Joar Svanemyr

Creating an Enabling Environment for Adolescent Sexual and Reproductive Health: A Framework and Promising Approaches

This article provides a conceptual framework and points out the key elements for creating enabling environments for adolescent sexual and reproductive health (ASRH). An ecological framework is applied to organize the key elements of enabling environments for ASRH. At the individual level, strategies that are being implemented and seem promising are those that empower girls, build their individual assets, and create safe spaces. At the relationship level, strategies that are being implemented and seem promising include efforts to build parental support and communication as well as peer support networks. At the community level, strategies to engage men and boys and the wider community to transform gender and other social norms are being tested and may hold promise. Finally, at the broadest societal level, efforts to promote laws and policies that protect and promote human rights and address societal awareness about ASRH issues, including through mass media approaches, need to be considered.

Avoiding unwanted pregnancy — the role of communication, information and knowledge in the use of contraception among young Norwegian women

Despite relatively easy access to contraceptives, a liberal attitude to pregnancies out of wedlock and a widespread family planning education in schools, too a high number of adolescent women in Oslo, the capital of Norway, become pregnant and resort to abortions. The aim of this study was to identify some new entry points to sexuality, contraceptive, abortion and post-abortion counselling. Using a qualitative approach, we interviewed 102 young women in Oslo who were seeking either an abortion or contraceptives. The study demonstrated that contraceptive awareness is good, but that there are different levels of consistency in contraceptive use among women, and that even women with few partners and fairly good contraceptive compliance sometimes experience unplanned pregnancy. The study reviews some issues of importance where communication with young women could be improved. These issues include better formal information about OCs, increased information on emergency contraception, better condom promotion, and an attempt to involve better informed adults, including paramedical professional counselling. In addition, contraceptive prescriptions should accord to the type of behaviour and the relationships the young women have.

Preventing child marriages: first international day of the girl child “my life, my right, end child marriage”

On 17 November 2011, the United Nations General Assembly adopted a resolution (A/RES/66/170) designating 11 October as the first International Day of the Girl Child choosing ending child marriages as the theme of the day. Child marriage is a fundamental human rights violation and impacts all aspects of a girl’s life. These marriages deny a girl of her childhood, disrupts her education, limits her opportunities, increases her risk of violence and abuse, and jeopardizes her health. The article presents data about the prevalence and effects, contributing factors and recommends action for prevention.

Scaling up sexuality education in Senegal: integrating family life education into the national curriculum

Abstract In Senegal, school-based sexuality education has evolved over 20 years from family life education (FLE) pilot projects into cross-curricular subjects located within the national curriculum of primary and secondary schools. We conducted a literature review and semi-structured interviews to gather information regarding the scale and nature of FLE scale-up. Data were analysed using the ExpandNet/WHO framework, conceptualising scale-up from a systems perspective as composed of interrelated elements and strategic choices. Key enabling factors that facilitated the scale-up of FLE included (1) programme clarity, relevance and credibility; (2) programme adaptability to young people’s evolving sexual and reproductive health priorities; (3) the engagement of a strong and credible resource team comprising government and civil society agencies; (4) a favourable policy environment; and (5) deliberate strategic choices for horizontal and vertical scale-up. Barriers included sociocultural conservatism that creates resistance to content areas deemed to be culturally sensitive, resulting in partial scale-up in terms of content and coverage, as well as structural barriers that make it difficult to find space in the curriculum to deliver the full programme. Lessons learned from Senegal’s experience can strengthen efforts to scale-up school-based sexuality education programmes in other culturally conservative low- and middle-income countries.

Research priorities on ending child marriage and supporting married girls.

Over the past few years the issue of child marriage has received growing political and programmatic attention. In spite of some progress in a number of countries, global rates have not declined over the past decade. Knowledge gaps remain in understanding trends, drivers and approaches to ending child marriage, especially to understand what is needed to achieve results on a large scale. This commentary summarizes the outcomes of an Expert Group Meeting organized by World Health Organization to discuss research priorities on Ending Child Marriage and Supporting Married Girls. It presents research gaps and recommends priorities for research in five key areas; (i) prevalence and trends of child marriage; (ii) causes of child marriage (iii) consequences of child marriage; (iv) efforts to prevent child marriage; (v) efforts to support married girls.

Scaling up of Life Skills Based Education in Pakistan: a case study

Young people between the ages of 10 and 19 make up 23% of Pakistans population. In Pakistan, young people face many challenges in terms of sexual and reproductive health (SRH) issues. These include early marriage and pregnancy, low use of contraception, use of unsafe abortion, lack of relevant information and poor knowledge about bodily development including puberty and menstruation, sexuality, reproduction and HIV. This paper examines the scale-up of a rights-based, life skills-based education programme during the period from 2004 until 2013, which included comprehensive education about SRH issues. The programme was introduced by Rutgers WPF Pakistan in a total of 1188 schools. Introduction and scale-up were made possible by a combination of attributes among the organisations leading the development of the programme and the users. The main challenge, which related to the conservative operating environment in which the programme was first introduced, was addressed through a multiplicity of media and advocacy activities in the community, among parents, and by involving teachers, school administrators, district education departments and Muslim scholars in the development and review of the curriculum. The scale-up of a comprehensive sexuality education programme that targets young people in a conservative Muslim country is possible when there is careful curriculum design and materials and approaches are developed in close collaboration with key stakeholders.

Programa Geração Biz, Mozambique: how did this adolescent health initiative grow from a pilot to a national programme, and what did it achieve?

Adolescent sexual and reproductive health gained particular traction in Mozambique following the 1994 International Conference on Population and Development leading to the inception of Programa Geração Biz (PGB), a multi-sectoral initiative that was piloted starting in 1999 and fully scaled-up to all provinces by 2007. We conducted a systematic review of the literature to gather information on PGB and analyzed how it planned and managed the scale-up effort using the WHO-ExpandNet framework. PGB’s activities comprised a clear and credible innovation. Appropriate resource and user organizations further facilitated national scale-up. Challenges relating to the complex nature of the multi-sectoral approach and resistance due to norms about adolescent sexual and reproductive health hindered scaling-up in some geographic areas. The national government exhibited commitment and ownership to PGB through budgetary support and integration into multiple policies. This study adds to the documentation of successful scaling-up strategies that can provide guidance for policy makers and programme managers.

The health status of adolescents in Ecuador and the country’s response to the need for differentiated healthcare for adolescents

BackgroundAdolescents face a range of health problems but many barriers block their access to health services, and in particular to sexual and reproductive health services. The objective of this study was to assess the health needs of adolescents in Ecuador and to draw lessons from the ways the country has responded to their need for differentiated care.MethodsWe conducted a literature review and consulted key stakeholders.ResultsAdolescents in Ecuador today have a wide range of health care needs, in particular related to sexual and reproductive health. A major concern is the high rates of adolescent pregnancy. A national programme was established in 2007 to offer differentiated health care for adolescents—an effort that featured specially trained staff, enclaved facilities, respect for adolescents’ privacy and confidentiality, a friendly atmosphere, and a dedication to establishing trust. It resulted in rapid increases in visits by young persons both for preventive and curative services. In 2011, the government initiated a model for “integrated family and community health care” which led to a disruption of the central support for capacity building and follow-up of adolescent friendly services.ConclusionThe Ecuadorian experience has demonstrated the need for institutionalised differentiated care for adolescents who are facing a wide range of health issues.

Effectiveness of a girls’ empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial

BackgroundAdolescent pregnancies pose a risk to the young mothers and their babies. In Zambia, 35% of young girls in rural areas have given birth by the age of 18 years. Pregnancy rates are particularly high among out-of-school girls. Poverty, low enrolment in secondary school, myths and community norms all contribute to early childbearing. This protocol describes a trial aiming to measure the effect on early childbearing rates in a rural Zambian context of (1) economic support to girls and their families, and (2) combining economic support with a community intervention to enhance knowledge about sexual and reproductive health and supportive community norms.Methods/designThis cluster randomized controlled trial (CRCT) will have three arms. The clusters are rural schools with surrounding communities. Approximately 4900 girls in grade 7 in 2016 will be recruited from 157 schools in 12 districts. In one intervention arm, participating girls and their guardians will be offered cash transfers and payment of school fees. In the second intervention arm, there will be both economic support and a community intervention. The interventions will be implemented for approximately 2 years. The final survey will be 4.5 years after recruitment. The primary outcomes will be “incidence of births within 8 months of the end of the intervention period”, “incidence of births before girls’ 18th birthday” and “proportion of girls who sit for the grade 9 exam”. Final survey interviewers will be unaware of the intervention status of respondents. Analysis will be by intention-to-treat and adjusted for cluster design and confounders. Qualitative process evaluation will be conducted.DiscussionThis is the first CRCT to measure the effect of combining economic support with a community intervention to prevent adolescent childbearing in a low- or middle-income country. We have designed a programme that will be sustainable and feasible to scale up. The findings will be relevant for programmes for adolescent reproductive health in Zambia and similar contexts.Trial registrationISRCTN registry: ISRCTN12727868, (4 March 2016).