All women in the world have a right to expect adequate sexual and reproductive health care, and both the knowledge and the means to plan the size of their families. That's according to the United Nations, and most of the international community. And most agree that the sexual and reproductive health challenges of adolescents must also be urgently addressed.
Family Care International, or FCI, a New York-based non-profit organization is addressing those challenges in 20 countries.
In the Dominican Repubic, where Jeannette Tineo works as an FCI program officer, a full 25 percent of girls get pregnant by the time they are 20. She says that access to birth control, and accurate knowledge about its use are needed to correct the problem, and that political empowerment holds the key to achieving those goals.
"We are trying to change peoples' minds and tell them 'Yeah, you can participate. Yeah. You can be part of the political system and make a difference,'" she says. "That's because accurate information and family planning services are a right, something that's going to help people have more opportunities to develop as human beings in the ways they choose."
According to Dominican law, every municipality must maintain an office for youth affairs. FCI has been training young people to organize, then work together with government youth agencies to put modern sex education in the schools, to gain access to condoms, and to conduct community outreach programs that promote sex and AIDS education, violence prevention, and grassroots democracy.
"When young people go through this process of getting this training and participating at the local level," Tineo says, "they see the added value of thinking together, and designing strategies together to respond better to their needs."
FCI has met with some resistance among parents, school authorities and faith-based organizations who insist that abstinence is the best protection against teen pregnancy and sexually transmitted disease. These critics say that young people should focus on other non-sexual matters such as education, transportation, and jobs skills training.
This attitude rankles Ana, 17, a youth group leader whom FCI has trained. "Young people have many needs, but they are the ones who should say what needs they have and which ones are most important to them," she says. "Like it or not, they are sexually active, and it's important to them to have a healthy sexual life."
In Bolivia, a South American country where 70 percent of the population is indigenous, women of the Andean region and the Amazonian Lowlands often bear 13 children or more.
Yet only 30 percent of their babies are born in health centers, and rates of maternal and newborn mortality are very high. "So our first message is 'this is not just a 'women's problem.' This is a problem of the community… and everyone needs to participate!" says Alexia Escobar, FCI's national coordinator in Bolivia.
It is Escobar's job to train indigenous health promoters, and provide them with colorful flip charts and brochures they can take back to their rural towns to teach people about effective birth control and healthy motherhood. So far, 1,800 flip charts have been distributed -- some to locales reachable only after a five-day walk through the jungle, or by boat.
Traditionally, indigenous men allow women to have little power over their reproductive lives, a reality that goes hand-in-hand with high rates of domestic violence and marital rape.
"Culturally, women are not allowed to negotiate the use of condoms, so they cannot say 'Look, mi amor, today is a bad day, let's use some protection,'" Escobar says.
She adds that Bolivian men are opposed to using condoms for a number of reasons. "First, [they] do not think it is their responsibility. Second, they have a lot of prejudice against using family planning methods. Culturally, the masculinity of men is expressed by the number of children they have. And third, they don't want to use them condoms because it more pleasurable for them to have sex without them."
Escobar says that one FCI strategy is simply to appeal to men's sensitivity and compassion. "Men see their wives get ill, they see them losing their teeth because they lack vitamins, they see the health conditions getting worse because of the number of children they have…" "But," she says, "these things are not done overnight."
The political will seems to be changing. At the 2005 World Summit, leaders voiced a commitment to universal access to reproductive health care by 2015, and recent studies indicate near parity in secondary education for girls and boys worldwide. Better education leads to better economic success, which in turn leads to better health.