Academic journal article International Family Planning Perspectives

Behavior Change Evaluation of a Culturally Consistent Reproductive Health Program for Young Kenyans

Academic journal article International Family Planning Perspectives

Behavior Change Evaluation of a Culturally Consistent Reproductive Health Program for Young Kenyans

Article excerpt

CONTEXT: Few rigorous evaluations have been conducted of locally designed, culturally consistent adolescent reproductive health programs.

METHODS: A quasi-experimental research design was used to measure behavioral changes associated with a culturally consistent reproductive health program for young people in Kenya. Baseline and endline surveys were conducted in 1997 and 2001, respectively, in the project and control areas. Multivariate analysis was used to assess whether the project was associated with changes in young people's sexual initiation, safer-sex behavior and discussion of reproductive health issues with adults.

RESULTS: The 36-month project was associated with considerable changes in young people's sexual and reproductive health-related behavior, but behavior change differed by gender. Females in the project site were significantly more likely than those in the control site to adopt secondary abstinence (odds ratio, 3.3) and less likely to have had three or more sex partners (0.1). Males in the project site were more likely to use condoms than those in the control site (3.7). Both males and females in the project site were more likely to discuss sexual and reproductive health issues with a nonparent adult than were young people in the control site (1.9 and 5.5, respectively).

CONCLUSIONS: Interventions that adapt to indigenous traditions can be both acceptable to communities and associated with significant changes in young people's behavior.

International Family Planning Perspectives, 2004, 30(2):58-67


Increasingly, public health policies and programs have focused on the sexual and reproductive health needs of adolescents, particularly in the developing world. This is largely a result of recognition that adolescents constitute large segments of developing countries' populations, that they are disproportionately affected by negative reproductive health outcomes and that services for adults are not responsive to the needs of adolescents. (1) Most recently, alarming rates of HIV infection in young adults, particularly young women, have further focused attention on this vulnerable group, especially in Sub-Saharan Africa. (2)

Reproductive health interventions targeted at adolescents are a relatively new phenomenon in Sub-Saharan Africa, with the first programs having been established in the late 1970s. Most of these programs are educational and are delivered via youth centers, peers, the media and schools. (3) Few of these programs provide sexual and reproductive health services, perhaps because of discomfort with addressing the needs of unmarried, sexually active adolescents. (4) Despite considerable evidence to the contrary, many policymakers fear that discussing family life or sex education will encourage young people to experiment with sex and may increase risky sexual behavior. Some cite previous research on drug education programs for young people showing that certain programs--especially those that take the "just say no" approach--may, in fact, increase experimentation. (5)

One of the major problems with adolescent reproductive health programs in the developing world has been the lack of rigorous evaluation of their impact on young people's knowledge, attitudes and behavior. (6) Without such evidence, it has been difficult to convince policymakers that these programs are likely to improve the health outcomes of young people, or, at least, to do no harm. Most of the evaluations of youth programs have been conducted in the developed world, and the majority of these have focused on school-based programs. (7)

More recently, studies in Sub-Saharan Africa have focused on changes in knowledge and attitudes, and to a lesser extent, in behavior, related to youth programs--most of which are peer education interventions. An evaluation of a peer education program in Cameroon revealed that residence in the project site was correlated with increases in young people's knowledge of sexually transmitted infections (STIs). …

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