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Improving Adolescent Reproductive Health - Bangladesh

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In 2000, the Population Council and the Urban Family Health Partnership (UFHP) launched a programme in northwestern Bangladesh to study the effectiveness of a large-scale intervention to improve adolescent reproductive health (RH) knowledge and practices. Approximately 12,000 urban households were selected from each of two intervention sites and a control site for the interventions, which include:
  • making the social environment conducive to change by sensitising various stakeholders about the reproductive health information and service needs of adolescents
  • educating both in-school and out-of-school adolescents about human physiology, reproduction, and contraception, and
  • sensitising the NGO clinic staff to adolescents' reproductive health needs, such as keeping separate clinic hours for adolescents and ensuring confidentiality.
Main Communication Strategies
Organisers began by conducting a baseline survey of 42,760 households (27,670 of which were in experimental sites). A total of 2971 adolescents aged 13-19 were interviewed, half of which were girls. Only unmarried adolescents were included in the analysis. The baseline focus group discussions found that parents find it very difficult to discuss RH issues with their children; they believe that school would be a better place for RH education. Not surprisingly, then, the survey found that only 0.5% of girls and 1.6% of boys discussed RH issues with their fathers (more than two-thirds of girls reported that they discussed these issues with their mothers). The primary source of RH information for the 130 unmarried sexually active adolescents was friends. Over 90% of all the adolescents interviewed reported that they had not visited health facilities in the last six months. More than 85% of the adolescents believed that they would not be treated respectfully if they visited a health facility for family planning (FP) services.

Based on this analysis, project staff conducted sensitisation meetings with parents, teachers, religious leaders, community leaders, health service providers,political leaders, and government officials. Behaviour change communication (BCC) materials, such as leaflets and brochures, were distributed to these "gatekeepers".

A 20-hour RH curriculum called "Alor Pothe Amra" was introduced to in-school and out-of-school adolescents. The curriculum included information about personal hygiene, food and nutrition, environment and sanitation, changes in adolescence, child health and immunisation, marriage and legal rights, gender roles, drug abuse, sexual relationships and sexual abuse, reproductive tract infections (RTIs)/sexually transmitted infections (STIs), HIV/AIDS, the childbirth process, antenatal care, postnatal care, population growth, and family planning.The curriculum used simple language, stories, case studies and feedback procedures.

Sixteen young adults aged 21-28 were selected as community facilitators ("health ambassadors") to conduct RH sessions for out-of-school adolescents. They participated in a five-day skills training on adolescent RH issues, preventive and curative health services. Out-of-school adolescents were organised into groups of 12-15 people of various ages, genders, employment status, and marital status. The facilitators led these group discussions and also helped their peers organise sports and cultural events to create opportunities for discussion. The Project Director and senior clinic staff distributed prizes at some of these events. More than 6,000 adolescents attended the 20-session RH course, more than half of whom were females. In addition, health ambassadors reached more than 2,000 adolescents with RH information.

Project staff provided the RH course at eight secondary schools. Twenty-four teachers were trained for four days to teach 15 participatory sessions. The teachers then met once every month to share their experiences; a refresher training on pedagogical techniques was held after six months. In addition, 44 health ambassadors (19 boys and 25 girls) from the eight schools were trained to inform peers about services offered by the clinics, educate peers about drug abuse and violence, and organise drama groups in schools. More than 1,500 adolescents (65% of whom were girls) attended the RH sessions.

Health care providers were trained to make facilities more adolescent-friendly by providing RH care and family planning services, offering anxiety and depression treatment and/or referral, and offering special convenient hours for adolescents only. Staff members were trained to approach adolescent clients with care and respect, as well as to maintain privacy. A confidential telephone hotline and post-box were established for adolescents who are not comfortable visiting a health care facility. Queries were answered in the adolescents' column of a local newspaper. UFHP-supported NGOs introduced prepaid health cards enabling adolescents to visit doctors at a UFHP clinic without any additional consultation fees for one year. Adolescents who participate in RH sessions receive free services. A total of 4,580 adolescents (94% of whom were girls) visited clinics during the project. Two-thirds of those who visited were out of school, 57% were unmarried, and 89% were unemployed.
Development Issues: 

Reproductive Health, HIV/AIDS, Youth.

Key Points: 

Organisers have shared some of the lessons learned from this project. They claim that RH education can be provided to adolescents in schools using both peer educators and teachers. Comparison of pre-test and post-test surveys, they say, indicates an overall increase in RH knowledge among adolescents.

Partner Text: 

The Population Council's Frontiers in Reproductive Health (FRONTIERS) and Family Planning Associationof Bangladesh (FPAB)'s UFHP. Financial support was provided by US Agency for International Development (USAID).

Source: 

Letter sent from Sohini Roychowdhury to The Communication Initiative on March 10 2003; Research Update No: 1, January 2001 [PDF]; Research Update No: 2, January 2002.

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