Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress

Abstract

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented.This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America.1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants.2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress.3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations.Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose.

Practical lessons for bringing policy-makers on board in sexual and reproductive health research

“…Policy-makers seemed to recognize the problem of teenage pregnancy (CERCA) and were willing to work in the frame of national regulations on post-abortion services (INPAC). This shows that policy-makers could be mobilized on sensitive SRH questions by finding a common language adapted to the local context (CERCA; [12, 19]). However, it may require from researchers to adopt their terminology, which raises questions on how far an agreement is actually reached between research and policy-makers (CERCA; [12]).…”

“…CERCA has obtained results in terms of policy-makers’ involvement and policy change at various levels – these results are described in this article published by members of the consortium [19]. Follow-up is needed to see how the evidence is being used in the various contexts in which the projects were/are being implemented.…”

Salud sexual y reproductiva de adolescentes en Chile: el rol de la educación sexual

“…Lo anterior va en la línea de lo que presenta la literatura, donde se sostiene que educadores y centros de salud proveen de una educación sexual limitada, desde un enfoque reduccionista de riesgo y a través de mensajes negativos (29). En cuatro de las cinco comunas estudiadas los Espacios Amigables están situados en los Centros de Salud o lugares aledaños a éstos, lo que genera que los adolescentes reciban información y educación en torno a la sexualidad por las vías del sector salud y de educación de manera independiente y descoordinada entre ambos sectores, siendo incluso en muchos casos contradictoria en sus enfoques.…”

“…Junto con lo anterior, se enfatiza en la importancia de generar capacitación continua al personal de salud que trabaja en la SSR de los jóvenes, así como su inclusión en el diseño, ejecución y monitoreo de los servicios (3). Además, aparecen como recomendaciones centrales la inclusión de intervenciones basadas en la comunidad, principalmente en aquellos contextos con altas tasas de deserción escolar (29). Al igual que los resultados de nuestra investigación, la evidencia muestra que los adolescentes transmiten como una necesidad el involucramiento de adultos y familia en educación sexual e información en uso de métodos anticonceptivos, negociaciones de pareja en sexualidad, preparación en la toma de decisiones en torno a la sexualidad (29).…”

Exploring linkages between research, policy and practice in the Netherlands: perspectives on sexual and reproductive health and rights knowledge flows

“…Globally, academic institutes are being encouraged to conduct more societally relevant research, non-governmental organisations (NGOs) are required to show programme efficacy, and policies need to be transparent and evidence informed [2–8]. To achieve this, strengthened connections between actors in the different fields are needed, meaning that they share, use and contribute to each other’s knowledge development and products.…”