Communities That Care
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 behaviour. 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. (Source: Personalized Pop Reporter, 6 October 2003).