ADDRESSING ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH: TOOLS FOR POSITIVE YOUTH DEVELOPMENT

Global Health Practitioners Conference

May 6, 2014

WHAT WE’LL DISCUSS • Solutions from the 2013 UNFPA State

of the World Population report1

• Why take action?

• Strategies that work

• Tools to engage and motivate

adolescents and their communities

1 Motherhood in Childhood – Facing the Challenge of Adolescent Pregnancy

“I was 14… My mom and her sisters began to prepare food, and my dad asked my brothers, sisters and me to wear our best clothes because

we were about to have a party. Because I didn’t know what was going on, I celebrated

like everyone else. It was that day I learned that it was my wedding and that I

had to join my husband. I tried to escape but was

caught. So I found myself with a husband

three times older than me…. This marriage was supposed to save me from debauchery.

School was over, just like that. Ten

months later, I found myself with a baby in my arms. One day I decided to run away, but I agreed

to come back to my husband if he would let me go back to school. I returned to school, have

three children and am in seventh grade.”

Clarisse, 17, Chad

WHY TAKE ACTION?

GIRLS

HEALTH

EDUCATION

EQUALITY ECONOMIC

WELL-BEING

ACHIEVE POTENTIAL

WHAT CAN WE DO? 8 WAYS TO GET THERE

1

2

3 8

7

6 4

5

Focus on Girls

10 to 14

End Child

Marriage

Use Multi-level

Approaches

Support

Human Rights

Promote Girls’

Education

Engage Men

and Boys

Expand

Sexuality

Education &

Access to

Services

Equitable

Development

THEME VYA OLDER

adolescents

NEWLY

MARRIED NEW PARENTS

Sexual and

Reproductive

Health

Knowledge of

puberty

differences

Knowledge of

SRH rights and

responsibilities

Self-efficacy for

service utilization

Desire to delay

pregnancy

Partner support

for SRH

Couple

communication

related to

fertility/FP

Gender

equitable

norms &

attitudes

Siblings should

share chores

Boys and girls

should both go

to school

Girls should stay

in school

Youth should

delay marriage

Equitable

d-making in

couple

Male/female

children equally

desired

Birth & Infancy

Very Young Adolescence

Older Adolescence

Marriage Parenting Post-Partum

Life-Course Approach

WHAT CAN WE DO?: THEORETICAL FRAMEWORK

WHAT CAN WE DO? IRH EXAMPLES

My C

hangin

g B

ody

• Rwanda & Guatemala

• 2005-2010

• CRS, APROFAM

• English, French, Spanish

GR

EA

T T

oolk

it

• Northern Uganda

• 2010-2015

• Pathfinder International & Save the Children

• English, Acholi

Cycl

eSm

art

Kit

• Rwanda, Guatemala, and US

• 2012-2013

• INGOs and CBOs

• English (Africa, US), Kinyarwanda, Spanish

MOVING FROM RESEARCH TO ACTION

PHASE I

Formative research and intervention design.

PHASES II

Develop and test intervention package.

PHASES III

Intervention scale-up and documentation

MY CHANGING BODY FOR BODY LITERACY/ FERTILITY AWARENESS

1

• Addresses gaps in life skills and materials for use in VYA programs

• Fertility awareness & self care

• Body literacy

• Physical/emotional changes

• Influence of gender norms on sexual and reproductive selves

KNOWLEDGE OF MALE FERTILITY AMONG YOUTH AND PARENTS

BEFORE AND AFTER MCB

0%

20%

40%

60%

80%

100%

120%

Parents* Youth* Parents* Youth*

Pre Post

NOCTURNAL

EJACULATION NORMAL FERTILE EVERY DAY

p<.01

0 10 20 30 40 50 60

Masculine

Masc / Fem

Feminine

Pre

Post

YOUTH SHIFT TOWARDS LESS STEREOTYPED GENDER ATTITUDES

AFTER MCB-GUATEMALA

(n=57)

“I HEARD SOMEONE INSULTING MY CLASSMATE SAYING THAT HE IS SKINNY AND HAS SPOTS ON HIS FACE…I SCOLDED HIM AND ASKED THAT HE NEVER

DENIGRATE OTHERS BECAUSE IT IS NORMAL THAT A MAN’S BODY CHANGES AS HE GROWS.”

- “MY CHANGING BODY” VYA PARTICIPANT

THE

GREAT TOOLKIT FOR SRH

2

UGANDA

GENDER ROLES A man should have the final say in all decisions

84

70

69

85

67

63

0 20 40 60 80 100

NM/NP

OA

VYA

Female

Male

% of adolescents Source: Baseline Survey

NM/NP N = 202 (females), 304 (males)

OA N = 549 (females), 545 (males)

VYA N = 227 (females), 223 (males)

ATTITUDES TOWARDS GENDER-BASED VIOLENCE (GBV)

32

45

37 39

49

41 41

51

46

0

10

20

30

40

50

60

Deserve beaten

Tolerate violence

Private matter

OA

NM/NP

Adult

% o

f ad

ole

scen

ts

Source: Baseline Survey

NM/NP N = 202 (females), 304 (males)

OA N = 549 (females), 545 (males)

Adults N = 216 (females), 182 (males)

GREAT TOOLKIT: OVERVIEW

LEVEL OF PARTICIPANT ENGAGEMENT (by toolkit element)

73.5 85.5 80

60

50

100

68.1

91.8

63.7

81.8

0

20

40

60

80

100

120

% of groups reporting highlevels of discussion

% of groups reporting highsatisfaction

Activity Cards Boys’ Flipbook

Girls’ Flipbook Community Board Game

Radio Discussion GuideSource: Monitoring Data

N = 146 Groups/Platforms

VYA: CHANGES IN KNOWLEDGE & COMMUNICATION

Males Females

26.9

35.5

47.8 53.3

0

10

20

30

40

50

60

70

80

90

100

Fertiledays

Puberty

Pre

Post

41.5

54.5 51

76.2

0

10

20

30

40

50

60

70

80

90

100

Fertiledays

Puberty

Pre

Post

Source: Pre-Post Test (Post Test Results)

N = 65 (pre test), 41 (post test) N = 66 (pre test), 43 (post test)

NM/NP: CHANGES IN COUPLE INITIATION OF FP (% by sex)

37 32.5

78.3

63.9

0

10

20

30

40

50

60

70

80

90

100

Males Females

Pre

Post

Source: Pre-Post Test (Post Test Results)

Pre Test N = 68 (male), 62 (female)

Post Test N = 43 (male), 34 (female)

I sat down with my brothers and told them that I am in a group called GREAT. They have been teaching us that if you want to be ideal man, you have to be a person who does not drink, you should not quarrel with a woman, you should not beat people. If there is a problem you need to come and ask gently without quarreling. I started the talk because I saw that there really is a problem in my home. There is no respect, sometimes they drink and then start fighting. I told them this is not good, let us discuss. Then I brought this idea to

them. I told them how we should live together in a better way.” - 19 year-old married male

Source: Cohort Interviews

THE

CYCLESMART KIT FOR BODY LITERACY AND

FERTILITY AWARENESS

3

CYCLESMART: RWANDA

• CycleBeads® has been

used in the United States

and Africa to teach

young people about

puberty

• No guidance or tools on

how to use CycleBeads

effectively to teach

young people about

fertility and puberty

THE CYCLESMART KIT

• Includes CycleBeads and a simple,

factual brochure about puberty and

fertility.

• May be supplemented with other

materials as needed

• Is designed to help adolescents, ages 10

to 14, develop fertility awareness and

body literacy

• Helps parents, teachers, health

providers, peer-educators and others

talk to young girls and boys

MEAN KNOWLEDGE INDICES AT

BASELINE AND ENDLINE

0.64

0.85

0.76 0.77

0.52

0.75

0.92

0.84

0.91

0.76

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Femalefertility

Malefertility

Pubertychanges

Safechoices

CycleBeads

Baseline

Endline

p <0.01

“ALTHOUGH THE BROCHURE IS MOSTLY ABOUT GIRLS, IT’S

IMPORTANT FOR BOYS TO HAVE THIS INFORMATION BECAUSE IT HELPS US UNDERSTAND WHAT GIRLS ARE EXPERIENCING

AND TO NOT TEASE THEM ABOUT IT.” - CYCLESMART VYA BOY FROM NYABIHU

USING [THE CYCLESMART KIT] TO DISCUSS PUBERTY CHANGES

WITH PARENTS OR TEACHERS WILL MAKE US CONFIDENT TO DISCUSS SUCH THINGS WITH ANY PERSON.” - CYCLESMART VYA BOY FROM RWAMAGANA

SUCCESSFUL INTERVENTIONS:

STRENGTHEN PROTECTIVE FACTORS.

POLICIES AND PROGRAMS:

REDUCE YOUTH VULNERABILITIES & BUILD

THEIR ASSETS.

? GROUP

HANDOUTS Q:

! GROUP REPORTS A: