For young people, the complicated issues surrounding sexuality and reproductive health present a world of challenges. There are more young people alive now than ever before in history — more than 1.2 billion people between 10 and 19 years old — and many of them are very poor, out of school, and vulnerable. Many become sexually active during adolescence, but often social norms, cultural taboos, and ineffective or inaccessible education and health care systems are barriers that can prevent them from accessing the information and services they need in order to embark on safe and healthy adult lives.

The stakes could not be higher. When young people don't have access to information about their sexuality, or to condoms and other contraceptive methods, the impact is intensely personal — an unwanted pregnancy, infection with HIV or another sexually-transmitted infection, or injury in a violent relationship — but is catastrophic also for communities and for countries. Nearly half of all adult HIV infections now occur among young people aged 15 to 24. Pregnancy-related deaths are the leading cause of mortality for 15-19 year old girls in developing countries.

In many countries, youth-friendly laws and policies aim to ensure that young people have access to high quality, comprehensive information and services and to encourage youth participation in policy and program development. FCI works to build the capacity of our national and community-based youth-serving partners to make sure that these promises are kept, that young people have a seat at the table, and that  young voices are heard — so that all young people are empowered to control their sexuality; protect themselves from infection, unwanted pregnancy, and sexual violence; decide whether and when to have children; and become independent, productive contributors to their communities and nations.

Providing essential information on sexuality and health

Research has shown that young people who are educated about their sexuality tend to delay sexual activity, avoid risky sexual practices, use condoms and other contraceptives, and have sex less often and with fewer sexual partners. Since the 1990s, FCI has been developing educational materials for adolescents — first in English-speaking Africa, and later for young people in other parts of Africa, in Latin America, and in the Caribbean. Our youth-focused education and advocacy materials have been adapted to local contexts and translated into French, Spanish, Dutch, Haitian Creole, Swahili, and a range of other African languages. We have trained local partners to adapt and use these resources in more than 30 countries, reaching tens of thousands of young people around the world. They have brought new evidence-based, participatory, rights-focused ways of communicating about sexuality to health care workers, educators, youth leaders, parents, and young people themselves.

FCI also develops and implements programs that use our educational materials to help young people learn (and teach each other) about sexuality and reproductive health. In Mali, where a majority of the population is under 25 years old and 40% of young women become teen mothers, FCI is reaching out to young workers — who don’t benefit from school-based programs — with information on reproductive health, contraception, and HIV prevention. In partnership with national health, youth, and education ministries and with local NGOs, and through a joint program with the InterArts Foundation, we train young people as peer educators, who then raise the awareness of apprentices, laborers, street vendors, sex workers, and domestic workers on HIV and sexual and reproductive health issues. Through these programs, FCI has reached more than 22,000 young people with crucial information.

Empowering young advocates

Through FCI's youth work in many countries, we have found that young people and the agencies that serve them are often unaware of government policies and commitments related to young people’s sexual and reproductive health and rights. To address this gap, FCI works to provide young people and youth-serving organizations with the information and skills they need to hold governments accountable, producing toolkits, guides, and training curricula in a range of languages.

Working to prevent and treat obstetric fistula

Obstetric fistula, a devastating injury that results from obstructed or prolonged labor and often leads to a lifetime of illness and social ostracism, can happen to any woman who doesn't have access to skilled childbirth care. But it is a particularly common complication of adolescent pregnancy, because a young woman's pelvis may not be fully developed. FCI work on obstetric fistula includes:

• Producing and sharing the recommendations from Living Testimony: Obstetric Fistula and Inequities in Maternal Health, which sheds light on the personal and social impact of fistula, provides tools to empower local advocates, and highlights promising practices for preventing and treating fistula and helping survivors reintegrate in society
  
• Conducting community-based advocacy on the harmful impact of child marriage on the health and future livelihood of young girls
• Working globally and locally to promote skilled maternity care, both through our advocacy and through on-the-ground programs including the Skilled Care Initiative
  
• helping rural villagers arrange transportation so that women in prolonged labor can get to the lifesaving care they need
  
• providing hundreds of women with fistula repair surgery, and with support for reintegration into their communities

Strengthening policies and programs

FCI has worked at the United Nations and other global and regional forums to advance recognition of and protection for adolescents’ sexual and reproductive health and rights, preserve language supportive of the ICPD Programme of Action, and oppose policies that limit young people's access to sexual and reproductive health information and services. At the country level, FCI works with local partners to increase awareness and promote the implementation of supportive national youth laws and policies. And our strategies for helping health care workers and facilities to be more “youth friendly” in providing young people with information and supplies to prevent pregnancy and infection have been adopted by youth-serving partners in a range of countries in Latin America and the Caribbean, and in East and West Africa.