Adolescent reproductive health_Nana Dagadu_5.6.14

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Adolescent reproductive health_Nana Dagadu_5.6.14

  1. 1. ADDRESSING ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH: TOOLS FOR POSITIVE YOUTH DEVELOPMENT Global Health Practitioners Conference May 6, 2014
  2. 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. 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
  4. 4. WHY TAKE ACTION? GIRLS HEALTH EDUCATION EQUALITY ECONOMIC WELL-BEING ACHIEVE POTENTIAL
  5. 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. 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. 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. 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
  9. 9. MY CHANGING BODY FOR BODY LITERACY/ FERTILITY AWARENESS 1
  10. 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. 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. 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. 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
  14. 14. THE GREAT TOOLKIT FOR SRH 2 UGANDA
  15. 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. 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)
  17. 17. GREAT TOOLKIT: OVERVIEW
  18. 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. 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. 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. 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
  22. 22. THE CYCLESMART KIT FOR BODY LITERACY AND FERTILITY AWARENESS 3
  23. 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. 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. 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. 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
  27. 27. SUCCESSFUL INTERVENTIONS: STRENGTHEN PROTECTIVE FACTORS. POLICIES AND PROGRAMS: REDUCE YOUTH VULNERABILITIES & BUILD THEIR ASSETS.
  28. 28. ? GROUP HANDOUTSQ:
  29. 29. ! GROUP REPORTSA:

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