07 Presentation AnnaKotirant v1 e

The access of young people in Finland to services: 

The access of young people in Finland to services Anna Kotiranta-Ainamo The Sexual Health Clinic Family Federation of Finland, Väestöliitto

Väestöliitto, The Family Federation of Finland: 

Väestöliitto, The Family Federation of Finland A Finnish NGO founded in 1941 National and global expertise on SRHR issues The Development Cooperation Unit of Väestöliitto has a mission to promote global sexual and reproductive health and rights Advocacy work in Finland and Europe, SRHR consultancies, overseas development projects, operational research Projects in Nepal, India, Malawi, Namibia and Mexico

Finland 60 years ago: 

Finland 60 years ago There was poor country, suffering the consequences of second world war STDs were common Contraception hardly existing, Women dying of illegal abortion

From 1950s’ to the beginning of 1970: 

From 1950s’ to the beginning of 1970 TV in ”every” home Oral contraceptives (OC) world wide economic growth legislation

Sexual behavior: 

Sexual behavior The sharpest decline in age at first intercourse in women occurred in the late 1960s and early 1970s. Age at first sexual intercourse did not significantly changed anymore during the 1980s in Finland; in 2004 of 15 year old girls and boys, 33 % and 28 %, respectively, had had intercourse. Median age at first intercourse is 17 for girls and 18 for boys. Has not changed Of 17 year old girls 80 % reported that condom was used at their first intercourse and 8 % used OC.

Sexual behavior: 

Sexual behavior The liberal use of contraception, sexual education in schools, Health centers in ”every” municipality NOT tempting to start earlier

Legislation in Finland: 

Legislation in Finland The abortion law 1970 (“on social grounds “) The Public Health Law (1972) guarantied free primary health care and prevention for the whole population Sexuality education was integrated into school programs in 1970 to ensure practice of safer sex, which refers to avoiding pregnancy and STD, and to permit the development of a positive sexuality.

Responsibility of municipalities in Finland: 

Responsibility of municipalities in Finland Contraceptive counseling units were founded throughout the country. Public health nurses & midwifes well trained School health developed, school health nurses participated in sexuality education Close connection between education and services

Young peoples access to services: 

Young peoples access to services In theory the situation was good in the beginning of 1990 -health centers - school nurses -education in school - “contraceptive clinics” offering free starting pills for the first 3 mo

1994:”The Evolution of Sexual Health in Finland: How we did it” : 

1994: ”The Evolution of Sexual Health in Finland: How we did it” 2000: ”The Evolution of Sexual Health in Finland: How we spoiled it” 2006: How we did it again?

Abortions and deliveries per 1000 girls 15-19 year old in Finland 1975 to 1995: 

Abortions and deliveries per 1000 girls 15-19 year old in Finland 1975 to 1995

Abortions and deliveries per 1000 girls 15-19 year old in Finland 1975 to 2004: 

Abortions and deliveries per 1000 girls 15-19 year old in Finland 1975 to 2004

Number of 15-19 yr old girls and boys tested positive for Chlamydia in Finland 1988-2003: 

Number of 15-19 yr old girls and boys tested positive for Chlamydia in Finland 1988-2003 per 10 000

Number of 15-19 yr old girls and boys tested positive for Chlamydia in Finland 1988-2005: 

Number of 15-19 yr old girls and boys tested positive for Chlamydia in Finland 1988-2005 per 10 000

What happened in the beginning of 1990?: 

What happened in the beginning of 1990? ECONOMIC DEPRESSION

Changes in the society and legislation affecting sexual health: 

Changes in the society and legislation affecting sexual health Because of economic depression preventive medicine reduced and contraceptive clinics were shut down. Health care in schools was strongly reduced School sexuality education became voluntary in 1994 The price of OC-pills went up, negative publicity of OC-pills in 1995 Municipalities gained autonomy in how to carry out healthcare politics, although had not the expertise to do it Mass unemployment caused socioeconomic problems

Young people need continuous education: 

Young people need continuous education If the society does not provide it, they will learn from the media

Education now: 

Education now Sexuality education, integrated into Health education, became compulsory in schools again 2005 Health education in schools is taught accordingly: In elementary school (7-10 years) part of environment- and nature sciences In classes 5-6 (11-12 years) part of biology and geographics, as well as physics and chemistry In classes 7-9 (13-15 years) as an independent subject.

Aim of education grade 7-9 : 

Aim of education grade 7-9 know the characteristics of growth and development, understand physical, mental and social development in adolescence understand the significance of sense of community, human relations and caring for each other to human well-being describe and assess key factors promoting health and causing diseases and recognize and reflect on choices relating to health and safety assess the significance of the environment, lifestyle, culture and the media from the perspectives of health and safety sexual health: human relations, sexuality, behaviour and related values and norms know the basics of sexual health, be aware of the significance of contraception and methods of contraception and be able to reflect on and justify responsible sexual behaviour

FINLAND 2006: 

FINLAND 2006 A Health center in every municipality Services low cost/ free of charge Apx 1 doctor for 2000 people Appointed nurse, psychologist, counselor in every school again, (not every day…) Sexuality education in schools But is it enough ?

Sexual health of young people: 

Sexual health of young people Self-confidence Self-esteem Knowledge Skills Attitudes

Lisa, 17 years old: 

Lisa, 17 years old Came for a routine check-up, first visit in NAO OC prescribed 5 mo earlier in a local health center, for painful menstruation and as a contraceptive boyfriend the same age, both were virgins at the time of pill-prescription the doctor had performed a routine gynecological examination to her and taken STD samples and a pregnancy test! She had found the examination painful and testing humiliating (”didn't the doctor believe me?”)

Services for Youth: 

Services for Youth WE need tailor-made services for youth

Sexual health services: 

Sexual health services Services for adolescents can be provided in various settings. The clinic should have a youth-friendly atmosphere, where young people can feel welcome and comfortable. Unquestionable confidentiality is important. The providers must not moralize and judge the adolescents To treat adolescents with respect indicating that young people are important. The customer has the right to her/his body

Breast and pelvic examinations are unnecessary for women who wish to start OCs in whom:: 

Breast and pelvic examinations are unnecessary for women who wish to start OCs in whom: Gynecological history reveals no symptoms Pregnancy has been appropriately excluded There is no history of symptomatic breast conditions. Faculty of Family Planning and Reproductive Health Care of the Royal College of Obstetricians and Gynaecologists http://www.ffprhc.org.uk

Adolescent services: 

Adolescent services Clinic, free of charge <18yrs Phone line Internet www.seksuaaliterveys.org Sexuality education Training for professionals Material production 150 articles, 20 TV and 35 radio programs annually Advocacy

Business news: 

Business news Banks don’t hand out millions to just anyone. Why would you ? Condom makes sure you will have the exclusive right to your sperm until you want to merge it with an egg cell you consider worth the fusion. www.seksuaaliterveys.org/kondomikampanja/index_eng.html

Conclusions: 

Conclusions When adolescent sexuality is not condemned but sexuality education and sexual health services are provided, it is possible to profoundly improve adolescent sexual health with comparatively small costs. But each year new groups of young people mature, requiring new efforts. Education, counseling and services are all needed. If the resources are cut too much or not given, negative effects are soon evident. Political commitment and resources provided are reflected in results obtained