Having their say – young people and sexual health in Nicaragua

How do adolescents learn about sex and sexual health in Nicaragua? Do they have access to good information? How should reproductive health services address the needs of adolescents? Marie Stopes International reports on an innovative new project in Nicaragua.

The project gets adolescents involved in deciding what kind of information they need. Services are then set up using existing youth organisations, such as those connected to churches. Many of these groups work with low-income youths. Keeping young people involved and respecting their need for privacy are essential to the ongoing success of the project.

Nicaragua has the highest rate of adolescent pregnancy in Central America. One in every four children is born to a mother under 19 years old. Sexual activity begins at an early age, particularly in rural and marginal urban areas. Adolescents are particularly vulnerable to sexually transmitted infections (STIs) including HIV.

This project tested a new model of adolescent sexual and reproductive healthcare in Nicaragua. The aim is to increase young people’s access to information, education and communication (IEC) and health services. IEC covers basic sexual and reproductive health and related themes, such as violence, drugs and personal development. Clinical facilities include both medical and psychological services.

The project is highly participative and is primarily directed at adolescents from families with low incomes. Youth organisations, such as church groups, are closely involved. Young people themselves help to design and implement the project activities. This provides a low cost method of increasing adolescents’ access using the existing infrastructure of youth organisations.

An assessment of the project found that:

• The human component of services and the personalities of service providers are more important to young people than technical quality.
• Adolescents’ participation in training and as youth promoters is limited by the little time they have available.
• Use of services by adolescents is low until they gain confidence in service providers and the project.

The report has several important recommendations for the implementation of similar projects:

• IEC methodologies must be participative and fun.
• Psychological services are essential for low-income adolescents who live in a violent and abusive environment and have poor communication with the adults in their lives.
• More adolescents will use the services if they are free, as those from very low income families cannot afford to pay for treatment.
• Services should be adapted to the characteristics and needs of each group of adolescents. Needs vary with age, socio-economic level, and degree of family and community support.
• Clinics should provide privacy from adults. If adults are involved they should be professionals from youth organisations rather than community members whom adolescents may not trust.
• Community-based service provision may be more sustainable than work with youth organisations. Financial sustainability is hard to achieve in a project directed at low-income adolescents.

Source(s):
‘Social franchising of adolescent reproductive health education and services – Nicaragua. Final implementation report’ Marie Stopes International, by M. Braddock and C. Morris, 2000
Related source: 'Social franchising reproductive health services. Can it work? A review of the experience', Marie Stopes International Working Paper 5, by E. Smith, 2002 Full document.

Funded by: Marie Stopes International

id21 Research Highlight: 25 July 2002

Further Information:
Claire Morris
Regional Director for Latin America
Marie Stopes International
153-157 Cleveland Street
London W1T 6QW
UK

Tel: +44 (0)20 7574 7422
Fax: +44 (0)20 7574 7407
Contact the contributor: claire.morris@stopes.org.uk

Marie Stopes International

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