Building Support for Adolescent Sexuality and Reproductive Health Education and Responding to Resistance in Conservative Contexts: Cases From Pakistan

Abstract

While there is no one-size-fits-all approach to building community support for such programs, key strategies in Pakistan included: (1) sensitizing and engaging key stakeholders, including religious groups, schools, health and education government officials, parents, and adolescents themselves; (2) tactfully designing and framing the curricula with careful consideration of context and sensitive topics; (3) institutionalizing the programs within the school system; (4) showcasing school programs to increase transparency; and (5) engaging the media to build positive public perceptions.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time

“…When resistance arises, we must map influential stakeholders and decision-makers, understand their priorities and concerns, proactively engage with media and civil society, and directly counter misinformation with compelling data, evidence, and stories. By using such strategies, programs have shown that it is possible to navigate sensitivities to CSE, for example, in countries as diverse as Mexico, Nigeria, Pakistan, and the U.S. [45,46,102,103].…”

“…Throughout these efforts, we must recognize that perfect cannot be the enemy of the good, and that the path to scale-up will be messy and nonlinear. For example, Aahung, an indigenous nongovernmental organization, persevered diligently through changes in government, backlash, and even floods to achieve scaleup of its life skillsebased education program in Pakistan, referred to earlier (Figure 1) [45]. Many of the countries that have demonstrated success on ASRHR have shown that it can be useful to start strategically (and sometimes, opportunistically) versus comprehensively; then, once a program is up and running, add additional components or content.…”

Building an enabling environment and responding to resistance to sexuality education programmes: experience from Jharkhand, India

“…For example, the usefulness of the public-private partnership between the Government of Jharkhand and C3 – whereby the programme can benefit from governments’ inherent credibility and authority and its schools as an existing delivery platform on the one hand, and NGOs’ ability to nimbly navigate contentious waters while offering enhanced technical support on the other – match similar experiences from Senegal and Mexico [ 17 , 18 ]. Similarly, the choice to label Udaan as an AEP instead of CSE echoes choices made by many programmes in other contexts, such as use of “family life education” or “reproductive health education” in Senegal, “family life and HIV education” in Nigeria, and “life skills based education” in Pakistan [ 8 , 9 , 17 , 19 , 20 ]. One factor that differed in the case of Udaan as compared to findings from other contexts is political support: Udaan benefited from a state government (and specifically the JSACS and the DoE) which recognized the SRH needs of its adolescents, believed that CSE could help to address these needs, was fully committed to owning the programme in partnership with a credible and competent NGO, and was not afraid to stand up to opposition when backlash arose.…”

“…Likewise, another strategy used by other programmes – namely addressing backlash or resistance by engaging with religious leaders – was not as pronounced with the case of Udaan, given that the resistance that emerged was not explicitly grounded in religious ideology or driven by religious leaders [ 1 , 3 , 17 , 20 ]. Programmes that have done this have used strategies such as including references to religious texts within programmatic materials, or compromising on content about especially contentious issues [ 8 , 9 , 17 , 20 ].…”

“…1 ) ([ 1 , 2 ]; Additional file 1 ). As part of an ongoing effort by the World Health Organization (WHO) to understand and document strategies for creating an enabling environment for CSE and overcoming resistance, this article aims to analyse C3’s experience in designing, implementing, and managing Udaan by answering the following research questions: [ 2 , 8 , 9 ] What strategies did the Government of Jharkhand and C3 use to create a supportive environment for Udaan and enable it to survive in a context where many other programmes failed to do so? What processes did the Government of Jharkhand and C3 use to respond to resistance that emerged during Udaan's implementation?…”