Because they often lack autonomy, decision-making skills and access to information and services, adolescents are vulnerable to a host of reproductive health problems.
For adolescent refugees, this vulnerability is compounded by violence, separation from family and poor living conditions. Health programs typically focus on the provision of emergency services, such as clean water and sanitation, and reproductive health programs are usually designed for pregnant women and their infants. Little attention is given to young people who have questions about puberty, menstruation, sexuality or relationships.
To address the unique health needs of adolescent refugees, the World Association of Girl Guides and Girl Scouts (WAGGGS) and FHI developed a comprehensive training and peer education project. The Health of Adolescent Refugees Project (HARP) allows young women to earn a merit badge by completing a series of activities that include teaching others about reproductive health. A two-year pilot project in Uganda, Zambia and Egypt, financed by the United Nations Population Fund, concluded in 2000, and an evaluation by FHI found the program was successful in improving young girls' use of health-care services and their self-esteem. Using local funding, scouts continue to earn the badge in each of the three countries.
"One of the most important things we accomplished is that we proved you can offer reproductive health education to adolescent refugees," says Lindsay Gilbert, a WAGGGS project and program development executive. "We proved you can provide education that can change knowledge and behavior. The girls who participated in the project told us they had ambitions and hopes for the future. Families were also able to learn from their daughters."
In each country, 10 women, most of them refugees, were trained to be group leaders. In Uganda and Zambia, 600 girls living in refugee camps initially participated in HARP, while in Egypt, 100 refugee girls living throughout Cairo participated.
To earn the badge, girls participate in educational activities and attend sessions where they discuss health topics, including the female reproductive system, physical and emotional changes during puberty, relationships, the human body, nutrition, hygiene and disease prevention. Three different curricula were developed: one for girls ages seven to 10, one for ages 11 to 14, and one for ages 15 and older. Topics vary by age, with girls ages seven to 10 learning about physical and emotional changes during adolescence, girls ages 11 to 14 learning about sexually transmitted diseases and pregnancy prevention, and girls ages 15 and older learning about healthy pregnancies and baby care.
Girls must complete other compulsory and optional activities to earn their badges.1Compulsory activities vary by age but center on developing a notebook of drawings girls prepare to share with friends. For example, during HARP, girls ages seven to 10 were asked to draw pictures of the human body, while girls ages 15 and older were asked to draw illustrations of maternal-child health. In addition, girls used the notebook to store materials from other HARP activities, including journals about their menstrual cycles, songs or poems written to honor an important woman in their lives, or a quiz for peers on HIV transmission.
To earn their badges, girls serve as peer educators in their communities and must reach at least 25 other girls through informal group discussions, one-on-one visits, distribution of educational materials or formal talks.
Girls can also earn bronze, silver or gold certificates for additional tasks, such as planning and preparing a healthy meal, performing a drama based on health themes or developing a list of recommendations for health agencies that work with adolescent refugees. All tasks focus on passing knowledge along to others.
In evaluating HARP, FHI found that participants understood general health messages about puberty, personal hygiene, sanitation and nutrition. However, girls had a harder time comprehending more complex topics. For example, some girls did not understand the "safe" period of the menstrual cycle. Reasons for this may have been that educational materials were printed in English, not local languages, and that text was rarely illustrated. Also, guide leaders had experience with teaching methods that emphasized rote learning rather than student participation. In addition, concepts such as "gender" and "self-esteem" were new to the girls and difficult to explain.2
Besides increasing girls' knowledge about health, HARP gave participants a safe place to gather, an outlet for creativity and an opportunity to have fun -- elements often missing from the lives of young female refugees. Also, HARP gave young women a chance to interact with older women who are caring, nurturing role models.
A problem in implementing the project was that many adolescents were reluctant to discuss some reproductive health issues. Some girls in Zambia were embarrassed by drawings of the uterus. Others were embarrassed when boys made comments about their notebooks. Some did not want to take the notebooks home for their families to see.
HARP also benefited adults who worked with adolescents. One project coordinator gained new knowledge about reproductive health. "It is a shame that I did not know some of these things until I was 30 years old, but at least I know them now," she says. Others say HARP participation increased their status in the community. "I am famous in my village now," says one of the leaders in Uganda. And national coordinators working with the project say they gained empathy for refugees. Says one trainer in Egypt, "I never saw these people in our communities before, but now they are visible to me. Now they see me in the market and call out to me, and I know they are here."
Although HARP was designed exclusively for girls, an important lesson learned was the need to develop activities for adolescent boys. "It became clear that the communities wanted the boys involved as well," says Gilbert. "As a girl learned about family planning, it was difficult to put what she learned into action if she didn't have the understanding of her male partner."
Male involvement will be a central component of a new project by WAGGGS and FHI. The Healthy Adolescent Project in India (HAPI) will work with the Bharat Scouts and Guides Association to adapt the HARP curriculum for boys and girls, offering different programs for ages 10 to 13 and ages 14 and older. The project, which will be conducted at seven sites in West Bengal, is funded by the David and Lucile Packard Foundation.
HAPI hopes to reach thousands of youth through peer education. Health providers also will work with scout and guide groups, giving talks during meetings, promoting adolescent health at special events, and conducting tours of local health clinics for young people.
"What is most exciting about these programs is that we are reaching adolescents with health information just as they are forming life-long attitudes and habits," says Matthew Tiedemann of FHI, who works with HARP and HAPI. "We are reaching them through an established, trusted network -- guides and scouts -- and we are applying the lessons learned from HARP to the HAPI project. We hope there will be opportunities to adapt the program in even more countries."
-- Barbara Barnett
References
- World Association of Girl Guides and Girl Scouts. Badge Curriculum: Health of Adolescent Refugees Project. London: World Association of Girl Guides and Girl Scouts, Family Health International, the United Nations Population Fund, nd; World Association of Girl Guides and Girl Scouts. The Leader's Handbook: Health of Adolescent Refugees Project. London: World Association of Girl Guides and Girl Scouts, Family Health International, the United Nations Population Fund, nd.
- Family Health International. The Health of Adolescent Refugees Project (HARP): Evaluation of the Pilot Project. Research Triangle Park, NC: Family Health International, 2000.
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