>>Available in Word and PDF

Introduction
For Nigeria's over 24 million adolescents aged 10-19, there are several challenges that come with surviving in today's fast-changing world. The traditional norms and behavioral controls that once guided adolescence are breaking down due to several factors that include increasing poverty, rural-urban migration, and the influence of the world media. With the increasing opportunity to acquire formal education, many more young people are spending more years in school and consequently, they are getting married later, especially in the urban areas of Nigeria.

Building Support for Adolescent Health Education and Services in Nigeria: Reflections from the Experience of Action Health Incorporated

As a result, most Nigerian adolescents have had sexual intercourse by age 20 and often with more than one partner. And the HIV epidemic is on the verge of exploding. More than half of all reported AIDS cases in Nigeria over the last three years were among 15-24 year olds. Girls are particularly vulnerable to exploitation and sexual abuse even in their own homes by close family members.  All across Nigeria, there are many young people dealing with challenges around their sexuality, with little or no support from parents or communities.

AHI's Adolescent Health Programme
My organization, Action Health Incorporated (AHI) was founded against this background, with a mission to improve the health and uphold the rights of Nigerian adolescents. When we started in 1989, we started from nothing. I was a young reporter on the women's desk of a national newspaper, and my husband was a budding medical doctor in private practice. The friends with whom we started AHI were also young and inexperienced in adolescent issues, but we all had a deep concern about the situation of young people and a strong desire to make a difference.

We started out with school-based awareness raising activities, reaching only a few hundred young people. Today, AHI serves more than 30,000 adolescents a year through our youth center, clinic, and in-school peer education programs.

We also focus advocacy efforts on ensuring that all the international agreements and treaties signed by Nigeria are translated into action at the local level. For example, we set up several meetings with Education Ministry officials in Lagos to ensure that girls who become pregnant while still in school are not expelled. We distribute fact sheets and easy-to-read materials to officials to acquaint them with the reality of girls and boys lives outside the classrooms. We encourage them to visit our programmes to see for themselves the difference they could make if they would change policy so that many more young people have access to sexuality and reproductive health education in the school system. We pursue this goal so vigorously because we believe that putting in place the appropriate guidelines is the only way we can achieve long-term systemic change for young people. Thanks to the work of several NGOs and other groups in Nigeria, many community-based responses have emerged over the last decade to change the adolescent sexual and reproductive health landscape.

Nigeria's Journey with Sexuality Education and Services for Adolescents
In 1992, a reactionary article, which harshly criticized AHI, was published by the opposition and prompted the government to ban our work in schools. Since then, Nigeria has moved from a situation of institutional denial to a point where issues of sexuality education and services for adolescents have a place on the national agenda. We now have National Guidelines for Comprehensive Sexuality Education, a National Framework for addressing Adolescent Reproductive Health, and the HIV/AIDS Emergency Action Plan (HEAP) to address the looming AIDS epidemic. In August 2001, the government took a major step and approved a national curriculum for sexuality education for upper primary, junior secondary, senior secondary and tertiary institutions. Less than a month ago, 46 master trainers completed training to guide implementation of the curriculum in all 774 local education districts, which will be completed over the next two years.

But Nigeria's accomplishments have not, by any means, come easily. They came as a result of the dogged commitment of several courageous actors who dared to challenge the status quo under the dark days of military dictatorship. They were also the result of changing national circumstances, namely the national HIV/AIDS epidemic, which has woken up many of those who were either in denial or deep slumber.

Pushing the Boundaries to Accommodate Adolescents' Needs
At AHI, we have learned a few lessons about building community support for adolescent sexual and reproductive health and rights:

1. Get the Support of Parents and Community Leaders
Providing sexuality education and services to adolescents remains contentious in Nigeria, as in many other places, and is constantly challenged by those who believe that access to information will encourage adolescents to be sexually active. As you know, all empirical evidence is to the contrary but a major task remains in clearing these misconceptions within the communities that we serve.

Without parents and community members' support, it is impossible to successfully provide adolescents with the kind of education they need to adopt safe and responsible sexual behavior. Naturally, parents want to protect their children from harm, and many of them genuinely believe that the way to do this is by withholding information about sexuality so that their children do not begin to experiment with sex prematurely.

We help parents understand the importance of communicating openly and factually with their children. We encourage them to ask questions about the approaches we utilize at AHI, and many of them end up asking for help in communicating effectively with their children. Today, parents of the young people we serve have become our greatest allies. Apart from peers and publications, parents and school officials rank third as the most important source for referrals to our program.

2. Build Alliances with Other Stakeholders
We have learned that as advocates, we cannot hope to succeed alone. We need to develop a critical mass of dependable allies who are willing to speak out in support of young people's sexual and reproductive health and rights, or we risk being singled out and typecast as the organization interested in subverting the community's accepted norms. The power of partnership can bring about overwhelming social change that may be difficult or even impossible for one group to achieve. When we come together, we tap into each other's strengths. For example, in 1996, 80 groups, ranging from youth-serving organizations to religious associations, arrived at a consensus in drafting national sexuality education guidelines and together endorsed the document that has since been adopted by the government. When AHI partnered with the Federal Ministry of Health to convene the first Nigerian conference on adolescent health, we did not have to panic because we knew we could rely on allies from all over the country with whom we had cultivated relationships over the years.

Based on the convictions and collective wisdom of all these allies, we were able to create great change at this conference, held in the capital city of Abuja in 1999. Three hundred-fifty stakeholders from non-governmental and governmental agencies, including young people, endorsed a national framework for addressing adolescent reproductive health in Nigeria.

3. Be Proactive in the Media and Frame the Discourse
When doing controversial work, organisations must learn to be in the media before the opposition, in order to set the pace and direction of the discourse.

In Nigeria, we have worked hard with the media to clarify the difference between the terms "sex" and "sexuality." We continue to reinforce that "sexuality education" is the correct term for the work we do because of its comprehensive nature in emphasizing the social, cultural, psychological, and spiritual dimensions of our humanity rather than just reproduction, anatomy, and disease prevention. We have consistently shared with our media colleagues research findings that show that fear-based education evokes negative feelings about our sexuality and inhibits learning about sexuality and promoting sexual health.

Our own experience in dealing with the opposition has also taught us that we have to engage representatives of the media, not just by providing coverage of our events, but also by helping them to understand our work, so that instead of sensationalizing information, they present it completely and factually. We allow them open access to our libraries for referencing, provide background materials for their reports, and stand ready to provide them with technical information when required. Thus, we position ourselves as a valuable resource for their work.

Conclusion
The strides made thus far in Nigeria have been the result of the dogged commitment of many Nigerian stakeholders within government and non-governmental organisations. Very critical too, has been the political will and commitment of our country's new leadership in embracing the need for positive action for the sake of the Nigerian child. As President Olusegun Obasanjo's stated in his foreword to the very progressive HIV/AIDS Emergency Action Plan (HEAP) for Nigeria, and I quote, "I reaffirm my commitment and that of the Government of Nigeria to confront the HIV/AIDS epidemic head-on.Generations yet unborn will not forgive us if we do otherwise."

Nigeria still requires a lot of support for its programmatic interventions, so long it doesn't involve the mass importation of fear-based, abstinence only education or inadequate health services that don't respond to young people.  For any programme to achieve the objective of getting young people to adopt responsible sexual behaviour, it must give factual and complete information, provide choices and address young people's diverse needs. The last thing Nigerians need is any intervention that will rob us of the gains we are beginning to make with guiding our country's adolescents safely through the crossroads.

Finally, I would like to leave you with some thoughts about a 12-year-old Nigerian girl for whom this work would have made a whole world of difference. She is a student at the most prestigeous girls' secondary school in Nigeria. The principal of this school wrote me last year to ask that I come and do a sexuality training for her students. I felt that my services were needed more in the low-income communities and public schools, since surely these girls are better off. But just the other day this principal sent me an SOS. Something horrible had happened. This 12-year-old girl, who had never been told anything about sex, was lured into an abandoned room and raped by a teacher. After the school found out and had him arrested, the principal received nearly a dozen anonymous letters from current students, saying that they too had been assaulted by him. The man had worked at the school for 13 years.

This incident illustrates how important work in this field is, and how important it is that we reach all adolescents, regardless of background or income.

This speech was part of Adolescents at the Crossroads, a panel presentation on adolescent sexuality education organized by IWHC in cooperation with Aahung (Pakistan), Action Health Incorporated (Nigeria), the Youth Coalition, the United Nations Population Fund, the World Health Organization, and the World Bank, during the UN General Assembly Special Session on Children (May 8-10, 2002).

Tag it:

?