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September 2004, Vol. 10, No. 3 Transitions to Adulthood Standardized interventions rarely meet all the needs of clients in every location. Thus, Population Council investigators have long advocated using social science research findings to guide program priorities. A recent evaluation of a reproductive health program for young Kenyans provides an example of the power of this method. Program strategies were tailored to specific geographic areas based on the results of research in the local communities. Not only was the intervention acceptable, but a postintervention survey found that young people living in the project area were more likely than other young people to discuss issues of sexuality with adults and to protect themselves against HIV infection and unwanted pregnancy.
Adolescent sexual and
reproductive health The Nyeri Youth Health Project is an intervention for young people implemented by the Family Planning Association of Kenya in collaboration with representatives from the community. The Population Council provided technical assistance for the formative research, the design of the intervention and its management information system, and the creation of the quasi-experimental design of the project, which allowed for its evaluation. The intervention took place in Nyeri municipality between 1998 and 2000. Nyeri’s population includes about 14,000 unmarried young people aged 10–24, the primary target group for the project. The control site, Nyahururu municipality, is located more than 100 kilometers from Nyeri in the same province, Central Province. The two locations are similar in ethnic and religious composition, socioeconomic status, and health and educational infrastructure. The researchers carried out cross-sectional surveys in the project and control sites before and after the intervention and considered changes in the project site that were significantly different from those in the control to be associated with the project activities. In order to design effective reproductive health services for youth, the program managers undertook qualitative research during a year-long planning phase. First, they assessed staff attitudes about providing sexual and reproductive health information and services to young people. Next, they conducted in-depth interviews and focus group discussions among young people, their parents, and community leaders. These activities revealed that both young people and parents preferred that adults, rather than peers, deliver such information. Among the Kikuyu, the largest ethnic group in Kenya, parents of adolescents traditionally sent their children to other parents to receive instruction on sexuality and related issues. Consistent with this practice, the Nyeri Youth Health Project enlisted respected young parents living in the community to give adolescents sexual and reproductive health information and referrals for services. These counselors, known as Friends of Youth, received a month of training on community, family, and individual values; adolescent development; sexuality; gender roles; relationships; pregnancy; sexually transmitted infections; HIV/AIDS; harmful traditional practices, such as female genital cutting; substance abuse; planning for the future; children’s rights; and advocacy. The Friends of Youth gave adolescents in need of health services coupons that entitled them to visit participating providers, mostly in the private sector. These services were subsidized by the providers and the Family Planning Association of Kenya. Before they conducted educational activities, the 25 counselors went house to house in their assigned areas to introduce themselves and learn about local needs. After this informal community assessment, counselors conducted a range of activities with young people, including group discussions, role-playing exercises, drama activities, and lectures. Counselors also worked with parents and teachers in the area. In all, counselors made more than 40,000 contacts with young people and 5,800 contacts with parents during the three years of the project. Prior to the intervention, the researchers interviewed 1,544 unmarried young people in the project and control areas. Following the intervention, they interviewed 1,865 young people. By the end of the project, nearly half of Nyeri parents were aware of the project, and 19 percent had attended sessions with a counselor; two-thirds of all young people aged 10–24 were aware of the program, and one-third had had contact with a counselor. Significant
change The experiment has demonstrated the importance of learning about community needs and exploring local culture. “Despite the incredible diversity in Africa, policymakers have stuck with a small set of intervention models,” says Population Council public health scientist Annabel S. Erulkar, lead researcher of the study. “The Nyeri Youth Health Project adapted the traditional Kikuyu system of atiri, or respected adult counselor, to give young people information and support.” This intervention shows that programs adapted from local cultures can help improve the reproductive health status of young people in sub-Saharan Africa. The researchers have received a grant to scale up the intervention throughout the rest of Central Province and in slum areas of Nairobi.
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