Growing up is tough, no matter where you are.
For young people living across fragile states, the challenges of obtaining reproductive health services are greater – and the potential consequences of hampered access is that much more dire.
Globally, 2 in 5 girls aged 15-19 across Sub-Saharan Africa don’t have access to modern contraception.
But in Cameroon – a nation with high unemployment and increased risk of violence and conflict – one in four girls aged 15-19 does not have access to modern contraception. And among married girls of the same age, only one in 10 reports using a contraceptive method.
In a country in which one in five girls will have given birth by the age of 19, the impetus remains to ensure all girls, no matter the contexts in which they live, have the tools and information they need to make the best decisions for their health and for their lives.
Through Jeune S3 (Santé, Sexualité, Sécurité) Programme, we –PSI Europe in partnership with PSI network member ACMS (Association Camerounaise pour le Marketing Social) and a Cordaid-led consortium—are addressing the gaps by bringing comprehensive sexuality education (CSE) closer to the Cameroonian young people who need it the most.
In Crisis, We Learn
In many of the developing spaces in which we work, limited resources, entrenched stigmas and gaps in youth-friendly providers deter young people from desiring contraception – let alone considering it as a tool of value for their lives.
Fragile contexts at risk of conflict face the same issues, however on a far deeper level.
Resources are even more stretched; young people face heightened rates of violence (often by the same people who are supposed to protect them), and product supplies are limited.
The reality stands that, even when young people can make it to a clinic, contraceptive shortages may mean unavailability of their method of choice, or worse yet, no provider on-site to attend to their needs.
Responding to the unique needs of young people living in conflict countries like Cameroon requires digging into the realities that color young people’s worlds, and programming in response to the myriad of nuanced forces that shape, and often limit, how young people make the reproductive health choices that shape their lives.
Stepping into Young People’s Worlds
Understanding young people’s worlds requires that we step into their lives.
In Cameroon, young people shared that they craved spaces that ensured confidentiality, that they lacked trusted sources to turn to for their reproductive health questions and when these elements were on offer, they desired them in an accessible and meaningful way.
School- and community-based programming offer a way forward.
Jeune S3 Cameroon works across 36 schools and 23 community-based locations to deliver in- and out-of-school youth-friendly CSE courses.
Since launching CSE courses in 2018, Jeune S3 Cameroon has reached 41,700+ young people with sexual and reproductive health (SRH) information. Some teachers have reported (albeit anecdotally) that, since leading CSE sessions, the number of unwanted pregnancies has reduced in their schools.
What We’ve Learned:
- A fragile context requires some finessing. In contexts at risk of conflict, it is even more important to listen to young people’s needs and to involve them in program design, because their needs can be so specific and may require interventions, means, that are beyond health. Plus, it’s critical to allow space for flexibility and curiosity; fragile contexts require that an adaptive footing to best position us to quickly respond to contextual shifts, all while ensuring young people’s needs inform our decisions, every step of the way.
- Getting parents on-board is critical. Community mobilizers engage parents to secure their support for their children to attend the 3-month CSE session.
- Of course, not all parents say yes right away. So we work at it. We host workshops for parents introducing the purpose and value of CSE sessions, and then go deeper to support parents to engage in reproductive health conversations with their children. As a result, we’ve seen parents allow their daughters and sons to take part in CSE sessions — a notable trend in a country in which stigma around reproductive health remains high, and social and cultural norms traditionally see girls as destined only to be housewives.
- Sex ed, in schools. In-schools, Jeune S3 primes teachers to deliver CSE for older students (ages 15-24) centered on values, self-esteem, gender, unwanted pregnancies, STIs and HIV, and gender-based violence; and for younger students (ages 10-14) on interpersonal communication, gender norms and gender-based violence, menstrual hygiene, youth rights, unwanted pregnancies and contraception.
- Same approach, different location. CSE sessions also run during community-based events, hosted with support from local organizations and led by community mobilizers and health providers. Two in five attendees at community-based sessions are aged 10-14; unlike the in-school counterpart, community-based sessions offer young participants referrals for youth-friendly SRH services at partner clinics.
- Segmenting by age, and need. Whether in- or out-of-school, all sessions apply a participatory approach to engaging students; younger students act out topics through role-plays, while older students take part in brainstorms around various presented scenarios. Community-based events incorporate animated videos translated into the local language; young people are encouraged to weigh in on the learning-based approaches of most interest to them.
- Partnerships power the work. To ensure consistency across all events and classes, Jeune S3 works in partnership with the Ministry of Education to choose leads trained by regional ministries of health, Cordaid and UNFPA. These champions identify the schools that will best integrate CSE courses and provide trainings to prime teachers to lead the sessions. Inspectors monitor progress across schools, and organize quarterly meetings with school teachers and leaders to collect reports, discuss best practices and challenges, and work together to drive the project – and its impact – forward.
- We iterate, a lot. We operate in an environment in which cultural and social norms run deep; in response, we run ongoing value clarifications workshops to understand the pulse of local actors (from parents to teachers to the students themselves) and tailor our program messaging to meet the values they hold.
As we in the global health community continue to adapt our overall approach to adolescent and youth SRH interventions, we must commit to not overlook the populations moving through their teens amidst the woes of conflict and crisis.
Fragile contexts and countries in conflict require a finessed approach to designing youth-resonant and community-accepted SRH programming.
After all, no young person should be left behind. Growing up is hard enough.
Images courtesy of Think Place