Amor Youth Clinic Network

The first youth clinics in Estonia were established at the beginning of the 1990s on account of the high rate of unwanted pregnancies and STIs among young people. The idea of youth clinics was inspired by the experience of Sweden. To begin, the ESHA organised training sessions for youth counsellors (with teachers from Finland, the Netherlands, and Sweden) and compiled sexual education literature. The idea to create a network of ideologically unified youth clinics, with the ongoing training of workers, resulted from one of the first training sessions and led local enthusiasts established youth clinics independently in various parts of Estonia. The ESHA eventually became a unifying umbrella organisation. As of late 2009, 18 youth clinics in 14 counties offer services in the following ways: through departments within larger health institutions (9 clinics), as free-of-charge services for young people at private gynaecological practices (7 clinics), or as private practices set up especially for this service (2 clinics). Two directions have been followed in the organisation of ongoing training courses for clinic staff: one that provides additional in-service training and guidance to existing staff members and another that offers basic training in youth counselling to new workers.

The main principles of Amor clinics are to help young people accept their sexuality and to recognise their needs and rights, as well to provide trustworthy information and counselling. Young people must feel secure, welcome, and respected in the clinics. Ideally, clinic specialists (doctor, midwife, nurse, social worker, psychologist) work together as a team so that the services for young people complement each other to form a whole. To encourage visits - whenever possible - youth clinics are: established in places accessible to young people and separate from other health care establishments; sensitive to young people's schedules; and protective of privacy (e.g., youth may visit alone, in pairs, or in groups).

Accessibility is a key commitment and challenge. For example, youth living in rural areas have more difficulties in reaching clinics. This was one reason for the initiation of a telephone counselling service, which can often help solve a problem without a visit to the clinic, reducing the number of unnecessary visits and waiting times. Similarly, an online counselling service through the Amor youth clinic website is supported by a team of 30 specialists, most of whom work at youth clinics, that answer queries received by email. (The internet is accessible to most people in Estonia, including young people in rural areas and disabled people, whose access to professional help is usually limited.) The correspondent remains anonymous and receives a personalised answer via email. The website also features a discussion forum, a "frequently asked questions" (FAQ) page, and resource pages including articles such as those in Amor's "ABC to Love" series. To improve access to counselling and information for non-ethnic Estonians, the website is also being gradually made available in Russian. Finally, because there are considerably fewer visits by young males, several clinics provide separate hours for counselling for boys and young men. Youth clinics also try to support visits by young males by organising additional training courses and directives for the existing male counsellors, compiling a pamphlet in Estonian as well as Russian ("Suggestions for Young Males"), distributing a flyer about visiting hours, and publishing male-oriented articles on Amor's website.

As outlined here, Amor's in-clinic medical and psychological counselling is designed to offer information, improve a young person's self-evaluation skills, and offer support in making individual decisions. In addition, lectures and group discussions provide young people with information and the opportunity to discuss their sexuality and close relationships. Schools generally cover topics that are easily taught in a lecture format (STIs/HIV, puberty, contraceptive methods), and sexual topics are presented more in terms of the dangers and problems. Lectures at the clinic take a different approach. The discussion may be redirected during the lecture according to the interests and questions of the students. Where possible, lecturers use interactive methods, such as group work, discussions, and games. Through lectures, students become acquainted with the clinics, their methods, and staff members, thus (hopefully) helping to reduce possible barriers for visiting a clinic.

Youth, Reproductive Health.

According to organisers, major socioeconomic changes have taken place in Estonia since it regained independence in 1991 - amongst them: implementation of health care reforms and establishment of a health insurance fund that receives 13% of every employee's wages; availability of all modern contraceptives; and inclusion of sex education in the school curriculum. Although the prevalence of STIs increased abruptly in the 1990s, since 2000 there has been a decrease in the incidence of traditional STIs (syphilis and gonorrhoea) - the prevalence of chlamydia and viral STIs (herpes and papilloma virus) remains high. In 2000, the HIV epidemic began spreading in north-eastern Estonia, especially among injecting drug users (IDUs). Young people accounted for almost 40% of newly registered cases in 2007.