Advocating for Adolescent Reproductive Health in Sub-Saharan Africa[PDF]

Also available in French in [PDF] format.

A successful advocacy campaign targets three distinct groups that influence one another: opinion leaders, the public, and the media. Many opinion leaders will be more likely to support adolescent health initiatives when they believe the public agrees with their position. The media educates the public about the need for the proposed policy change. An educated public is more likely to express their support for the advocacy campaign's goals to community and national opinion leaders.

Public Education

Public education helps an advocacy campaign build a broad foundation of support. Effective public education provides people with information about young people's reproductive health, and shows them how a proposed policy change can make young people healthier. It also suggests how the public can help and shows them why they should be involved. The goal of public education is to inform and mobilize the public.

Public education is most effective when specific audiences are targeted with tailored messages and information. Advocates may decide, for example, to target parents, members of religious groups, people in a certain part of town, or elders. Two examples follow. First, a youth-serving agency advocating for changes in school policy may focus its public education efforts on parents because their opinions may influence school officials. The campaign may also target religious leaders and school officials. Second, an agency advocating for improvements in the government's support for HIV/AIDS prevention may educate local businesses about AIDS' negative effect on employees and profits and encourage the businesses to speak out about a prevention program.

As each audience is identified, gather information and create messages that will be likely to persuade that group of people. Separate materials should be created for each audience. The concerns of parents, elders, business people, and teens will usually vary. The type of audience will also determine the strategies used to reach them. For example, an effort to reach out to people in a certain part of the community might involve planning an event in the local community center. To reach business people, advocates may want to create and distribute a short, factual pamphlet.

Educational pieces should be short and easy to read. They should explain the need for the program as well as describe the program's components and its intended effects. Educational materials are a good opportunity to provide answers to questions, address concerns, and correct misinformation about the program.

Materials should include:

• National, state, and local statistics on adolescent reproductive health that may be affected by the proposed program or policy, such as rates of sexual activity, lack of access to medical care, rates of pregnancy, reported AIDS and STD cases;
• Factual information that describes the local situation, explains why the proposed program or policy is necessary, and describes its intended effects;
• Information on similar programs implemented elsewhere;
• Research and other facts that rebut expected criticisms from the opposition;
• Supportive media coverage of the issue, such as newspaper articles or editorials; and
• Information about the advocacy effort's purpose and goals and include a list of members.

Other Activities to Educate the Public

Written materials are only one way to reach out. Other events present opportunities to provide the public with information. The following opportunities can be used to answer questions, respond to concerns, and encourage broader community participation:

• Hold a community event to provide information about a reproductive health problem and encourage people to support the solution.
• Ask other organizations that are planning events for permission to hand out materials about the advocacy campaign and to meet with the public.
• Give presentations at local meetings, including parent teacher associations, traditional councils, training workshops, neighborhood associations, and other community gatherings.
• Ask opinion leaders to talk to their friends, family, and community about the issue. If these opinion leaders are difficult to reach, write letters and enclose materials for them to read.
• Go where the audience is, such as markets, bus stops, agricultural association meetings, community centers, and public areas. Distribute materials and simply talk to people about the advocacy campaign.
• Conduct polls or surveys to gauge community support.
• Write articles about the advocacy effort for newsletters.

Working With the Media

Media coverage is important in public education because it carries information to a much larger audience.

Fortunately, adolescent sexuality is a story that is often interesting to the press. Unfortunately, it is also a story that is frequently covered in a negative way. The media reflect the public's discomfort with adolescents and sexuality, and reporters and editors often chose to highlight stories that portray young people as either reckless or helpless victims.

YSOs can have an effect on the way the public views young people by working with the media to dispel negative stereotypes. Providing the public with a better understanding of youth, as well as what YSOs offer, can build support for youth programs.

Successful media plans usually follow a four-step process.

1. Define the role of the media in the advocacy campaign. Getting public education out through the media enhances outreach efforts and supports advocacy goals and objectives. Build contacts with the media long before they may be needed.

Reporters with newspapers, radio and TV provide interviews that can help make the public aware of youth issues and can build support for changes in local and national policies. Consider exactly what kind of media attention will support the advocacy goals as well as how to generate the desired media attention. The right message, at the wrong time, can hurt an advocacy campaign.

For example, a strong message about important reproductive health education for young people may hurt the effort if it's release coincides with the illness and death of a prominent and respected opponent of such education.

Some advocacy campaigns choose not to work with the media at all. For example, if there is no local newspaper, TV, or radio, outreach to the press may not be worthwhile or cost effective. A local effort might instead use other means of reaching out to policy makers and the public.

When working with the media, think about the audiences the effort must reach. Newspapers are a popular and inexpensive method of educating the public. Working with a reporter on a story or asking a newspaper to cover an event can provide an organization with free publicity. Yet, newspapers reach only some people. Members of the community who are not literate in the paper's language or who read another paper—or even no paper—may not see the story. Defining the audience also points to which media will be most effective.

2. Choose the message carefully. The media generates public attention; use this attention to educate the public. Make sure the information is interesting and persuasive.

The community is usually interested in stories about young people, particularly young people's health. However, the media often report adolescent stories in ways that make young people seem irresponsible, dangerous, and disrespectful of traditions. This frequently confirms some people's opinions about youth as a problem and rarely helps to provide young people with increased access to information or services.

To build public support, first consider the characteristics, interests, and opinions of the intended audience; then present the issue in a way that is most likely to generate support and action from that audience.

For example, a campaign that is trying to convince school officials to adopt a better reproductive health curriculum would also like to convince parents to support the change. Parents often worry that providing information to youth will only lead them into sex. Yet, many of these parents are also very concerned about the spread of HIV/AIDS. To win the support of parents, the campaign may want media stories that focus on the HIV/AIDS epidemic, and how the new curriculum will educate young people to be safe through abstinence and condom use.

Finally, selecting a message should not be confused with misleading the public or creating false expectations about what a program offers. There is no easier way to lose credibility than to be untruthful. Always tell the truth in public education efforts.

3. Determine what activities to hold and what materials will be needed. Decide when, where, and how to work with the media to achieve the maximum effect. Determine who in the organization or network is responsible for each component of this effort.

An organization or network must determine what materials and staff time are necessary for its media activities. The advocacy campaign should designate one or more spokespeople to work consistently with the press. The spokespeople should build contacts with members of the press long before the campaign begins to request press coverage. Select reporters to provide with short, concise, and factual information on youth issues. Create personal connections by inviting reporters to attend a short, informal event with young people and members of the advocacy campaign. Reporters who work on short deadlines value contacts who quickly and promptly give them information for whatever story they are working on. Building a reputation as a reliable expert assures that when the spokesperson calls the reporter later to suggest a story, he or she will be likely to listen.

Working in an advocacy network makes it easier to provide materials for the media because each member organization will have publications or other materials that can be sent to reporters. Advocates should always have some basic information or fact sheets on youth issues always available to give to reporters in small press packets.

4. Evaluate the press campaign. Keeping track of how the media covers youth issues provides information to improve media outreach. Setting realistic expectations helps to understand and evaluate press experience. An advocacy campaign cannot control what the media report. It can only provide reporters with information and a key message that it hopes will appear in the final story. Success is measured in how well the campaign influenced the final product.

A news story should present the campaign's side of the story fairly, but it may present other viewpoints as well. The story should incorporate at least one of the major points raised in the interview and should quote spokespeople accurately. Most importantly, a news story should not only educate the community about the issues but also heighten public support for the solutions.

Copies of press coverage that mention advocacy efforts, records of materials created for the press, and information on contacts with members of the press, will provide a sense of how well the campaign is working with the media. For more information on evaluation of advocacy activities, see Chapter 9, Monitoring and Evaluating Advocacy Efforts.

Other Tips for Working With the Media

The Spokesperson—Designate a spokesperson to provide reporters with a consistent contact for interviews, information, and media follow-up. The spokesperson should be articulate and well versed on adolescent health issues. He or she should be able to speak clearly and directly to the issue without using unfamiliar terms. All members of an advocacy campaign should know who the spokesperson is and should immediately refer questions from the press to that person.

Responding to Requests for Information—Reporters will not continue to work with spokespeople who fail to supply them with needed information in a timely manner. Responding quickly increases the chances of being quoted in the final story. However, some members of the media will not be supportive and may represent sharply diverging political beliefs. Advocates should be aware of the political bias and/or affiliation of reporters and the media. Focus efforts on reporters and media who are supportive.

When You Don't Know—If the spokesperson does not know the answer to a question, he or she should say so. Reporters can ask anything, and they assume that the spokesperson's answer reflects the opinion and stand of the entire campaign. A spokesperson has the right to decline to answer any question. When questions are asked to which the spokesperson is uncomfortable responding, the safest rule is not to answer the question. The spokesperson should never be drawn into criticism of colleagues but should carefully reserve criticism for important events and serious opponents. Remember that any remarks made to a reporter may appear in the final story. If something should not be published, the spokesperson should not say it.

The Story—The spokesperson should plan in advance what points to make. Anticipate difficult questions and practice answering them in a role playing situation prior to the interview. Focus on two to three points to stress in the conversation or interview.

Short sentences that stand alone enable the reporter to use the spokesperson's words. Reporters will paraphrase long, wordy sentences, and the results may be disappointing. To get the reporter to focus on the perspective of the advocacy effort, the spokesperson may use a technique called "bridging." For example, if the interviewer asks an irrelevant question, such as "Doesn't sex education in the schools promote promiscuity?", the spokesperson can say "I think the real issue [or question] is what will protect the health of our young people."

The Press Information Packet—One important tool for a media campaign is the press information packet. It should contain basic background material on the organization or network. Factual information can be used to educate reporters on the issues and interest them in a story. Whether or not an advocacy campaign needs a press information packet depends on the size of the campaign. A small campaign may not wish to spend time and effort to create a press packet, but may reach out to the media in other ways. A large campaign, which deals with many different members of the media, will find that the packet can save time, attract attention, and provide information and quotable statements.

A packet may include:

• Information about the advocacy network (if one exists), including a list of members and the network's mission and goals;
• Contact information for the press spokesperson;
• Background data (such as fact sheets) on adolescents and AIDS, STDs, and other health issues;
• Information on YSOs and their programs;
• Positive press coverage the campaign has received;
• Information on how the proposed program or policy change will address community needs; and
• Materials that help reporters write a story, such as recent research on young people's reproductive health, quotes from the campaign leadership, and copies of other opinion leaders' speeches or testimony.

Working With the Media—The advocacy campaign should develop a press list, including contact information for the various forms of media that serve the target audience. A press list should contain the newspaper, television, and radio outlets in the area as well as their news deadlines. The characteristics of the audience for each media source are important to know.

In addition to the press information packet, there are a number of means of developing contacts with the press and getting attention in the media.

Events—Inviting the media to an event already planned is an inexpensive way to generate contacts and publicity. The opening of a new youth center, a play or sketch performed by young people, or a meeting between local leaders and a youth delegation are all opportunities to attract the interest of the media. Tell participants in advance that the media will be coming. A spokesperson or liaison should be available to assist members of the press, provide background information, and introduce them to notable people present.

Letters to the Editor—Newspapers frequently print letters to the editor that address an issue which has been in the news recently. The letters to the editor section is one of the most frequently read sections of newspapers and is an ideal place to respond to criticism or concerns. Letters should be brief and persuasive, and should use clear facts or quotes from respected opinion leaders. A prominent member of the community can be asked to write or sign a letter drafted by a member of the advocacy campaign.

News Releases—A news release is a one- to two-page (400 to 800 words) description of an event, program, or activity. Some newspapers use news releases without changing them. Sometimes, reporters attend the event or may follow up to write a story. News releases should include the following: 1) one or two quotes from leaders; 2) facts: who, what, where, when, why and how; and 3) contact information for the spokesperson. The main point of the news release should appear in the first two paragraphs.

Television and Radio—Many television and radio stations have news as well as discussion shows for current issues. Identify news directors and talk show producers who may be interested in covering the issue. The host of a discussion shows may be interested in dedicating an edition to a suggested issue. "Call-in" radio shows on a relevant topic can provide opportunities for a spokesperson or leader to speak directly to the radio audience.

Case Study—Kenya Youth Initiatives Project (KYIP), Part 2

The Kenya Youth Initiatives Project was designed to reduce unintended pregnancies and STD rates among Kenyan youth. KYIP's advocacy objectives included increasing the knowledge of policy makers and community leaders about the consequences of unintended pregnancies, STDs, and HIV/AIDS among Kenyan youth. KYIP analyzed media articles on adolescent reproductive health issues and responded with information, education, and communication (IEC) materials that presented more accurate information.

Focus group discussions were held with 37 groups of adolescents and parents throughout Kenya. The focus groups provided information on which to base IEC activities and media outreach. KYIP also held a one-week materials development workshop for YSOs throughout Kenya to develop messages based on information from the focus groups discussions.

IEC

The IEC group prepared three brochures for distribution in conjunction with other project activities. Were You Ever Nine? gives parents tips and recommendations for talking with their children about reproductive health. Two booklets for youth, Play the Game Right and Enjoy present both factual information and stories of other young people. The brochures discuss how young people make decisions regarding their sexual and reproductive health and describe the outcomes of their decisions.

Radio

KYIP's one-hour, weekly, Youth Variety Show was cited by the Kenyan Minister of Education at an Africa-wide conference as an example of quality programming for youth. The call-in format permitted discussion of sensitive issues, such as HIV/AIDS, contraception, and female genital mutilation (FGM). Each weekly show featured a diverse panel of youth, health experts, and artists who promoted responsible decision making, positive health behaviors, and increased self-confidence.

A national household survey found that, within six months, 63 percent of Kenyans ages 15 to 17 reported listening to the program. The number of youth citing radio as their reason for visiting health clinics rose from 23 percent to 56 percent among new clients. Parents appreciated the program for showing the difficulties and questions their children face growing up. Youth used the radio show as an opportunity to get answers to questions they felt they could not discuss with their parents.

The show became so popular that corporate funding continued to support the weekly broadcast after funding for KYIP ended. The show has also inspired a weekly newspaper column, Teen Bus, appearing in a national newspaper.

Case Study—The Population Impact Project (PIP), University of Ghana

Ghana's official population policy was established in 1969. Since then, the population has nearly doubled, yet economic growth has improved only slightly. This situation inspired leaders to convene ThePopulation and National Reconstruction Conference in 1986. Conference participants focused on two major objectives of Ghana's 1969 population policy: 1) to reduce the population growth rate from an estimated 3.2 percent to 2.0 percent per year, and 2) to reduce the total fertility rate from 4.6 to 4.0 children per woman by the year 2000.

Participants felt these objectives were still desirable and achievable, and identified three reasons why the policy had so far been unsuccessful: 1) a lack of national political commitment; 2) a sense that the policy was donor driven and; 3) an emphasis on family planning at the expense of other population-related policy issues such as women's roles, the environment, and urbanization. Several professors from the University of Ghana formed the Population Impact Project (PIP) to follow through on ideas generated at the conference. The project was designed to address the identified obstacles to achieving Ghana's policy goals through a public education campaign combining PIP staff's knowledge and media experience.

PIP recognized that successfully advocating to policy makers and government officials would require broad-based support from other Ghanaian organizations involved with population issues. PIP's advocacy materials provided high-level officials with examples of problems and needs and proposed solutions to population issues based on community research. PIP also researched and presented data in a clear format that educates policy makers and encourages policy interventions that respond to the needs of Ghanaians. National and community-based organizations clearly benefit from government support for their activities. During the course of the project, PIP has developed partnerships with a number of organizations in Ghana, including the National Population Council, the Ghana Ministry of Health, the National Council of Women and Development, the May Day Rural Health Project, and the Planned Parenthood Association of Ghana. These organizations provide valuable insights to policy makers.

Advocacy Strategy

PIP's advocacy campaign also targets leaders at the district and local levels. Traditional leaders, heads of women's organizations, educators, religious leaders, youth, and the media are important audiences for this information. PIP reaches out to diverse target audiences through a combination of activities.

1. Developing and disseminating booklets on population-related topics. Clear and concise booklets use uncomplicated charts and tables that can be understood by an audience unfamiliar with population and development issues. The booklets use relevant national statistics from reliable sources and are written by respected local experts on development issues.
2. Seminars, workshops, presentations and meetings with top officials. PIP organizes seminars and presentations for policy makers and is routinely invited to make presentations for educators, students, and public administrators as well to demonstrate the relationship between population growth and development.
3. Radio and television broadcasts and national newspaper articles. PIP encourages journalists to discuss population policy in the press and believes that public attention to population policy will motivate government officials to act. Media interest has grown so great that PIP established a resource center and holds workshops to educate the press about the basics of population growth. Reporters attending the workshops meet PIP representatives who become press sources for population information.

Activities Specifically Targeting Adolescents

PIP increasingly focuses its advocacy efforts on the special needs of adolescents. One publication in PIP's series of informational booklets, Adolescent Fertility and Reproductive Health in Ghana (1995), includes facts on adolescent fertility in Ghana, the reasons for high adolescent fertility rates, and the social, economic, and physical consequences of early sexual involvement and early childbearing. It suggests policy interventions, such as prioritizing family life education in schools, improving adolescents' access to family planning services, emphasizing education for girls, and involving adolescents in program design. To further enhance the booklet's impact, PIP developed a presentation on adolescent fertility and reproductive health for policy makers, and invites adolescents to attend these presentations at the regional and district levels.

Results and Evaluation

PIP has experienced no open opposition to their advocacy activities concerning adolescent reproductive health. However, the National Catholic Secretariat and the Christian Council of Ghana have expressed general discomfort with widespread contraceptive availability. To allay concerns from groups that have reservations about contraception and family life education for adolescents, PIP tries to address their perspectives in presentations and seminars.

Evaluation shows that PIP has had a measurable impact on raising national awareness of Ghana's population policy. Structured interviews with 80 high ranking policy makers showed that most are familiar with the project, and many have used PIP's most widely known booklet, Population Growth and Development in Ghana. PIP's advocacy efforts are credited with increases in governmental support of population programs. PIP's materials continue to be in demand by government offices, and the project has generated numerous newspaper and radio stories on population issues.

Lessons Learned

Projects which aim to raise awareness of population issues must be prepared to sustain their advocacy efforts over an extended period of time. Change occurs slowly, and supportive policy makers may retire or leave office. In addition, advocates must be ready to demonstrate how their issues relate to other issues of public concern, such as economic development, women's empowerment, and the environment. PIP's success can be attributed to the project's commitment to establishing broad support for Ghana's population policy. The project has helped to facilitate communication between decision makers and organizations working in the field, allowing field workers' experience to directly inform national population policies.