Youth's reproductive health needs are increasingly urgent: While most
young people become sexually active before the age of 20, few use
reliable contraception and many are at risk of unplanned pregnancy.
Meanwhile, up to half of all new HIV infections occur in many parts of
the world in people under age 25. Appropriately, policy-makers, program
managers, and providers are anxious to address these problems. Before
acting, however, they should consult a large body of research concerning
youths' reproductive health.
The FOCUS on Young Adults Program, which operated from 1995 to 2001
with funds from the U.S. Agency for International Development (USAID),
assembled essential research to guide development of reproductive health
projects for young adults. Surveys in 10 countries clarified how various
factors affect adolescent sexual and risk-taking behaviors. FOCUS also
analyzed interventions and evaluations of programs addressing policies
and clinical services for youth, and knowledge, attitudes, and behaviors
of youth. In total, it identified 39 programmatic interventions that had
been rigorously evaluated.
In general, FOCUS found that adolescent reproductive health programs
did not increase sexual risk-taking behaviors and that they influenced
knowledge and attitudes more than behaviors, which were usually only
minimally affected. The following are more specific conclusions based on
the 39 rigorously evaluated interventions, of which more than half (21)
were school-based, with other programs working through mass media (6),
communities (4), the workplace (4), and health facilities (4):
- School-based programs often increase knowledge and
influence attitudes. Half of the interventions affected short-term
behavior, including delaying sexual debut and reducing the number of
sexual partners. While school-based programs offer a chance to reach
many youth, issues still to be addressed include what is taught, by
whom, at what age, and how.
- Mass media programs, which usually included social
marketing campaigns, can also reach many youth. They are most
effective when combined with personal contact or referrals to health
services. The mass media interventions improved knowledge and
attitudes and appeared to affect behavior in some cases. Their
impact on in-school youth was greater than their impact on
out-of-school youth.
- Community-based programs, which commonly include peer
education, appear promising and are popular, but many questions
remain unanswered. Such programs have not yet been shown to be
sustainable or cost-effective.
- Workplace programs, which targeted out-of-school youth
employed by the army, brothels, and factories, improved knowledge
and attitudes. But these programs had less impact on behavior.
- Health facility-based programs have tried to make clinical
services friendly to youth or to add such services to youth centers.
These efforts have generally not increased youths' use of clinical
services.
How can this research help program planners devise interventions,
allocate limited resources, expand pilot projects, and collaborate with
related youth projects? From its survey research, its rigorous
evaluations of 39 interventions, and its reviews of qualitative and
other research, the FOCUS program made several recommendations. These
include broad-based advocacy to support reproductive health efforts
aimed at youth, well-designed reproductive health education in schools,
and condom promotion through social marketing programs and mass media.
FOCUS also suggested that program managers and policy-makers
incorporate monitoring and evaluation from the start, tailor a mixture
of programs and policies to the target population, and design projects
anticipating their expansion.
— William Finger and Maryanne Pribila, YouthNet Information
Dissemination
This article is based on the FOCUS End of Program Report, synthesized
into a 32-page summary by YouthNet, the USAID-funded global program
addressing youth reproductive health and HIV prevention. To request a
copy, e-mail youthnetpubs@fhi.org.
A copy of the summary
also can be printed from FHI's Web site.
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