PYD for Marginalized or Vulnerable Populations:

What are the barriers to and facilitators for including vulnerable or marginalized populations in universal PYD programs?

How are vulnerable and marginalized groups experiencing these barriers and facilitators?
How effective are universal PYD programs at serving the needs of vulnerable and marginalized sub-groups?

PYD and youth-focused programs may not be accessible to all eligible youth. Youth from disadvantaged segments of the population are often underrepresented and overlooked in research and programming. Yet, they face more significant barriers compared to other youth. Intrinsic, contextual, and structural (ICS) factors can create additional barriers for VMY. Intrinsic factors, such as gender, disability status, and sexual orientation, make it more challenging to access PYD and other youth-focused programs.

YP2LE's recent review of programs targeting vulnerable and marginalized youth (VMY) found that the evidence base on inclusive PYD programming, while limited, is growing. The literature addresses health, education, economic growth, democracy, and governance, but a greater cross-sectoral focus is still lacking in peer-reviewed and grey literature. Further, the dearth of information and rigorous evaluations focused on PYD programs targeting VMY make it challenging to identify and design program intervention approaches. Programs can better support vulnerable and marginalized youth when they span multiple sectors and have several components for youth entry and participation. The programs also benefit youth when it recognizes and addresses the intersecting vulnerabilities of youth, harnessing the support of community-based activities and stakeholders, and family members.

YP2LE's ICS typology illustrates the interplay of intrinsic factors and contextual- and structural-level barriers faced by VMY populations seeking to engage in PYD and other youth-focused programs.

Figure: Intrinsic, Contextual, and Structural Barriers to Accessing PYD Programs.

Structural Barriers

Structural barriers include societal factors that cause harm or create an environment that perpetuates the marginalization of VMY. Public policies are a primary societal factor that shapes VMY's enabling environment. Public policies (or lack thereof) on health, democracy and governance, economics, education, and gender equity can maintain economic or social inequalities that create additional barriers to participating in PYD and other youth-focused programs.

Poverty is another structural barrier that decreases a person's likelihood of accessing PYD and other youth-focused programs. Lack of income is a common structural barrier to accessing a host of different services, with adolescent girls and young women being the most disadvantaged.

Contextual Barriers

Contextual barriers refer to factors that can emerge in the various settings (e.g., schools, health facilities, and neighborhoods) in which social relationships occur. Stigma is a common contextual barrier that prevents access to relevant programs and services among VMY. Stigma related to HIV, disability, and sexual orientation have contributed to VMY's underrepresentation in youth programs. Furthermore, internalized stigma discourages VMY youth from accessing services, interacting with providers, or seeking to change community stigma, which can exacerbate adverse health outcomes. The effect of stigma on access to programs appears to be worse among girls than boys due to the persistent gender-biased norms about girls' potential economic and social value. Cultural and social norms related to gender shape context-specific ideologies about adolescent reproductive health. Fear of violating cultural and social norms is a barrier for VMY accessing youth-focused programming.

The interplay of intrinsic and contextual factors also manifests through a lack of commitment to ensuring the successful implementation of youth-focused programs and services. YP2LE's systematic review revealed that youth responsive implementation is rare. Although we develop policies and programs for youth, institutional support and implementation of the programs are limited and inadequate, making the programs less relevant and responsive to the needs and challenges experienced by VMY.

These barriers can impact youth's development and potentially have long-term negative repercussions. For example, stigma related to HIV or sexual orientation may impact youth’s willingness to engage in available services. Additional damaging gender norms about adolescent girls and young women’s social and economic potential may prevent their participation in services or activities that contribute to nurturing relevant skillsets.

Facilitators

YP2LE identified several facilitators of access to and engagement with PYD and youth-focused programming among VMY in LMICs:

Psychosocial wellbeing and social isolation
Unmet sexual and reproductive health and other health needs
Harmful social norms
Lack of employment and economic opportunities
Increased exposure to violence and violence perpetration
Breakdown of family unit and youth being forced to assume adult responsibilities (particularly in conflict settings)
Social stigma and discrimination
Interruption of schooling and displacement in the wake of conflict

Public policies that promote access to youth-focused programming are critical facilitators of service use. Public policies remain an essential lever for expanding programs' access to the greatest number of VMY across territorial jurisdictions.

Community involvement can be a powerful facilitator of VMY's access to PYD programming. Engaging community leaders contributed to greater outreach and mobilization of eligible community members. Vulnerable and marginalized youth are often hidden and hard-to-reach populations. Programs need to engage and involve trusted community leaders can help track and recruit eligible VMY. This approach leads to a more significant representation of target populations in PYD and in other youth-focused programming.

Including VMY's peers as educators or training facilitators may increase program reach. Peer educators use the same language as VMYs, understand and answer questions, convey information in an engaging and less stigmatizing way than older adults, and talk openly about sensitive issues. We can enhance youth programs' relevance and responsiveness by providing physical, safe spaces accessible to everyone. A consistent, safe space or physical environment facilitates both the access and engagement of VMY with programming. Providing safe spaces and stigma-free programming is crucial to facilitating VMY's initial and recurrent access.

We can optimize the reach of these youth programs by integrating services with current community-based, youth-focused programming. Utilizing existing institutions and resources is also helpful when scaling up programs. Relatedly, creative uses of media have made it more possible to reach many VMY.