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Impact Data - Improving the Reproductive Health of Youth in Senegal

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Senegal is undergoing rapid urbanisation, which is spurring changes in traditional social and family structure. These changes have, in turn, led to a rise in early sexual activity among young adults and increased exposure to unwanted pregnancy and sexually transmitted infections. In Senegal, where 28% of the population is between 10-19 years of age, a renewed focus on reproductive health (RH) services appears timely.

In this context, an intervention was launched in October 1999 by the Population Council/FRONTIERS Program and partners in communities, health facilities, and schools in 3 urban areas in northern Senegal (Louga, St. Louis, and Diourbel). The project addressed 10- to 19-year old boys and girls and their parents in an effort to explore how community networks could influence the adolescent family environment and, in turn, RH. In Louga and St. Louis, clinic- and community-based interventions were offered; St. Louis also introduced a school-based intervention. Intervention activities were conducted for 15 months.

Methodologies
The study used a pre- and post-test control group design. Three study sites were employed to investigate the relative effectiveness of two sets of interventions, comparing one to the other and to a comparison group.
Knowledge Shifts
Young people's knowledge of reproductive health increased. The proportion of adolescents knowing one or more contraceptive methods rose from 49% to 61% in St. Louis and from 59% to 69% in Louga. Knowledge of the consistent and correct use of condoms also increased significantly and was nearly universal in both intervention sites. The proportion of youth knowing the period when a girl can become pregnant increased from 21% to 26% in St. Louis and 14% to 25% in Louga. When youth were asked about ways to avoid sexually transmitted infections (STIs), references to abstinence increased.
Practices
Overall, sexual activity among unmarried Senegalese adolescents is low: 20% of boys and 4% of girls reported that they had ever had intercourse. Among sexually experienced youth, the proportion reporting a sexual encounter during the last 6 months decreased from 48% to 36%. The average number of sexual partners dropped from 2.1 to 1.5.

However, condom use also declined. The use of condoms at first sexual experience decreased from 32% to 21% in St. Louis, and use at last intercourse dropped from 48% to 34%. Significant decreases also took place in Louga and the control site. The intervention introduced messages on abstinence, fidelity, and condoms, but abstinence and fidelity were highlighted by providers.

Youth who reported visiting a health facility rose from 5% to 12% in St. Louis and from 7% to 12% in Louga. About half the visits were RH-related. Although the school-based intervention succeeded in integrating RH information into the curriculum, it was not well integrated with the community and clinic activities.
Increased Discussion of Development Issues
Communication on the part of both parents and adolescents' has "greatly improved. Adolescents sought more information from adults and from qualified sources, rather than from their friends. Nevertheless, a family atmosphere conducive to communication is still lacking, and at the same time, the expectations of adolescents have risen greatly".
Access
The final evaluation showed that the interventions exposed the adolescents to information on reproductive health (RH) in St. Louis and Louga. Two age groups were reached at school. Boys received more information than girls. Outside school, the 15-19 year age group was the most widely reached group. In Diourbel, the control site, the proportion of adolescents who received RH information shows that large-scale intensive activities were carried out in this area.

Specifically, at the community level 37 community members and 60 peer educators were trained.
  • Number of adults reached by: mass activities = 1,433; conferences and meetings = 589; talk sessions = 1,679
  • Number of adolescents reached by: curriculum groups = 6,218 girls and 4,029 boys (St. Louis) and 4,647 girls and 3,464 boys in Louga; counseling sessions = 299 boys and girls; curriculum groups = 454 adolescents

At the clinic level, 10 national-level trainers were trained, 32 health providers were trained, 24 personnel were sensitised, and 11 Aide ADOs were trained.
  • 1607 adolescents received care and 545 adolescents participated in clinic curriculum groups
  • Aide ADOs provided 944 people with counseling

At the school level, 26 teachers were trained and 52 local education agencies were trained.
  • 5,538 students were reached in classes and events
  • Community peer educators worked in 67 classes: 35 teachers educated 980 students with the curriculum "Grandir en Harmonie"
Source
Letters sent to The Communication Initiative from Laura Raney on September 25 and December 4 2003 and from Edmond Bagde on January 20 2004; and Operations Research summary on the FRONTIERS site.