India: nationwide reproductive and child health programme

This article presents an outline of India's Reproductive and Child Health (RCH) Programme. This program provides special interventions for the country's adolescent population. One of its main objectives is to help stabilize population numbers, including adolescents, at a level consistent with the needs and goals of national development. A committee of experts constituted in the Department of Family Welfare developed an appropriate package for adolescents, focusing on counseling and the provision of reproductive health services through the existing health care delivery system. In addition, special projects for people living in urban slums and tribal areas have been incorporated in the RCH Programme. Its view has been to improve the delivery of family health care services. The success of the Programme has depended on the development of a strong partnership between the Government and non-Governmental organizations, and in overcoming age-old values and prejudice against adolescent girls. Moreover, India's reconceptualized population education, which brings the education of adolescents into focus, includes elements of adolescent reproductive health.     

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.     

Strengthening strategies to improve adolescent reproductive health through materials development. Indonesia

This article concerns a 3-year materials development project that was implemented by the Indonesian Planned Parenthood Association and the Bureau of Non-Physical Family Resilience. The project was developed in response to the need for improving adolescent reproductive health in Jakarta, Yogyakarta and West Java, where adolescent problems have been increasing during the last decade. The project's long-term goal is centered on raising the commitment of families to instill in their children a better understanding of adolescent reproductive health concepts and desirable family values. For its short-term objectives, the project seeks to develop a basic information, education and communication (IEC)/counseling strategy and policy in support of a family-centered approach to adolescent reproductive health; promote better understanding of reproductive health needs of adolescents among the policy-makers; and improving the IEC/counseling skills of personnel at the community level. The project used five strategies to achieve its goals; namely, 1) preparation of a media development and production plan; 2) conducting a needs assessment; 3) production of three types of materials; 4) implementation of three key activities; and 5) periodic monitoring of activities.     

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.     

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.     

Nepal: positive trends in ARH

This article records the Nepalese Government's adoption of a strategy, which is consistent with Nepal's second long-term health plan (1997-2017). The primary health care system would deliver an integrated reproductive health package, which gives emphasis on gender perspective, community participation, equitable access and intersectoral collaboration. In addition, some of the appropriate interventions being pursued are the formulation of national policies, provision of counseling and sex education and information, supplying contraceptives, and delivering youth-friendly reproductive health services. However, serious problems hindering efforts to implement effective adolescent reproductive health programs include limited access to food and health care; high infant and maternal mortality rate due to early and frequent pregnancies; low level of contraceptive use and increasing frequency of sexually transmitted diseases cases among adolescents; and low level of literacy, particularly among girls.     

未婚青年生殖健康现状及对计生服务的需求

采用问卷调查方式，调查内容包括未婚青年生殖健康现状、对婚前性行为、人工流产的态度与看法、对计生服务的需求状况与期望；结果表明：1、农村未婚从业青年婚前性行为、人工流产有明显增多趋势，人流经历确实造成了身心伤害；2、未婚青年迫切需要生殖健康与避孕节育措施服务；3、计划生育部门应有效转变观念，拓宽服务领域，提高服务质量。     

Promotion of adolescent reproductive health and healthy living. Malaysia

This article discusses a 3-year project, "Promotion of Adolescent Reproductive Health and Healthy Living," which was implemented by the Federation of Family Planning Associations, Malaysia. The project seeks to achieve the following: 1) development of a reproductive health of adolescent module (RHAM) for trainers and educators; 2) training of trainers; 3) sharing of adolescent reproductive health experiences in Asian countries; and 4) setting up three service models in Sabah, Selangor, and Terengganu to provide reproductive health (RH) care to adolescents and youth. The first part of the RHAM with the trainer's manual has been finalized and will be tested in a workshop. The second part, a teacher's guide, is under preparation. A series of training on the use of the RHAM will be conducted including a 5-day national workshop, which will be followed by several state level workshops. The three service models being set up have specific orientations. The Sabah model is putting up a youth clinic for adolescents within its clinic network. The Selangor model is developing a Youth Resource Center for training and youth involvement in RH activities. Lastly, the Terengganu family planning association (FPA) has developed a Youth Center web site, which features the history, mission, and activities of the Terengganu FPA.     

Examining the Experiences of a Short Break Scheme amongst Adolescents with Disabilities (Service Users) and their Parents

Globally, families who care for a child or adolescent with disabilities have been found to experience high levels of maternal ill health, stress, depression and family breakdown. In extreme cases, children and adolescents may have to move away from their family to a permanent residential placement. A potentially more appropriate and cost-effective approach is the provision of family support services; predominantly these have taken the form of short break schemes, whereby temporary (respite) care is issued to provide short-term relief for the family (e.g. regular afternoon care). This research reported the impact of a short break scheme from the perspective of the service users and their parents by conducting interviews with adolescents with disabilities and quantitative questionnaires with the parents, following a summer short break scheme.     

Programme guidelines. How effective are sex education programmes? Findings

Adolescent reproductive health program promotion in Asia and Oceania has been hindered by a lack of appreciation on the part of parents, educators, policy makers, and development planners of the benefits of sex education. Concerns persist that sex education encourages adolescent promiscuity. However, a World Health Organization review of 1050 studies on sex education failed to provide any support for this position. In fact, the research shows that sex education can actually help to delay first intercourse among teens who are not already sexually active and promotes consistent contraceptive use among those who are sexually active. A comprehensive literature review commissioned by the US Agency for International Development as well as a US Centers for Disease Control study corroborated this finding. Cross-national comparisons have indicated adolescent pregnancy rates are lower in countries with liberal policies in terms of sex education programs and the provision of adolescent sexual health services.     

Reaching adolescents: a role for radio

The radio is a powerful means to reach adolescents and to address their concerns, particularly those that are not being addressed by their families or by the school curriculum. Proving this point is a radio program, "Sandhikhan" (Bengali for adolescence), which aired on national radio covering adolescent health issues, particularly reproductive health. The program's impact was the subject of a WBVHA survey among adolescent radio listeners in West Bengal. About 79% (369 individual listeners) of the respondents rated the radio program very good, with only a negligible 1% describing it as unnecessary. Only 21% of respondents listened to the program alone, with the majority listening in the company of friends, mothers, sisters, brothers, fathers, and other relatives. This suggested a wider group of listeners in addition to the program's primary target audience. Clearly, findings pointed to the effectiveness of teaching adolescent health on the air and the role that was played by WBVHA in developing healthy attitudes and habits among its young audience. The findings of the survey will provide the basis for producing educational materials on reproductive health for students as well as teachers.     

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.     

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.     

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.     

Developing a program for sexually abused adolescents: The research-service partnership

This paper outlines the process of developing and implementing a new community service program for sexually abused adolescents and highlights the advantages of a functional research-service agency partnership in shortening the planning phase and sharpening the focus on such key factors as program components, site selection, and evaluation approaches.Data have been presented at the mid-point of the demonstration program's operation that show the program to be achieving its purposes in terms of impacting the rate of reporting and confirmation of child sexual abuse in the community.Other data indicate that the program is, in fact, being utilized as intended primarily by adolescents and that the incidence of reported and confirmed adolescent sexual abuse in particular is rising as a result.Impressions concerning the overwash effects of the program upon the community—and surrounding communities—have also been presented.The ultimate value of a continuing research-service agency partnership will perhaps be best determined by the quality of the final report on the program to be prepared in March, 1979. We expect chat the research emphasis upon accuracy in the data and the service interest upon interpreting their practical import will yield an honest assessment of the program's impact and its usefulness to other communities in meeting the needs of adolescent victims of sexual abuse.     

Programme guidelines: effective and ineffective school-based sex and HIV / AIDS education programmes

In several countries, despite considerable opposition to sex and HIV/AIDS education programs, school-based reproductive and sexual health education is gradually gaining ground. It has expanded to include adolescent and sexual health. There exist positive trends and evident changes in the delivery of school-based reproductive and sexual health education. Among these are the following: 1) systemic and deliberate incorporation of adolescent reproductive and sexual health issues in the school curriculum in countries that have UN Population Fund population programs; 2) inclusion of reproductive and sexual health issues in different subjects, which paves the way for their incorporation into the curriculum; 3) continuous improvement in the delivery, content, methodologies and activities of population education, particularly the inclusion of topics concerned with reproductive and sexual health and greater emphasis on the behavioral and skills development; and 4) the growing nongovernmental organization involvement in the provision of reproductive and sexual health education and training. Numerous factors ensure the success of the programs; they are the use of social learning and cognitive behavioral theory and clear mission statements, communication and negotiation practical exercises, values formation, interactive strategy development, effective training, behavior change--particularly with regard to risk-taking behavior, and provision of a supportive environment.     

Strengthening access to improved reproductive health services through the Bangladesh Red Crescent Society. RAS/98/P64

This project aims to strengthen access to improved reproductive health (RH) services through the Bangladesh Red Crescent Society (BDRCS). Being the implementing agency, the facilities and technical and human resource capacity of BDRCS should be strengthened in order to manage quality RH services, especially clinical family planning and safe motherhood activities. In addition, strengthening of the BDRCS should be done to enhance Red Cross volunteer activities by mobilizing grassroots men and women to raise the demand for family planning and reproductive health services, with assistance from government health workers. To this effect, several strategies are implemented: 1) upgrade two BDRCS hospitals in Sylhet and Banglabazar; 2) provide postnatal counseling for clinical contraceptive by trainee paramedics and nurses; and 3) establish referral linkages with other RH international partners. Target groups include the Sylhet town and old parts of Dhaka City. An outline of the main activities of the project is given.     

Measures to improve ARH programmes

This paper proposes measures to improve adolescent reproductive health programs through a sociocultural perspective. The measures include 1) identifying the problem and understand its nature within its cultural context; 2) assessing the sociocultural context to obtain a clear understanding of the cultural aspects that affect adolescent sexuality and pregnancy; 3) handling cultural biases and ensuring accuracy of information; 4) identifying the specific needs of adolescents and view their problems from their own perspective; 5) incorporating a true gender approach; 6) reaching out to young men; 7) involving adolescents in all stages of the programs; 8) communicating effectively with adolescents in all stages of the programs; 9) developing skills to avoid risks; 10) generating capacity to make informed decisions; 11) developing services that are accessible to adolescents; 12) sensitizing health personnel; 13) developing a multidisciplinary approach; and 14) creating an appropriate environment for the program. The brief explanation of each measure is presented.     

Mandatory parental involvement in contraceptive services for minors

This article examines the issues that are raised by the requirement of mandatory parental notification in cases where adolescents are provided with contraceptives. In 1982, the US Department of Health and Human Services announced its intention to institute a new regulation requiring family planning clinics funded under Title X of the Public Health Service Act to notify parents or guardians of unemancipated minors under 18 years of age within 10 days after the adolescent received prescrrption contraceptive devices or drugs. Although this regulation has not been put into effect, it may reappear in the legislative process and social workers should be prepared to respond. Such a regulation undermines a key objective of Title X to reach teenagers through counseling, education, and confidential medical services that would prevent unwanted pregnancies. Mandatory parental notification would force many teenagers to use less effective contraceptive methods or none at all. It further ignores the harmful effect of forcing a confrontation within a family in which a lack of communication may already be a problem. It has been estimated that parental notification stipulations would result in 33,000 more unwanted pregnancies among teenagers 17 years of age and younger who are now practicing effective contraception. School social workers are urged to experiment with varying approaches that have better changes of building ties to the family than parental notification regulations. If the regulation is put in place, social workers and other professionals must be prepared to help students and their families cope as effectively as possible with the practical reality of the situation.