Reproductive Health Programs for Young
The delivery of reproductive health information, counseling and services to young people is an emerging area. Many efforts involve schools, although courses typically avoid sensitive sexual issues and oftenespecially in Africa and Asiarefrain from discussing sexuality altogether. Compounding the difficulty is that not all young people attend school. Health facilities, too, are beginning to establish youth services, but many adolescents are reluctant to take advantage of this option.
What types of programs can be
used to reach youth in
Outreach has emerged as an innovative way to reach young people. This summary describes how education and services are offered at special youth sites or through the efforts of roving health educators who bring information and services directly to adolescents. Outreach programs can be grouped into the following categories:
Youth centers include those that seek to prevent too-early pregnancy along with other risky behaviors while helping to enhance life skills, and those that assist pregnant and parenting teens to pursue educational and vocational objectives.
Peer promotion programs deliver information and services in the community and workplace
through peers similar in age and background. These programs are successful in difficult-to- reach populations such as out-of-school youth, street children and commercial sex workers.
Community outreach programs reach youth in the community, but services are typically delivered by adult health professionals. One example is a workplace model, where information and services are provided by the employer or health agency at the place of employment.
Reproductive health programs provided by youth-oriented organizations for their consti-tuents are often characterized by a high degree of youth involvement in their operations.
What are the key elements of outreach program design
Establishing reproductive health outreach programs for young people can be tremendously challenging. According to professionals who have managed, funded or observed outreach programs, several elements are instrumental in reaching youth. They include:
1 Clearly stating process and behavioral
objectives before the project begins is a prerequisite to measuring project success. What
is feasible also depends on the cultural and political environment. An AIDSCAP study
conducted in Haiti found that providing a variety of prevention options, from abstinence
to condom use, offered target audiences a choice and allowed gatekeepers to remain neutral
or supportive of certain activities.2
Strategic Planning. A common mistake is promising more than a project can deliver, whether through optimism, inexperience or the desire to please stakeholders.
Target Audience Identification. Young people are a diverse population and respond to different approaches and messages. The same socioeconomic or cultural group may need different messages at different stages of their young adulthood.3 It is important, therefore, to identify the specific target group in regard to age, marital status, school status, gender and other factors relevant to planned activities.4 Not only does this process facilitate development of a feasible workplan and appropriate strategy, it avoids the trap of reaching an accessible group, such as in-school youth, at the expense of more needy young people.1 Targeting younger, pre-sexually active teens was a successful strategy for a Peruvian family planning associations youth center, and has the great advantage of teaching responsible behaviors before unsafe and unhealthy habits become entrenched.5
Needs Assessment. Once a target audience has been identified, it is important to conduct a needs assessment to plan relevant outreach activities. The World Health Organization underscores the importance of repeating this process at various times once the program is underway.6 Particularly in HIV/AIDS preven-tion, understanding the target groups specific needs may be key to designing an effective intervention. A Brazilian project for street children began its design by conducting in-depth interviews to understand their high-risk behaviors, especially the role of sex in their lives and what is important to them.7
Youth Involvement. Common sense dictates that the target group can best identify its own needs, and it may feel more a part of an effort if it has the opportunity to be substantively involved. Experts recommend that young people be involved in many, if not all, stages of their programs. They regard this concept as an important guiding principles in work with youth. Trends support the growing strategic emphasis on youth involvement. A study of 103 adolescent reproductive health projects, conducted by the Center for Population Options, reported that more than half of the projects involve youth in a significant way.8
Community Involvement. There is wide agreement that community involvement plays a role in program success. Depending on a programs objectives and sensitivities, specific groups should be identified for targeted activities, including policymakers, health professionals and religious and other community leaders. At the same time, the community as a whole needs to be engaged to come up with solutions to harmful gender-related practices, such as forced sex and female genital mutilation, that serve as barriers to improving adolescent reproductive health.9 A review of AIDS-prevention activities in Haiti concluded that seeking the expert advice of community leaders before implementing a project helped foster a sense of local ownership, with the sense that the community has a stake in the process.2
Parental Involvement. The acceptance and support of parents is important to the success of youth outreach programs. One way to gain this support is to convince parents of the consequences of not dealing with adolescent reproductive health.10 The UMATI project in Tanzania concluded that it was especially important for programs like theirs to gain parental support because absenteeism on the part of young women is typically caused by household obligations.11 Young people have indicated a desire that their parents be better informed and, where possible, that they participate in activities of youth programs.12
Evaluation Design and Monitoring. Project staff are becoming increasingly aware of the importance of effective monitoring and evaluation mechanisms to improve their programmatic activities.2 Organizers of the Red Cross AIDS-prevention project in Jamaica, for example, improved their project design through individual feedback, regular debriefings and quantitative reports.13 Young people themselves are becoming more involved in evaluation tasks, facilitating their cooperation in providing needed information and also in the resulting activities.14 What are the key elements of implementing peer projects?
Young people have always sought and received information from one another, and they are doing so today in increasing numbers.15 Having especially-trained peers provide information helps to ensure its accuracy and usefulness, and peers are often better at contacting their own age and social groups.4 There is also evidence that outreach programs using peer educators are less costly per contraceptive user.16 The following are characteristics of successful peer programs:
Careful Peer Selection. Peer promoters should be selected based on important characteristics and interests. Peers should be capable of being respectful and able to hold confidences; credible role models, especially for the behaviors they advocate; admired and respected for their social skills; committed to good reproductive health, including contraception and STD prevention; and good at communicating.17 They also need to share characteristics of their target audience (such as age, language and ethnicity) so they are true "peers" and can relate well.
Training. Training of peer educators and adult counselors is a critical element in all young adult programs, given the special needs of this age group.18,19 Some analysts suggest that all staff involved in youth projects, including administrators, should receive training in order to be better managers, know what to expect, and be supportive.20 Training should be participatory and offered over time as refresher courses.11
Clearly Defined Responsibilities. Peer promoters need a clear understanding of what is expected of them. If managers hope to achieve a certain level of accomplishment, specific objectives and tasks must be identified and agreed upon by peer promoters.21
Effective Supervision and Support. Peer promoters require close supervision of their activities and reinforcement of their efforts.21 This oversight must continue throughout the life of the project. Supervisors must work with peers to identify their task-related needs and areas for upgradingand then address those gaps.
Availability of Relevant Materials. Materials that peer educators use with their peers should be accurate, clear, interesting and relevant.22 It is especially important for materials to address sexuality fits into young peoples relationships and lives.19 Presentation of the materials should allow for participation and interaction, such as question-and-answer periods, group discussions, drama presentations and role-playing.10,23
Planning for Turnover. Young people will naturally grow older, leaving the age range appropriate for peer programs. But they will also move on to other pursuits faster than adults, given their need to establish personal lives and careers. Projects can minimize turnover with good supervision and by rewarding peer promoters. Planning for the inevitable need for replacements, such as by training more promoters than needed to provide alternates for absentees and/or dropouts, can lessen the impact of peer turnover.20,24
1Senderowitz, J. 1995. Adolescent Health: Reassessing the Passage to Adulthood. World Bank Discussion Papers No. 272.
2AIDSCAP. 1996. Descriptive Analysis of AIDSCAP/Haiti BCC Projects: Some Lessons from the Field. Family Health International.
3Brabin, L. 1995. "Preventive and Curative Care for Adolescents: The Role of the Health Sector." (Prepared for WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health.)
4Fee, N. and M. Youssef. 1993. "Young People, AIDS and STD Prevention: Experience of Peer Approaches in Developing Countries." Global Programme on AIDS, WHO. (Draft).
5International Planned Parenthood Federation (IPPF). 1995. "Working with Youth." (A Report of IPPFs Youth Task Force and Youth Consultation Meeting).
6World Health Organization (WHO). In press. "Programming for Adolescent Health." (Technical Report of the WHO/UNFPA/UNICEF Study Group).
7Merritt, A.P. and M. Raffaeli. 1993. "Creating a Model HIV Prevention Program for Youth." The Child, Youth and Family Services Quarterly 16(2). American Psychological Association.
8Barker, G., J. Hirsh, and S. Neidell. 1991. Serving the Future: An Update on Adolescent Pregnancy Prevention Programs in Developing Countries. Washington, DC: International Center on Adolescent Fertility, Center for Population Options.
9Moore, K. and D. Rogow, eds. 1994. "Family Planning, Gender and Adolescence." (Family Planning and Reproductive Health Briefing Sheets for a Gender Analysis). New York: Population Council.
10International Planned Parenthood Federation (IPPF). 1994. "Understanding Adolescents." (IPPF Report on Young Peoples Sexual and Reproductive Health Needs).
11Pathfinder International. 1995. "Adolescent Project Evaluation." (Draft).
12Marie Stopes International. 1995. "A Cross Cultural Study of Adolescents to Family Planning and Reproductive Health Services." (Final Report to the World Bank).
13Kauffman, C., J. Brower, L. Hue and S. Randolph. 1996. AIDSCAP Subproject Final Narrative Report: Together We Can, HIV/STD Peer Education Project. American Red Cross and Jamaica Red Cross.
14Weiss, E., D. Whelan and G.R. Gupta. 1996. Vulnerability and Opportunity: Adolescents and HIV/AIDS in the Developing World. Washington, DC: International Center for Research on Women.
15Barker, G., and S. Rich. 1992. Influences on Adolescent Sexuality in Nigeria and Kenya: Findings from Recent Focus-Group Discussions. Studies in Family Planning 23(3).
16Townsend, J. et al. 1987. Sex Education and Family Planning Services for Young Adults: Urban Strategies in Mexico. Studies in Family Planning 18(2): 103-108.
17Hawkins, K., D. Ojakaa, and B. Moshesha. 1992. Review of the Youth Programme of the Family Guidance Association of Ethiopia. London: IPPF.
18Brandrup-Lukanow, A. et al. 1991. "Adolescent Sexual and Reproductive Health." (Report of the Workshop, CIE, Paris, 8-11 1991). IPPF. "Understanding Adolescents."
19 McCauley, A. and C. Salter. 1995. Meeting the Needs of Young Adults. Population Reports Series J (41).
20Perry, C. and R. Sieving. 1991. "Peer Involvement in Global AIDS Prevention Among Adolescents." (Unpublished review commissioned by the WHO Global Programme on AIDS).
21UNICEF. 1996. Youth Health For a Change: A UNICEF Notebook on Programming for Young Peoples Health and Development. (Working Draft I.)
22WHO/UNFPA/UNICEF. 1995. "Programming for Adolescent Health." (Discussion paper prepared for the WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health.)
23Panos Institute. 1996. AIDS and Young People. Panos AIDS Briefing No. 4.
24Flannagan, D. et al. 1996. Peer Education in Projects Supported by AIDSCAP: A Study of 21 Projects in Africa, Asia and Latin America. AIDSCAP.
u The In Focus series summarizes for professional working in developing countries some of the program experience and limited research available on young adult reproductive health concerns. This issue overviews a longer paper prepared by Judith Senderowitz for the FOCUS on Young Adults Program as part of a publication series presenting the key elements of young adult reproductive health programs. Each of the longer papers in the key element publication series can be downloaded from the FOCUS web site: