Involving Young People in Reproductive Health Programs

Involving young people in reproductive health programs means identifying ways for them to participate in a meaningful way in some aspect of a project's planning, implementation, and/or evaluation. Although working with young people as partners is a new challenge for many managers, studies indicate that this approach is becoming more common. As many as one-third to one-half of adolescent reproductive health projects surveyed in two separate countries involved young people in a variety of roles.^4,17 Among the most typical of these were projects that had identified young people’s special needs and concerns through needs assessments, and projects that engaged young people as peer educators. There is, however, a serious lack of evaluation of this approach. Virtually no research findings indicate which strategies to involve youth result in what kinds and degree of benefits to the target group.

Why is it helpful to involve young people in their own reproductive health programs?

• Youth input can help ensure that programs are relevant to young people’s actual needs.
• Youth can help identify messages, communication channels, and activities popular with their subculture.
• Young people can effectively publicize program activities and help interest their peers in becoming program participants.
• Youth spokespersons can give credibility to the program and serve as an outreach link to the community.²³
• Involving youth from the start can enhance young people’s sense of ownership in a project.
• Involving young people as program leaders and educators provides an alternative to the adult professional and can sometimes yield better outcomes. Such involvement also enhances the skills, self-esteem, and leadership potential of the young people who are trained as peer educators. ^5,7,11,23

Many experts in the reproductive health of young adults believe that young people themselves should be involved in many, if not all, stages of a project, including design, implementation, and evaluation.^13,15,16,20 Some projects place youth involvement at the very center of their strategy and design:

• The Youth for Youth Project began in 1990 in six countries (Colombia, Egypt, Jamaica, Senegal, Sierra Leone, and Sri Lanka) and is coordinated by the International Planned Parenthood Federation (IPPF) and funded by the United Nations Population Fund (UNFPA). With the collaboration of both governmental and non-governmental organizations (NGOs), each project made a point of involving young people in defining solutions to their own health problems. This led to a number of pioneering activities. For example, one project in Sierra Leone addressed the problem of female genital mutilation. This was the first time the issue had been taken on by a youth group. A wide range of young people were reached by the project, including those living in urban slums and prisons, school children, the military, and young people who already had children of their own.^8,10,18

• The West African Youth Initiative (WAYI) emphasized youth involvement in its nine community-based peer education projects in Nigeria and Ghana. While peer education is the standard intervention used by the projects, other strategies to involve youth were also used—especially in decision-making. The project was designed to assist small non-governmental and governmental projects that were planning or beginning reproductive health education activities for young people at the community level.^1,2,14

• The Mathare Youth Sports Association (MYSA) in Kenya, which promotes sports and slum clean-up activities, also includes reproductive health education. Its emphasis on youth participation is its most unique aspect. The project is for youth and run by youth. MYSA has a bottom-up decision-making structure that has successfully empowered youth to develop skills, become role models, and serve as responsible members of society.²¹

Some projects have identified specific program aspects for involving youth, such as:  

• The Youth for Youth Project planned each country's program by convening 4-5 day workshops at which youth identified the reproductive health needs of young people in their countries and helped identify project plans to meet these needs.¹⁰

• To increase youth decision-making and oversight related to the Under-20s Club and other youth activities in Grenada, young people serve as members of the Grenada Family Planning Association's Board of Directors.¹⁹

• In Honduras, Proyecto Alternativas (Alternatives Project) instituted a Youth Advisory Council to formalize planning and decision-making by youth.²⁶ Profamilia in the Dominican Republic also uses this strategy.¹⁹

• Many projects involve young people as peer educators, (for example, in the WAYI project, but there are other ways young people can serve as implementers. They can be clinic counselors,¹² recruiters, as in a project in Chile,³ or managers, as in the Mathare Project in Kenya.²¹

• Although youth involvement in evaluation is lagging behind other project components, the WAYI project has successfully engaged its peer educators in the management information system services, and in using monitoring and information services and quarterly reporting mechanisms.¹

• The Youth Committees of projects participating in Youth for Youth helped to refine the evaluation methodology and also provided information to develop evaluation indicators.¹⁰

While youth involvement is advocated by most major international agencies, such as WHO,²⁵ UNFPA,²⁶ UNICEF,²² and IPPF,⁹ and while its advantages are intuitively plausible, there has been little evaluation designed to relate the involvement of youth in overall program aspects with improved program outcomes.

The ongoing evaluation of WAYI is trying to identify the contribution of youth by assessing young people's ability to identify problems and generate solutions; by identifying the contributions of peers in improving knowledge, attitudes, and practice (KAP); and by examining staff attitudes and behaviors related to youth management of the projects. Preliminary results suggest overall staff support for involving young people. Nevertheless, projects often need help to involve youth in all facets of programs.¹ For example, some project staff have not allowed youth a role in financial management citing their lack of trust in youth concerning money.¹⁴

Peer education programs, on the other hand, have a longer history of youth involvement, and evaluations do show some positive results:

• WAYI peer projects report statistically significant positive effects on reproductive health knowledge, self-efficacy, and behavior.¹⁴

• A CARE project in Kenya, Community Resources for Under 18s on STDs and HIV (CRUSH), using peer-to-peer learning, reported that the target group of out-of-school youth displayed better knowledge, more positive attitudes, and signs of behavioral change toward STD/HIV prevention when compared to the non-participating control group.⁶

• In a Thai factory setting, a peer-led group of single female adolescents demonstrated the most significant improvements in HIV prevention knowledge and enabling skills compared to those in the adult-led sessions or those in sessions using only educational materials.²⁴

• Adult professionals have traditionally planned and conducted programs for youth and are often resistant to change.

• Working with young people as partners runs counter to cultural patterns in many countries.

• Dependence on young people to assume key tasks (planning, oversight, and staffing functions) carries some predictable risks and requires added investments, including high turnover, less than reliable participation because of competing demands and interests in young people’s lives, the need for additional supervision, an incentive and reward structure, and extra training, both for the young participants and the adults they work with.

• Other than peer education approaches, there have been few other model strategies that actively involve youth in program planning, implementation, and evaluation.

• Evaluation of specific youth involvement strategies is scant, yet badly needed as guidance for program planners.

References

1. Advocates For Youth. The West African Youth Initiative. Presented at the National Council on International Health Annual Conference, Washington, DC. June 1996.
2. Association for Reproductive and Family Health, Advocates For Youth International and African Regional Health Education Center. The evaluation design for the West African Youth Initiative (WAYI). Undated.
3. Barker G, Fontes M. Review and Analysis of International Experience with Programs Targeted on At-Risk Youth. Unpublished report for the Government of Colombia. The World Bank, 1996.
4. Barker G, Hirsch J, Neidell S. Serving the Future: An Update on Adolescent Pregnancy Prevention Programs in Developing Countries. International Center on Adolescent Fertility, Center for Population Options, 1991.
5. Bartling H, Cameron H, Cronk B, et al. Assessing the Evaluation Process: Adolescent Peer Counseling in Latin America. Report prepared for IPPF/WHR and the Applied Workshop in Economic and Political Development of the School of International and Public Affairs, Columbia University. 1996.
6. Chege I, Avarand J, Ngay A. Final Evaluation Report. Communication Resources for the Under 18's on STDs and HIV (CRUSH) Project. 1995.
7. Flanagan D, Williams C, Mahler H. Peer Education in Projects Supported by AIDSCAP: A Study of 21 Projects in Africa, Asia and Latin America. AIDSCAP, 1996.
8. International Planned Parenthood Federation (IPPF). Understanding Adolescents. An IPPF Report on Young People's Sexual and Reproductive Health Needs. IPPF, 1994.
9. International Planned Parenthood Federation (IPPF). Working with Youth. A Report of IPPF's Youth Task Force and Youth Consultation meeting. IPPF, 1995.
10. International Planned Parenthood Federation (IPPF). Youth for Youth: Promotion of Adolescent Reproductive Health through NGO Collaboration. IPPF, 1993.
11. International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR). Responding to the Challenge: Preventing Unwanted Teenage Pregnancy in Latin America and the Caribbean. A project paper on five years of funding from the William and Flora Hewlett Foundation. IPPF, 1995.
12. Jay MS, Durant RH., Shoffit T, et al. Effect of Peer Counselors on Adolescent Compliance in Use of Oral Contraceptives. Pediatrics 73(2): (1984).
13. Koontz SL, Conly SR. Youth at Risk: Meeting the Sexual Health Needs of Adolescents. Population Policy Information Kit #9. Population Action International, 1994.
14. Lane C. Peer Education: Hopes and Realities/The West African Youth Initiative. Presented at the Johns Hopkins University/CEDPA symposium, "The Young and the Restless," Washington, DC. April 1997.
15. Marie Stopes International. A Cross-Cultural Study of Adolescents' Access to Family Planning and Reproductive Health Education and Services. Final report to the World Bank, 1995.
16. McCauley AP, Salter C. Meeting the Needs of Young Adults. Population Reports. Series J, No. 41. October 1995.
17. Peplinsky NL. Addressing Needs and Opportunities: A Survey of Programs for Adolescents. ICRW, 1994.
18. Senanayake P. Youth for Youth—Focus on Adolescent Reproductive Health. The Health Exchange, 1992.
19. Stewart L. [FOCUS] Personal Communication. 1996.
20. Themmen E. Adolescent Sexual and Reproductive Health Resource Materials: A Needs Assessment in English-Speaking Africa. Family Care International, 1996.
21. Transgrud R. Adolescent Sexual and Reproductive Health in Eastern and Southern Africa. (Draft). Prepared for USAID/REDSO, May 1997.
22. United Nations Children’s Fund (UNICEF). Youth Health—For a Change. A UNICEF Notebook on Programming for Young People's Health and Development. (Working draft I) UNICEF, 1996.
23. U.S. Department Of Health and Human Services, Public Health Service. The Prevention Marketing Initiative: Youth Involvement. Prepared for the Centers for Disease Control and Prevention by the Academy for Educational Development. (Draft) March 1997.
24. Weiss E, Whelan D, Gupta GR. Vulnerability and Opportunity: Adolescents and HIV/AIDS in the Developing World. International Center for Research on Women (ICRW), 1996.
25. World Health Organization (WHO). Programming Adolescent Health. Technical Report of the WHO/UNFPA/ UNICEF Study Group. In press.
26. World Health Organization/United Nations Population Fund/United Nations Children’s Fund (WHO/UNFPA/ UNICEF). Programming for Adolescent Health. Discussion paper prepared for WHO/UNFPA/ UNICEF study group on programming for adolescent health. Saillon, Switzerland, 29 November-4 December 1995.