Science and Success in Developing Countries: Holistic Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections

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Executive Summary [HTML] [PDF]

Program Components

• Comprehensive sexual health program for unmarried youth, including information about sexual risk reduction, abstinence, and use of condoms and other contraception
• Community-based sexual health counseling and contraceptive services at a youth health counseling center
• Sex education through youth-focused pamphlets and lectures
• Group activities, including interactive discussion, on sexual health issues
• Contraceptives and condoms made available free of charge to young people
• Sexual health videos, shown at local cinemas prior to popular movies
• Training for family planning providers in provision of youth-friendly services
• Meetings of community leaders and parents

For Use With

• Unmarried youth, ages 15 to 24
• Urban youth
• In-school and out-of-school youth

Evaluation Methodology

• Quasi-experimental evaluation design in two towns in Songjiang district, Shanghai, among unmarried youth ages 15 through 24
• Baseline survey among youth in intervention (n=1,220) and comparison (n=1,007) towns; follow-up survey 20 months later among youth in intervention (n=1,148) and comparison (n=894) towns

Evaluation Findings

• Increased partner communication about use of contraception—males
• Increased use of contraception
• Increased use of condoms

Description

The program is designed to increase the sexual health information and services available to unmarried youth (ages 15 through 24). The intervention includes preparatory work with the community to ensure adults' support of sexual health information and services for the community's unmarried youth. The program also includes training for family planning staff on important aspects of youth-friendly services, such as providing counseling, being nonjudgmental and friendly, and assuring adolescents' confidentiality.[20]

For the community's youth, the program distributes educational pamphlets on physiology and reproduction, sexual responsibility (including abstinence), relationships, love, marriage and family, responsible and safer sex, contraception and condom use, and STIs, including HIV. Youth also receive information on where and how to access reproductive health services and contraceptive counseling and supplies. The program offers three educational videos, each of which runs at a local theater prior to the showing of a popular movie. The program also includes a lecture by an educator and 36 short presentations on sexual health issues, followed by discussion sessions for youth who are in relationships or dating. The program includes a youth health counseling center in the town's center, staffed by a trained young counselor. The center offers a reading room with sexual health information. Leaflets and bulletins in the community inform youth of the youth center's counseling and contraceptive services. Finally, the program makes contraceptives—including condoms, oral contraceptives, creams, suppositories, films, and emergency contraceptive pills—available free of charge to the community's youth. These contraceptive methods as well as free pregnancy test kits are available to youth through the network of family planning service providers, the youth health counseling center, and the activity discussion groups.[20]

Evaluation Methodology

In April 2000, two towns in Songjiang district, Shanghai, China, were selected for the intervention study. The towns both had a good network of family planning providers, relatively stable populations where few people moved frequently, and supportive authorities. The two towns were also similar in socioeconomic levels, geographic features, and socio-cultural customs. Nonrandom sampling was used to select the intervention and comparison sites, and all unmarried youth ages 15 through 24 were eligible to participate in the study, irrespective of school status, so long as they had no intention at baseline to marry or to leave the town within one year. No eligible subject refused to participate. A total of 1,220 unmarried youth in the intervention site and 1,007 in the comparison site were interviewed at baseline, including 1,304 out-of-school youth and 923 high school students. At follow-up, 91.7 percent of eligible youth completed a second survey, including 94 percent from the intervention site (n=1,148) and 89 percent from the comparison site (n=894). Both baseline and follow-up surveys were self-administered under conditions that helped ensure anonymity and privacy to youth.[20]

No significant differences were observed at baseline in school status (in- or out-of-school), leisure activities, family type, type of school, or relationships with classmates in the profiles of young people from the two sites. For example, 57 percent of youth from the intervention site and 60 percent of youth from the comparison site were no longer in school. At the same time, youth from the intervention town tended to be slightly younger (28 and 27 percent, respectively, were ages 15 through 17; and four percent and eight percent, respectively, were ages 22 through 24). Youth from the intervention site were somewhat more likely to be university students or to have a higher educational level (52 percent had graduated from senior high school and eight percent from college) than youth from the comparison site (44 percent, high school, and four percent, college). In both sites, females tended to be younger, more likely to be in school, and more likely to be engaged in administrative occupations than were males.[20]

At baseline, 10 percent of youth from the intervention site had ever had sex (11 percent of males, nine percent of females) versus 12 percent of youth from the comparison site (13 percent of males; 11 percent of females). Sixty-five percent of sexually experienced youth from the intervention site had ever used contraception (68 percent of males and 60 percent of females) versus 75 percent of youth from the comparison site (73 percent of males and 77 percent of females). Thirty-four percent of sexually experienced youth from the intervention site reported regular contraceptive use (33 percent of males and 36 percent of females), versus 44 percent of youth from the comparison site (45 percent of males and 44 percent of females). Seventy-four percent of sexually experienced youth from the intervention site reported having used condoms (76 percent of males and 71 percent of females) versus 71 percent of youth from the comparison site (74 percent of males and 68 percent of females).[20]

The four main indicators measured were 1) ever use of contraceptives, 2) regular use of contraceptives, 3) ever use of condoms, and 4) use of contraceptives at first sex. For youth who reported sexual experience at baseline and/or post-intervention surveys, effects of the intervention on contraceptive use were analyzed using logistic regression, adjusting for factors such as age, gender, educational level, school status, occupation, and family socioeconomic status.[20]

At follow-up, nearly 100 percent of youth in the intervention site reported receiving the educational materials and about 76 percent said they had read most or all of the materials. About 79 percent reported seeing at least one video and 50 percent reported seeing two or more videos. Nearly 33 percent reported participating in one or more discussion groups. Counselors provided 328 counseling sessions to youth. Providers reported distributing the following free products to young people: 4,348 condoms, 137 packages of oral contraceptive pills, 146 packages of films, 107 tubes of cream, 870 suppositories, 106 packages of emergency contraceptive pills, and 93 pregnancy test kits.[20]

Outcomes

• Behaviors—
  • Increased partner communication about use of contraception—Between baseline and follow-up, the proportion of youth who reporting making joint decisions (communicating) with a partner about contraception rose significantly among sexually experienced males in the intervention site (50 to 77 percent).21 Joint decision making dropped somewhat among males in the comparison site (67 to 63 percent). Reports of joint decision making dropped slightly among females in the intervention site (from 86 to 83 percent) and rose somewhat among females in the comparison site (65 to 77 percent).[20]
  • Increased use of contraception—Proportions of youth reporting ever use and/or consistent use of contraception rose significantly among sexually experienced youth in the intervention site between baseline and follow-up.
    • At the intervention site, reports of ever use of contraception rose significantly among all youth (from 65 to 99 percent), among males (68 to 99 percent), and among females (60 to 99 percent). At the same time, among sexually experienced youth at the comparison site ever contraceptive use rose less (75 to 83 percent). The rise in ever use of contraception was statistically significant for females and for all youth at the intervention site.[20]
    • The proportions reporting regular use of contraception rose significantly among sexually experienced youth from the intervention site between baseline and follow-up overall (34 to 89 percent) as well as among males (33 to 88 percent) and females (36 to 90 percent). At the same time among sexually experienced youth at the comparison site regular contraceptive use remained unchanged (44 percent to 45 percent).[20]
  • Increased use of condoms—The proportions of sexually experienced youth at the intervention site reporting ever use of condoms rose significantly between baseline and follow-up, overall (74 to 97 percent) as well as among males (76 to 98 percent), and females (71 to 97 percent). In the comparison site, condom use among sexually experienced youth also rose, but not significantly (71 to 81 percent), primarily due to increased use among females (68 to 85 percent) a rise that was not statistically significant.[20]

Note: At follow-up, there were no significant differences between youth in the intervention and comparison sites, overall or by gender, in percentages that had initiated sexual intercourse. Evaluators note that findings on use of contraception and condoms strongly support the idea that a youth-friendly intervention can enhance safer sex behaviors.[20]

For More Information, Contact

• Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, 2140 Xie Tu Road, Shanghai 200034, China; e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it