Reproductive & Sexual Health Education-Care-Counseling for Married Adolescents, Rural India

As part of a collaborative project with the International Center for Research on Women (ICRW), the KEM Memorial Hospital conducted a research project designed to respond to the reproductive and sexual health concerns of married adolescents in poor rural areas of India. To address their limited access to information and services, KEM tested the feasibility of implementing an integrated package of community-based reproductive health information, clinical referrals and services, and sexuality counseling for married youth ages 14 to 25 in a rural part of Maharashtra state. This intervention was characterised by intensive training of couples from the community (rather than women alone or men alone) to serve as community health educators, as well as the provision of professional sexuality and marital counseling to young rural, married couples. The study began in September 2000 and ended in March 2003.

The intervention components that this study tested included:

• Reproductive health education (RHE) - training and supporting volunteer community-level educators (CLE) to conduct interactive sessions on various RSH topics
• Counseling - providing a professional counselor for reproductive and, in particular, sexual health issues, to whom the CLE can refer young married men, women, or couples together
• Clinical referral - providing a system of referrals to good quality clinical services through the CLEs or counselor to address RSH concerns raised by project participants.

Specifically, community volunteers were trained in RSH issues and communication skills so as to conduct RHE sessions; basic referral skills; and basic counseling skills to refer youth as needed to the professional counselor. The study found that it is feasible to use community volunteers for these purposes, with certain caveats:

• A significant number of young women - and many but fewer young men - were eager to participate
• 5 men and 9 women were trained as CLEs, with little drop-out, attesting to their commitment
• Using couples as a team of educators, rather than an individual man or woman, was more effective, acceptable and able to reach other young married couples
• The time and effort to train volunteers, prepare a manual for them to use in the field, field-test, modify, and finalise activities was much longer than envisaged
• In order for a CLE to be effective and accepted, the decision about whom to pick as a CLE had to take into account pre-existing community perceptions and acceptability of that young person

KEM monitored these interventions, with a special focus on degree of community participation. Tools included attendance records at RHE and counseling sessions, self- and external evaluations of CLEs, pre-post questionnaires, group discussions and individual interviews with participants, case documentation by the counselor, and multiple records for clinical referral including type of service and follow-up. Quantitative evaluation comprised baseline and endline surveys of 114 and 76 couples, respectively.

KEM researchers found strong community interest in the intervention; participation was high. The RHE sessions were carried out in 2 phases, separated by a period of about 2 months. About 68% of baseline couples participated in at least one of the Phase I RHE sessions; in Phase II, while men's participation remained largely unchanged, over 80% of young married women attended at least once. Clinical and counseling service use increased. In particular, the programme was able to encourage young couples to seek counseling.

Researchers found an increase in RSH knowledge. Preliminary analyses suggest that there has been a 10-25% increase in knowledge on specific issues, though this change varies by gender. Data from young married women shows some increase in their knowledge of contraceptive methods, pregnancy care, delivery risks, causes of infertility, menstruation, and knowledge of HIV transmission. For young men, there was no significant change in levels of knowledge about delivery risks or infertility. Both quantitative and qualitative data suggest that couple communication around RSH and treatment of reproductive and sexual infections has increased.

Source:

Letter sent from Kerry MacQuarrie to The Communication Initiative on January 9 2004.

To request a copy of this document, or for more information, contact:

Dr. Rohini Pande

Project Director, ICRW

1717 Massachusetts Avenue, NW, Suite 302

Washington, DC 20036 USA

Tel.: (202) 797-0007

rpande@icrw.org

Project page on ICRW site