1. USAID/Dhaka’s Adolescent Reproductive Health Program A Brief Overview!

2. Adolescent Profile • Adolescents (10-19) -- 22 percent of population (28 million) • Average age of marriage 15 • Average age of first birth 17 (ARH 2002 Baseline) • Adolescent fertility rates among the highest in the world -- 155 births per 1000 (DHS) • Only 40 percent of married adolescents using contraception (ARH 2002) • 23 percent of the rural girls feel FP is bad (ICDDR,B) • 45 percent of unmarried adolescents are aware of how HIV/AIDS is transmitted (ICDDR,B)

3. Why is USAID/Dhaka interested in ARH? • Adolescence is a time when life habits and expectations are formed • Risk-taking behavior is high, while knowledge of the consequences is low • During this period, adolescents learn to make decisions for themselves

4. What have we learned from past programs? • Most adolescent-specific service sites only reach a small number of adolescents • Few adolescents seek services, even if available • Many school-based programs are only able to provide basic health information • In the past, mass media approaches have avoided explicit, targeted information

5. What does USAID/Dhaka’s ARH Program focus on? • Component 1: HIV/AIDS prevention and control for sexually activeadolescents • Component 2: MMR/IMR reduction for married adolescents • Component 3: Improved reproductive health knowledge and skills for married and unmarried adolescents

6. Component 1: Why HIV/AIDS? • Young men do not know about HIV/AIDS and STI transmission or prevention (up to 45%) • Young men frequent brothels • They don’t use condoms because they are either unaware of the need or can’t get them (shopkeepers) • STI rates among sex workers are very high (Syphilis - 50%)

7. Component 1: What do we want to do? • Increase awareness about HIV/AIDS and STI transmission and prevention • Increase condom use • Increase utilization of STI services

8. Component 1: How will we do this? • Through social marketing, use a strategic communication approach to promote condom use for HIV/AIDS prevention (presently just for FP) • Implement HIV/AIDS awareness creation activities among high-risk adolescent populations (e.g. peer education, street dramas) • Reduce barriers to selling and distributing condoms • Enable STI treatment and counseling for high-risk populations through outreach

9. Component 2: Why MMR/IMR? • Adolescent girls get pregnant following an early marriage (average age around 17) • 36% of girls under 20 are normally pregnant • Many girls and families are unaware of the risks associated with early pregnancy • Adolescent girls are unaware of when or where to go for RH services • Poor nutrition, early pregnancy lead to obstructed labor, maternal mortality

10. Component 2: What do we want to do? • Increase awareness about: • delayed marriage • delayed pregnancy (First or Second) • the risks associated with adolescent pregnancy • Increase utilization of MCH services among adolescents (e.g. family planning, ante-natal, etc.)

11. Component 2: How will we do this? • Mass media campaigns (radio and TV programs) • Targeted print materials • Adolescent-friendly ante-natal services through static and satellite clinics (NSDP) • Newlywed couples program

12. Component 3: Why ARH information and skills? • Few adolescents have correct knowledge about ARH issues • Most youth want to know more • Most don’t know how or where to get correct information - rumors and advice from friends or pornography are unreliable sources

13. Component 3: What do we want to do? • Increase basic knowledge of ARH • Increase basic knowledge of where to go for services • Increase adolescents’ life skills

14. Component 3: How will we do this? A.MOTIVATION - Entertainment Education • Radio Magazine Series (52 episodes) • Pilot TV Show - Variety show format with youth anchors (13 episodes) • Four Q and A booklets on: Puberty, Relationships, Marriage, FP, HIV/AIDS and STIs • Four videos with adolescents: ‘speaking out’ on Puberty, Relationships, Marriage, FP, HIV/AIDS and STIs

15. Component 3: How will we do this? B. ABILITY TO ACT - Through Life Skills • ARH Package: Four Video facilitators’ guides on Puberty, Relationships, Marriage, FP, HIV/AIDS and STIs for: • decision making and problem solving • critical and creative thinking • communication and interpersonal skills • self awareness and empathy • coping with stress and emotions • Training on use of ARH materials by core life skills facilitators

16. Component 3: How will we do this? C. ENABLING ENVIRONMENT - throughcollaboration • Gradual political commitment and policy change • Creating demand for and strengthening adolescent-friendly services • Increasing involvement of educational sector - long term change needed

17. Bringing the pieces together: BCC Overview Program Objectives Overall Strategy Program Goals Channels & Materials • Reduced maternal mortality • Increased age of first pregnancy • Delayed age at marriage • Reduced maternal malnutrition • Reduced STI/HIV transmission • Increased use of FP • Increased use of condoms (for sexually active) • Increased availability and use of adolescent-friendly services • Increased service-seeking behavior • Increased acceptance of puberty as natural process • Reduced prevalence of sexual abuse • Decreased prevalence of substance abuse • Information • Motivation • Psychosocial skills development • Enabling environment • Info booklets and brochures • Radio & TV series • Videos and users’ guides/ life skills manuals • Service provider & teacher training • Program implementors’ training Behavior Development and Behavior Change

18. BCC Channels Mass media Group facilitation Behavior Development and Behavior Change Interpersonal communication Community mobilization

19. BCC Audiences Family Peers Adolescents Community & religious leaders Teachers Service providers Policy makers

20. Guiding Principles • Research Research Research • All program activities will be branded with a single logo • All activities are done in collaboration with UN agencies, GOB and NGOs in an ARH Working Group forum for joint ownership and therefore wider dissemination (national program effort) • All materials will be extensively tested to ensure the messages are clear • An emphasis is being placed on bringing about positive behavior change, not just an increase in knowledge • A baseline survey has been done so that impact can be measured over time (18 months) • Next Steps?

21. THANK YOU!