Improving the Reproductive Health of Adolescents in Senegal

This 78-page report describes a 15-month intervention carried out by the Population Council/FRONTIERS Program, and its 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, reproductive health (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. In all components, youth participation was key.

A quasi-experimental design was used to determine the feasibility, effectiveness, and cost of this communication-centred initiative to foster a supportive environment for dealing with young people's RH problems and needs, to make existing services more accessible to this population, and to provide RH information and skills in schools.

Excerpts from the Report follow:


Feasibility

• "The study demonstrated that it is possible to carry out interventions to improve adolescents' knowledge of reproductive health topics despite the sensitive nature of this question in Senegal's socio-cultural context. The interventions provided an opportunity not only to promote positive values such as abstinence until marriage and respect for adolescents of the other gender, but also to discuss responsible sexuality. The program did not attempt to promote or distribute condoms through the new mechanisms developed, given the newness of the reproductive health themes and the sensitive nature of adolescent reproductive health...
• Mobilization of politicians, administrative heads, religious and community leaders was achieved, and they all showed a strong commitment for the program. Some of them assumed proactive roles that show potential support that could be tapped in the future. A multi-agency partnership between the health department, community, schools, and the media proved that a multi-sectorial approach is feasible when organized through an operational technical committee.
• Young people's involvement...led to high levels of mobilization and very little dropout of peer educators. However, the local technical committee must be cautious to maintain a balance between mass mobilization activities, of which young people are fond, and inter-personal education activities, which are more effective for changing knowledge, attitudes, and behavior.
• Peers educators' capacities in using management tools are limited, and the sensitization of the non-educated adolescents on reproductive health is more difficult and requires more time than for in-school adolescents. Clinic interventions using young people as providers' aides to welcome and counsel adolescents made facilities more attractive for young people...

Effectiveness

• The...interventions led to greater exposure of adolescents to reproductive health information in Louga and in Saint-Louis. The 10-14 and 15-19 age groups were also influenced at school. However, the boys received more information than girls. Outside school, it was the adolescents aged 15-19 who were most influenced.
• Parents' attitudes towards reproductive health programs were more favorable after the interventions. Women were more influenced in part because they are more easily accessed through their community-based organizations....Communication on reproductive health topics increased within each group. However...other adults and trained specialists were more accessed by the adolescents.
• The interventions also led to a significant improvement in the knowledge of puberty among the girls in Louga and in Saint-Louis, the risks related to early sexuality, and knowledge of contraceptives including condoms....The interventions seem to have had an effect on limiting sexual activity but not on protection through the use of condoms or other contraceptive methods.
• Adolescents directly exposed to the interventions had in general improved knowledge, attitudes, and behavior compared to those who were not exposed. This is promising for the future as more systematic intervention and exposure to reproductive health programs will be developed...

Program Implications

• The topics of contraception in general and the condom in particular were addressed only superficially by the implementers. Yet the data show that these are subjects for which the adolescents wish to receive very straightforward information. It is necessary therefore to scrutinize the implementers...to ensure they feel comfortable and competent to convey accurate, value-free information....The implementers and the communities should also know that adolescents do not become more permissive when they learn about contraception; this study clearly demonstrated the opposite effect.
• On the issue of teaching adolescents about the menstrual cycle, a consensus was not reached....As girls' menstrual cycles are subject to many fluctuations, it is more difficult to accurately assess fertile and infertile periods. If assessed incorrectly, a sexually active girl may become pregnant if relying on this as a contraceptive method. Discussions should be initiated and a consensus should be reached on how to convey this important information.
• The decline in using condoms or other contraceptives as a means of protection versus being faithful to one partner is an important result. Even if the message of being faithful to one partner is encouraged to reduce the risk of STIs [sexually transmitted infections] including HIV/AIDS, it is important that IEC [information, education, and communication] messages toward sexually active adolescents also emphasize dual protection against early pregnancy...
• The targeted male parents were poorly influenced because they are less frequently organized in groups and thus more difficult to reach collectively....It will be necessary to use the media and religious leaders if this strategy is to benefit male parents and youth.
• The young adolescents (10-14 years old) who were less intensely targeted by the interventions have shown the need to gain information on materials and services...
• Parent-child communication is still insufficient. Adolescents show an eagerness to discuss reproductive health with their parents and seek better education on these issues. Parents have expressed their wish to convey this information to their children, but they are limited due to their poor understanding of the subject, lack of opportunities to talk about it, and their fear of encouraging risky behaviors. It is necessary to establish a program with 'parent schooling'...
• The strategies aimed at schools were conservative and did not mobilize all the teachers and administrative heads. A specific program is needed to provide a favorable school environment towards reproductive health before addressing the targeted adolescents.
• The fact that sexual activity had not increased since the interventions were introduced shows that it is possible to inform adolescents in a straightforward manner about reproductive health without their engaging in early sexual activity with regrettable consequences, as communities fear. These results will help program leaders in the quest for a wide-scale expansion of reproductive health programs for adolescents."

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