Originally posted on the BBC Media Action Insight blog by Dr. Venkatraman Chandra-Mouli and Marina Plesons, World Health Organization (WHO) Department of Reproductive Health and Research, December 1 2016 - How can community engagement be used to promote young people's sexual and reproductive health in conservative countries? Two education programmes in Pakistan offer some answers.
Around the world, there is deep-seated discomfort about adolescent sexuality outside of marriage. Many don't accept that teenagers have sex; those that do typically see it as a problem only made worse by sexuality education. As a result, policymakers are reticent, school heads and teachers are uncomfortable and community groups are often opposed to sexuality education, paralysing action in many countries.
There are consequently few examples of scaled-up and sustainable programmes [PDF] to educate young people about sexual and reproductive health in an age-appropriate and context-specific way. Yet a small number of organisations, including Aahung [PDF] and Rutgers WPF in Pakistan - an indigenous and Dutch organisation, respectively - are coming to understand and navigate these obstacles, by learning through their own experience of engaging with communities.
Adapting to Pakistani society and culture
Recognising societal and cultural barriers to sexuality education, both Aahung and Rutgers WPF adapted World Health Organization guidelines for life skills-based education (LSBE) to the local context in Pakistan. LSBE aims to inform students about health while equipping them with skills to better manage their own lives and make healthier decisions.
Before engaging with stakeholders, Aahung carried out a power mapping exercise to identify influential community members. It then organised a series of communication-focused activities, such as learning forums and in-person meetings, to gain support from local religious groups and school associations up to the Department of Education.
Having consulted with these communities, Aahung recognised it would be culturally inappropriate to directly address sensitive topics like pre-marital sexual activity by talking about contraceptives. Instead, the organisation targets related problems - including child marriage and gender-based violence - identified as problems by local actors themselves.
In this way, Aahung simultaneously serves these community interests while adhering to internationally established recommendations by focusing on common intermediate outcomes, such as comfort with one's own body, communication skills, confidence and decision-making abilities.
Successfully reaching adolescents also requires embracing those in their immediate circles of influence. Realising this, Aahung supports the sensitisation and counselling of parents and the wider community by school administrators and teachers. To increase transparency, Aahung held public theatre performances and discussion sessions to demystify LSBE and win people over to its way of working. Rutgers WPF created a Parents Involvement Strategy in 2011 in pursuit of this same goal.
Engaging media to prevent and respond to backlash
Media can be both a friend and foe to sexuality education efforts, as both organisations have seen.
In 2011 and 2012, conservative media outlets linked to a religious political party, Jamat-ul-Islami, criticised Rutgers WPF for 'breaking the moral fabric of Pakistan' and corrupting the minds of pupils. Following parliamentary discussions, the organisation's work was stopped in Punjab and it was advised to get the content vetted by religious scholars in Sindh.
In response, Rutgers WPF reached out to a small group of respected and well-known journalists from print, radio and television to help facilitate a dialogue with mass media personnel in the affected provinces. This stimulated public discussion of how LSBE could address the vulnerabilities of adolescents.
Additionally, school visits demonstrated to media personnel how the programme increased the confidence and performance of students and teachers. They saw for themselves that the accusations about Rutgers WPF (e.g. that it was teaching 11-year-old children how to have sex) were false. The participating journalists went on to produce a number of stories about what they learned.
Rutgers WPF also arranged for progressive religious scholars to review the content of its LBSE curriculum and supplement its content with messages from the Koran. This work fed into a series of meetings with parliamentarians, policy makers, religious scholars and media personnel that culminated in permission to resume LSBE in schools in Sindh.
While Aahung also underwent a similar review, it decided against including religious content in the curriculum. Instead, it used a human rights-based approach to bring legitimacy to its work, demonstrating that different approaches to sexuality education can be successful in the same context.
Aahung and Rutgers WFP recognise that it's not enough to run effective education programmes if they aren't accepted locally and by society-at-large. Both organisations know they must be ready to respond to occasional backlash (often coordinated) from media, religious institutions and other groups. Yet they also value the media as an ally in preventing and responding to this same backlash. A two-pronged approach, whereby these organisations reach out to local communities while simultaneously working with the media, secures both organisations’ local support as well as a network of journalists ready to champion their cause in the face of heated opposition.
For additional detail on LSBE in Pakistan, read this journal article summary.
Dr Venkatraman Chandra-Mouli works on Adolescent Sexual and Reproductive Health (ASRH) in the World Health Organization's Department of Reproductive Health and Research. With over 25 years of experience, he focuses on building the evidence base on ASRH, and supporting countries to translate this evidence into action.
Marina Plesons is a public health student interning with Dr Chandra-Mouli; she is also the co-founder of Health Advocacy Innovations.
This blog was developed with input from Sheena Hadi, Executive Director of Aahung, and Qadeer Baig, Pakistan Country Representative for Rutgers WPF.
Image credit: Aahung