Creating an Enabling Environment for Adolescent Sexual and Reproductive Health: A Framework and Promising Approaches

Svanemyr, Joar; Amin, Avni; Robles, Omar; Greene, Michael B.

doi:10.1016/j.jadohealth.2014.09.011

Cited by 171 publications

(177 citation statements)

References 27 publications

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“…Evidence from Ghana suggests that adolescent SRHR activities should also target parents (and community members) as a way of breaking socio-cultural barriers [21]. School programmes have been shown to be more effective in empowering adolescents in relation to their SRHR when linked to the community [22,23]. It is evident from the mentioned studies that addressing adolescent SRHR can only be achieved through multi-sectorial approaches that involve working with all relevant stakeholders, including parents, community members and policymakers; in other words, the CBHS [23,24].…”

Section: Introductionmentioning

confidence: 99%

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Mulubwa¹,

Hurtig²,

Zulu³

et al. 2020

Reprod Health

111

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Introduction: Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents.Methods: This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. Results: We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages.

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Section: Introductionmentioning

confidence: 99%

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Mulubwa¹,

Hurtig²,

Zulu³

et al. 2020

Reprod Health

111

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show abstract

“…Several factors may increase adolescents' risk of adverse SRH events and preventing access to appropriate SRH services [7,8]. Multiple studies have focused on barriers that hinder youth from accessing SRH services [9,10,11]. Currently, there are only two Youth Friendly Health Clinic (YFHCs) in Laos.…”

Section: Introductionmentioning

confidence: 99%

Perceived Barriers in Accessing Sexual and Reproductive Health Services for Youth in Lao People’s Democratic Republic

Thongmixay

Essink

Greeuw

et al. 2019

Preprint

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Background: Sexual activity during youth is common in Lao PDR. However, young people seldom utilize sexual and reproductive health services and subsequently suffer from poor sexual and reproductive health. The aim of this qualitative study was to explore the barriers perceived by youth that prevent their access to sexual and reproductive health services. Methods:Twenty-nine semi-structured interviews were conducted with 22 participants aged 15-25 years, from urban and rural areas. A vignette was used during interviews with those who had no experience with sexual and reproductive health services. Additionally, seven semi-structured interviews were conducted with health providers from youth-friendly health clinics and from public sexual and reproductive health services. Data were analyzed using a thematic approach. Results:The main barriers preventing young people from accessing sexual and reproductive health services were related to cognitive accessibility and psychosocial accessibility. The cognitive accessibility barriers were a lack of sexual knowledge and a lack of awareness of services. Perceived barriers in psychosocial accessibility were the feelings of shyness and shame caused by negative cultural attitudes to premarital sex, and the fear of parents finding out about visits to public sexual and reproductive health services, due to lack of confidentiality in the services and among health providers. In addition, the barriers of geographical accessibility, mainly insufficient availability of youth-friendly health clinics. Conclusion:To improve access to services, a multi-component strategy is needed: promotion of youth-friendly health clinics; sexual education in schools; a formal referral system between schools and youth-friendly health clinics; and community support interventions. Prior to implementation, more research should be done on the applicability of these methods in the Laos context. Future research should try to determine the cost-effectiveness of youth-friendly health clinics integrated in a district hospital and stand-alone clinics, to provide insight into which form should be further developed.

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“…Beyond empowering girls and building individual assets, an enabling environment needs building at family, community and societal levels [8]. We draw on the capability approach, social norms theory and gender theory to help achieve a more nuanced understanding of pathways to school dropout.…”

Section: Introductionmentioning

confidence: 99%

Education, poverty and "purity" in the context of adolescent girls' secondary school retention and dropout: A qualitative study from Karnataka, southern India

et al. 2018

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BackgroundGender-related norms and poverty remain important structural barriers to secondary school attendance among adolescent girls in southern India. We analyse how gender norms interact with family deprivation and dynamics to result in girls dropping out of school; we identify the main facilitators of school retention and changes to gender socialisation.MethodsLongitudinal qualitative case studies with 36 girls were nested within a cluster randomized trial to evaluate the Samata intervention targeting adolescent girls in Bagalkote and Vijayapura districts in northern Karnataka. We used two rounds of in-depth interviews, conducted in 2014 at a time when respondents were in 8th standard at the age of 13 to 14 and sixteen months later. We combined thematic and narrative analyses.ResultsOur study found that poverty and socioeconomic realities at the household level strongly affect conformity with discriminatory gender practices such as restricting girls’ mobility. The value placed on education by parents clearly differentiates the regular school goers from those frequently absent and others who dropped out. With active encouragement of the girls’ educational and career aspirations, parents engendered the girl’s agency to communicate openly both at home and at school, allowing subtle changes to gender performance while resisting the pressure of social sanctions. In contrast, where educational aspirations were weak, parents invested more intensely in enforcing correct performance of gender, prioritising her well-being by aiming to secure her future in a good marriage. Among poorer families, girls’ domestic duties came at the cost of schooling with concerns about protecting her sexual purity predominating.ConclusionsIn contexts where a strong gender ideology of virginity before marriage rules, subtle shifts in harmful gender practices are possible. Interventions aiming to improve education need to target the most deprived families, focussing on trust building through open communication.

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Creating an Enabling Environment for Adolescent Sexual and Reproductive Health: A Framework and Promising Approaches

Cited by 171 publications

References 27 publications

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

Perceived Barriers in Accessing Sexual and Reproductive Health Services for Youth in Lao People’s Democratic Republic

Education, poverty and "purity" in the context of adolescent girls' secondary school retention and dropout: A qualitative study from Karnataka, southern India

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