ARH in Cambodia (Phnom Penh and Sihanoukville municipalities and Battambang and Kampong Cham provinces). RAS/98/P12

In Cambodia, the International Planned Parenthood Federation, through the Reproductive Health (RH) Association of Cambodia, seeks to help strengthen the national capacity to deliver RH services and high-quality RH information, education and communication (IEC) materials for adolescents in four project areas. It also aims to increase the utilization of RH services by young people aged 12-25 years. Its strategies include providing back-up IEC services and specialist technical inputs to the production of radio shows, and sharing the family life education curriculum as a resource. The main activities of the project consist of: 1) meeting with stakeholders to encourage community participation and carrying out needs assessment; 2) organizing adolescent reproductive health services and providing special clinic facilities; 3) setting up of youth club activities and mobilizing, training and supporting youth volunteers to provide outreach, peer education and referrals to clinic services; and 4) training and disseminating IEC materials.     

Lao Youth Union networks to promote adolescent reproductive health

The Central Lao Youth Union (LYU) is implementing the third component of the Reproductive Health Sub-Program. It has collaborated with the National Statistic Center in a knowledge, attitude, and practice study on reproductive health among adolescents and youth between the ages of 15 and 24. The findings of this study will provide data on the knowledge that youth have on birth spacing and contraceptive methods; their attitudes towards unwanted pregnancy, reproduction, sexually transmitted diseases, HIV/AIDS and substance abuse; and common youth practices concerning heterosexual relationships, sexual relationships, discussions on sex, planning for marriage, and sex with commercial sex workers. Moreover, the LYU is also collaborating with the Institute for Mother and Child Health, the Lao Women's Union, and the Ministry of Education in developing a reproductive health manual. The manual will cover reproductive health-related topics that will be used as reference material for LYU leaders and volunteers at the district and village levels.     

Survey reveals slow strides in promoting adolescent reproductive health in Vietnam

This article presents the findings of a survey evaluating the adolescent reproductive health program by the Vietnamese Government. Conducted by the Population Research Consultants, survey findings revealed several setbacks of the adolescent reproductive health program; these included the following: 1) adolescents favor radio, television and newspapers as sources of reproductive health (RH) information; 2) adolescents have no knowledge of pregnancy, sexually transmitted diseases, and HIV/AIDS prevention; 3) the demand for RH information varies according to the sociodemographic characteristics of respondents; 4) while the majority of adolescents do not favor premarital sex and premarital pregnancy, their choice is to keep and deliver the baby in case of a premarital pregnancy; 5) adolescents give a poor rating to the quality of RH/family planning services at the centers; 6) adolescents need to further understand RH but not knowing its meaning, they cannot tell what type of information they require; 6) adolescents have poor knowledge of adolescent reproductive health; 7) friendship and love are often discussed among adolescents, but sexuality rarely is; and 8) adolescents have poor knowledge of RH and poor interest in RH/family planning service facilities.     

National news. Cambodia. The future of ARH

The escalating HIV/AIDS crisis in Cambodia underscores the importance of reproductive health programs aimed at adolescents. Although the Cambodian Government has not developed a strategy specifically aimed at reaching youth, it has initiated several related health promotion and HIV/AIDS prevention programs. Such programming is especially urgent in light of rapid economic changes in Cambodia and the growing influence of the mass media on urban youth. An in-country paper prepared by a staff member of the Youth Department of Cambodia's Ministry of Education, Youth, and Sports stressed the importance of four factors: 1) designation of young couples as a target for birth spacing campaigns and services, 2) realistic HIV/AIDS educational messages in the mass media, 3) incorporation of traditional practices in adolescent reproductive health campaigns, and 4) greater sensitivity to youth culture and habits.     

National news. Bangladesh. Mobilizing the youth through youth clubs. Population education for girls: PSTC experience

Involvement of Youths in Population and Family Welfare Activities through Youth Clubs, a project supported by the United Nations Population Fund, has developed innovative ways of reaching Bangladeshi youth with reproductive health messages. One such project, executed by the Ministry of Youth and Sports, provided training in family life education to 74 youth training centers and launched population activities through 200 youth clubs in 98 thanas. Benchmark surveys were conducted in priority areas identified by individual clubs. A primary health care intervention reached 23,000 women and children with health card and sanitation programs. Follow-up surveys have revealed significant improvements in youth's knowledge of health, nutrition, maternal-child health, sanitation, and environmental conservation. In another Bangladeshi program, girls 9-19 years old received education through the Population Services and Training Center on topics such as the advantages of delayed marriage, family planning methods, and maternal-child health.     

Bhutan: impressive strides in health and education

This article reports the important developments in adolescent health and education status in Bhutan. These developments consist of a change in the focus of Bhutan's UNFPA-supportive reproductive health services. The country has also included adolescents as a primary target of reproductive health services. Adolescent girls have become the beneficiaries of a school health program developed by the Division of Education, and a comprehensive youth guidance program is under development by the Youth Guidance and Counseling Section of the Education Division. This change is a response to the increasing youth population; over 58% of the total population is aged under 25 years, and over 15% is aged under 15 years. Although initiatives to improve youth status has been undertaken, some problems still remain. These include malnourishment, pregnancy complications, and rise of sexually transmitted diseases, which raises the potential for the spread of HIV/AIDS.     

Reproductive health through community involvement with special attention to adolescents and clinical contraception. RAS/98/P63

This article outlines the objectives, strategies and main activities of Save the Children Fund/Bangladesh to increase reproductive health (RH) through community involvement with special attention to adolescents and clinical contraception. It is noted that the ways to increase the range of reproductive information and care available to adolescents are being explored, with a view to improving their sexual and RH knowledge and practices, and to increasing clinical contraception use. The following strategies are being implemented: 1) strengthen the capacity of local partners, which include the districts of Khulna, Moulavibazar, Cox's Bazar and Panchagarh; 2) conduct participatory workshops with adolescent groups; 3) promote advocacy for adolescents regarding their needs; 4) develop a platform for adolescent and adolescent-friendly clinics; and 5) promote community-based programs in RH and family planning, especially contraception. A summary of the main program activities of the project is given.     

Sri Lanka: a holistic approach to reproductive health

In response to the request of Sri Lankan adolescents in the provision of family planning knowledge prior to marriage, a holistic approach to reproductive health education program supported by the UN Population Fund/Dutch multi-bilateral assistance was adopted. This program is jointly coordinated by the Social Science Department of the National Institute of Education and the Department of Science and Health. It conducts counseling by peers and teachers and educating parents concerning adolescent health. In addition, the Government invited nongovernmental organizations and private sectors to assist in the development of a national policy concerning reproductive and adolescent health. Policy statements were recognized by the public and programs at the community level were implemented by a task force. The government initiated preventive strategies through the counseling center network of the National Youth Services Council and the vocational training centers of the Vocational Training Authority. Reactions of Sri Lankan adolescents to these initiatives have been positive. They have demonstrated favorable attitude towards reproductive health and are receptive to family planning concerns. However, there is still a need to provide an organized service delivery program to ensure the availability and provision of contraception to adolescents.     

Bangladesh: recognizing adolescents as a great resource

This article presents the initiatives undertaken by the government and other organizations to improve adolescent reproductive health in Bangladesh. The Health and Population Sector Programme under the 5-year Health and Population Sector Strategy (HPSS) of Bangladesh targeted married youth and soon-to-be-married adolescents. It has provided training of field workers so they can provide health services in an adolescent-friendly atmosphere. The Government has also collaborated with nongovernmental organizations and agencies that could help in the formulation of well-planned policy for adolescent health. These agencies include the UN International Children's Emergency Fund, UN Population Fund and WHO. In addition, on-going multisectoral coordination of various sectors, such as education, labor law and justice, youth and social affairs, has been developed and has contributed to the success of the Programme.     

Advocacy and IEC strategies. Getting the most from the experience of others in promoting adolescent reproductive and sexual health

The UN Educational, Scientific and Cultural Organization Regional Clearing House on Population Education has commissioned a series of case studies on the promotion of adolescent reproductive and sexual health, with emphasis placed on advocacy and information, education and communication (IEC). The case studies will document the experiences of Bangladesh, China, India, Indonesia, Iran, Malaysia, Philippines, Sri Lanka, and Thailand. The advocacy activities include programs to gain the support of lawmakers and policymakers, the mass media and other influential groups. IEC activities, on the other hand, reach out to the youth, counselors, teachers and trainers, extension workers and motivators, and health personnel. Advocacy and IEC also differ in strategies. Political lobbying, high level meetings, seminars, mass media campaigns, and advocacy skills training are typical advocacy strategies; while, individual counseling, research, non-governmental organization involvement in communities, youth camps are of IEC strategies. The case studies also examine national policies, program responses and strategies, and factors that have contributed to best practices, and innovative approaches to advocacy and IEC. The impact of the target groups of the case studies will be evaluated and those with successful outcomes will be identified.     

Promoting reproductive health practices among working adolescents and young adults (industrial workers). RAS/88/P11

In Cambodia, Care (Deutschland), through the Cambodia Health Education Development (CHED) and the Reproductive Health Association of Cambodia, is working towards the promotion of reproductive health (RH) practices among working adolescents and young adults. The project seeks to reach a minimum target group of 10,000 out-of-school, single, working adolescents and young adults aged 12-29 years, and at least 50 trained RH providers and educators in selected project sites. It also aims to provide specialist RH services to at least 200 single adolescents and young adults per month and per newly operational RH facility in project areas; and to build the capacity of at least two partner nongovernmental organizations in adolescent RH services. As its two-part strategy, the project is sharing information, education, and communication (IEC) expertise and using CHED as an informal IEC clearing house. The main activities of the project are outlined.     

How and where we live,learn, and play matters: An introduction to the special issue

Abstract

A holistic approach to providing health education and services integrates the Social Determinants of Health (SDH)—an approach Healthy Teen Network calls Youth 360°—to recognize that where youth live, learn, and play matters. Long promoted by such stalwarts in the public health field as the World Health Organization and Centers for Disease and Control, the SDH are now broadly recognized, including in the field of adolescent sexual and reproductive health (ASRH), as the only way to engage and address the needs of all youth. But stating this and truly understating how to make this happen are very different animals.     

The Davao Teen Centre empowers the youth of Mindanao. Philippines

This article discusses the Development and Family Life Education for the Youth (DAFLEY) Project in Davao City, Philippines. The DAFLEY aimed to make the youth enlightened citizens of the future by educating them on reproductive health care services, gender equality, and responsible parenthood. It was established by the Family Planning Organization of the Philippines and is being carried out through the Davao Teen Centre (DTC), which provides reproductive and sexual health care services through counseling, face-to-face or by telephone. In an effort to reach out to more teenagers in Mindanao, the DTC introduced radio programs offering on-the-air advice to adolescents with problems ranging from boy-girl relationships and unplanned pregnancies to more complex and serious problems. Public response to the programs has been enthusiastic. The youth that have benefited from the DTC counseling refute a conservative belief that sex education leads to promiscuity and sexual experimentation. They state the respect they have for their bodies and their sense of responsibility as proof of the value of the reproductive health education and services that they have received.     

Media education to improve adolescent sexual and reproductive health in Cambodia. RAS/98/P10

Through the use of interactive radio and other media, Health Unlimited through its implementing agencies, the Cambodia Health Education Media Services and Cambodia Health Education and Development is working towards increasing knowledge of reproductive and sexual health among Cambodian adolescents. It also seeks to promote the use of reproductive and sexual health services for the youth; improve youth involvement in developing information, education and communication (IEC) materials on reproductive health; and increase the capacity of nongovernmental organizations, government agencies and the private sector to develop IEC for the youth. The strategies being pursued include exploring the role of radio and using nongovernmental organization expertise in radio show production and sharing IEC messages with the media. The main activities being carried include the production of interactive radio magazine programs for the youth along with magazine supplements, training of health and media staff and providing them with work experience, and involving the youth in media production by using an interactive format and focus group discussion.     

Without Sex Education: Exploring the social and sexual vulnerabilities of rural Bangladeshi girls and boys

In 1997, two organizations, BRAC (Bangladesh Rural Advancement Committee) and ICDDR,B (International Center for Diarrheal Disease Research), as part of their collaborative research model, developed an HIV/AIDS prevention strategy for rural Bangladeshi youth. Currently, HIV/AIDS is not apparent in rural Bangladesh. Other sexual and reproductive health problems are more pressing. Moreover, there are few inor out-of-school sex education programs for adolescents in Bangladesh. Therefore, preliminary qualitative research was conducted to understand the broad parameters of sexual and reproductive health within the sociocultural context of young people's risks and vulnerabilities. Exploratory research revealed that youth were vulnerable to sexual diseases, late-term abortions, sexual violence, reproductive tract infections, and premarital pregnancies. Adolescents and adults thought that youth today need sex education. Adults said that youth should not be educated about condom use because this would conflict with a girl's prospects for an arranged marriage. Bangladeshi youth today are being exposed to experiences unfamiliar to their parents. Lacking appropriate knowledge, information and awareness about sexual and reproductive health unduly heightens young people's fears, and increases their social and sexual vulnerabilities.     

The Educational Attainment Process Among Adolescents with Disabilities And Children of Parents with Disabilities

This article uses data from the National Longitudinal Survey of Youth 1997 (NLSY97) to examine the relationship between disability, parental and youth university expectations in 1997, and youth high school completion and university enrolment by 2003. Results indicate that educational attainment is not equal for young adults with and without disabilities in the United States. Parents—but not adolescents—are likely to reduce their educational expectations when adolescents have a mild or serious disability, net of school performance. These parental—but not adolescent—expectations are significantly associated with high school completion. Finally, even after controlling for educational expectations and school performance, youth with serious disabilities are much less likely to graduate from high school than youth without disabilities. Despite the considerable strides made in the implementation of the Individuals with Disabilities Education Act, students with disabilities are not achieving educational parity in graded schooling.     

InFection Four: Development of a Youth-Informed Sexual Health Card Game

Games may be useful tools for learning and communicating about sexual and reproductive health. This article discusses the collaborative design and subsequent evaluation of a narrative-based card game. This game was created in a workshop based on positive youth development, which allowed youth to be involved as game designers and game players. Human-centered design informed the workshop and gave the youth opportunities to have meaningful roles, learn skills, and focus on an issue that affects their peers. The intervention was constructed to teach about sexual and reproductive health and also to provide skills to address the medical, social, and emotional aspects of sexually transmitted infections (STIs). During the evaluation of the resultant game, student players were critical of the game but admitted to learning essential facts about STIs. This study demonstrates the feasibility of collaboratively designing a game with youth for youth resulting in a playable and educational tool.     

Democratic reform paves the way for new reproductive health strategy and advocacy. Mongolia

Ms. Munkhuu, senior adviser to the Reproductive Health Advocacy Project in Mongolia, reports the implementation as well as the impact of its National Adolescent Health Program. She relates the program's beginnings with the adoption of the National Program in Reproductive Health in 1997, which made adolescent reproductive health issues a public concern. Through the program, formal health education was incorporated in the secondary school curriculum. Other developments of the program were the training of trainers, publication of a quarterly newspaper called the Uerkhel--Love for adolescents, creation of educational radio and television programs on adolescent sexuality, and the establishment of a hot line service. In conclusion, Ms. Munkhuu emphasizes the need to make the program more effective and responsive by improving the country's information system and by increasing reproductive health awareness among policy-makers and the general public. Advocacy training should also be actively pursued.     

Expanding access to quality reproductive health services in underserved outlying districts in Bangladesh. RAS/98/P65

In Bangladesh, the International Planned Parenthood Federation, through the Family Planning Association of Bangladesh, works to increase access to quality reproductive health (RH) care services among low- and medium-income groups in underserved outlying districts. The strategies being pursued are as follows: 1) expand RH services (with special emphasis on long-term methods) through special work units/upgraded clinics and mobile clinics; 2) develop and use information, education and communication materials for information and awareness raising; 3) hold community-based meetings for information dissemination, RH awareness and motivation, and clinical contraception; 4) conduct advocacy campaigns to increase demand for RH services; 5) organize adolescent school-based programs and peer group meetings on awareness raising and RH; 6) strengthen field units/local nongovernmental organizations and community based organizations through training and support; 7) promote inter-linkages with other RH information partners, government agencies and other nongovernmental organizations; and 8) establish a cost recovery process for sustainability. A summary of the main activities of the program is provided.     

Boys are not exempt: Sexual exploitation of adolescents in sub-Saharan Africa

Research on youth sexual exploitation in Africa has largely neglected the experiences of exploited boys. To date, much of the research in sub-Saharan Africa continues to consider boys mainly as exploiters but not as exploited. Using the only publicly available population-based surveys from the National Survey of Adolescents, conducted in four sub-Saharan African countries — Burkina Faso, Ghana, Malawi, and Uganda—we assessed factors associated with transactional sexual behaviour among never-married adolescent boys and girls. We also examined whether boys’ reported sexual exploitation was linked to similar risky sexual behaviours as has been noted among girls in sub-Saharan Africa. Results from our analyses indicated that even though adolescent girls have a somewhat higher likelihood of reporting sexual abuse and exploitation, the odds of trading sex were significantly elevated for previously traumatized boys (that is those with a history of sexual and physical abuse) but not for their female counterparts. Just like adolescent girls, transactional sexual behaviour was associated with the risk of having concurrent multiple sexual partners for boys. These findings support the reality of boys’ sexual exploitation within the African context, and further highlight the importance of including males in general and boys in particular in population-based studies on sexual health, risk, and protective factors in the sub-Saharan African region. Understanding the factors linked to sexual exploitation for both boys and girls will help in developing policies and programs that could improve the overall sexual and reproductive health outcomes among adolescents and youth in sub-Saharan Africa.