1. ADDRESSING ADOLESCENT SEXUAL
AND REPRODUCTIVE HEALTH: TOOLS
FOR POSITIVE YOUTH DEVELOPMENT
Global Health
Practitioners Conference
May 6, 2014
2. 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
3. “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
5. 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
6. 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
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
7. WHAT CAN WE DO? IRH EXAMPLES
MyChangingBody
• Rwanda &
Guatemala
• 2005-2010
• CRS, APROFAM
• English, French,
Spanish
GREATToolkit • Northern
Uganda
• 2010-2015
• Pathfinder
International &
Save the
Children
• English, Acholi
CycleSmartKit
• Rwanda,
Guatemala,
and US
• 2012-2013
• INGOs and
CBOs
• English (Africa,
US),
Kinyarwanda,
Spanish
8. 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
10. • 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
11. 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
12. 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)
13. “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
15. 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)
16. ATTITUDES TOWARDS
GENDER-BASED VIOLENCE (GBV)
32
45
3739
49
4141
51
46
0
10
20
30
40
50
60
Deserve
beaten
Tolerate
violence
Private
matter
OA
NM/NP
Adult
%ofadolescents
Source: Baseline Survey
NM/NP N = 202 (females), 304 (males)
OA N = 549 (females), 545 (males)
Adults N = 216 (females), 182 (males)
18. LEVEL OF PARTICIPANT ENGAGEMENT
(by toolkit element)
73.5
85.580
60
50
100
68.1
91.8
63.7
81.8
0
20
40
60
80
100
120
% of groups reporting high
levels of discussion
% of groups reporting high
satisfaction
Activity Cards Boys’ Flipbook
Girls’ Flipbook Community Board Game
Radio Discussion Guide
Source: Monitoring Data
N = 146 Groups/Platforms
19. 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
Fertile
days
Puberty
Pre
Post
41.5
54.5
51
76.2
0
10
20
30
40
50
60
70
80
90
100
Fertile
days
Puberty
Pre
Post
Source: Pre-Post Test (Post Test Results)
N = 65 (pre test), 41 (post test) N = 66 (pre test), 43 (post test)
20. 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)
21. 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
23. 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
24. 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
25. 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
Female
fertility
Male
fertility
Puberty
changes
Safe
choices
CycleBeads
Baseline
Endline
p <0.01
26. “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