Peer education in sexual and reproductive health programming: a Cambodian case study

Abstract

This article analyses in detail the impact and effectiveness of peer-education projects implemented in Cambodia under the Reproductive Health Initiative for Asia (RHI), in an attempt to provide important lessons for the design and implementation of such interventions and to contribute to the development of best practice. Under RHI, which was the first programme in Cambodia designed specifically to address the sexual and reproductive health needs of young people, peer education was implemented as if it were a directly transferable method, rather than a process to be rooted in specific social and political contexts. Consequently, peer-education concepts of empowerment and participation conflicted with hierarchical traditions and local power relations concerning gender and poverty; peer educators were trained to deliver messages developed by adults; and interventions were not designed to reflect the social dynamics of youth peer groups. IntroductionPeer health-education interventions with young people are often divorced from the social and political context in which they are implemented (Turner and Shephard 1999). Power relations that form an important part of the social dynamics among young people, such as those relating to gender and poverty, are regularly overlooked in many peer-education programmes and interventions. Despite the mismatch between the rhetoric and the reality of peer education, and a distinct lack of evidence-based planning, engaging young people in interventions concerning sexual and reproductive health in a way that aims to increase their autonomy remains attractive to development-assistance agencies.In this article, after briefly setting the scene and outlining our research methodology, we present the findings from primary and secondary research into the impact and effectiveness of peer-education projects implemented over a five-year period in Cambodia.

How Effective is Peer Education in Addressing Young People’s Sexual and Reproductive Health Needs in Developing Countries?

“…Peer education is currently one of the most widely adopted health promotion strategies used with young people, and is almost universally represented as effective. The literature reviewed 2 here, and the authors’ extensive participation in and observation of peer education interventions (including recent studies, notably Knibbs and Price, in press; Price, 2004a,b), indicate that peer education is an imprecisely defined strategy (Shiner, 1999), which appeals to constituencies with diverse viewpoints and priorities. For some, peer education is simply a means to spread information, with one agency defining its purpose as ‘to convey education messages to a target group’ (UNODC, 2000, p. 53).…”

“…In such discourse, involvement is equated with participation and participation with empowerment. However, the claim that peer education is empowering and participatory is often made simply on the grounds that targeted young people take part (see Knibbs and Price, in press). Peer education initiatives that challenge existing power relations are rare, due in part to the ambivalence surrounding young people:…”

A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries

“…Furthermore, lack of adequate FP knowledge hampers females’ approval of modern contraception and sexual autonomy. Filling these knowledge gaps will require ongoing investments in awareness campaigns of various forms, such as mass media dissemination [ 54 ] or peer educational approaches [ 55 , 56 ]. In addition, while religious belief systems tend to play a fairly central role for most LMIC societies, religious leaders tend to take an often hesitant or even obstructive position towards modern contraception [ 57 , 58 ].…”

Can Peer Education Make a Difference? Evaluation of a South African Adolescent Peer Education Program to Promote Sexual and Reproductive Health

“…Prevalence is particularly high amongst young people and disproportionately high for girls [2]. Governments, particularly those with limited resources, are attracted to peer education as a health and behavior communication intervention because of its potential to access and influence large numbers of young people [3] and also because of its potential to be empowering to the participants [3,4]. The theoretical frameworks guiding peer education [5,6] suggest that the similarity of experience between young people facilitates communication and their discussions avoid the usual problems inherent in 'professional-client' power relationships.…”