tackled the question, “How can we dismantle the barriers that hinder young people's access to respectful, high-quality SRH services?”, focusing on provider bias, confidentiality, and privacy as critical factors.
We talked about how many clinics are not practically set up to protect patients’ privacy, especially in small rural settings. We heard stories of lives that were completely changed because they could not access contraception or abortion. We learned about how some youth could access quality SRH, but only if they could afford it.
We discussed how providers might ask unnecessary, even condescending, questions, often requiring permission from partners or parents. Some providers and staff may use their personal ideology or biases as justification for denying care.
These experiences can have a ripple effect – one that is compounded by issues of equity and access. The reputation of a clinic can spread through networks, as peers share with others about their experiences, both good or poor, potentially setting the tone for youth SRH care for an entire community.
We ranked the SRH services that are the most important to young people. Surprisingly, comprehensive sexual education (CSE) ranked first.
When I think of SRH care, CSE doesn’t immediately come to mind. However, empowerment and awareness is foundational: Young people need to know about their own SRH and that we have a right to accessible, quality SRH care.
This was a valuable reminder of the importance of the work we do at ETR. For example, the Next4You project is developing an innovative web app in collaboration with current and former foster youth. Through a trauma-informed, healing-centered co-design process, our team created a gamified curriculum that covers a wide range of sexual wellness topics. Next4You reflects the stories of young people with experience in foster care and is accessible via mobile devices, targeting the gap in CSE that many experience.
In the field of SRH, we tend to compartmentalize. Funding and initiatives are often issue-specific, and there are many practical reasons for doing so. But in reality, issues of contraception, menstruation, abortion, STI prevention, gender identity, sexuality, and healthy relationships are interconnected.
Through our discussions for the MY SRH Initiative, we agreed that we would like to see holistic measures of the experiences of young people that are not compartmentalized to any one type of SRH care.
The critical need to meet youth where they are was a major theme in our discussions. It was galvanizing to see tenets of ETR’s youth engagement reflected in conversations at Women Deliver and see how urgently it is needed across the globe. This opportunity with the MY SRH Initiative was not only inspiring, but it truly reflected the motto “Nothing about us, without us.”
Young people can tell when something was built for us, by us. We want opportunities to be heard and contribute in safe and empowering spaces. Our shared experiences navigating SRH services can uncover critical gaps, as well as opportunities for innovative solutions to improve the care that we want, need, and deserve.
Sarah Han (she/her/hers) is a Youth-Centered Health Designer for the YTH Initiative of ETR where she supports research and design projects developing innovative health solutions for young people around the world. She received her Master’s in Public Health in the Maternal, Child, and Adolescent Health track from the University of California, Berkeley. Sarah is passionate about how technology, design, and innovation can be leveraged to move the needle on entrenched or overlooked sexual and reproductive health issues. She can be reached firstname.lastname@example.org.