I grew up in India. While in my late teens and studying to be a doctor, I met the girl whom I married some years later. A year or so into our relationship we started to have sex. We decided to use condoms. Getting them at a government-run clinic was out of question. They were known to provide free condoms called Nirodh, which were said to be as smelly and thick as bicycle inner tubes. Asking our family doctor was also out of question. He knew my mother and I had no doubt that he would tell.

因此，我曾经步行去药房，等到其他顾客离开，然后鼓起勇气向柜台后面的人寻求高档杜雷克斯避孕套。有时我成功了，走出去，感觉像国王。其他时候，我被责骂并被送走。我仍然记得我的耳朵羞愧地燃烧。那是40年前，但是我从与我一起工作的世界青少年中知道，他们继续面临许多获得避孕药具的障碍。

不同的青少年，不同的障碍

In many societies, unmarried adolescents are not supposed to have sex. Laws and policies forbid providing them with contraception. Even when there are no legal or policy restrictions, health workers refuse to provide unmarried adolescents with contraception.

即使没有法律或政策限制，卫生工作者也拒绝为未婚青少年提供避孕。

已婚青少年承受着孩子的压力。许多社会要求女孩成为非性before marriage,完全性on their marriage night, and沃within a year. In this context, there is no discussion of contraception until they have one or more children, especially male children.

Most societies do not acknowledge the sexuality of groups such as adolescents with disabilities or those living with HIV. Neither do they acknowledge the vulnerability of adolescent girls and boys in humanitarian crises situations.

最后，没有人愿意知道或处理非自愿性，这是由成年人或同龄人的口头强迫或身体力量引起的。被强奸的女孩可能需要预防艾滋病毒，紧急避孕或安全流产的预防后，这都是禁忌。

克服这些障碍

这些强大而广泛的禁忌在改善青少年避孕访问方面导致了有限和不一致的进展。这必须改变。我们必须承认青少年是他们的性生物。我们必须尝试记住当我们成为青少年时发现性的喜悦。我们必须为青少年提供他们所需的信息，技能和工具，以保护自己免受不必要的怀孕和性传播感染的影响。

With that in mind, I recommend the following:

• 我们需要为青少年提供满足他们需求的性教育。
• We need to change the way we provide adolescents with contraceptives by offering them a range of contraceptives and helping them choose what best meets their needs, and use a mix of communication channels—public, private, social marketing and social franchising to expand their availability. We must go beyond one-off training to use a package of evidence-based actions to ensure that health workers are competent and responsive to their adolescent clients.
• 我们需要解决女孩生活的社会和经济环境。在许多地方，青春期女孩没有能力做出避孕决策。即使他们能够获得和使用避孕措施，当他们是有限的教育和就业前景时，在有限的不良选择中，早期怀孕也可能是有限的不良选择中最好的。

To reach the 1.2 billion adolescents in the world, we must move from small-scale short-lived projects to large-scale and sustained programs.

To reach the 1.2 billion adolescents in the world, we must move from small-scale short-lived projects to large-scale and sustained programs. For this, we need national policies and strategies, and work plans and budgets that are evidence-based and tailored to the realities on the ground. Most importantly, we need robust implementation so that programs are high quality and reach a significant scale while paying attention to equity.

我们需要领导的政府项目和参与volve a range of players including adolescents. For this to happen, coordination systems must be in place to engage key sectors such as education, draw upon the energy and expertise of civil society, recognize the complementary role that the public, the private sector and social marketing programs can play, and to meaningfully engage young people.

一些国家向我们表明，这可以做到。在15年的时间内，采用多组分计划，包括主动避孕促销，英格兰使少年怀孕减少了50％以上。这种下降发生在该国的每个地区。

埃塞俄比亚是另一个杰出的例子。1980年代中期的内战和饥荒对该国造成了灾难性影响。但是，超过12年的周期，具有雄心勃勃的基本卫生工作者计划，埃塞俄比亚has increased contraceptive use in married adolescents from 5% to nearly 30%。它也有将童婚和女性生殖器肢解的速度减半，，，，although this decline is more marked in some provinces than in others. These countries have shown that with good leadership and strong management progress is possible.

There will be logistic and social challenges in moving forward. Understanding and overcoming them will require leadership and good management, which is why a strong and sustained focus on implementation must be combined with monitoring and program reviews to generate data that could be used in quick learning cycles to shape and reshape policies and programs.

There is likely to be backlash from those that oppose our efforts to provide adolescents with contraceptive information and services, and to empower them to take charge of their lives. We must do our best to bring these individuals and organizations on board. But we must not be silenced or stopped. We must stand our ground and we must prevail. We owe that to the world’s adolescents.