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Many young people have limited access to sexual and reproductive health services, making it hard for them to access family planning and HIV services.



According to the World Health Organization (WHO) around 225 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. This puts them at greater risk of unplanned pregnancies and potentially HIV.



Ahead of the International Conference on Family Planning (9-12 Nov), in Bali, organisations such as the International HIV/AIDS Alliance, are calling for greater integration of sexual and reproductive health and HIV services. Lucy Stackpool-Moore, the Alliance's senior advisor on sexual and reproductive health, said: "Integration of services can increase the range of services provided to and taken up by communities, especially young people, saving time and money in settings where resources are particularly limited. Most importantly, it can play a role in expanding access to services that allow people to choose if, when and how they want to plan to have a family.”



Misconceptions about contraception



In western Africa only 9 per cent of married women use modern methods of family planning, according to a report by the Population Reference Bureau. Myths claiming contraception causes weight gain, cancer, high blood pressure and even a reduction in sex drive, affect young people's willingness to access family planning services. This results in women having more children than desired, complications from deliveries and unsafe abortions.



Seun Ademola, 20, from Ogun state, south-west Nigeria did not plan to get pregnant. She is not happy about it and she is considering an abortion, but she has had no support from home in making this decision.



"My parents back home have threatened to disown me if I have an abortion. It is for this reason I had to relocate to the city so I don't face the stigma from my family and friends," says Ademola.



HIV and stigma



Stigma can limit the choices that young people can make relating to planning families and accessing health services. It is an issue Ninido Mergen, an 18-year-old woman living with HIV, faces in her life. She says: “I know most of the workers at the clinic where I get my antiretroviral drugs and they always avoid me when I come for my medication.



"It’s not easy for people living with HIV in Nigeria. The stigma is high despite several NGOs and health organisations advertising on TV and radio trying to educate people about HIV, but that has not changed how people treat those living with HIV like me," says Mergen.



"We also have limited family planning choices. For me, I only use male condom as a contraceptive method because the nurse at the hospital told me that any other family planning method I use, could result in me infecting my partner. To her, I should not even be having sex unless my partner is also living with HIV.



"Even with the male condoms, I am scared because of it breaking. To make matters worse, I cannot disclose my status to a new partner before sex because the moment I do, he will end the relationship and avoid me like a plague. So what I do is to simply avoid sexual relationships," says Mergen.





Concerns about anonymity



Barrister Esther Uzoma, a human rights activist, says most young people in Nigeria do not want to be seen accessing sexual and reproductive health services because of stigma and discrimination, particularly if they are young people.



"Youth friendly service centres are not situated in places where young people usually hang out so they can easily access them,” she says. “They exist either in public hospitals, where the identity of people accessing the services are not protected, or in private hospitals where the high cost implication serves as a deterrent. So young people end up not getting the help they need.



“Another challenge is the lack of open discussions on sex. Sexuality and reproductive health must be a huge part of youth education."



Making efforts to enable young people to access services



Young people have unique experiences of stigma and discrimination and youth friendly services are essential to tackling issues around unwanted pregnancies and risk of HIV. In the Nigerian city Abuja, the AIDS Healthcare Foundation is one organisation trying to tackle these issues.



Christine Awunor, HIV prevention co-ordinator at the Foundation, says: "We have been working on providing an integrated sexual and reproductive health and HIV service so that young people, especially girls and women, can access these services with ease thus saving time and money.



“We have also been carrying out several campaigns, including free HIV testing and counselling services to encourage young people to access such services. We call on Nigerians to stop the stigma on young women who seek such services.”



Achieving the sustainable development goals (SDGs)



In Nigeria, as well as across Africa, poor knowledge of modern contraceptive methods, sociocultural practices, lack of relevant health policies and youth-friendly services are factors that continue to limit young people accessing sexual and reproductive health services.



In September, as part of the UN development agenda beyond 2015, the world adopted a new set of global development goals. Goal three is to ensure healthy lives and promote well-being for all at all ages. This means governments are now committed to ensure access to sexual and reproductive health services for all people by 2030, regardless of age, sexual orientation or any other factor that might cause people to be denied services.



It remains to be seen how Nigeria, and all the other member states of the UN, will truly embrace the new goals and ensure that young people are not left behind when it comes to ensuring healthy lives for all.



Nnamdi Eseme lives in Nigeria and is a member of the Key Correspondents network which focuses on marginalised groups affected by HIV, to report the health and human rights stories that matter to them. The network is supported by the International HIV/AIDS Alliance.