International Public Health Commons^™

Sexuality And Hiv Education: Time For A Paradigm Shift, Nicole Haberland, Deborah Rogow

Poverty, Gender, and Youth

For decades, curriculum-based sexuality education has been a cornerstone of school- and community-based efforts to improve young people’s sexual and reproductive health, and more recently to prevent HIV infection. Unfortunately, public discourse about sex education has been mired in polarizing debates that distract attention from determining how sex and HIV education programs might best achieve the shared goals of many different constituencies. A recent comprehensive review of the impact of school-based sexuality and HIV education programs in developed and developing countries found that two-thirds of the programs reduced the risk associated with one or more reported sexual behaviors. This finding …

Girls Left Behind: Redirecting Hiv Interventions Toward The Most Vulnerable, Judith Bruce

Poverty, Gender, and Youth

As we enter the third decade of the HIV pandemic in sub-Saharan Africa, young women—often adolescent girls—are the new face of the disease. In particular, HIV/AIDS is threatening those girls and young women with limited social and economic assets—those who are unable to avoid, manage, or leave unsafe sexual relationships inside and outside of marriage. Girls at risk of sexual exploitation are not a small minority; they are counted in the hundreds of millions. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 23 explores: structural determinants of risk, failure to reach the most vulnerable, moving ahead with the …

Obtaining More Accurate And Reliable Information From Adolescents Regarding Sti/Hiv Risk Behaviors, Barbara Mensch, Paul C. Hewett

Poverty, Gender, and Youth

To investigate the quality of self-reported data on sexual behavior, Population Council researchers conducted a study in a rural district of Malawi. They implemented a randomized experiment to assess whether audio computer-assisted self-interviewing (ACASI) produces more valid data on sexual behavior than face-to-face interviews. The Malawi study builds on an experiment conducted as part of a household-based survey of Kenyan adolescents. In Kenya and Malawi, there is clear evidence that mode of interviewing and probing of various sexual partnerships affect the reporting of sexual activity. According to Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 25, ACASI is …

Evaluación De Las Múltiples Desventajas De Las Niñas Mayas: Efectos Del Género, El Origen Étnico, La Pobreza Y El Lugar De Residencia Sobre La Educación En Guatemala, Kelly Hallman, Sara Peracca, Jennifer Catino, Marta Julia Ruiz

Poverty, Gender, and Youth

Aunque el acceso a la educación primaria en Guatemala se incrementó en los últimos años, especialmente en las áreas rurales, los índices de finalización de escuela primaria y de alfabetismo corespondeientes a personas jóvenes continúan estando entre los más bajos de Latinoamérica, y persisten otros problemas como el ingreso tardío, la repetición de cursos y el abandono temprano. Se estima que el índice de alfabetismo entre adultos es del 85 por ciento en Latinoamérica en general, comparado con sólo un 70 por ciento en Guatemala. Aunque los pueblos indígenas en Latinoamérica por lo general tienen menos escolaridad que los no …

Les Filles Sont Oubliées : Rediriger Les Interventions En Matière De Vih Vers Les Plus Vulnérables, Judith Bruce

Poverty, Gender, and Youth

Alors que nous entrons dans la troisième décennie de la pandémie de VIH en Afrique subsaharienne, les jeunes femmes, le plus souvent les adolescentes, sont le nouveau visage de la maladie. Le VIH/SIDA menace en particulier les jeunes femmes et les adolescentes qui se trouvent dans des situations sociaux-économiques peu favorables, celles qui ne peuvent éviter, gérer ni échapper à des relations sexuelles à risque au sein même du mariage or hors mariage. Les filles présentant un risque d'être exploitées sexuellement ne représentent pas une petite minorité; on peut les compter par centaines de millions. Promouvoir des transitions vers l'âge …

Las Niñas Rezagadas: Dirigir Las Intervenciones De Vih Hacia Las Más Vulnerables, Judith Bruce

Poverty, Gender, and Youth

Al ingresar en la tercera década de la pandemia del VIH en el África subsahariana, las mujeres jóvenes—a menudo adolescentes—conforman el nuevo rostro de la enfermedad. En especial, el VIH/SIDA amenaza a aquellas niñas y mujeres jóvenes con limitados posibilidades sociales y económicas; quienes que no pueden evitar, controlar o abandonar las relaciones sexuales inseguras, dentro y fuera del matrimonio. Las niñas que están en riesgo de ser explotatas sexualmente no constituyen una pequeña minoría; se calculan en cientos de millones. Promoción de transiciones a la vida adulta: Sanas, seguras y productivas N° 23 explora: los determinantes estructurales de riesgo, …

Towards Messages That Matter: Understanding And Addressing Hiv And Srh Risks Among Married Young People In India, Armin Jamshedji-Neogi, Renu Kapoor, Jayashree Kumar, Ashwini Bhalerao Gandhi, Lakshmi Murthy, K.G. Santhya, Shireen J. Jejeebhoy, Saswata Ghosh, Vijaya Nidadavolu, Nicole Haberland, Komal Saxena, M.A. Jose

Poverty, Gender, and Youth

Although there is increasing interest in young people's sexual and reproductive health (SRH) situations and needs in India, married young people have received little attention as a vulnerable group with distinct needs because marriage is assumed to be safe and because married youth are assumed to face none of the stigma that their unmarried counterparts experience in accessing SRH services. However, emerging evidence shows that within this subpopulation, married young women and men constitute groups with distinct risks of HIV and other poor SRH outcomes. There remains a need to better understand their unique vulnerabilities and to design programs that …

Changing Transitions To Adulthood In Vietnam's Remote Northern Uplands: A Focus On Ethnic Minority Youth And Their Families, Bussarawan Teerawichitchainan, Hac Van Vinh, Nguyen Thi Phuong Lan

Poverty, Gender, and Youth

Ethnic minorities, who tend to live in remote mountainous areas, account for 15 percent of Vietnam’s 84 million total population and, according to a recent estimate, 61 percent of them are poor. Evidence suggests that despite recent efforts by the Government of Vietnam to promote poverty reduction in remote areas, a majority of ethnic minorities have not yet experienced positive change, contrary to their Kinh (ethnic Vietnamese) neighbors who have enjoyed substantial improvement in living standards. To identify program interventions that promote healthy human development and, in turn, positively affect Vietnam’s economic growth, it is crucial to have a comprehensive …

Premarital Sex And Schooling Transitions In Four Sub-Saharan African Countries, Ann E. Biddlecom, Richard Gregory, Cynthia B. Lloyd, Barbara Mensch

Poverty, Gender, and Youth

Using data from the 2004 National Survey of Adolescents conducted in Burkina Faso, Ghana, Malawi, and Uganda, this Population Council working paper investigates the timing of two key transitions in adolescence—school exit and premarital sex—among those who remain enrolled in school at the beginning of adolescence (age 12). Girls appear more vulnerable to dropout once they become sexually mature and once they engage in premarital sex. While girls were found to be less likely than boys, at any given age and controlling for other covariates, to have had premarital sex (except in Ghana), school enrollment and the timing of school …

Casamento Infantil No Contexto Da Epidemia Do Vih, Judith Bruce

Poverty, Gender, and Youth

Da forma como a epidemia do VIH cresceu, transformou-se em muitos contextos numa doença de mulheres joven. Na África subsariana, 75% dos 6,2 milhões de jovens com idades entre os 15–24 que vivem com o VIH são mulheres. Ao mesmo tempo, o casamento infantil, apesar de estar a diminuir, continua. Em certos locais africanos, um número elevado de raparigas encontra-se em risco de casarem ainda crianças e muitos milhões de jovens esposas casaram ainda crianças. Para entender melhor estes fenómenos com semelhanças em comum—casamento infantil e epidemia do VIH—o Population Council adoptou uma abordagem em vários níveis. Um nível de …

Éducation Sexuelle Et Vih : Il Est Temps De Changer De Méthodologie, Nicole Haberland, Deborah Rogow

Poverty, Gender, and Youth

Pendant des décennies, l’éducation sexuelle basée sur un curriculum a été la pierre angulaire des efforts en fournis par les écoles et les communautés pour améliorer la santé sexuelle et génésique des jeunes, et plus récemment pour prévenir le VIH. Malheureusement, le discours public sur l'éducation sexuelle s’est égaré dans des débats polarisés qui ont détourné l'attention de la manière dont les programmes d'éducation sexuelle et VIH peuvent atteindre le mieux possible les objectifs partagés par différentes circonscriptions. Une étude exhaustive récente de l'impact des programmes d'éducation sexuelle et VIH dispensés par les écoles dans les pays développés et en …

Educación Sobre Sexualidad Y Vih: Tiempo Para Un Cambio De Paradigma, Nicole Haberland, Deborah Rogow

Poverty, Gender, and Youth

Durante décadas, la educación sexual basada en un programa de estudio fue la piedra angular de los esfuerzos de la escuela y de la comunidad para mejorar la salud sexual y reproductiva de los jóvenes y, en forma más reciente, para prevenir la infección de VIH. Desafortunadamente, el discurso público sobre educación sexual ha estado envuelto en debates contradictorios que sirven para distraer la atención en lugar de determinar en que manera los programas de educación sobre sexualidad y VIH podrían alcanzar mejor los objetivos compartidos de las distintas partes. Una reseña exhaustiva que se realizó recientemente sobre el impacto …

Jovens Abandonadas: Redireccionar As Intervenções De Vih No Sentido Das Mais Vulneráveis, Judith Bruce

Poverty, Gender, and Youth

No início da terceira década da pandemia do VIH na África Subsariana, as mulheres jovens—muitas vezes adolescentes—são o novo rosto da doença. O VIH/SIDA está a ameaçar, sobretudo, raparigas e jovens com rendimentos sociais e económicos limitados—as que não conseguem evitar, controlar ou sair de relações sexuais inseguras dentro e fora do casamento. As jovens em risco de exploração sexual não são uma pequena minoria, contam-se entre elas centenas de milhões. Promover Transições para a Idade Adulta: Saudáveis, Seguras e Produtivas Nº 23 explora: determinantes estruturais de risco, falta chegar às mais vulneráveis, avançar com os meios que temos e …

Le Contexte De L’Initiation Sexuelle En Évolution Dans La Région Subsaharienne De L’Afrique, Barbara Mensch

Poverty, Gender, and Youth

L'ampleur de l'épidémie du SIDA en Afrique subsaharienne expose particulièrement les jeunes femmes au risque de l'infection par le VIH et requiert une meilleure compréhension des comportements reproductifs, y compris l'initiation sexuelle et les relations sexuelles pré-maritales. La croissance des relations sexuelles pré-maritales est une conséquence inévitable des mariages tardifs dans les pays en développement, en particulier à cause du fait que la période pendant laquelle les filles sont sexuellement mûres et non mariées est prolongée quand le mariage est retardé. Un récent projet du Population Council a fait des recherches sur les liens entre le changement d'âge au mariage …

Leave No Woman Behind, Ethiopia: Baseline Report, Annabel Erulkar, Tekle-Ab Mekbib, Helen Amdemikael, Garry Conille

Poverty, Gender, and Youth

“Leave No Woman Behind, Ethiopia” is an experimental project being implemented in rural areas of Ethiopia’s Amhara region. The project uses the mobilization of women into groups and adult literacy as an entry point for reproductive health education and referrals. Measurement of the program’s impact is being undertaken using a quasi-experimental research design including baseline and endline surveys in six Kebele Associations in rural Amhara. This report presents findings from the baseline survey conducted among more than 3,000 girls and women aged 10–45 in rural Amhara region. The results cover a broad range of topics including education, work, livelihoods, social …

Addressing The Sexual And Reproductive Health Needs Of Young People: Perspectives And Experiences Of Stakeholders From The Health And Non-Health Sectors, K.G. Santhya, Shireen J. Jejeebhoy, Saswata Ghosh, Nicole Haberland

Poverty, Gender, and Youth

In India, recent policies have underscored the right of adolescents and youth to sexual and reproductive health (SRH) counseling and services. Despite recent policies and programs, little information is available on the extent to which policy recommendations and program strategies have been implemented, and the extent to which services serve the disparate needs of married and unmarried young women and men. Also, there is limited evidence about the extent to which health-care providers at different levels of service delivery and stakeholders from other sectors are involved in providing SRH and HIV/AIDS-related information and services to young people, or their perceptions …

Ethnic Differentials In Parental Health Seeking For Childhood Illness In Vietnam, Bussarawan Teerawichitchainan, James F. Phillips

Poverty, Gender, and Youth

The recent introduction of user fees for Vietnam’s primary healthcare services has generated concern that economic policies may adversely affect health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This Population Council working paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under age 5 recorded by the 2001–02 Vietnam National Health Survey. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Results suggest that social equity …

Child Marriage In The Context Of The Hiv Epidemic, Judith Bruce

Poverty, Gender, and Youth

As the HIV epidemic has matured, in many settings it has become a disease of young women. In sub-Saharan Africa, 75 percent of the 6.2 million young people aged 15–24 living with HIV are female. At the same time, child marriage, though on the decline, persists. In parts of Africa, large numbers of girls are at risk of child marriage, and many millions of young wives were married as children. To better understand these twin phenomena—child marriage and the HIV epidemic—the Population Council adopted a multilevel approach. One level of investigation examines the effect of child marriage on the epidemic, …

The Changing Context Of Sexual Initiation In Sub-Saharan Africa, Barbara Mensch

Poverty, Gender, and Youth

The magnitude of the AIDS epidemic in sub-Saharan Africa puts young women at particularly high risk for HIV infection and calls for a better understanding of reproductive behavior, including sexual initiation and premarital sex. An increase in premarital sex is an inevitable consequence of later marriage in the developing world, if for no other reason than that the period during which girls are sexually mature and unmarried is prolonged when marriage is postponed. A recent Population Council project investigated the links between changing age at marriage and premarital sexual behavior in 27 sub-Saharan African countries. After documenting the decline in …

Reducir La Exclusión Social Des Las Niñas, Kelly Hallman, Eva Roca

Poverty, Gender, and Youth

En todo el mundo, las niñas son sistemáticamente excluidas de la participación en la vida social, económica y política. La ausencia de niñas en estos terrenos tiene consecuencias, no solo para las mismas jóvenes sino también para la sociedad en su totalidad, ya que se exacerba la pobreza y se perpetúan las disparidades de salud, educación y éxito económico. A nivel internacional, esta marginación dificulta o hace imposible que algunos países logren objetivos en toda la sociedad, como los Objetivos de Desarrollo del Milenio, considerados por las Naciones Unidas como parámetros para reducir la pobreza. Desde hace algunos años, el …

Tuko Pamoja: A Guide For Peer Educators, Program For Appropriate Technology In Health (Path)

Reproductive Health

This guide was developed by Program for Appropriate Technology in Health (PATH) and is part of the Kenya Adolescent Reproductive Health Project’s Tuko Pamoja (We Are Together) series. Based on KARHP’s Adolescent Reproductive Health and Life Skills Curriculum, the guide is designed to help facilitate dialogue between adults and young people on issues related to adolescent reproductive health. It can be used to help peer educators share information and lead discussions with their peers on physical and emotional changes during adolescence, staying healthy, planning for the future, making good decisions, and preventing pregnancy and HIV and AIDS. The information can …

Grandir En Harmonie: Document De Références, Population Council

Reproductive Health

Ce document de référence fournit des informations pour accompagner les animateurs du curriculum « Grandir en harmonie » en santé de la reproduction. Il s’adresse principalement aux pairs éducateurs et aux assistants d’adolescent(e)s pour les aider à préparer les adolescents(e) à aborder la sexualité en connaissance de cause, de manière responsable et dans le respect des valeurs de leur communauté. Son contenu peut également être adapté pour les jeunes de 20 à 24 ans. Le document couvre des sujets tels que : lʼadolescence; les valeurs; le genre; les mutilations génitales féminines; comprendre son corps; le tabagisme, l’alcoolisme et la toxicomanie; …

Grandir En Harmonie: Guide De L'Utilisateur, Population Council

Reproductive Health

Ce guide de l’utilisateur fournit des informations pour aider les animateurs du programme « Grandir en harmonie » à jouer efficacement leur rôle d’éducateur pair. Le guide décrit la mission, les tâches et la cible des activités à faire avec les adolescent(e)s/jeunes. Ces activités leur permettent de renforcer leurs capacités à prendre des décisions afin de mieux se réaliser maintenant et dans le futur. Le guide aide les animateurs avec l’organisation, la méthodologie et le matériel de soutien pour les sessions.

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This user’s guide provides information to help “Growing in Harmony” curriculum facilitators effectively carry out their role of …

Grandir En Harmonie: Curriculum D'Animation Des Pairs-Éducateurs Et Des Aides-Ados Ou Jeunes Écoutant, Population Council

Reproductive Health

« Grandir en harmonie » est un curriculum d’animation en santé de la reproduction a l’intention des pair éducateurs et des aides-adolescent(e)s, principalement, pour préparer les adolescent(e)s à aborder la sexualité en connaisance de cause, de manière responsable et dans le respect des valeurs de leur milieu. Son contenu peut aussi être utilisé par les jeunes de 20 à 24 ans, mais avec des méthodes appropriées (panel, thé-débat, etc.). D’autre types d’utilisateurs l’ont expérimenté et ont trouvé que c’était une ressource utile pour la conduite de leurs activités: aides-adolescent(e)s, enseignants, prestataires de santé et autres encadreurs de jeunes. Leurs remarques …

Mainstreaming Emergency Contraception In Ethiopia's Public Sector: Final Project Report, Jill Keesbury, Hailegiorgis Aytenfisu, Spike Bradford

Reproductive Health

The Ethiopian Ministry of Health, the Ethiopian Society of Obstetricians and Gynecologists, and ECafrique launched a two-year project in 2004 to mainstream emergency contraception (EC) in the country’s public sector. The project aimed at improving reproductive health care among young women and reducing the country’s abortion rate by expanding access to EC. Overall, its goal was to demonstrate the feasibility of integrating EC within the public sector’s broader contraceptive mix and was guided by the following objectives: to scale-up and promote public sector EC services in five of Ethiopia’s most populated regions; to document the characteristics and use patterns of …

The Resolution Of Unintended Pregnancy Among Female Students At The University Of Ghana, Legon, Angela El-Adas

Reproductive Health

Little has been done to investigate the knowledge, attitudes, and practices of university students regarding unintended pregnancy likely because their middle-class status precludes their being considered a “deprived population.” Female students in tertiary institutions of higher learning are at an age and in a social context that makes them extremely susceptible to unintended pregnancy and the consequences of unsafe abortions. It is necessary to take steps to reduce the incidence of unwanted pregnancy and unsafe abortions among this group of “high risk” women. This study sought to investigate the extent of knowledge that female students at the University of Ghana, …

Kenya: Mobilize Health Care Providers To Advocate Against Fgm/C, Frontiers In Reproductive Health

Reproductive Health

Female genital mutilation/cutting (FGM/C) is illegal in Kenya. The practice has declined slightly, yet it is nearly universal among the Abagusii, a relatively affluent ethnic group residing in the Nyanza province in western Kenya. Half of cut women reported that they had been cut by a health worker, however providers express willingness to advocate against the practice. This study, launched in 2004 by the Population Council’s FRONTIERS Program, examined the role of health providers in FGM/C in Kenya’s Abagusii community. As noted in this brief, the objectives were to understand the motivations behind the medicalization of FGM/C and determine the …

Bolivia: Marketing And Economic Analyses Help Ngos Develop Strategies For Sustainability, Frontiers In Reproductive Health

Reproductive Health

Many nongovernmental organizations (NGOs) face reduced funding for reproductive health services and are seeking ways to assess and enhance their ability to generate income to cover their service costs. In 2004, following a workshop on financial sustainability presented by the Population Council’s FRONTIERS Program, three Bolivian NGOs—Prosalud; the Center for Research, Education, and Services (CIES); and the Association of Rural Health Programs (APSAR)—developed operations research studies to improve their financial sustainability. The Prosalud and CIES studies included a cost-recovery study, a study measuring clients’ willingness to pay for services, and a market segmentation study to compare the NGOs’ services with …

Bangladesh: Rh Curriculum Enhances Vocational Students' Knowledge And Behavior, Frontiers In Reproductive Health

Reproductive Health

In 2004, the Population Council’s FRONTIERS Program and the Bangladesh Ministry of Youth and Sports collaborated on an intervention to introduce reproductive health education into government-run vocational-training courses. The training, offered to males and females aged 15–30, includes livestock husbandry, electronics, and secretarial work. The intervention built upon the positive results of the 1999 Bangladesh Youth Reproductive Health Study, which introduced a life-skills curriculum into secondary schools. The interactive reproductive health curriculum was modified to suit older adolescents and youth attending courses at vocational training centers. Topics included reproductive biology, family planning, pregnancy, sexually transmitted infections, critical thinking, and negotiation …

South Africa: Improve Facility Management To Increase Nurse Retention, Frontiers In Reproductive Health

Reproductive Health

South Africa’s medical infrastructure is relatively well developed, but its maternal mortality rate remains high and numerous studies document poor maternal care. Shortages in nursing staff are a major factor in quality-of-care problems on maternity wards. A Population Council FRONTIERS study of antenatal care in rural clinics in Kwa-Zulu Natal showed that between one-third and one-half of providers interviewed had worked at their clinics for less than a year. In 2004, FRONTIERS followed up on the Kwa-Zulu Natal study to document factors affecting the tenure, motivations, and working conditions of maternal-health nursing staff in three South African provinces. The study …