An Overdue Conversation: Meeting the Sexual and Reproductive Health Needs of Orphans, Vulnerable Children and Youth

Serra Sippel is the Deputy Director at the Center for Health and Gender Equity (CHANGE).

Attention to the lives of orphans and vulnerable children has increased with celebrity adoptions of African children by Madonna and Angelina Jolie and Brad Pitt, and the opening of an elite school for girls in South Africa by Oprah Whinfrey. For decades children (defined as children under the age of 18) have been targets for acts of charity by celebrities, focusing on their special needs: food, education, vaccinations, and health care. But rarely addressed, if at all, are the very real sexual and reproductive health needs of orphans and vulnerable children (OVCs).

Throughout the world, children and youth are living without the support, protection and care of parents. They are also often abandoned by the state, making them susceptible to violence, exploitation and disease. Many of these youngsters are condemned to live on city streets, in conflict and war zones, and in refugee camps where there is no protection from violence, coercion and exploitation. Many are caring for siblings and dying parents—often selling sex to support them—and are at risk of exploitation and HIV infection. Some are already infected with HIV and often lack the skills and knowledge to prevent sexual transmission of the virus to others and re-infection for themselves.

Studies confirm this. One recent study in Zimbabwe found a greater number of HIV infections among female OVCs ages 15-18 than among their non-OVC peers. In addition, the female OVCs experienced higher rates of STI symptoms and teenage pregnancy. A study in Rwanda and Zambia examining sexual behaviors of 10-19 year-olds found that those who were orphaned experienced earlier sexual debuts than non-orphans.

These young people live as best they can without protection from HIV infection, other sexually transmitted infections (STIs) and unintended pregnancies, and they suffer—young women and girls in particular—when their sexual and reproductive rights are not upheld.

Sexuality is basic and fundamental to our humanity. Yet many today have difficulty—some actually experience discomfort—addressing issues of sex and sexuality. This is especially true of young people's sexuality. In fact, one could rightly assert that the global community has been remiss in addressing sexual and reproductive health and rights of children and youth.

This negligence is found at both the national and international levels and much of it is driven by ideological and extreme religious perspectives on both sexual and reproductive health and rights and the rights of children. At the 2002 United Nations Children's Summit, the United States (one of only two countries—the other Somalia—that has not ratified the Convention on the Rights of the Child) joined the Holy See and a block of conservative Islamic states to obstruct consensus on issues related to the sexual and reproductive health and rights of youth, objecting to comprehensive sexuality education for youth and insisting upon abstinence-only education. They sought to uphold the rights of parents to control information communicated to their children, which meant they also opposed confidential counseling for youth.

Although "children" has been defined as individuals below the age of 18 (Convention on the Rights of the Child), most people hear "children" and envision a five-year-old rather than an adolescent or teenager. I propose that we change our language so that instead of OVCs we say OVCYs (orphans, vulnerable children and youth); this will enable policy makers and advocates to better understand the diverse needs (including, but not limited to, sexual and reproductive health) of this population.

Some fear that giving children and youth too much information about sexuality, reproduction and methods to avoid unintended pregnancies and STIs will encourage sexual promiscuity. But evidence shows that access to comprehensive sexuality information delays debut of sexual intercourse and protects those youth who are or will be sexually active from STIs and unintended pregnancies. And in light of the HIV and AIDS epidemic, information and services about safer sex—including condom use—as well as confidentiality and informed consent are critical to meeting the health needs of children and youth, especially those who are orphaned and vulnerable.

We cannot ignore reality. And the reality is that ignoring the sexual and reproductive health and rights of orphans and vulnerable children leaves them vulnerable.

If we are serious about providing real support to them, programs for OVCYs must integrate age appropriate, gender sensitive, comprehensive sexual and reproductive health services and education in order to meet the basic needs of this growing and vulnerable population.

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