Reproductive Health in Developing Countries

Adolescents: taken more seriously?

UN General Assembly Special Sessions:

Drugs (1998)

HIV/AIDS (2001)

Children (2002)

More adolescents than anytime in recorded history

1.2 billion 10-19

1.7 billion 10-24

20-25% of world’s population

86% in developing countries

Slide 5

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HIV/AIDS

12 million 15-24 living with HIV/AIDS

6,000 infected daily

Account for >1/2 new infections

62% female

>20% in many sub-Saharan

rates 2^nd highest in Caribbean

Why:

Info?

Skills?

Societal norms & practices?

Access to youth friendly services?

Policies?

Slide 9

Sexual abuse & violence in Sub-Saharan Africa

estimating prevalence difficult

regular physical abuse of young women: Uganda (46%), Tanzania (60%), Kenya (42%), Zambia (40%)

½ of sexual assaults against girls <15

boys also (15% Ugandan boys)

effects on women & children who witness

social stigma prevents speaking out

Barriers to RH care

Lack info (e.g. not at risk, myths, unaware)

Stigma (males & females)

Provider attitudes & skills

Concerns about confidentiality

Logistics

Policies

Social/cultural barriers (seek permission)

What are “Youth Friendly” RH Services?

Visible

Clinical/program environment

Staff attitudes (training, supervision, monitoring)

Convenient hours/location

Affordable

Full range of RH care

Policies & procedures (protocols, guidelines)

Youth involved @ all stages

Sensitive to gender norms

Slide 13

Beyond Clinics

Pharmacies

Kiosks

Retail stores

Youth Centers

School/Clinic links

Mass media/theatre

Slide 15

Strategic Steps

Needs assessment

Goals & objectives

Collaborations

Involve youth

Educate public (media)

Persuade policy makers

Anticipate/respond to opposition

Evaluate results & adjust

Needs Assessment

Assess health status of target youth in specific community

Gather info on availability & utilization of services, including gaps & barriers

Assess local, national, regional, institutional policies that affect availability & utilization

I. Assess Needs

% sexually active

Birth, STI rates

% using contraception

Mean age marriage, first birth

Maternal/infant mortality rates

Substance abuse rates

Incidence of sexual violence

School drop out rates

Number of street youth

% youth enrolled in primary & secondary school

II. Assess Info & Services

What RH services exist?

Are services available? Youth friendly?

What services not available?

How many use RH each month? Year?

Transportation available?

What barriers to accessing?

Extent/quality of school RH education?

Do some groups receive/others don’t?

Any medial campaigns?

Slide 20

Obtain Data

Public health surveillance

Local health, education & social service providers

Surveys

Focus Groups

Assess & Rank Needs

Severity

Frequency/prevalence

Social & economic consequences

Amenable to change

Feasibility, capacity to affect change

Examples of Public Health Policy Advocacy

Increase funding

Change laws/policies

Encourage public/private collaborations

Revise internal policies & procedures



	UN General Assembly Special Sessions:
		Drugs (1998)
		HIV/AIDS (2001)
		Children (2002)



	1.2 billion 10-19

	1.7 billion 10-24

	20-25% of world’s population

	86% in developing countries


	12 million 15-24 living with HIV/AIDS
	6,000 infected daily
	Account for >1/2 new infections
	62% female
	>20% in many sub-Saharan
	rates 2^nd highest in Caribbean
	Why:
		Info?
		Skills?
		Societal norms & practices?
		Access to youth friendly services?
		Policies?


	estimating prevalence difficult
	regular physical abuse of young women: Uganda (46%), Tanzania (60%), Kenya (42%), Zambia (40%)
	½ of sexual assaults against girls <15
	boys also (15% Ugandan boys)
	effects on women & children who witness
	social stigma prevents speaking out


	Lack info (e.g. not at risk, myths, unaware)
	Stigma (males & females)
	Provider attitudes & skills
	Concerns about confidentiality
	Logistics
	Policies
	Social/cultural barriers (seek permission)


	Visible
	Clinical/program environment
	Staff attitudes (training, supervision, monitoring)
	Convenient hours/location
	Affordable
	Full range of RH care
	Policies & procedures (protocols, guidelines)
	Youth involved @ all stages
	Sensitive to gender norms


	Pharmacies
	Kiosks
	Retail stores
	Youth Centers
	School/Clinic links
	Mass media/theatre


	Needs assessment
	Goals & objectives
	Collaborations
	Involve youth
	Educate public (media)
	Persuade policy makers
	Anticipate/respond to opposition
	Evaluate results & adjust


	Assess health status of target youth in specific community
	Gather info on availability & utilization of services, including gaps & barriers
	Assess local, national, regional, institutional policies that affect availability & utilization


	% sexually active
	Birth, STI rates
	% using contraception
	Mean age marriage, first birth
	Maternal/infant mortality rates
	Substance abuse rates
	Incidence of sexual violence
	School drop out rates
	Number of street youth
	% youth enrolled in primary & secondary school


	What RH services exist?
	Are services available? Youth friendly?
	What services not available?
	How many use RH each month? Year?
	Transportation available?
	What barriers to accessing?
	Extent/quality of school RH education?
	Do some groups receive/others don’t?
	Any medial campaigns?


	Public health surveillance
	Local health, education & social service providers
	Surveys
	Focus Groups


	Severity
	Frequency/prevalence
	Social & economic consequences
	Amenable to change
	Feasibility, capacity to affect change


	Increase funding
	Change laws/policies
	Encourage public/private collaborations
	Revise internal policies & procedures