Universal access to sexual reproductive health: a faraway goal

The Sustainable Development Goals 2030 aim to ensure universal access to sexual and reproductive healthcare services.

Although the past few decades have seen countries make progress, the gains are inequitable among different communities.

Toybox works with children and young people in street situations across Asia, Africa and Latin America. In our work through local partners, we see healthcare services falling short in coverage and quality, particularly when it comes to communities connected to the streets.

Why children and young people in street situations are being left behind

Children and young people in street situations often face barriers to sexual and reproductive healthcare, such as stigma, discrimination and limited access to services. Many struggle to find safe and confidential spaces to seek medical advice and treatment, particularly for sexual health concerns. At times, they are unable to access services due to user fees or transport costs, or they lack proper identification documents which are required to register for treatment. 

Poor resource allocation to public health budgets also leads to gaps in health infrastructure which makes it harder to access health services, particularly for communities that are marginalised, such as those connected to the streets.

Life on the streets for children and young people

CHADET, Toybox’s partner in Ethiopia, finds one of the major challenges faced by children in street situations is the lack of shelter and safe sleeping spaces at night. This contributes to children engaging in unwanted sexual activity in exchange for a sleeping space. A recent study  on the lives and health of street children in Addis Ababa found nearly 70% of girls living on the streets are sexually abused and 30% are raped before the age of 18. CHADET is working with Toybox in Addis Ababa to provide access to safe spaces with sanitation facilities, and non-formal education sessions to children in street situations.

In Kenya, Esther, Programme Manager at Toybox’s partner Pendekezo Letu (PKL), says sexual and gender-based violence experienced by children and young people in street situations in Nairobi is significantly higher among migrants. Migrant communities lack official identification documents so often fall prey to exploitation, including sexual harassment. Young girls and boys from migrant communities are subjected to physical and sexual violence by street gangs,  the wider community and sometimes their employers. Violence can also happen in ‘bases’, which are temporary areas where street-connected children and young people sleep.

A lack of basic resources often leads children and young people in street situations to have transactional sex to survive, and in some cases they are paid very little or not paid at all.. This includes Samaya*, 13, from Kenya who got pregnant after having sex with another young person at her base, believing he would protect her from harassment by older gang members. Samaya had no awareness or knowledge about the health services to access for her pregnancy. Like her, many pregnant teenage girls in street situations do not receive any antenatal care or health information. Reports from Toybox-supported projects in Kenya also find girls and women who experience sexual violence (by strangers or people known to them) do not report the assaults to the police due to fear of retaliation and a lack of trust in authorities.

Kenya has a Menstrual Hygiene Management Strategy.  But despite its recommendations, budget limitations mean there is a lack of menstrual health products for young people in the juvenile legal system, especially in remand centres and police stations.

PKL, with Toybox’s support, is working to ensure all children and young people in street situations in Nairobi can access comprehensive sexual and reproductive health services by strengthening local health promoter networks within communities.

In Delhi, India, Maya*, 14, undertakes domestic work with her mother. She  told Toybox’s partner CHETNA that she is not allowed to use the toilet at her employer’s house, and the public toilets in her community have no electricity. After being abused in the community toilets, Maya is now scared to use them and will always look for someone to accompany her when she goes. CHETNA is working with children in street situations in Jaipur and Delhi to promote understanding on menstrual health and hygiene practices and improve access to and safe usage of public services like toilets.

In Nepal, Debia* is a single mother and a second-generation member of a street living community. She recalls how her childhood was spent on the streets of Kathmandu trying to save herself from daily sexual harassment and bullying. A rape attempt forced her to marry a fellow street youth who in turn became her abuser. It took her many years to break away from him and free herself from the cycle of abuse and violence. Toybox, through partnership with local organisation SathSath, has been working with young people like Debia to build their confidence, leadership skills and awareness of their rights and how to seek social security and protection.

Way forward

At Toybox, we are working closely with our local partners and stakeholders to strengthen understanding around the sexual and reproductive rights of children and young people in street situations, including menstrual health.There is a need to recognise the complex interactions and vulnerabilities faced by children and young people who find the streets their home. It is important to understand the factors that contribute to children and young people experiencing violence or becoming a perpetrator.  

There is a need for an integrated response to prevent and protect children and young people from sexual and gender-based violence in street situations. Our work with communities on income generation, education and rights awareness shows there is a need for programmes and policies focused on livelihoods, health and education, which should be interlinked to ensure universal access to sexual and reproductive healthcare services.

It is important that communities in street situations can access public health services without  the need for identification documents or user fees. An increase in allocation towards public health services is crucial to ensure infrastructural gaps can be plugged. For example, local-level health workers in public health systems, such as the Community Health Promoters in Kenya or the ASHA or Anganwadi workers in India, should be trained to support communities in street situations to access vital services and programmes.

It is only through such joined-up approaches that children and young people in street situations can claim their sexual and reproductive health and rights, and the injustices they experience can be reduced.

* Participant names have been changed.

Toybox is a UK-based international development organisation with a vision to end the injustice of street children, one of the world’s most vulnerable groups. Toybox works in urban environments, with local partners in Latin America, Africa and Asia and is currently helping thousands of children in the most dangerous cities of our world.