Because they often lack autonomy, decision-making skills and access to
information and services, adolescents are vulnerable to a host of
reproductive health problems.
For adolescent refugees, this vulnerability is compounded by violence,
separation from family and poor living conditions. Health programs
typically focus on the provision of emergency services, such as clean
water and sanitation, and reproductive health programs are usually
designed for pregnant women and their infants. Little attention is given
to young people who have questions about puberty, menstruation, sexuality
or relationships.
To address the unique health needs of adolescent refugees, the World
Association of Girl Guides and Girl Scouts (WAGGGS) and FHI developed a
comprehensive training and peer education project. The Health of
Adolescent Refugees Project (HARP) allows young women to earn a merit
badge by completing a series of activities that include teaching others
about reproductive health. A two-year pilot project in Uganda, Zambia and
Egypt, financed by the United Nations Population Fund, concluded in 2000,
and an evaluation by FHI found the program was successful in improving
young girls' use of health-care services and their self-esteem. Using
local funding, scouts continue to earn the badge in each of the three
countries.
"One of the most important things we accomplished is that we
proved you can offer reproductive health education to adolescent
refugees," says Lindsay Gilbert, a WAGGGS project and program
development executive. "We proved you can provide education that can
change knowledge and behavior. The girls who participated in the project
told us they had ambitions and hopes for the future. Families were also
able to learn from their daughters."
In each country, 10 women, most of them refugees, were trained to be
group leaders. In Uganda and Zambia, 600 girls living in refugee camps
initially participated in HARP, while in Egypt, 100 refugee girls living
throughout Cairo participated.
To earn the badge, girls participate in educational activities and
attend sessions where they discuss health topics, including the female
reproductive system, physical and emotional changes during puberty,
relationships, the human body, nutrition, hygiene and disease prevention.
Three different curricula were developed: one for girls ages seven to 10,
one for ages 11 to 14, and one for ages 15 and older. Topics vary by age,
with girls ages seven to 10 learning about physical and emotional changes
during adolescence, girls ages 11 to 14 learning about sexually
transmitted diseases and pregnancy prevention, and girls ages 15 and older
learning about healthy pregnancies and baby care.
Girls must complete other compulsory and optional activities to earn
their badges.1Compulsory activities vary by age but center on
developing a notebook of drawings girls prepare to share with friends. For
example, during HARP, girls ages seven to 10 were asked to draw pictures
of the human body, while girls ages 15 and older were asked to draw
illustrations of maternal-child health. In addition, girls used the
notebook to store materials from other HARP activities, including journals
about their menstrual cycles, songs or poems written to honor an important
woman in their lives, or a quiz for peers on HIV transmission.
To earn their badges, girls serve as peer educators in their
communities and must reach at least 25 other girls through informal group
discussions, one-on-one visits, distribution of educational materials or
formal talks.
Girls can also earn bronze, silver or gold certificates for additional
tasks, such as planning and preparing a healthy meal, performing a drama
based on health themes or developing a list of recommendations for health
agencies that work with adolescent refugees. All tasks focus on passing
knowledge along to others.
In evaluating HARP, FHI found that participants understood general
health messages about puberty, personal hygiene, sanitation and nutrition.
However, girls had a harder time comprehending more complex topics. For
example, some girls did not understand the "safe" period of the
menstrual cycle. Reasons for this may have been that educational materials
were printed in English, not local languages, and that text was rarely
illustrated. Also, guide leaders had experience with teaching methods that
emphasized rote learning rather than student participation. In addition,
concepts such as "gender" and "self-esteem" were new
to the girls and difficult to explain.2
Besides increasing girls' knowledge about health, HARP gave
participants a safe place to gather, an outlet for creativity and an
opportunity to have fun -- elements often missing from the lives of young
female refugees. Also, HARP gave young women a chance to interact with
older women who are caring, nurturing role models.
A problem in implementing the project was that many adolescents were
reluctant to discuss some reproductive health issues. Some girls in Zambia
were embarrassed by drawings of the uterus. Others were embarrassed when
boys made comments about their notebooks. Some did not want to take the
notebooks home for their families to see.
HARP also benefited adults who worked with adolescents. One project
coordinator gained new knowledge about reproductive health. "It is a
shame that I did not know some of these things until I was 30 years old,
but at least I know them now," she says. Others say HARP
participation increased their status in the community. "I am famous
in my village now," says one of the leaders in Uganda. And national
coordinators working with the project say they gained empathy for
refugees. Says one trainer in Egypt, "I never saw these people in our
communities before, but now they are visible to me. Now they see me in the
market and call out to me, and I know they are here."
Although HARP was designed exclusively for girls, an important lesson
learned was the need to develop activities for adolescent boys. "It
became clear that the communities wanted the boys involved as well,"
says Gilbert. "As a girl learned about family planning, it was
difficult to put what she learned into action if she didn't have the
understanding of her male partner."
Male
involvement will be a central component of a new project by WAGGGS and
FHI. The Healthy Adolescent Project in India (HAPI) will work with the
Bharat Scouts and Guides Association to adapt the HARP curriculum for boys
and girls, offering different programs for ages 10 to 13 and ages 14 and
older. The project, which will be conducted at seven sites in West Bengal,
is funded by the David and Lucile Packard Foundation.
HAPI hopes to reach thousands of youth through peer education. Health
providers also will work with scout and guide groups, giving talks during
meetings, promoting adolescent health at special events, and conducting
tours of local health clinics for young people.
"What is most exciting about these programs is that we are
reaching adolescents with health information just as they are forming
life-long attitudes and habits," says Matthew Tiedemann of FHI, who
works with HARP and HAPI. "We are reaching them through an
established, trusted network -- guides and scouts -- and we are applying
the lessons learned from HARP to the HAPI project. We hope there will be
opportunities to adapt the program in even more countries."
-- Barbara Barnett
References
- World Association of Girl Guides and Girl Scouts. Badge
Curriculum: Health of Adolescent Refugees Project. London: World
Association of Girl Guides and Girl Scouts, Family Health
International, the United Nations Population Fund, nd; World
Association of Girl Guides and Girl Scouts. The Leader's Handbook:
Health of Adolescent Refugees Project. London: World Association
of Girl Guides and Girl Scouts, Family Health International, the
United Nations Population Fund, nd.
- Family Health International. The Health of
Adolescent Refugees Project (HARP): Evaluation of the Pilot Project.
Research Triangle Park, NC: Family Health International, 2000.
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