Programs for Adolescent
Sexual and Reproductive
Health: What Works?
May 1 2014
Defining 1.8 billion Youth
•Around 1 in 4 persons is an adolescent aged 10-
•In all developing countries, youth are about 29
percent of the total population
•There will be about 72 million more youth in 2025
than there are today
•About 16 million girls aged 15 to 19 years and two
million girls under the age of 15 give birth every
year. The majority of these births occur within
•More than 30% of girls in developing countries are
married before age 18, with 14% married before
Insanity: doing the same things over and over
and expecting different results Albert Einstein
Around the world:
Ineffective interventions intended to improve adolescent sexual and
reproductive health (ASRH) continue be implemented;
Effective interventions are not replicated with attention to those attributes
that contribute to their effectiveness
As a result:
There are no observed health behaviour changes nor beneficial
outcomes for youth
Questions are raised about the value of ASRH policies and programs
Human and financial resources are used that could be deployed
Three interventions are proven to be ineffective in improving
adolescent sexual and reproductive health, yet continue to be
• Youth centers are
meeting points that
offer a youth-
friendly, safe, non-
1. Youth centers are not effective in delivering sexual
and reproductive health services for adolescents.
2. An evaluation of 18 youth centre programs showed:
– Older male youths who live nearby used the services, mainly
– There were no or limited effects on the use of sexual and
reproductive health services or commodities
– The cost per beneficiary was very high
YOUTH CENTERS – What have we
PEER EDUCATION: A Popular Approach
• Peer education is popular
– It makes use of existing
information exchange and
open discussion between
adolescents of similar age
and social status
– It provides opportunities for
regular contact in a friendly
– It may be more successful
at getting to hard to reach
youth over traditional adult-
PEER EDUCATION – What have we
Five meta-analyses of peer education program implemented
over many years in different contexts conclude that peer
education programs show limited effects in promoting safe
behaviours and in improving health, on their own.
Greatest impact is often among the peer educators themselves
“Peer education might be more effective if it is integrated in
holistic interventions and if the role of peer educators is
redefined in a way that makes them more of a source of
sensitization and referral to experts and services.”
1. Harden A, Oakley A, Oliver S. Peer-delivered health promotion for young people: A systematic review of different study designs.
Health Education Journal. 2001; 60(4):339-353.
2. Medley A, Kennedy C, O'Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries:
A systematic review and meta-analysis. AIDS Education and Prevention. 2009; 21(3):181-206.
3. Kim CR, Free C. Recent evaluations of the Peer Led approach in adolescent sexual health education: A systematic review.‐
Perspectives on sexual and reproductive health. 2008; 40(3):144-151.
4. Maticka-Tyndale E, Barnett JP. Peer-led interventions to reduce HIV risk of youth: A review. Evaluation and Program Planning.
5. Tolli M. Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health
promotion for young people: A systematic review of European studies. Health Education Research. 2012;27(5):904-913.
•A widespread harmful practice that affects enormous numbers
One third of the world’s girls are married before the age of
18 and 1 in 9 are married before the age of 15.
In 2010, 67 million aged 20-24 were married before age
If present trends continue, an average of 14.2 million girls
will marry each year.
•Countries with the highest prevalence of child marriage are
concentrated in Western and Sub-Saharan Africa, but the
largest number of child brides reside in South Asia.
•Early marriage is linked to early childbearing, which has
numerous and serious consequences for the health and well-
being of girls and their babies.
CHILD MARRIAGE – what have we learned?
• The contribution of legislation to change the practice has been very
• There is little correlation between legislation and trends
• There are very few indications that laws and legal reforms have
contributed to discouraging and eradicating child marriage.
• Among the 12 African countries that have had more than 10% decrease
in general, only three countries are considered to have a strong legal
framework (Ethiopia, Liberia, Sierra Leone).
• In the few countries with declining rates it is not possible to ascribe the
changes to legal reforms or legal mechanisms.
1. J Svanemyr, E Scolaro, K Blondeel, V Chandra-Mouli, M Temmerman. The contribution of laws to change the practice of child
marriage in Africa. 2013. Paper prepared by WHO for the Inter-Parliamentary Union.
2. S Lee-Rife, A Malhotra, A Warner, A McGonagle Glinski. What works to prevent child marriage: A review of the evidence. Studies in
Family Planning. 2012. 43, 4, 287-303.
Soooo, what DOES work?
• Two interventions
have proven to be
effective but are
often executed with
little attention to
those key attributes
that contribute to
relevant approach to teaching
about sex and relationships by
providing scientifically accurate,
UNESCO, UNAIDS, UNFPA, UNICEF and WHO. International
technical guidance on sexuality education. Volume 1. The
rationale for sexuality education. An evidence-informed
approach for schools, teachers and health educators. UNESCO.
COMPREHENSIVE SEXUALITY EDUCATION: what
makes it effective?
Common characteristics that effectively increase
knowledge, clarify values and attitudes, increase skills
and affect behaviour include:
1.The process of developing the curriculum
2.The content of curriculum itself
3.The manner in which it is delivered
UNESCO, UNAIDS, UNFPA, UNICEF and WHO. International technical guidance on sexuality education. Volume 1. The rationale for
sexuality education. An evidence-informed approach for schools, teachers and health educators. UNESCO. Paris. 2009.
To be considered adolescent-friendly, health services should be:
•Adolescents are able to obtain the health services that are available
•Adolescents are willing to obtain the health services that are available
•All adolescents, not just some groups of adolescents, are able to obtain the health services that are available
•The right health services (i.e. the ones they need) are provided to them
•The right health services are provided in the right way, and make a positive contribution to their health
WHO. Making health services adolescent friendly. Developing national quality standards. WHO. Geneva. 2013.
ADOLESCENT FRIENDLY HEALTH SERVICES
ADOLESCENT FRIENDLY HEALTH SERVICES –
Health services have been shown to increase utilization of health
services by adolescents only if they have all four of these
1.Health service providers are trained and supported to be non
judgemental and friendly in their dealings with adolescents
2.Actions are taken to make health facilities welcoming and appealing
3.Communication with adolescents to inform them about the
availability of ‘friendly’ health services and to encourage them to use
the services when needed
4.Communication with community members to make them aware of
the importance of providing adolescents with health services
New Ways of Thinking: Prevention vs
• Most common approach globally to youth
reproductive health has focused on the treatment of
• Growing evidence base of methodologies that
prevent or moderate problems and consequences
before they occur
New Understanding: The Adolescent Brain
SKILL-BUILDING: Intentional focus on broadening youth perspectives;
development of social, problem-solving and communication skills;
PARTICIPATION: Engaging and partnering with youth by offering
meaningful and developmentally appropriate opportunities for
participation (e.g., youth-led discussion, real choices) and leadership
(e.g., youth as peer counselors, tutors, evaluators, and contributors)
MEMBERSHIP: Creating a sense of membership and/or a sense of
commitment to school, workplace, culture, and community
NORMS AND EXPECTATIONS: Establishing norms and high
expectations for positive youth behavior and action that are
sanctioned by the group
ADULT-YOUTH RELATIONSHIPS: Establishing deep and meaningful
ways for young people and adults to relate and engage with each
other and specific training for adult leaders
INFORMATION AND SERVICES: Providing problem-specific
information and access to developmentally appropriate services
Source: Developed by the Academy for Educational Development, derived from Eccles and Gootman, eds. (2002).
Community Programs to Promote Youth Development . National Academies of Science.
Greater attention to Positive Youth Development
Resources for ASRH programming: