By Alexandra Angel, Sexual and Reproductive Health Technical Advisor, PSI; and Maimouna Paraiso, Youth Strategy Lead for PSI Niger
With the launch of PSI’s Global Strategy in 2018, we pledged to reimagine young people’s access to modern contraception.
It required that we double down on our standard approach to adolescent and youth sexual and reproductive health (AYSRH), to acknowledge the gaps and – in partnership with young people and the influencers that shape their worlds – pave new pathways to put power and choice into the hands of our youngest consumers.
In Niger, that meant working our way into the local, public schools to reach adolescents and youth on their home turf.
In Focus: Niger
On average, women in Niger will give birth to seven children. And among surveys of women aged 15 and 18, most young women have sex for the first time after marriage. Even then, however, women indicate a low need for contraception.
The consequences of too early and too frequent births affect women and ripple across communities. Supporting women to make healthy choices for their lives remains a priority; and beginning that work before women get married, is key.
Through funding from Global Affairs Canada (GAC), program staff identified introducing AYSRH sessions in schools as an innovative way to reach a new segment of youth.
Our work framed around GAC’s priorities for this specific project. Namely:
- Increased knowledge of Sexual and Reproductive Health and Rights (SRHR) among women and adolescent girls.
- Improved support for SRHR among influencers, including men, religious leaders or community leaders.
- Increased access to a range of SRH products and services for women and adolescent girls.
- Increased knowledge of key stakeholders on effective delivery of quality SRH services in the Francophone West Africa region.
Schools hold a captive audience of young people, and in Niger (a country where women typically continue to say they want about nine children), those enrolled in schools may be the ones most receptive to messages about delaying first birth.
By sharing contraceptive messaging with young people who might be most interested in using them, PSI could test the kinds of messages that will be well received by young people and the community.
Since summer 2019, we’ve integrated sexual education programming into 16 public schools in Tahoua in southern Niger, reaching 233 girls and 453 boys aged 10-19! Each school is located in a zone that has close access to a GAC supported health facility with a youth-friendly provider.
Our experience in Tahoua has left us with a bounty of applicable learnings – what to do and what to amend, next round – as we look to scale our efforts in other regions of Niger, and beyond.
Getting AYSRH into School
To build support, start early—start broad
Early in program implementation, PSI extended an invitation to the Ministry of Education to participate in the project kick-off meeting. While this is a step routinely taken by PSI with Ministries of Health, working with a Ministry of Education is a newer experience. This was a key first step in a months-long process of eventual advocacy for running AYSRH outreach activities in schools.
Find an “In”
Niger’s national secondary school curriculum includes basic health education (with human biology courses a part of the curriculum). This was an opportunity.
Our plan? Integrate AYSRH components into the existing national program near GAC-supported clinics. We knew we needed to work within national policy requiring that sex education in schools lead with abstinence before broadening to address contraception as an option for those who choose to have sex before marriage.
National support? Check! Time to go local.
With support obtained from the national-level, we geared up for local buy-in on the administrative level.
Program staff met with local leaders involved in youth programming: heads of schools, of youth outreach programs and of health curriculum programming for schools in the region. We spoke to , demonstrating how incorporating sex ed into the school system would benefit not just students, but teachers and curriculum developers, too.
To make AYSRH relevant to young people, lead with what they say matters to them.
In Niger, child marriage is common. We therefore orient our AYSRH curriculum around young people’s life goals and the steps needed to live a healthy life. We asked: “What does a successful life look like to you? What kind of a career do you aspire to have? What can prevent you from reaching these goals?” The group of adolescents (smart young people that they are!) led themselves to their own answer: having children before you are ready can prevent you from reaching your goals.
7 Do’s and Don’ts (that you, too, can apply!)
1. A strong facilitator is needed for youth outreach events. It’s not easy to keep a group of 60 students engaged and energized!
2. While acting in accordance with national policies, and – in Niger specifically – while remembering to devote adequate time to discussing abstinence, moving that part of the lesson along quickly can save time to speak more fully on the entire range of modern contraceptive options for those students who already know abstinence isn’t for them.
3. Get the teachers involved! While one-off lessons are great, getting them built into teachers’ annual workplans would be even better. You can sell this as a free lesson plan that you create for teachers, something they don’t have to plan out, but that is a lesson-in-a-box all prepared for them.
4. There’s a lot in a name: Calling these lessons Sexual and Reproductive Health lessons meant that some initial stakeholders thought PSI wanted to teach young people how to have sex. Instead, consider names like Human Biology or Human Health, to move away from names that sound like red flags to some stakeholders.
5. Education is one thing. Access is another. The PSI team linked students to services by telling them where young people could access quality AYSRH services. However, what more can be done? How can we bring these services closer to young people, making them available where adolescents can most easily access them?
6. Link to reliable sources of digital information, but don’t reinvent the wheel. Let students know where they can get more information on their own, from the privacy of their own phone. Sometimes this means creating something new; sometimes it means linking to another PSI vetted site, like PSI’s Project Ignite-Cote d’Ivoire’s Entre Nous Facebook page, or digital counseling tools like Mjanja Connect through PSI’s Adolescents 360 in Tanzania.
7. Consider how post abortion care and safe abortion access can be integrated into conversations with young people, as accessible in a given context. Comprehensive services are a must.