By Ximena Luengo and Virginia Toledo
As it is in many Latin American countries, the number of unwanted teenage pregnancies is rising in Chile. Chilean adolescents need information on sexual and reproductive health, mental health, nutrition, and substance abuse. To address these needs, the University of Chile’s Center for Adolescent Reproductive Medicine and Development (Centro de Medicina Reproductiva y Desarollo Integral del Adolescente — CEMERA) developed and implemented a school-based educational and service-linked program during the 1994 and 1995 school years, which was based on a program originally implemented in Baltimore, Maryland.
Targeting and Objectives
The program was implemented in two public schools in Chile’s capital, Santiago, for students in grades 7 to 12. More than 2,600 students attended the schools involved in the intervention. For evaluation purposes, another 2,000 students from similar public schools not involved in the program served as a control group.
The program used an approach that integrated education about sexuality into a more general curriculum about adolescent development. The goal of the program was to help students develop more responsible attitudes toward their personal conduct, particularly with respect to their sexuality. The objectives were to:
- delay first intercourse,
- promote safer sex and the use of contraceptives for those already sexually active,
- reduce the occurrence of unwanted pregnancies, and
- encourage the return to school of those already pregnant or parenting.
Activities and Sustainability
Teachers trained by Cemera taught sexual and reproductive health education in the classroom. CEMERA also maintained a staff presence at the school and referred students to their clinic, which was open daily for all adolescents and provided free counseling and medical services. Ongoing workshops for adolescents and parents also addressed emotional development and sexuality. A library and a hotline provided additional information and help to those who needed it.
Focus groups composed of adolescents were used to develop the school curriculum. Student representatives elected by each class periodically provided feedback to the program advisors and conveyed information back to the students.
As planned, CEMERA’s participation in the program ended after the second year; however, during the first two years of operation, steps were taken to ensure the program’s sustainability. Teachers were trained and provided with the written materials necessary to continue to teach the course after CEMERA’s involvement ended. Courses based on the CEMERA program are also being integrated into the curriculum of other schools. The Ministry of Health’s clinic personnel were trained in adolescent development and sexuality and Ministry clinics agreed to provide continuing consultation to adolescents.
Program Success
An evaluation of the program compared students from the intervention group with those in the control group. Several successful outcomes were noted.
- Knowledge about sexual and reproductive health among students in participating schools increased significantly.
- Students who completed the program demonstrated more responsible and mature attitudes toward sexuality than those who did not.
- Male students in the program schools became sexually active at a later age than the norm, and female students in the program schools initiated sex at later ages than girls in the schools where the intervention did not occur.
- Use of contraception increased among sexually active boys and girls in the program schools.
- The number of unwanted pregnancies decreased.
Factors that led to the success of this program were:
- using an integrated approach that presents sexual and reproductive health education within the context of other adolescent development topics,
- engaging students in the design of the curriculum, and
- involving parents in a parallel course.
Another key factor was the availability of clinic services to address health needs and provide contraception. Equally important to the program’s sustainability was the training of teachers. This was particularly critical because teachers will continue to work with students after CEMERA’s direct involvement has ended.
Lessons Learned
Considerable effort and lobbying of public officials were put into winning approval of state officials to implement a program in Santiago’s municipal schools.
When a school-based program is implemented, it is important to ensure coordination among all authorities: the central authorities from the Ministry of Education and the local authorities, including school principals and the heads of parent and student organizations. From the outset, it is critical to keep all participants informed so that they remain involved and are more likely to work together to implement the program.
The training of teachers, independent of their direct participation in the program, is important. So too is a parallel program for parents, so that they are aware of what their children are learning in school. This helps ensure that parents become part of the program and give it their support.
The program should be culturally appropriate to the locality in which it is instituted and to the target population. Cultural sensitivity includes using age-appropriate materials, as well as being aware of distinctions among students from different areas, different types of schools (public or private), and different socioeconomic backgrounds. Program materials can then be adjusted as warranted.
Finally, a school-based educational program must be linked with clinical services for youth. Programs that raise adolescents’ awareness of their health needs require support services that can, in turn, respond to their health problems and concerns. Knowledge about health needs diminishes when there are no complementary health sources available. It is equally important that these services are easily accessible and close to school.
Contact Information:
Ramiro Molina, Director
CEMERA
Universidad de Chile
Tel: 56-2-737 7080
Fax: 56-2-735 6512
Email: cemera@uchile.cl
Web site: www.cemera.uchile.cl
