Youth reproductive health programmes have begun to receive growing attention in recent years for several reasons.

• The threat of HIV/AIDS has brought youth sexual and reproductive health behaviour to the forefront. It is estimated that 20-25 per cent of all HIV infection worldwide occur amongst young people¹. Similarly, the prevalence of STDs are highest amongst young people, particularly young women, in the age group 15-29².

• Although the fertility rates for women under 20 are declining, the total number of births among youth are increasing due to the growth in the youth population. It has been estimated that 40 per cent of all 14-year old girls alive today will be pregnant at least once by the time they are 20^3.  And yet, a large proportion of them still have no access to reliable sexual or   reproductive health education or needed services.

• While the knowledge about family planning and contraceptive methods among married couples in the reproductive age group has increased, there is no evidence that such maturity has increased among the youth population.

• The knowledge and practices at the adolescent/youth stage will serve as a foundation for healthy behaviour at later stages in life. Therefore, investments in youth reproductive health programmes will yield benefits over the whole life-span.

• The youth/adolescent population group is large; currently more than half the world’s population is under 25 years of age and 29 per cent are between the ages of 10-25 years.

While the necessity of meeting the sexual and reproductive health needs of youth is widely recognized, the services to meet them have lagged behind. There have been several small scale innovative projects, but very little action has taken place to upscale them. As a result, these small scale projects have not produced widely accepted programme patterns for youth reproductive health. At the same time, there is limited experience with respect to both programme management and resource implications.  Therefore, proactive actions will be required to upscale these innovations in a smooth and cost-effective manner.

A Strategy for Upscaling

Broadly, the process of upscaling new innovations proceeds through three phases: innovations, demonstration in realistic programme settings and wide spread expansion (Figure 1).

During the innovations phase, effectiveness is the major concern. The key question to be addressed is -- whether the objectives can be achieved and how? Efficacious programme interventions are identified through the process of experimentation. The innovations may take place in many countries and  implemented by many organizations within a country. Therefore, it is useful to document the promising ones and disseminate the experiences and lessons learned.

Efficiency becomes the major concern during the demonstration phase.  Innovations are examined to see if they can be simplified and if unnecessary or ineffective activities can be eliminated. Thus these engineered innovations are implemented in realistic programme settings to evaluate their impact and to identify the required activities if the intervention is to be implemented more widely.

Finally, upscaling strategies need to be developed.  How to upscale, while retaining effectiveness and efficiency of demonstration experience, become the major focus during this phase. Many middle and operating level managers need to be trained before the proven programme interventions can be implemented on a wider scale.
 

Guided by the above process, ICOMP's strategy therefore comprises of the following:
 

1. Documentation of innovative and successful adolescent/youth sexual and reproductive health programmes;
2. Dissemination of findings from the documentation;
3. Regional and national workshops for indepth dissemination of the documentation and advocacy for adolescent/youth sexual and
4.  reproductive health needs;
5. Networking.  Establishment of a network for sharing of information and expertise as well as for empowerment of young people active in
6.  adolescent/youth sexual and reproductive health work;
7.  Training of trainers and managers, development of training curricula, training of health workers and counsellors in collaboration with expert agencies; and
8. Linkages.  Working in close cooperation with NGOs, donors and experts to provide help for organizations and governments wishing to upscale innovative projects.

As a follow-up to the documentation process, a regional workshop, with SIDA support, on Innovative Approaches in Youth Reproductive Health Programmes, was held in June 1995. The workshop drew the participation of innovators, programme managers, NGOs, government agencies and international agencies.
 

Case Studies

The documentation of innovations and workshop deliberations form the basis for case studies on adolescent/youth sexual and reproductive health in this volume of innovations.
 

Reproductive and Sexual Health Education (Sri Lanka)

With support and collaboration from the school authorities, the Family Planning Association of Sri Lanka (FPASL) has succeeded in bringing the topic of reproductive and sexual health education to Sri Lankan schools, thus reaching nearly 200,000 school children in the age group 14-18 with information concerning physiology, reproduction, and diseases. The main objective of the Reproductive and Sexual Health Education is to assist young people in acquiring scientific knowledge about reproduction, sexuality, and STDs including HIV/AIDS.

The project is a school-based programme in which trained project teachers conduct 3-hour sessions on topics related to youth sexual and reproductive health using a variety of audio-visual materials. Female teachers with teaching experience in science subjects are selected as project teachers. Prior to project implementation, they attend a six-week training programme and develop IEC materials for use in the project. Assisting the project teachers are project officers who are responsible for administering and setting up all the organizational arrangements to conduct the teaching classes. They are also trained in the six-week training programme.

AIDS Prevention through Health Education and Non-Formal Counselling: Reaching Youth Working in Factories (Thailand)

Although Thailand has a lot of experience in HIV/AIDS prevention, there is very little attention given to address the increasing prevalence of HIV infection among youth working in factories. The project is the first attempt to reach this group of youth.

Three major activities form the project: (1) Development of training and educational materials for the target group; (2) Training of trainers; and (3) Training of factory managers/owners and youth factory workers.

The project realized that having a holistic understanding of reproductive health is likely to enhance workers’ comprehension of HIV/AIDS and its prevention, hence making HIV/AIDS prevention projects more effective. In light of this, the project will adopt a reproductive health approach in its second phase of project implementation. At the same time, emphasis on prevention skills and coping skills will be stressed.

The Young Inspirers: Making Sexual and Reproductive Health a
Youth Affair (India)

Religious and cultural values are strong in Lucknow, India. It is in this environment that a group of trained youth provide information and counselling concerning youth sexuality and reproductive health as well as general health to fellow youth. Being able to do so within such an environment is an achievement.

Since 1993, the Young Inspirers (YI) have encouraged youth participation through the participatory approaches used in programme implementation. As such, youth are able to express their concerns and suggest ways of overcoming their problems. Those who have been reached by the YI are encouraged to spread the message to their families and friends, thus creating a multiplier effect.

Youth Advisory Centre (Malaysia)

The Youth Advisory Centre (YAC) has, since 1979, been providing youth with a space of their own. Youth who visit the Centre have access to information, services (counselling and skills training), a library and most important, someone who listens to them.

The YAC undertakes outreach activities where both in-school and out-of-school youth are reached. Among the in-school youth, the youth camps where participants are educated on health, sexuality, communication and problem solving through the use of role-play and games, is most popular. The workshops at factories specifically target female youth.

Due to regulations, the YAC is not able to provide contraceptive services. However, it has developed referral linkages with volunteer doctors so that youth have access to such services.

Development and Family Life Education for Youth (Philippines)

The Development and Family Life Education programme has been able to generate support for its activities because they are implemented within the contemporary realities of young people’s sexual behaviour while being sensitive to the local culture.

The programme consists of a Teen Centre which is managed by trained youth volunteers. The Centre, open daily from 9am to 6pm, is equipped with recreational facilities and a mini library. Separate rooms are provided for counselling and telephone hot line services. The receiving room, equipped with audio-visual facilities and indoor games, is used for group discussions, meetings and seminars but social interaction is also encouraged. In addition, outreach activities including income generating projects are also carried out.