This 55-page report examines a community-based adolescent reproductive health (ARH) intervention that sought to provide young people with concrete tools and skills to educate - and mobilise attitude and behaviour change among - their peers. Spearheaded by the Bangladesh Center for Communication Programs (BCCP) with technical assistance from CCP and the national ARH Working Group, this multimedia, interactive toolkit revolves around 4 thematic areas: 1) physical and emotional changes; 2) sexuality, sexual attraction and delay of sexual debut; 3) preventing HIV and other sexually transmitted infections (STIs); and 4) preparing for marriage. Offered as part of the large-scale, multi-sectoral ARH Communication Program campaign called 'Nijeke Jano' (Know Yourself), the Toolkit provides youth educators with a series of 4 educational and entertaining videos, 4 accompanying Facilitator's Guides, Question and Answer Booklets, and RH-related comic books. To assist in effective delivery of the kit, BCCP developed a training curriculum. Using participatory approaches, the workshop approach aims to increase knowledge and strengthen essential life skills such as decision making, negotiation, and interpersonal communication related to reproductive risks.

To assess the toolkit's effectiveness, materials and approaches for community-based organisations (CBOs) were tested in a year-long pilot intervention in 3 upazilas (administrative units). This pilot intervention involved 6 local non-governmental organisations (NGOs) and included 1-day sensitisation sessions with key stakeholders (e.g., government personnel and NGO service providers), 1-day orientation sessions with
community leaders and schoolteachers, and 4-day workshops for adolescents. A total
of 3360 adolescent boys and girls participated in these workshops, which included
sessions on puberty and adolescence, personal relationships, sexual feelings, and
RH issues. In addition to the workshops, a total of 4500 information booklets, 1000 parent brochures, 4500 newsletters, and comic books on specific issues were distributed to adolescents and adults in the pilot intervention communities. Six adolescent-friendly corners were established within local health facilities.

As part of this pilot study, 2 surveys were conducted of adolescents and their parents
in both the intervention sites and selected comparison sites. (The first survey consisted of 1,702 adolescents between the ages of 13 and 19 years and 1,203 parents interviewed between February and March 2004. The second survey consisted of 1,827 adolescents and 1,276 parents interviewed between June and July 2005.) This report presents the key findings from these surveys. In brief,

• Adolescents' knowledge of 3 RH topics - pregnancy, contraception, and maternal health - increased significantly more between 2004 and 2005 in the intervention areas than in the comparison areas. However, while knowledge of puberty and adolescence was higher in the intervention areas than in the comparison areas, the small change in this knowledge, relative to the trend observed in the comparison areas, suggests that this difference was not due to the programme. Furthermore, little change over time was observed for knowledge of HIV/AIDS in either the intervention or comparison sites.
• Adolescents in the intervention areas experienced significantly greater changes in their self-esteem and in their perceptions of peer norms related to risky sexual behaviour between 2004 and 2005 than did adolescents in the comparison areas. In addition, adolescents living in the intervention areas were able to list significantly more
  negative consequences associated with early childbearing (assumed to reflect greater
  critical thinking skills) in 2005 than in 2004, although no change was observed in the
  comparison areas. In contrast, there was no apparent effect of the programme on
  adolescents' level of comfort with the changes that occur during adolescence or with
  their confidence in their problem-solving skills.
• While both adolescents and parents in the intervention areas reported greater parent-child communication about RH than those in the comparison areas, the lack of change between 2004 and 2005 suggests that this difference is not due to the workshops.
• While some parents' perceptions related to the timing of girls' marriage, fertility, and adolescent decision-making within the household did increase between 2004 and 2005 in the intervention areas, these increases were matched by those observed in the comparison areas.
• While the proportion of unmarried adolescent males reporting that they had ever had sex decreased significantly in the intervention areas between 2004 and 2005, there was no corresponding change in the comparison communities. No effect was seen on contraceptive use among married female adolescents.

In conclusion, the authors note that use of this toolkit can effectively address some of the psychosocial factors and behaviours related to ARH. However, challenges remain; for instance, no effects were observed in adolescents' confidence for problem-solving, their critical thinking skills, or in their interpersonal communication about RH with parents or older family members. "While these results call for a review of the existing approaches used by the toolkit for life skills development, participant narratives (examples included in Appendix B) suggest that the program may affect these life skills in subtle ways that are less easily captured in structured surveys." Furthermore, "The lack of an effect on contraceptive use highlights the need for more intensive efforts among parents and community leaders to promote household environments in which young married women are able to delay their first birth through contraceptive use."

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