adolescent reproductive health_nana dagadu_5.6.14
TRANSCRIPT
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: