Today's young adults are our future. Their energy, leadership and wisdom will shape the world during this new century. They will care for our own generation as we grow older and they will nurture the next generation to come.
Consequently, protecting their good health is a vital concern for all of us. Effective strategies and programs to protect the reproductive health of young adults are needed in every country, but are especially urgent for youth in developing countries.
Around the world, thousands of young women die each year from complications due to an unplanned pregnancy, many of them resulting from clandestine abortions. And in 18 African countries, at least a third of today's 15-year-olds are expected to become infected with HIV during their adult lives and will die from this terrible disease.
For developing-country adolescents to avoid unplanned pregnancies, disease and other serious reproductive health problems, they need accurate information and services. We need a variety of carefully designed school-based programs, community efforts and responsible mass media messages to help educate youth.
|
 |
|
Nancy Williamson of FHI and Frontiers in Reproductive Health. |
In the abstract, what youth need for good reproductive health is easy to identify. Young adults need a basic understanding of how their bodies work and the reproductive health concerns they face, as can be provided through family life education. They need ways to develop stronger interpersonal skills (for example, how to avoid unprotected sex). They should know about specific health services available to them (treatment for sexually transmitted diseases, contraception and postabortion care) and how to obtain commodities (condoms and other contraceptives, drugs for treatment and educational materials). They should be aware that the choices they make today could help or harm them and those they love, perhaps with lasting consequences.
However, specific approaches to meeting adolescent reproductive health needs vary considerably. Some programs take a holistic approach to youth development while others favor a more targeted approach to reproductive health. Approaches include family life education in schools, media campaigns (print and broadcast media), peer education programs, youth centers, telephone hotlines, theater groups and postabortion or postpartum programs. Some religious-based programs and sports programs are involved in reproductive health strategies for youth, as are a variety of other projects: social marketing of condoms to youth, HIV counseling and testing, efforts to keep youth in schools, job training, discouragement of early marriage, and premarital counseling among them. Most current programs are on a small scale. (A recent review of youth programs in developing countries has been prepared by Judith Senderowitz, a consultant who has written extensively on adolescence.)1
Only a tiny percentage of the world's resources is devoted to helping youth in developing countries realize their potential. Given the huge numbers of youth and the seriousness of the problems, there is a temptation to commit all available resources to action programs and just "get on with it." Evaluation may seem like a luxury.
Limited resources
But get on with what? Hard decisions must be made about how to allocate very limited resources. Many programs reach youth long after they need the information rather than when the information is most crucial. Other programs may not deal with the most pressing concerns facing youth. Health professionals and program managers lack adequate information on cost-effective ways to reach the largest number of youth, including both boys and girls, different age groups, in-school and out-of-school youth, and unmarried and married youth.
Take the example of youth centers, places where adolescents can congregate for recreation and also have access to reproductive health services or information. At first glance, this seems like a reasonable approach. But a recent evaluation of 14 centers in Africa found that youth centers typically serve small numbers of youth (often older males), are not particularly good places to deliver reproductive health information and services, and are relatively expensive.2
Other researchers have found that youth centers in Mexico were less cost-effective than a community youth program in recruiting family planning users.3 On the other hand, postpartum programs such as one in Jamaica and another in Mexico have been quite successful in encouraging adolescent mothers to postpone a second pregnancy.4 Regrettably, information on cost-effectiveness is lacking for most adolescent programs in developing countries.
How can program managers monitor the impacts of different approaches and the resources required? How does one choose which approaches are more successful and should be expanded? Below are key questions managers might ask:
What behaviors is the program trying to change? Is the program preventive, curative, or both? Once these key features are identified, meaningful core indicators can be developed.
Are the planned activities targeted toward changing those behaviors?
Is the program targeted to all youth in a geographical area or is it focused on a specific group (e.g., older or younger youth, boys or girls, in-school or out-of-school youth, married or unmarried youth)? Will it serve only the youth who come to the site?
Is the program having an impact beyond the changes that one would expect as young people mature?
Is the program having an impact beyond other changes occurring in the project area? (Comparing the area being served with a similar "control" area that is not being served will help determine this.)
What are the additional costs required to implement the program?
Would the money be better spent on another kind of program?
If the program does have an impact, can it be sustained?
If successful, can the program be expanded?
The Frontiers in Reproductive Health project of the Population Council and its partners, FHI and Tulane University, are addressing these questions for youth programs in Mexico, Bangladesh, Kenya and Senegal. A strategy to improve the environment for adolescent reproductive health and to make services more youth-friendly is being compared with a strategy that includes both of those elements plus a school-based program. The cost-effectiveness of the two strategies is included in the evaluation.
Careful monitoring and evaluation are urgently needed precisely because the needs of our youth are so important.
Dr. Williamson is seconded from FHI to the Population Council to work on the Washington-based Frontiers in Reproductive Health. The U.S. Agency for International Development supports this worldwide operations research project.
Additional reading
Two recent publications to help evaluate youth programs are: A Guide to Monitoring and Evaluating Adolescent Reproductive Health Programs by Susan Adamchak, Katherine Bond, Laurel MacLaren, et al. and Getting to Scale in Young Adult Reproductive Health Programs by Janet Smith and Charlotte Colvin. Both are available from: FOCUS on Young Adults, Pathfinder International, Attn: Communications Advisor, 1201 Connecticut Avenue NW, Suite 501, Washington, DC 20036, USA. E-mail: focus@pathfind.org.
References
- Senderowitz J. A review of program approaches to adolescent reproductive health. Unpublished paper. U.S. Agency for International Development, 2000.
- Erulkar AS. Overview of youth centre assessments in Kenya, Zimbabwe, and Ghana. Unpublished paper. The Population Council, 2000.
- Townsend JW, Diáz de May E, Sepúlveda Y, et al. Sex education and family planning services for young adults: alternative urban strategies in Mexico. Stud Fam Plann 1987;18(2):103-8.
- Chávez N, Schenkel P, Vernon R. Postpartum Education for Adolescents: Evaluation and Refining of a Model for Institutionalization. Mexico City: Centro de Orientación para Adolescentes and The Population Council, 1992.
Click to select preferred language, if other than English: French | Spanish.
