Tracy’s comment in Wednesday’s class got me thinking about how to get adolescents to community centers. I know that these centers existed in many communities and also that these women’s community centers are being pushed as really effective and sustainable interventions. But how much do adolescents use these centers and for what purpose?
In researching this topic, I came across a paper that did a meta-analysis of all studies that looked at the effectiveness of different programs in Africa.
1. School-based programs were based on education on HIV, AIDS and sexually transmitted infections, general RH education, integrated school and clinic for HIV and general education. 22 studies were examined. The proportion of all studies reporting a significant positive impact was: 17 of 21 studies assessing knowledge and attitudes; 4 of 11 studies assessing delayed sex; 3 of 6 studies assessing the number of partners; 6 of 10 studies assessing contraceptive use; and 1 of 3 studies assessing service use.
2. Mass media programs included spreading awareness and ads on different health interventions through media only and media with social marketing. Six studies were examined: 5 of 6 studies assessing knowledge and attitudes found a positive effect on knowledge and attitudes. Three of 4 studies that included social marketing found a positive effect on knowledge and attitudes. The studies found mixed results for behavior outcomes.
3. Community-based programs focused on youth development, peer educators and educational programs. There were five studies that found that community-based programs improved knowledge about sexually transmitted infections, knowledge and attitudes, educational level, employment, service use and delayed sex.
4. Workplace programs were present in the four of the studies and all 4 studies found a positive effect on knowledge and attitudes. The 2 studies assessing contraceptive use found increased use with the program.
5. Health-facility based programs such as youth-friendly services and creation of a a youth center improved knowledge and increased service use and contraceptive use.
Most of the studies in the review assessed self-reported sexual and health-seeking behavior. The review focused on assessing knowledge and attitudes, delayed sex, number of partners, contraceptive use and service use. Most interventions appeared to have a positive effect on knowledge and attitudes, but the effect on behavior was less consistent. Thus most interventions seem to spread awareness, but how do you go about incentivizing a change in behavior? The creation of youth specific interventions, like the creation of a youth community center or community based programs focusing on peer educators/youth development seemed to be the most effective at changing attitudes.
Another study looked at downstream interventions for adolescents in the developing world. As I have mentioned before, child marriage and teen pregnancies are common enough that they affect the overall health of adolescent girls. Because of high levels of early childbearing in developing countries, pregnancy and childbirth are the leading causes of death among women aged 15–19. A study looked at the Demographic and Health Survey data for 15 developing countries and examined adolescents’ use of antenatal care, delivery care and infant immunization services compared with use by older women.
In five of the 15 countries, women aged 18 or younger were less likely than women aged 19–23 to use either antenatal care or delivery care, or both. Younger mothers in six countries were less likely than older mothers to have their infants immunized. The interesting details came in looking at the specific countries that showed these effects. The association of age and health care use was largely limited to Bangladesh, India, Indonesia, Nicaragua, Peru and Uganda. Except in Uganda, there were no differences in health care use by mother’s age in the African countries.
When I came across this study, I was confused as to why was there such a stark difference in Southeast Asian and Latin American countries, but not in African countries. Has the prevalence of HIV in Africa reduced the stigma around adolescent sexual health or sexual health in general? The effect also might be related to the decision making power of women in these countries; child marriage is much more common in Southeast Asia than in Africa. Marriage patterns, inheritance customs and age differentials between spouses lead to women’s being more disadvantaged within marriage in this region than in others [3]. Women’s decision-making power has been significantly and positively correlated with infant immunizations in Sub-Saharan Africa, Latin America and South Asia. Of these three regions, South Asia shows the strongest evidence of lack of decision-making power and the effects of gender inequality [4]. If women’s status and power are disproportionately lower among adolescents than among older women, then this may partly explain the lesser use of health services by this age-group in these countries.
But all of this is just hypothesizing. There are a whole host of issues that might be behind these differences in adolescent health in the developing world, and creating the most effective interventions for youth might be different in Africa versus India because of these differences.
[1] “The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence” by Speizer I S, Magnani R J, Colvin C E
[2] Adolescents’ Use of Maternal and Child Health Services in Developing Countries
By Heidi W. Reynolds, Emelita L. Wong and Heidi Tucker
[3] Smith L et al., The Importance of Women’s Status for Child Nutrition in Developing Countries, Washington, DC: International Food Policy Research Institute, 2003.
[4] Chowdhury S, Pregnancy and postpartum experience among first time young parents in Bangladesh: preliminary observations, in: Bott S et al., eds., Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia, Geneva: WHO, 2003, pp. 59–61.
2 Comments
I like that you followed up with things we discussed in class in this post. It would be interesting to hear more about specific interventions for youth and how they differ, if they do, from those of adults. It would also be interesting to know what these centers and interventions are doing to educate women in other ways (i.e. about labor, agency, etc.) since many of these seem to focus on reproductive and sexual health. I wonder if interventions that combine this education with other things are more or less successful in actually changing behaviors.
I thought the question you posed is a crucial one. After raising awareness, how can behavioral changes be incentivized or implemented, especially in the face of cultural, economic and religious barriers? I liked that you focused on this issue after we had debated about it during section. I was and am a little skeptical about the effectiveness of these programs, not to say that I don’t think that they won’t ever work. Out of curiosity, I was wondering which countries were studied in Africa: were they all poor countries, some of the more developed countries in Africa or a wide-range? I would love to read more about your question on whether or not the prevalence of HIV in Africa reduced the stigma around adolescent sexual health and sexual health in general. Lastly, I believe, as you stated, that the most effective interventions for youth are different in Africa versus India. To take it a step further, I think that interventions are different even within countries, especially where different tribes and religions and cultures are concerned.