Taking action: achieving gender equality and empowering women

64 Chapter 4
Schools can
provide life
skills education
Financing interventions for sexual and reproductive health and rights
Governments have generated funds to finance reproductive health services in
many ways. Each involves tradeoffs between equity and efficiency (see table
4.2 in the report of the Task Force on Child Health and Maternal Health; UN
Millennium Project 2005b). Most health services are financed by general tax
revenue, but user fees have become a complementary source of financing in
many countries in recent decades. User fees have many problems. They tend
to be highly regressive and to curtail the use of services by poor people. User
fees also reduce women’s use of reproductive health services (Nanda 2002),
and they do not generate adequate revenue to support the provision of basic
services. Abolishing user fees for basic sexual and reproductive health services,
such as family planning and maternal health services, is therefore an important
recommendation of the task force.
Interventions outside the health sector
Improvements in reproductive and sexual health also require interventions
outside the health sector. Girls’ education is important. Schools can provide
life skills education, including information on health, nutrition, and family
planning. Ideally, such curricula would be introduced in primary schools and
continue through the secondary level.
Sexuality education remains a divisive topic in most parts of the world
(Kirby and others 1997). In many developing countries schools do not offer
sexuality education and in others it is offered too late to influence behavior.
And while the typical school-based curriculum may contain useful information
about the differences between male and female reproductive systems, it
does not usually provide an opportunity for young people to learn relationship
skills or discuss norms and peer pressure (Raju and Leonard 2000; Laack
1995; Laack and others 1997).
Yet, there are many good programs. Evaluations of comprehensive sexuality
education programs in the United States found the programs to be associated
with delayed sexual initiation and reduced abortion and birthrates among
the participants (Jorgensen, Potts, and Camp 1993; Kirby and others 1997).
Evaluations of other programs worldwide indicate that they increase knowledge
among youth about HIV/AIDS prevention and increase the confidence
of young people to practice safe behaviors such as refusing sexual intercourse
or using condoms. Program impact is usually greatest among girls and younger
youth (Grunseit 1997; Kirby and others 1997).
Interventions to build political consensus
Finally, both health and nonhealth sector interventions to improve sexual and
reproductive health require an enabling policy and political environment. To
this end, stronger and more visible efforts to advance the Cairo Programme of
Action must continue. Policymakers should base decisionmaking on scientific