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Denied Birth Control, Teens Still Have Sex — Unsafe Sex

Illustrated By Anna Sudit.
Kenyan-born and Tanzania-based sexual health educator Maureen Oduor knows that soda doesn’t prevent pregnancy, but not all of the young women she counsels do. "In Kenya, adolescents believe that drinking a glass of Coca-Cola soda before and after sex can prevent a girl from getting pregnant," she tells me. In Tanzania, meanwhile, "people believe that use of contraceptives by a woman who has never had a child causes a woman to be barren or give birth to an abnormal child" — and in both countries, "there is a belief that if a girl [does] not have sex as a very early teen, like 12 or 13 years, then the vaginal opening is likely to close or get sealed."

In her work in Tanzania for SHDEPHA, an organisation that fights discrimination against people with HIV/AIDS and replaces contraception misinformation with education and services, Oduor is a professional myth-buster. Her passion for sex ed is personal. When she was 13, she tells me, she and her classmates at the all-girls boarding school they attended in rural Kenya arrived at their dorm after church one Sunday to find one of their fellow students — also 13 years old — lying limp on her bed. "The whole bed was soaked with blood, and the blood was dripping down," Oduor says. "We didn’t know what to do, because we had never seen something like this. Sundays in Kenya, most facilities close; our own school facility was closed. This was a school right in the village, eight kilometres to the tarmac road."

The girls’ classmate was bleeding to death before their eyes. "We [were] around eight students — we tried carrying her, but she was so tired; she had lost a lot of blood, so we just tried supporting her, and we walked for those eight kilometres," Oduor continues. "When we reached the tarmac road, that is around two, two and a half, three hours of walking, we got a vehicle. On reaching the hospital, she had already died." Oduor learned from hospital staff that her classmate had died from complications of an unsafe abortion, but quickly discovered that none of the staff at her school would admit as much to the students.

"What angered me most and what made me ask myself many questions was that this story was supposed to be swept under the carpet," Oduor says with intensity. "They [said] the girl was just sick, she died, okay, she’s going to be buried… She was not taught about family planning, she was not taught on how to negotiate [sex]... I witnessed that, and that’s how my world turned around, and I said, 'Is there anything I can do?'"

Oduor and I are speaking at the 2016 International Conference on Family Planning in Indonesia, and Oduor, now 30, has done quite a lot since witnessing her classmate’s death, starting a peer counselling group at her boarding school and going on to lead youth outreach at grassroots organisations in Kenya and Tanzania. Her message is clear: Young people are having sex, and they have the right to do it safely. "Young people are ready for this, and the time is now — we cannot say it is tomorrow," she says.

The world is welcoming the largest generation in history to its reproductive years. There are now 1.8 billion people between the ages of 10 and 24 — that’s the group the WHO defines as "young people" — and, shocking no one, they're having sex with each other. According to the Guttmacher Institute report Adding It Up: Costs and Benefits of Meeting The Contraceptive Needs of Adolescents, presented last month at the Women Deliver conference in Copenhagen, some two-thirds of adolescents in Africa and Latin America report having sexual intercourse by the age of 19; in Asia, the figure is around 41%, and that’s among both married and unmarried teens. Of the 252 million 15- to 19-year-old women in the developing world, 38 million are having sex and don’t want to get pregnant, but 23 million of those 38 million aren’t using modern contraception, a rate of unmet need that’s much higher than among adult women.

A Lancet study presented alongside the Guttmacher Institute report at Women Deliver reveals that unsafe sex is now the fastest-growing risk factor for ill health in young people (that’s all of them, not just those in developing countries), jumping from the 13th leading cause of death for 15- to 19-year-olds in 1990 to the second leading cause of death for them in 2013. In part, that's because the global health community has assumed teens to be healthy, with little need for specialised attention or investment. (That assumption hinges on not actually talking with teens about the fact that around the world, they are increasingly facing not only unsafe sex but injury, violence, obesity, and mental health issues.) And yet we know that denying young people contraception information and services leads to life-altering — or life-ending — consequences, including unintended pregnancy, STIs, pregnancy complications, social alienation, incomplete education, unemployment, poverty, and unsafe abortion.
Illustrated By Anna Sudit.
"One of the things that many policymakers prefer to believe is that adolescents aren’t sexually active, at least before marriage, and that’s not the case," Guttmacher Institute president Ann Starrs says during the Women Deliver presentation. "Another key fact is that out of 93 countries that reported to WHO on this issue, half of these countries — 49 — do not allow adolescents to seek contraceptive services without either a spouse or a parent’s approval."

Tanzania, where Oduor works, is one such country. As a result, "Dealing with myths and misconceptions remains my key challenge," she writes in a statement for the Gates Institute’s 120 Under 40 initiative to celebrate reproductive health advocates. "Wrong information is everywhere and very accessible to youths compared to right, correct information on family planning."
Birth control fallacies are, of course, not limited to East Africa but crop up wherever medically accurate, comprehensive sex ed is withheld. When I ask Philippines-based journalist and sex columnist Ana Santos, another attendee of the International Conference on Family Planning, about contraception myths in her country, she’s armed with some horrifying ones. People believe that "jumping after sex will prevent pregnancy" — although she notes, drily, that "a jump from what height is never mentioned" — and that "drinking coconut juice laced with bleach or Tide detergent will wash away the spermies." And since condoms can be hard to come by, people, especially young people, wrap Calypso plastic, a brand used to package iced candy, around their penises instead. "Totally ouchy, right?" Santos asks. Yes. And ineffective.

In the U.S, meanwhile, where dissemination of sexual health information to unmarried people isn't illegal, we are still reaping what generations of abstinence-only education and general avoidance of even age-appropriate sex talks have sown: no impact on teen sexual behaviour or HIV rates, and even positive correlations with teen pregnancy and STIs. Across the country, we actively introduce and perpetuate myths in a dangerous attempt to scare teens out of having sex before marriage, teaching them that condoms cause cancer, that birth control leads to infertility, or that women who sleep around are like a cup into which everyone spits. Abstinence programs do not lead kids to stop having sex. They lead them to start having unsafe sex, and that’s true around the world. Sadly, 13-year-olds need safe abortions in the U.S. as well as in Kenya, and they’re not getting them in either country.

The Guttmacher Institute’s report shows that in developing countries, we could meet teens’ need for contraception information and supplies at a cost of just £15 per user per year. That £15 would also fund healthcare worker training, upgraded health facilities, and education and outreach efforts to ensure that teens are using the right birth control method for them. Unintended pregnancies would drop by six million a year, meaning 2.1 million fewer unplanned births, 3.2 million fewer abortions, and 5,600 fewer maternal deaths. To even approach these outcomes, though, we have to first admit to the biggest myth of all: that teens don’t need birth control.

Young advocates like Oduor are dedicating their careers to fighting that belief. "I am very sure that young people are not going to allow anybody to leave them behind," she tells me. Their futures and lives depend on it.

This reporting was made possible by press fellowships to the 2016 International Conference on Family Planning and Women Deliver 2016 granted to the author by the United Nations Foundation and Women Deliver, respectively.

The Bed Post is a series that explores what holds us back from love and sex with whom we want, when we want, where we want, and how we want. We all deserve sex lives that are not only free of obvious evils, but full of what is good. Let’s talk about all of it.Follow me on Twitter at @hlmacmillen or email me at hayley.macmillen@refinery29 — I’d love to hear from you!